Comments by Robert Whitaker

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  • Someone Else: Re your account with us: In fact, you are listed as a “lifetime donor” in our database thanks to your generosity, and you should have received emails telling you how to set up a donor login. And once you set it up, you can have your browser remember it, and it will log you in automatically. We’ll write you privately now to make sure this is fixed.

    And sorry about the confusion here,

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  • The criticism here does raise an important question about Mad in America.

    We like to stay out of politics, whether domestic or in this case Middle East “politics.” However, we are interested in writing about research regarding the “social determinants” of mental health, and the reason is this: the prevailing narrative places the psychiatric suffering inside the head of the individual, and ignores the environment.

    And so we have written about articles in Transcultural Psychiatry before. When one of our science writers decided to write about this publication, we asked ourselves, how does it fit into the “social determinants of health” framework?

    I personally am given to being open about writing about journal articles, and so my thinking–perhaps naively–was this: if there was an article that spoke about “psychiatric difficulties” among the Israeli people, and then placed it within a framework of the social determinants of health, would we run it? And I thought, yes we would, because it fits into this theme of interest to us.

    That said, I should have made sure that theme was understood to be the point of this article, and I should also have made sure that it was correct in its facts regarding whether Gaza was “occupied” since Hamas took over. But that is the reasoning behind our publishing this article: we do regularly write about the “social determinants of health,” in opposition to a narrative that puts the suffering into a story about an individual’s “mental illness.” And we do so not because of politics, but rather we think that is a conception that, if embraced, leads to a different paradigm of care, starting with the understanding that you need to create environments that better nurture the “mental health” of populations around the world, and stop seeing suffering and psychiatric difficulties as arising within the individual, and that is the individual that needs to be fixed.

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  • No. No-one fro the BMJ or the American Journal of Psychiatry, or any of the study authors, ever responded to me or the petition. The standard ethical codes for editors of academic journals does state they should answer calls for retraction, and state what investigation they are pursuing. This wasn’t done here; just one more example of behavior by the AJP that flouts standards.

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  • Jonas,

    In our September 9 article on the scandal, we did note how the STAR*D authors hid this terrible one-year result. And I have written about this bottom-line results in a number of other articles. However, while they hid this result, there was a table in their Nov. 2006 article that did present this data (if you could make sense of the table), and so in that regard, the STAR*D authors didn’t inflate that result, or violate the protocol to produce an inflated result. That’s why the call for retraction focused on the protocol violations that were used to inflate the “cumulative remission rate” at the end of four steps of treatment.

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  • I appreciate these comments. I think there is a point of confusion here regarding the nature of this STAR*D study, and what it was set up to “test.” This confusion is present in Aftab’s comments about the 3% figure, and my reply in this post doesn’t really clear up this point of confusion.

    This was not a placebo-controlled trial, which, at least in theory, is designed to assess a difference in outcomes between drug treatment and what might called the “natural capacity to recovery”, e.g. the placebo group. The STAR*D study was designed to assess outcomes for “real-world” patients in treatment. The study was not an assessment of the efficacy of antidepressants, but rather an assessment of clinical management of depressed patients by psychiatrists, with antidepressants as the treatment of choice.

    As such, keeping people in treatment was a principal outcome to be assessed, and part of the protocol included elements designed to achieve that end. Patients were provided with educational materials that told of the expected benefits of antidepressants (as a treatment for a chemical imbalance, if I remember correctly); they were paid for participating in study evaluations; clinic staff called patients to remind them to come into the clinic; and there was even a newsletter sent to patients encouraging them to remain in the study.

    The reason that patients in the acute stage of care were given up to four chances to remit is that was seen to mimic real-world clinical practices. If a first drug didn’t work, then a second might. Or a combination of drugs. And this is why those who dropped out in the acute stage without an exit score that told of remission were counted as treatment failures; the dropouts were rejecting the treatment that was being offered.

    The one-year followup was designed with the same thought in mind. The STAR*D investigators wanted to see if the best possible clinical care, with regular follow-up appointments and adjustments of antidepressants, could keep people who had remitted well and in treatment. Once again, dropouts during this phase could be seen as treatment failures; those patients didn’t find it useful to stay in treatment.

    Thus, this wasn’t a study of the “efficacy” of antidepressants. This was a study of clinical care of depressed patients treated with antidepressants. It was psychiatry’s clinical care that was being assessed, and those who dropped out, whether in the acute stage or the follow-up stage, were rejecting that clinical care.

    As such, dropouts were seen as treatment failures in the STAR*D study. That’s why the graphic in the summary article presented a bottom-line endpoint: Of the 4041 who entered the study only 108 remained in clinical care and still well at the end of one year.

    What the STAR*D investigators were hoping for when they started the trial was that there would be a high percentage who remitted during the acute phase, and that they could then keep the remitted patients in treatment for the next year, and that continued antidepressant treatment would be shown to keep a high percentage of remitted patients well. They hoped to show the effectiveness of patients staying on antidepressants and in care, and instead they came up with the dismal result of 3% who stayed well and in the trial.

    Undoubtedly, this is also why the STAR*D investigators didn’t want to promote this outcome. Indeed, if dropouts had been followed up and many had been found to have remitted after leaving clinical care, these remissions would raise this question: Why did many patients have to leave treatment in order to get better? Any knowledge about the fate of the dropouts wouldn’t accrue to the perceived benefit of clinical care; it would only add to the picture of treatment failure in this study.

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  • Please note: In the youtube interview you have linked to, we are talking about the hiding of long-term results in NIMH trials and the STAR*D fraud. And what I am making reference to is how the 67% remission rate was peddled to the public, while the one-year outcome, as published by the STAR*D investigators in an obscure graphic, which told of 108 as having remitted and not having relapsed by that endpoint, was hidden from the public. That was their bottom-line figure, by the way. And so my point in this interview was that the STAR*D investigators should have made this end-point number known to the public, and if so, they could have explained about the number of dropouts.

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  • Thanks for this note. I actually screwed up this posting somewhat. I actually asked chatGPT twice to write an essay about the mad in america website, as I was interested to see what might change. The one I found most flattering was actually the first response, but then I mistakenly copied the second one for publication. The first one did speak more about the “revelations” of MIA, and in that sense I do think it was more accurate. And it did specifically speak, as 27/2017 of this unveiling. Here is the first response:

    Title: Mad in America: Revolutionizing Mental Health Discourse

    Introduction:

    The Mad in America website is a remarkable platform that challenges the dominant narrative surrounding mental health and offers an alternative perspective on psychiatric practices and treatments. With its thought-provoking articles, insightful interviews, and comprehensive research, Mad in America has become a leading voice in the critical examination of mental health systems and the pursuit of more humane and effective approaches to mental well-being. This essay aims to explore the significance of Mad in America in promoting a paradigm shift in mental health discourse.

    Unveiling the Dominant Narrative:

    For decades, the dominant narrative surrounding mental health has revolved around the medical model, which posits mental illnesses as primarily biological in nature and promotes the use of psychotropic medications as the primary solution. This approach often overlooks the complex interplay of social, psychological, and environmental factors in the development and experience of mental distress. Mad in America challenges this reductionist perspective, advocating for a more comprehensive understanding of mental health.

    Critiquing Biomedical Interventions:

    Mad in America serves as a platform for critical analysis of psychiatric medications and other biomedical interventions. It highlights the potential harms associated with overreliance on pharmaceutical treatments, shedding light on the long-term side effects, withdrawal symptoms, and questionable efficacy of many psychotropic drugs. By drawing attention to these issues, the website sparks crucial conversations about the need for informed consent, personalized care, and alternative approaches.

    Humanizing Mental Health Experiences:

    One of the strengths of Mad in America is its dedication to amplifying the voices of individuals with lived experience. By sharing personal stories and testimonies, the website humanizes mental health experiences and challenges stigmatizing narratives. It empowers individuals to articulate their own journeys and advocates for the recognition of diverse perspectives. This emphasis on storytelling and lived experience fosters empathy, understanding, and ultimately promotes a more compassionate society.

    Promoting Alternatives and Best Practices:

    Mad in America provides a platform for researchers, clinicians, and advocates to explore innovative approaches to mental health. The website highlights alternative models of care, such as Open Dialogue, peer support, trauma-informed therapy, and holistic practices. By showcasing these alternatives, Mad in America encourages a shift towards a more comprehensive and patient-centered approach that addresses the underlying causes of mental distress and prioritizes individual autonomy and empowerment.

    Challenging the Power Dynamics:

    Mad in America boldly confronts the power dynamics within the mental health field and raises important questions about the influence of the pharmaceutical industry, diagnostic overreach, and coercion within psychiatric practices. By exposing these systemic issues, the website encourages critical thinking and advocacy for reforms that prioritize human rights, social justice, and collaborative decision-making.

    Conclusion:

    Mad in America has emerged as a vital catalyst for change within the mental health arena. By challenging the dominant narrative, critiquing biomedical interventions, humanizing mental health experiences, promoting alternatives, and challenging power dynamics, the website fosters a more inclusive and holistic understanding of mental well-being. As society continues to evolve, Mad in America serves as a beacon of hope, offering evidence-based research and compassionate perspectives that strive to reshape mental health discourse for the betterment of individuals and communities.

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  • One of the challenges for Mad in America is to provide a forum for commentary that allows for respectful criticism of ideas, or assertions, without making such criticism devolve into a personal criticism of the blogger. It’s a fine line, but we have many people who have stopped blogging for us because they feel the commentary section can turn hostile. Here, David invited commentary, and so the criticism of “sleeping with the enemy” was raised. But that has now led to a thread that is critical of David personally–it’s a slippery slope from respectful criticism of ideas to personal criticism of the writer. And I have to say, the personal criticism of David Oaks that has emerged here pains me.

    He has been a national and international leader of psychiatric survivor activism for more than 40 years, and as I have often said, it was an interview that I had with David Oaks when I was writing a series for the Boston Globe in 1998 that prompted me to investigate the whole conventional narrative that psychiatry told about its diagnoses and treatments. David has defended his life’s work here, but I wish he wouldn’t have felt compelled to do so. The psychiatric survivor movement, in my opinion, is a civil rights movement, and it was rooted in that understanding when it emerged full force in the 1970s, and so that’s how I see David: As an individual who spent his life fighting for the civil rights of people whose rights are regularly oppressed and trampled on, with forced treatment with antipsychotics one visible element of that. So, if this commentary is going to provide any thoughts about David Oaks and his life’s work, I think that should be loud and clear, and I wish we could all remember this: He has been a Civil Rights activist and leader in the United States for decades. As such, it is an honor to have him write for Mad in America.

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  • Hi Janne,

    Let me speak to Ole Andreas and see if there is any way that documentary can be made available to the MiA community. I think that would be a great idea.

    I think Lake Hurdal is such an important initiative, and, as he said, proving that there is a different way forward. Ole is particularly proud of the fact that even when someone is hospitalized under a forced treatment order, the “treatment” can be centered around what the person would like that treatment to be like.

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  • To Anotherone: As I wrote, from its inception, Mad in America was designed to be a forum for people with lived experience to tell their stories, and that is to say, to give them voice and amplify their voice. It has always been at the core of what we do. My first book, Mad in America, was a history that honored that voice, and really, that book told a history centered on that personal experience. We are grateful to all who have had the courage to tell their story on Mad in America, and I believe, that in terms of our impact, it is the personal stories that have always made the greatest impact.

    My comment was to say, given that importance, there are voices of people with lived experience–people who have been greatly harmed by psychiatry–that aren’t being heard. And it’s precisely because we see the voice of those with lived experience so important that I spoke of our desire of finding a way to make their voices heard too.

    That is a motivation to further honor and make known the breadth of stories of people with lived experience, who can tell of harm done.

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  • Katel,

    You are misunderstanding my comment. We have always seen the personal stories of prime importance to what we do, and that has been true since our inception. In the second part of this podcast, you will hear from our personal stories editor, Emmeline Mead, about how important they are — they bear witness to the harm that psychiatry can and does cause.

    But given this importance, we have tried several times to recruit people with lived experience who we don’t much hear from. This has included trying to do video interviews with men and women released from prison with a psychiatric diagnosis; reaching youth of color who were psychiatrized while in foster care; people living in very poor and troubled neighborhoods whose struggles in that environment become reason for them to be committed involuntarily to hospitals, and put on AOT orders too. So my comment was about trying to find a way for MIA to provide a voice for “groups” in our society that don’t submit to us–to expand the breadth of the testaments that are the personal stories.

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  • In response to Dr. Angelo, I hope you are a better physician than you are financial analyst. We are a non-profit organization. I don’t own Mad in America . . . no one owns a non-profit organization.

    But this is an opportunity to make known our finances: I am extremely proud of how we operate.

    For the first four years of our existence, those who “staffed” Mad in America worked as volunteers. That included me (and I had put in money to start the webzine in 2012.) Once we began raising enough money to pay people, MIA adopted a socialist policy: I wanted those with lived experience who worked for us to be paid at the same rate as those who didn’t, and that includes me. And yes, I wanted the hourly rate to be a sufficient one that it showed we valued the skills and experience of all who worked for MIA.

    For years, we were operating on the edge of going belly up at a moment’s notice, with barely enough cash on hand to survive another two or three months. All of the guidebooks for running a non-profit tell you to try to get enough “cash on hand” to fund a year’s operations, and thanks to a three-year journalism grant and other generous donations we have come close in the past three years to reaching that goal, so that we know that we can survive another year.

    Our annual budget this year will be around $380k. With that funding, we operate a daily webzine that features science news, in-depth interviews, blogs from an international group of contributors, personal stories, around the web links, and original journalism articles. We have operated a continuing education effort for years, we air about 24 podcasts a year, and we now provide technical support and hosting services for 10 affiliates around the world.

    With this revenue, we pay a team of science writers for their daily contributions, our editors for blogs, personal stories, the family section, and Around the Web contributions, our writers of original journalism articles, the director of MIA Radio, the moderator of our comments section, our arts editor and tech person, and for years, the director of Mad in America Continuing Education. We of course have expenses related to hosting our site and the affiliate sites, software expenses, technical maintenance expenses, general administration expenses (accountants, etc.), and on and on, and we do all this on the annual revenue that what . . . equals the annual earnings of a single psychiatrist who pads his salary with a few talks for Pharma?

    And in terms of our reach, we expect to have about 5 million visitors to MIA and its affiliates in 2022. I would suggest we run a very efficient operation, and yes, that we accomplish a lot with our limited revenues.

    Finally, you seem to think my earning $40,480 in 2019 was exorbitant. I work seven days a week, and probably 60 to 70 hours a week (but pay myself for only 40 hours per week.) And since you apparently know nothing about the book industry, here’s the bottom line: my royalties from all of five of my books come to about $5k per year.

    In short, Dr. Angelo, I don’t own Mad in America. it’s a non-profit and a labor of love, and I am sure nearly everyone could be making more money working in other areas.

    And now, perhaps you can inform our readers about your earnings as a doctor. Are you a psychiatrist? Do you prescribe psychiatric drugs? If so, how much are you paid for a 15-minute visit?

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  • Well, Just this note re this comment from Nathan M.D. Princeton:

    “Why not mention the profits you make from your books? Your speaking engagements, from this your subsidized advertising resource, funded by many who can’t afford.”

    I have given hundreds of talks over the past 12 years, and I have no “fee” for a talk. There have been groups that offer a small honorarium, and I accept those honorariums. And if an honorarium isn’t offered, I regularly and happily speak for free, as many advocacy groups can attest. And just fyi, writing books is a lousy way to try to make a living. Writing prescriptions for psychiatric drugs is, I’m sure, a much more profitable endeavor.

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  • Just a couple of comments. First, we have a rule that while we don’t allow venomous attacks on individuals in our comments, there is one exception: we’ll print whatever people want to write about me.

    In my book Mad in America, which was focused on the history of the treatment of the “severely mentally ill,” I told of a history in which psychiatry regularly championed its somatic treatments as very effective (or even curative) when they were first introduced, and how none of them stood the test of time. There was a pattern in that history.

    In regard to antipsychotics, I wrote about how there was a line of research, early on, that told of drugs that could cause changes in the brain that at least some researchers came to understand could make patients more biologically vulnerable to psychosis, which of course was never told to patients or incorporated into any “selective use” model of the drugs. Tardive dyskinesia was another hazard that was long swept under the rug. At the same time, there were experiments and research studies in the 1970s that told of a significant percentage of people diagnosed with psychotic disorders, including schizophrenia, who could do well long term without antipsychotic medication.

    If you care about the “seriously mentally ill,” then you believe in informed consent, and you believe that a profession should adopt prescribing protocols in response to what research is revealing about the merits of their drugs. However, psychiatry as a guild failed in that duty once these problems with antipsychotic drugs became known, and it also became known that many patients could do better over the long term without the drugs. And what has been the result? Long-term outcomes for schizophrenia patients have declined in the past 40 plus years, and recovery rates are now worse than they were before the arrival of the antipsychotics.

    As for the allocation of societal resources, I wrote at length about the Soteria Project and its potential merits, which would require a societal commitment to funding such homes. That project was in essence shut down by the guild.

    I have never made subtle allusions to “slavemasters” and Nazis. What I wrote about in Mad in America is how the Nazi government, with the support of Germany psychiatrists, applied eugenic ideas to the mentally ill, and that it was this “group” that was first targeted and killed in the Holocaust. That is a historical truth.

    As for using terms like “insanity” and “madness”, you can’t write a history of psychiatry without using those terms.

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  • Richard,

    You make a great point about even the short-term use of psychiatric drugs. As many authors of personal stories on MIA have written, it was an initial prescription, often for a minor problem, that led them down the rabbit hole–to a more severe diagnosis (hello bipolar), and years on multiple psychiatric drugs. That is part of the “risk” in the risk-benefit equation that comes with initial prescribing of a psychiatric drug, which certainly isn’t incorporated into prescribing practices.

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  • Sandy,

    Why don’t you write a blog about this? This was a report based on Medicare’s own standard for measuring quality, and in a science review, we are not in a position to question the merits of that standard. The fact that it is Medicare making this determination is what makes it news. But in a blog, you can detail why you find these Medicare performance standards as flawed. That is the way — in a blog– that we can provide a forum for criticizing those standards.

    Personally, I agree that these type of “standards” can turn physicians into “robots” who are expected to follow a standard protocol, as opposed to responding to the needs of the patient on that day, and it’s pretty clear that a good “therapeutic relationship” is critical to good medicine, and standards of care throughout medicine do little to promote that relationship.

    Which is what I think you are getting at with your comment, and so it would make for a useful blog for our readers.

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  • Ted, this is always a challenge. he JAMA article asserted there was an “evidence base” for prescribing stimulants to three-year olds. The purpose of an article like this is to say to those who would believe this, let’s look at your evidence base, and does it justify that conclusion. That means examining such items as “effect sizes” and “number needed to treat.” That is the language of “evidence-based” medicine, and I know it can be off-putting. But here is a simpler summary:

    a) One justification given for prescribing stimulants to toddlers is that ADHD is a neurological disorder characterized by genetic and brain development abnormalities. The relevant research actually finds the opposite, which is that the overwhelming majority of those diagnosed with ADHD show no such abnormalities.

    b) The second relevant claim is that there are children “with ADHD” and children “without ADHD”, and that experienced clinicians can distinguish between the two. A child either has ADHD or doesn’t have ADHD. The relevant research shows that there is no such line, it’s all a construct. So that’s a second falsehood.

    c) The third claim is that the PATS trial showed stimulants to be a safe and effective treatment for toddlers diagnosed with ADHD. That too isn’t true; at least 85% of those so treated–even by the standards of the trial–didn’t receive a short-term benefit in terms of “symptom reduction,” and long-term, what you see is an intervention that turns toddlers into permanent mental patients.

    So, it’s a practice, said to be evidence-based, that in facts robs toddlers of their childhood and almost certainly will diminish their lives as adults, should they continue to take psychiatric drugs as they grow up (which two-thirds do.)

    That’s the bottom line. And that’s what our society is doing in the name of “evidence-based” medicine.

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  • I don’t think we can add much through a review. On the one hand, judging from the NY Times review, he is acknowledging that there have been no advances in treating “mental illness” in the past 40 years, and that the field has been selling us hype for four decades. So there is a sense of acknowledgement that the critics are right. But at the same time, he is maintaining a belief that there are effective drug treatments for mental disorders, and that the field is in fact learning a lot about the biology of mental disorders –it’s just that the knowledge is not getting translated into new treatments. And then he talks about our social failure, without acknowledging that this social failure has all taken place during the 40 years we have had “biological psychiatry.” Maybe we’ll have someone write a blog about this–that is what is really needed, rather than a review of the book.

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  • I struggled with the title, but the Tragic End was meant to mean, led to a tragic end where medicating three year olds is seen as a good thing to do. Even as the ADHD craze rose for school-age children, there was a sense that medicating preschoolers was a step too far. But now psychiatry has reached the “end point” of recommending it as a practice. And so the diagnosing and prescribing of stimulants to toddlers is rising fast.

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  • We have stayed out of the Covid treatment and vaccination debates — it’s not in our bailiwick. The point of this Around the Web is that here you have a doctor, going against an accepted practice and a) losing her license and b) having to undergo a psych evaluation. If you accept that as okay, then you can see that someone who refused to prescribe antipsychotics to a patient, given the accepted wisdom could lose their license and have to undergo a psych evaluation. That’s the connection to psychiatry in this instance, and that’s why it’s abusive..

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  • As you write Brett, the industry trials are designed to favor the drug, and then there are the problems with unblinding and investigator bias (due to the unblinding and financial influences), and the problem that negative trials go unpublished. And as Steve writes, the placebo group consists of is really a drug withdrawal group. What is astonishing is that in spite of all these biases that favor the study drug, the published trials still show only a minimal benefit. This suggests that if you ran trials that were free of industry influence and investigator bias, and did so in medication naive patients, then the efficacy benefit would not only disappear, but rather that placebo might produce superior outcomes in terms of reduction of symptoms.

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  • We published a “review” of the study because we thought it exemplified bad science, and how biological psychiatry seems to always be looking at the “flawed” biology of the individual (rather than trauma which is, even in the diagnosis, said to be the cause of the disorder), and this study seemed particularly idiotic because it didn’t include women with PTSD! I am not sure that came across as clear to all our readers.

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  • Someone Else: Amy Biancolli did this round-up of books at my request. It is, in fact, quite common for magazines, newspapers, and so forth, to gather reviews of multiple books into a “round-up” like this one. It’s really four separate reviews, and I can assure you that authors of books are happy to get their books reviewed as part of a round-up. This is a way to introduce more books of interest to MIA Readers.

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  • Thank everyone for these comments. I can see that Part Two, the deconstruction of the studies used to declare these drugs safe and effective, was too dense and minutely detailed. (I get a bit obsessive with detailing all the shenanigans.) I could basically have summarized the problems with these trials in this way:

    First, they used inclusion/exclusion criteria to select for patients who had responded positively to drug treatment in the past, and to exclude patients who had not responded well in the past.

    Second, in the injectable trials, they designed the trials so only those who had stabilized well on the injectable would then be entered into the randomized phase of the trial.

    Third, of course, is that the placebo groups were a drug-withdrawn group, and they could be expected to have an exacerbation of symptoms and suffer withdrawal symptoms that would worsen outcomes for this group in comparison with the medicated patients.

    Fourth, even with these biases, the drugs, in comparison to the drug-withdrawn placebo group, regularly failed to provide a clinically meaningful benefit. The difference in the reduction of symptoms, while statistically significant, wasn’t clinically meaningful.

    In other words, the trials are not meant to see if they provide a benefit to patients. They are designed to produce a “statistically significant benefit” for the drug group, using various machinations to help produce that end, and the fact that they don’t provide a clinically meaningful benefit, even in these biased trials, is irrelevant.

    I dig into the details really with the hope that those who are “experts” in trial design will see what a charade it all is. But I do see it made it difficult for readers to get through . . . chalk it up to my OCD on this issue.

    As for whether the root source of the problem is capitalism, the problem is that there isn’t a regulatory requirement for honest, independent trials. The flow of money within our existing environment surely tells of a marketing endeavor that brings psychiatric drugs to market and sells them, which is a failure of our particular capitalistic system. It could still be possible to have a capitalistic system that required independent testing of new drugs, and didn’t reward psychiatrists and other “experts” for shilling for the drugs. But we don’t have that requirement now, and it certainly betrays the public good not to have it.

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  • From our inception, Mad in America has sought to provide a forum for people whose lives have intersected with psychiatry and its treatments to tell their stories. However, we have always known that this didn’t provide a forum for the many, like Carlton, who wouldn’t be prompted to write their stories, or who would even know about Mad in America. With this story, we are launching an effort to provide a forum for those “Unheard Voices” that need to be heard as part of any societal “rethinking” of psychiatry and its treatments.

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  • Based on some of these comments, I think there is some misconception about the nature of this study by Harrow. It was a naturalistic study, and Harrow had nothing to do with the “treatment.”

    People who were “psychotic” were treated in the hospital with antipsychotics (conventional treatment.) They were discharged and then Harrow and Thomas Jobe simply followed up with them periodically for the next 20 years (followups were at 2 years, 4.5 years, 7.5 years, 10 years, 15 years and 20 years.) Some people stopped taking antipsychotics during the first two years, and other kept on taking the drugs. All Harrow did at the two year follow-up was report on this medication use, and he did so at each of the follow-ups.

    What he found, when he analyzed his followup data at the end of 15 and 20 years, that those patients who, for whatever reason, had taken themselves off antipsychotics by the 2-year follow-up (many may have stopped soon after being discharged from the hospital, and thus only been on antipsychotics for a short time) had by far the best outcomes over the long term, and many who had stopped using antipsychotics by year two never took the drugs again. Among the people who were still taking antipsychotics at year two, many may have taken themselves off the drugs by some later date, at least for a time. But what Harrow found was this: the best outcomes by far were those who had stopped taking the drugs at the two-year followup. So what you see in this naturalistic stud, which means Harrow was simply studying people who were diagnosed with a psychotic disorder and treated conventionally in the hospital by hospital staff and seeing how they fared over the long term.

    There was no protocol that called for anyone to go off the drugs by year two. Harrow just observed stark differenced between the long-term outcomes between those who had rejected the antipsychotics by year two, and those who were medication compliant during the study.

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  • Cabrogal, No we are not selecting posts in order to wind up our readers. yes, we have a policy of respecting the voices of lived experience, which of course means that many will express different opinions, including about topics as controversial as Kendra’s Law.

    You will note that not long ago we ran a two-part series on AOT, which was our own reporting on the matter, and among other things, we noted how it is not “effective” in achieving its stated goals.

    https://www.madinamerica.com/2019/07/twenty-years-kendras-law-case-aot/

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  • Richard,

    That list grew so long it became unusable. Plus we switched how we handled new writers for software reasons.The best way to see an individual’s blogs is just to put their name in our search engine. For instance, I just searched Richard Lewis, and this page turned up: https://www.madinamerica.com/?s=richard+lewis, which has a long list of your writings on MIA

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  • Cabrogal,

    Family and friends may recommend someone to the show, but the show then asks the person if they want to be on the show–the person, as you can see in the piece, is expecting the Fab Five to come and help them “remake” their lives. They give their consent.

    We were curious if the transformations depicted on the show were “real” to those who experienced them, and lasted. So we interviewed a number of people and you can read what their thoughts were here. So what the story does is this: It asks people who consented to being on the show what it was like for them (and they could have said it was horrible, but they did not,), and we asked them whether it had changed their lives, and in what way. So we were honoring their experience, whatever it may have been. I would think readers could see that as well and that’s the journalistic ethic on display here: there is a popular tv show that presents transformation in people’s lives, and we wanted to know what it was like for them. If they had said it was miserable and exploitive, we would have reported that. But that’s not what our reporter was told.

    That’s the key here, which I think readers could understand: We are seeking to know the experiences of people who have been on the show, and honor them. I would hope readers could read this piece with that understanding in mind.

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  • I appreciate these comments/criticisms regarding this post.

    First, re Phil Hickey’s blog. We didn’t remove his blog because of its general content. We temporarily removed it because we had put up an image that we felt violated our own standards, and because there was a section of content in it that we also felt violated one of our standards re personal criticisms. We asked Phil if we could then republish with a new image and that one part omitted, and he declined, and so we then forwarded readers to his own blog. We regularly publish Phil’s writings, and any error was on our part prior to its initial posting here.

    I think the criticisms regarding our publication of this post on Mind Medicine Australia are worth airing and considering. You’ll notice they weren’t moderated, which is evidence of how we think MIA should be open to criticism. After some discussion, and actually a fair amount of editing, I decided we should publish it for the following reasons: it was registered as a charity, there is ongoing research into these medicines (which would seem to make it a worthwhile subject), Mind Medicine is sponsoring research), and it does have an advisory board that includes medical people. We have also received complaints in the past from readers that we have been “hostile” to psychedelic therapies. Thus, we saw this post of some interest within our standard of allowing for posts of disparate perspectives.

    That said, criticism of the commercial interests are worth noting, and I appreciate this feedback.

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  • Kindred Spirit: If you were pushed to take Saphris in 2008, it would have been before it was approved for use. What happens is that after a company finishes its actual RCTs for NDA purposes, it then begins doing extension trials, which are unblinded and meant to show that the drug can be taken “safely” for longer periods of times. In this instance, there were so few people who were actually enrolled in placebo controlled trials that there was very little “safety data” with robust numbers of patients exposed to the drugs. So they ran these unblinded studies to get the exposure numbers up, which helps make it seem the drug has been throughly tested. And it meant a drug company payment to the psychiatrist who was trying to get you to take Saphris.

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  • People can identify themselves as they wish on the commenting section. They can participate in this discussion, as most everyone knows, with whatever name they wish.

    As for personal stories, their power comes from the fact that the authors stand up and say, this has been my experience, and this is who I am. We want to be a forum that lets society hear and know these stories, and often they are stories that tell of suffering and of loss related to psychiatric care.

    Anonymous stories do not have that impact. Readers just don’t know — emotionally — if the stories are real. And people who submit their personal stories are making a decision to tell their story in that public way. As Miranda wrote, we’ve made exceptions to this standard on occasion, but for eight years now, we have published personal stories, and if you go through this archive of stories, I think the authors have created a public voice of truth-telling that, at least in its quantity and breadth, is unequaled.

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  • One added note: If anyone is interested in my personal writings on this subject of systemic racism, please read my non-fiction book On the Laps of Gods. (It was initially titled 12 Condemned to Die, but changed during the publication process.) It is a book about the massacre of sharecroppers in Arkansas in 1919, and the subsequent mass arrest of leaders of a sharecroppers’ union. The legal struggle to free the 12 men condemned to die led to a Supreme Court decision that served as legal foundation for the Civil Rights movement.

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  • There are two issues here, in these comments, re MIA. The first is our mission. We have never had in our stated mission the word “reform.” From the start, MIA was a forum for “rethinking” psychiatry, which opens up many possibilities, and we have always provided a platform for writers who argue for abolition. Think of Bonnie Burstow, for example, who wrote here often. We mourned her loss when she passed. I should note that I also offered Oldhead that he could write a blog post, but he would have to use his real name. He declined.

    Here is our stated mission:

    Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.

    The point is we are not saying what the change should be. We are a forum for a larger community to express their thoughts on what that “rethinking” should lead to. Although I write posts here related to science reports, etc., I never write general “opinion” pieces. In fact, you will see very few opinion pieces that have ever been written by MIA editors in our seven-plus years.

    We are also a forum for the “comments” of our readers who can weigh in on this “rethinking” mission. And I should note that it is in this comment section, with some regularity, where readers of MIA are reminded of MIA’s flaws, and my personal shortcomings. We also have posted may blogs that are critical of MIA (such as this one by Sera). I believe that such criticism is evidence of the ‘open-mindedness” of our site, which is a quality that should exist in any forum devoted to “rethinking” psychiatry. Oldhead regularly expresses his disdain for me and MIA, and yet here he is, a regular presence in the commenting section.

    The second issue, which I think is a relevant one, is the makeup of our “staff.” The word staff here is actually a bit grandiose. We only have three people who receive a weekly salary (and not even full-time). We also have a “socialist” pay structure, where everyone–the three on “staff” and the others who contribute on an hourly basis–is paid the same (and not particularly well.) For my part, in interests of transparency, I put in funds at the start of MIA and worked without any pay for six years. The other two on staff currently are our blogs editor, Peter Simons, and Miranda Spencer, our personal stories editor.

    The largest number of “staff” you see are the science writers, which is a team of contributors that originated a Ph.D. psychology program at UMASS Boston. We have had, and still do have, a few members of the team who are “non-white.” That said, it doesn’t negate the criticism voiced here about the lack of diversity at MIA.

    I do think in terms of our content, you will find a number of articles, interviews, and blogs that focus on racism in our society, and particularly how such racism intersects with psychiatric practices. It is not a subject, as meremortal writes, that we have ignored.

    However, the bottom line is this: I think MIA’s failure to have diversity in its board and its staff, with the exception of several of our contributing science writers, is indeed exactly that . . . a failure, and I am glad that it was publicly pointed out. We can always strive to remake our organization too.

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  • Kindred Spirit: There have been thousands of opinions expressed about Trump that have no “objective measure.” The New York Times is free not to publish anything written by Lee, and so is the rest of the press. They are free to ignore her. But I don’t think the public is served when the press supports the suppression of opinion by a guild. The guild can criticize Lee if it wants, but you shouldn’t have the press taking its walking orders from the American Psychiatric Association. Why should the press care about what rule a guild makes regarding who can and can not offer opinions about a public figure? It’s okay for Lieberman to write in the New York Times that Trump is a jerk, but not okay for Lee to write that Trump is dangerous?

    Also, I don’t think the Goldwater rule even applies here — they weren’t diagnosing him with a mental illness.

    I find it a bit hard to understand why a community whose voices have so long been unheard, silenced by psychiatry, with people said to be unreliable witnesses to their own lives, would now welcome a guild seeking to silence others for expressing their opinions about Trump. I repeat myself, but I personally am against powerful institutions seeking to curb public debate about such a topic as a president’s fitness. I don’t think the media should be doing the wishes of the American Psychiatric Association in regard to public debate about the president’s fitness.

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  • Do you really want a guild that prevents criticisms of a president? Really? It’s not about whether Trump is dangerous or not. The public can weigh in on that. The authors here also weren’t diagnosing Trump with the DSM. Nor are they weighing in on dangerousness in a legal setting. And they weren’t weighing in on whether Trump is sane or insane. It’s about the assertion of power that limits public debate.

    Indeed, this article is about the New York Times throwing its prestige and weight behind a power play that does silence one group seeking to weigh in. Should columnists be silenced? Should ethicists be silenced? Nobody has to agree with what Lee and colleagues wrote; but to think that psychiatrists can’t weigh in with their thoughts about whether a president is dangerous?

    If you think psychiatrists should be muzzled, then you believe in muzzling criticism of a president.

    The APA and psychiatry as an institution have successfully “muzzled” critiques of psychiatry within the mainstream media, e.g. critiques regularly voiced in these pages. Is this a good thing? Maybe we should commission a piece that congratulates psychiatry, as an institution–and yes Lieberman too–for being so successful in keeping critiques of psychiatry out of the mainstream media.

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  • This was unbelievable, and yet all too common. We decided to make it an Around the Web because it was notable that the Times ran an obit. But then to solicit a comment from Ed Shorter, who in his history of psychiatry likened the arrival of antipsychotics to the arrival of antibiotics in infectious medicine, and then print his hateful comments was just such bad journalism. And of course revealing; you can be sure that if E. Fuller Torrey were to pass, the Times wouldn’t solicit comments from say David Oaks about Torrey’s work (or from anyone associated with Mad in America.)

    I was personally sickened by this, and intend to write a short piece about it, as soon as I get time. Hopefully later today or tomorrow morning.

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  • Eric,

    As you know, your original draft was quite long, and it went through several iterations with our editors. We didn’t change your title, as you can see. The piece is called “The Day I Became Schizophrenic.” In an early edit, there was a slight change made for clarity purposes in a sentence, which was the addition of “I don’t” in the sentence below:

    Assuming, of course, that you believe in “schizophrenia” at all.
    I don’t. Schizophrenia, to me, is nothing more than a word…

    Moreover, that edit was made in an early draft, and you okayed the publication of this piece. You wrote go ahead and publish if I said it was okay, and I thought it had ended up quite good.

    Our editors spent a lot of time on this piece. But given that you have written this comment that trashes one of our editors, I think it is appropriate to correct the record.

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  • Thanks for these comments. Rosalee, Re diagnosis: The “patients” may arrive with a diagnosis, because they are arriving from a public mental health system. But they aren’t being viewed through a diagnostic lens.

    Also, the user movement thrives in Norway, and We Shall Overcome is one of the oldest psychiatric survivor groups in Europe, and perhaps the oldest of any group still active today. One of their members works there now, and as I wrote, this is the place that when one of their own members had need for a respite/hospital, this is the one she fought to come to.

    My point is that the User Voice, which includes the psychiatric survivor voice, is very much present at this place. White Eagle is a small user group that also very much has a psychiatric survivor perspective.

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  • Oldhead, you know you are deliberately misreading what I wrote. This is how psychiatry, as an institution, responds to criticisms . . . it’s a rhetorical device they use to delegitimize criticism by saying it arises from a biased perspective. It’s a point about how psychiatry avoids dealing with legitimate criticisms.

    Beyond that, I am not going to respond. This is such a gross mischaracterization of what I wrote, and you know it to be so. And then, having grossly mischaracterized what I wrote, you then call it offensive.

    I am tired of this, I have to say.

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  • Someone else:

    Our Media Watch should not be confused with the politics of Trump’s “fake news” comments.

    The problem here, with the media’s interviewing of Williamson, is that this shows how psychiatry, as a guild, together with the pharmaceutical company, told to the press a false story about chemical imbalances and so forth, which by and large the media bought. Our goal here in this particular report was to assess whether the media, in its interviews with Marianne Williamson, displayed a knowledge of the science that exists within the research literature, or whether they had been informed by the false story that has been peddled to the media and to the public.

    I hope this distinction is clear.

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  • Kindred Spirit,

    Right now we have weaponry of all sorts circulating in American society. If you ban private ownership of assault weapons, and make it illegal, i would think it would make it much more difficult for any potential mass murderer to obtain one. And I would think that difficulty would extend to obtaining such weaponry with 3d printing technology.

    I don’t think banning assault weapons will eliminate all mass killings. But I do think that it would sharply reduce the frequency of such killings. It doesn’t go to the root causes at all. But it would go to the ease of acquiring weaponry of this sort, and that would be a help.

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  • Someone else: This brings up a good question: Is there a Second Amendment Right for individuals to own an assault weapon?

    Wikipedia has a good history of U.S. Supreme Court decisions regarding the Second Amendment. It was only recently that the U.S.Supreme Court said it gave the right for the individual to own a gun for self-protection in the home, and the Court, it is clear, has historically given states the license to limit access to certain types of weaponry, as the right of the individual to bear arms is not an unlimited one.

    https://en.wikipedia.org/wiki/Second_Amendment_to_the_United_States_Constitution

    While psychiatric drugs can stir homicidal behavior, there have been plenty of instances where psychiatric drugs haven’t been involved. Personally, I think we as a society can ban assault weapons while not intruding on a Second Amendment right, as interpreted by the Court, to maintain a firearm in the home for purposes of self-defense.

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  • Randall,

    That National Review article is linked to a Heritage Foundation report that is quite long, and so I don’t know where there original citations come from. The 20 times homicide rate cited for people diagnosed with schizophrenia doesn’t line up with any study I have ever seen (and the cited report is from the Heritage Foundation, and I can tell you that the claim in that report, which I did see, that says there is little relationship between gun ownership and suicide rates is just dead wrong. See the MIA report, Suicide in the Prozac ERa for data on this.

    If you read The Case Against AOT, you’ll find some discussion about this issue of violence by discharged patients from mental hospitals. Although such studies vary in their findings, in a study where the discharged cohort was matched to a similar general population cohort for education, income, and substance abuse, the violence disparities disappear. In such studies, the increased rate of violence by the discharged patients comes from those with a substance abuse problem..

    More to the point, an article appeared in the New YOrk Times yesterday, citing studies of mass killers. Only 20% had a psychiatric diagnosis, which is the percentage of people in society with a diagnosis. https://www.nytimes.com/2019/08/08/opinion/mass-shootings-mental-health.html?searchResultPosition=1

    In other words, there is no higher rate of mass killers emerging from that segment of the population than from the rest of the population.

    And remember, let’s say that 5% of the mass killers have a psychotic diagnosis. If there are 20 mass killings a year, that would mean one would be due to someone with a psychotic diagnosis. Are you going to restrict the citizien rights of several million people for the acts of one person?

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  • Thanks Randall,

    I appreciate your comment.

    I know you have linked to an article by the National Review, which of course is a publication that regularly puts forth Republican talking points, and I think this article is doing that.

    Now, in regard to this blog:

    Do you see the same rate of mass murders in countries that don’t allow access to assault weapons (but still have people said to be “mentally ill?” No.

    Do you see that it is people on disability due to mental illness who are the ones who are buying assault weapons and committing mass murders? I know of no evidence for that.

    Do you see that it is people who have been in a mental hospital and aren’t taking medications are the ones who are committing most of these mass murders? No.

    Is there evidence that forcing people to take antipsychotics, which is what Torrey urges, reduces the likelihood that they will commit mass murder? There is nothing in the AOT literature that shows that to be so.

    Is there any evidence that our expanded psychiatric enterprise, which sees more and more people getting diagnosed and treated, has reduced the frequency of mass murder? No.

    Of course people who commit mass murder are “disturbed” in some way. I don’t think you plan to bring an assault weapon into a public space and start shooting people if you are not “disturbed.” But what are the paths that these mass murderers are on before they act? They may have gotten psychiatric treatment. They may not have gotten psychiatric treatment. They may be on psychiatric drugs. They may not be on psychiatric drugs. And so on.

    So now, three questions.

    1) If you are going to “blame” mental illness, what is the legislative action that should follow? More screening for psychiatric disorders? Forced treatment? Banning all those with a psychiatric diagnosis from owning guns? Can you point to any evidence that “blaming mental illness” will lead to a societal change that will reduce the frequency of mass murder?

    2) Do you think that banning all assault weapons would reduce the frequency of mass murders? If so, that would be a more effective choice of action.

    3) In terms of numbers, there are a tiny number of disturbed people, including some who may have been psychotic, who commit mass murders. Do you think it is right to cast societal aspersion on the millions of people who have a psychiatric diagnosis, and limit their citizenship rights in some way (including subjecting them to forced treatment), for that reason? Do you tar the millions based on the actions of a few?

    There is a 2016 publication, by the American Psychiatric Association, titled Mass Shootings and Mental Illness. It states that people with “serious mental illness” commit about 3% of the violent crimes in our country each year. The percentage of people said to be seriously mentally ill in our country is higher than that. So why would we blame mass murder on that 3%, and target that group with legislation that curtailed their rights?

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  • Oldhead,

    It was the publication of DSM III, when the APA adopted its so called “medical model,” that soon led to the frequent diagnosing of children and adolescents with a psychiatric disorder, and their being told that they had a chemical imbalance in the brain. That was not happening to children and adolescents on a frequent basis prior to 1980 (and that is Laura’s story.) I didn’t know any school-age person who was diagnosed with a psychiatric disorder when I was growing up.

    Yes, the profession adopted regular use of neuroleptics after they arrived on the market in 1955, and at heavy doses, for those in mental hospitals. But the huge expansion of the mental health enterprise began in 1980, with the APA adopting its disease model, and that is the enterprise that swept Laura into its midst.

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  • To Sam: You write that there are “rare times” I visit this website, but just for the record, I run madinamerica.com. My first book was titled Mad in America, and after I published Anatomy of an Epidemic, I and others turned what had been my personal website, madinamerica.com, into this webzine, and I have led this effort ever since (for better or worse, whatever you think.) Just an FYI.

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  • Vortex,

    This is a really interesting thought.

    I think there are many factors contributing to the rise of adolescent anxiety and depression, starting with the push by psychiatry and the drug industry to get all of us, starting with youth, to be constantly on the lookout for such feelings within us. Then there is the competition to get into good colleges, and as Steve says, there is also the lack of a good path to economic independence for our youth today (particularly given the debt they may run up getting a college degree and pursuing a graduate degree.)

    But the “zealous overprotection of children and adolescents”, as you say, an obvious possible contributing factor, and one that I have actually wanted to write about. Children develop resilience and self-confidence by being out in nature and in social situations where they see themselves as learning to copy with those environments, and yes, ultimately on their own.

    I appreciate that there are two new books helping bring attention to this question.

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  • Thank you all for these comments. It’s clear many feel quite passionate about MIA, even those who write with some disparagement toward us. We’ll take all of this into consideration as we move ahead as an organization.

    One note on now having to click the comments button. Frankly, this just makes the whole page cleaner in appearance, and that means the comments page displays in a cleaner fashion too. Virtually every site does this. And I don’t think it takes too much effort to click on the comments button. We should have done this long ago for aesthetics reasons. And it doesn’t do anything negative in terms of limiting discussions, comments or so forth. In my opinion, it actually highlights them better, because they no longer appear stretched out at the bottom of the article.

    We are going to close this commentary now, as I think everyone has had their say and we have heard your feedback.

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  • After reading these comments, and seeing new information brought into the discussion, including the study conducted by pfluft, I am reminded anew by how there is, within the page of papers published by mainstream psychiatry, so often a lack of effort by the authors to really explore the data, and set it forth in detail, but rather you see a discussion of data and reasoning that really is meant to confirm the conventional thinking. It’s good to see this discussion here.

    The TADS study is a case in point. I saw that in one of the studies I reviewed cited as evidence that antidepressants didn’t increase the risk of suicide in youth! The initial corruption is just incorporated into later statistical reviews.

    This is the same with the Gibbon’s piece claiming that suicide in youth went up after the black box warning was put on the drugs. A corrupt bit of science, and pfluft’s study helps reminds us of that. And yet, you see Gibbon’s research still cited all the time as ecological evidence that antidepressants actually prevent suicide in youth.

    But just wanted to say I appreciated the discussion here.

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  • I should have weighed in on this before. (I posted this same comment on James Moore’s survey blog.)

    First off, since its inception six years ago,MIA has provided a forum for psychiatric survivors to tell their personal stories in blog posts that are featured on the front page, and thus get read by a larger audience. This has been one of the goals of MIA from the start, and the way you can make it possible for that survivor voice to be heard more widely is to create a site that isn’t hostile in tone and kind. So it rather irks me when I read of how we are somehow silencing the psychiatric survivor voice, etc. If you just want psychiatric survivors telling their stories to each other, that’s fine and understandable. But our goal was to give that voice a place in a wider societal discussion, and to reach beyond the choir.

    However, if we have a commenting section that is seen as hostile and always ready to attack those who have different views, that becomes a force that is helping to silence the survivor voice, because it diminishes the audience that is going to hear it and consider it.

    Moreover, we have lost any number of bloggers, including those who identify as psychiatric survivors, who stopped writing for us because of some of the responses by commenters (they felt personally attacked in some way or another.)

    And so what really are the changes we are proposing?

    One, we are trying to re-emphasize the need to be civil–both in tone and thought. We understand that there are many people who have been hurt by psychiatry as an institution, had their liberty taken away, and have felt betrayed by the stories that psychiatry has told the public. There should be a place for people to voice their rage, their anger, and so forth on the web. But because of what we are trying to do here, which is be a forum for a wider discussion about how to “rethink psychiatry” — and by the way, we have writers who are abolitionists, read Bonnie Burstow, for example–we are trying to say to all, park that emotional rage at the door, and engage in an intellectual fashion, and with a civility in tone and in thought.

    And the second change really is this: We are going to set up the comments section–as nearly all web sites have done–where readers will click on the comments and make a choice to enter that world of commentary. That will create a sense of choice by readers, and thus when readers complain that they have stopped coming because of the comments, we can say that it is up to them to decide whether to engage with the comments. The changes will also make our comments section more user friendly, and accessible . . . these changes should invite more readers to engage with the discussions.

    One of the things we realized from the survey is that so many people just avoid the comments altogether because of a sense that it can be a hostile place. We are TRYING TO ENLARGE THE AUDIENCE for those contributing through their comments, not diminish the audience. We are just asking everyone to engage in a way that help create an environment where people can listen to each other.

    And please, if you want to voice your displeasure, tell it to me. You can even write me at [email protected]. I am the one driving these changes, and so if you have a complaint, you don’t need to get mad at James Moore or Steve McRea.

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  • I should have weighed in on this before. (I also posted this comment on Steve McRea’s blog.)

    First off, since its inception six years ago,MIA has provided a forum for psychiatric survivors to tell their personal stories in blog posts that are featured on the front page, and thus get read by a larger audience. This has been one of the goals of MIA from the start, and the way you can make it possible for that survivor voice to be heard more widely is to create a site that isn’t hostile in tone and kind. So it rather irks me when I read of how we are somehow silencing the psychiatric survivor voice, etc. If you just want psychiatric survivors telling their stories to each other, that’s fine and understandable. But our goal was to give that voice a place in a wider societal discussion, and to reach beyond the choir.

    However, if we have a commenting section that is seen as hostile and always ready to attack those who have different views, that becomes a force that is helping to silence the survivor voice, because it diminishes the audience that is going to hear it and consider it.

    Moreover, we have lost any number of bloggers, including those who identify as psychiatric survivors, who stopped writing for us because of some of the responses by commenters (they felt personally attacked in some way or another.)

    And so what really are the changes we are proposing?

    One, we are trying to re-emphasize the need to be civil–both in tone and thought. We understand that there are many people who have been hurt by psychiatry as an institution, had their liberty taken away, and have felt betrayed by the stories that psychiatry has told the public. There should be a place for people to voice their rage, their anger, and so forth on the web. But because of what we are trying to do here, which is be a forum for a wider discussion about how to “rethink psychiatry” — and by the way, we have writers who are abolitionists, read Bonnie Burstow, for example–we are trying to say to all, park that emotional rage at the door, and engage in an intellectual fashion, and with a civility in tone and in thought.

    And the second change really is this: We are going to set up the comments section–as nearly all web sites have done–where readers will click on the comments and make a choice to enter that world of commentary. That will create a sense of choice by readers, and thus when readers complain that they have stopped coming because of the comments, we can say that it is up to them to decide whether to engage with the comments. The changes to the comments section also make it more user friendly, and accessible . . . these changes should invite more readers to engage with the discussions.

    One of the things we realized from the survey is that so many people just avoid the comments altogether because of a sense that it can be a hostile place. We are TRYING TO ENLARGE THE AUDIENCE for those contributing through their comments, not diminish the audience. We are just asking everyone to engage in a way that help create an environment where people can listen to each other.

    And please, if you want to voice your displeasure, tell it to me. You can even write me at [email protected]. I am the one driving these changes, and so if you have a complaint, you don’t need to get mad at James Moore or Steve McRea.

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  • Auntie Psychiatry you are exactly right. The media coverage reflected what the psychiatrists told them, and was included in the press release. The general media isn’t going to try to interpret the study; they let the “experts” do that for them. The blaming of the media for the hyping of the study by psychiatrists and the researchers themselves — see Cipriani’s quote in your comment–is ridiculous. And BMJ should be commenting about that, not about how the media failed. The mainstream media did just what you would expect, quote the press release and experts in depression.

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  • Thanks for these comments. Marie, on the high NNT of other drug interventions–I think this is the point of why NNTs should be the focus for informed consent for medical interventions of all types. They allow the individual to assess the “odds” of having a better outcome than they would without the intervention (regarding the target symptom or problem), versus the “harms” that might come from the treatment.

    This leads to Duncan’s comment about the “harms” being a separate matter. Well, in this piece, I am using “harm” to describe being exposed to the adverse effects of a psychotropic without benefitting from the treatment on the “target symptom.” Then the question is what are those adverse effects, how common are they, and so forth. I don’t think these are properly identified at all, leaving people contemplating taking a psychiatric drug really in the dark when assessing the potential harms, particularly when initial use of a drug proves to be a gateway to long-term use. Trying to better understand the short-term and long-term risks/harms that can come from taking a psychiatric drug is the other half of providing informed consent, and this too is missing in terms of what people are told.

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  • This is in reply to Oldhead and others questioning why we wrote this MIA Editors post.

    We were originally going to simply put up an Around the Web about this flagging of Julia’s talk. But then I thought it deserved more attention for this reason: It is yet another example of how challenges to the conventional narrative in psychiatry are shut down, or at least flagged as suspicious, in more general media forums.

    That is a theme that I have often written about, and in some ways is central to what I have written about in Mad in America, Anatomy of an Epidemic, and in Psychiatry Under the Influence (the last book co-authored with Lisa Cosgrove.) The powers that be-pharma, and psychiatry as an institution-have sold a false narrative to the public for at least the last 35 years, and one of the key ways they have defended that narrative is to delegitimize critics in the eyes of the conventional media (and TED talks is part of that conventional media.) The powers that be wrap themselves in the cloak of science, and they present those who would criticize their narrative, or challenge it in some way, as “flat-earthers,” and so forth.

    Given that enduring interest of mine, in how the media is manipulated, I thought it would be good, in the manner of news, to feature this flagging of Julia’s TED talk. It was news of a form of censorship.

    I decided that it would be best to have the “author” of this blog be MIA editors for two reasons.

    First, it was James Moore, who runs our MIA Radio Podcasts and is now contributing to our editorial content in various ways, who first noticed this and prepared an Around the Web. I then just added a bit of content to turn it into a blog post. So it was in fact a collaborative “authorship.”

    Second, TED’s flagging of Julia’s talk also represents an arrow that could be said to be directed at MIA too. Julia writes for us within a very particular context: She writes as a researcher who has done studies on the use of micronutrients as treatments for diagnoses that exist within the DSM, and on nutrition in general as it may contribute to mental wellness. And our point, in writing this post, is that Julia’s presentations — whether it be for a TED talk or for us — follow good scientific protocols. She tells of her study designs, and she accurately reports what other studies have found. And since her blogs are posted by MIA editors, the most appropriate authorship for this post was in fact MIA editors. We were defending the way Julia Rucklidge writes about these matters for MIA as well.

    Now, this post by MIA editors is different than writing an “editorial,” which would express an organizational opinion on some matter or another. We didn’t run an MIA editorial regarding the Murphy bill for the simple reason there was no need for us to do so, and in fact, in my opinion, doing so would have just served as a bit of a distraction. We have numerous very able writers, who are active in the trenches of advocacy work and peer-centered work, who wrote on MIA about their objections to the Murphy bill. Our proper role in that political effort was to provide a forum for their voices and for their arguments. Their voices needed to be front and center (and heard), and not ours as an editorial team.

    Two more points in response to the comments here.

    First, as an organization, we do not embrace any alternative therapies — such as micronutrient therapy — as a preferred form of care. We want to provide a forum for scientific reports about such therapies, and a forum for researchers and others to write about alternative therapies in blogs. But our editorial position — and this comes first and foremost from me — is very simple: While I am quite sure that our current paradigm of psychiatric care has failed, the task of creating a new narrative of mental health is one that must be taken up collectively. Our job is to help foster that collective discussion, but we, as an organization, do not have the “answers” that tell of what should be done.

    Second, regarding the use of quotations around psychiatric diagnoses, we have run plenty of blogs questioning the validity of DSM diagnoses. Lisa Cosgrove and I wrote about this at some length in Psychiatry Under the Influence. And when bloggers for MIA write posts about questioning those diagnoses, they may put quotations around the particular diagnosis.

    However, in blogs that are talking about research related to a particular diagnosis that exists in the DSM, it would be a self-serving distraction to put the diagnosis in quotes. Doing so would suddenly direct the readers’ attention to the questioning of the diagnosis, as opposed to keeping it focused on what can we learn about a therapy for people so diagnosed. I want MIA to have a voice, or an impact, within that larger societal discussion, and if we decide that we can’t even enter the world of that conventional narrative, with its DSM constructs, without always putting quotes around such words to remind readers that they are indeed constructs, as opposed to validated diseases, then we might as well shut down, for it would be signaling that only people with a certain belief are welcome here.

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  • Oldhead, MIA is not “teaching Mad Studies.” The people presenting the seminars are those who are involved in “Mad Studies” as academics, and as people with lived experience. We are simply hosting the webinar (and Emily organized it by recruiting the presenters.). MIA never “teaches” anything in its Continuing Ed courses; we simply host the courses and recruit the presenters.

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  • Thank you all for these comments.

    Peter, much of this research is dismissed by defenders of the usual practices by arguing there must be a difference between those who take antidepressants and those who do not in these “naturalistic studies.” In the Canadian disability study, for example, the researchers hypothesized that those who decided not to take antidepressants had a greater inner resilience. In the six-year NIMH study, while I don’t think there was any difference in baseline symptoms, once again there was some thought that those who eschewed antidpressants were more self-reliant, etc.

    The WHO study is different, however. The way this study was done was this: WHO researchers screened people coming into GP offices for treatment of some kind (physical ailments, etc.), and identified those who were depressed (and with baseline scores, etc.) But they didn’t say anything to the GPs, and hypothesized tht if the GPS identified the depressed patients and treated them, they would do better than the patients who were depressed but that the GPS failed to diagnose.

    The hypothesis didn’t pan out. Diagnosis plus treatment led to the worst result. But the researchers did have baseline scores for everyone, and as you can see in the graphic above, Medicated Patients Stop Getting Better After Three Months, their baseline scores were virtually the same. But what is so notable is the difference in trajectories following three months. You know how some patients complain about Prozac poop out, meaning the drug stops working? This graphic shows that.

    But beyond that, naturalistic studies always have this problem of possible differences in initial severity, or difference in personality types. But still they provide an important additional body of evidence to consider, and thus are part of the research evidence that needs to be reviewed.

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  • This is in response to the issue of the “elephant in the room,” which a number of comments have referred to.

    We at MIA aren’t going to refrain from writing about a program that is based on a totally different paradigm of care than the usual biological model because of larger political questions related to that country, regardless of how one might think about those politics. That’s not our thing, national politics, and the question is whether this Soteria model, being implemented as a possible first-line therapy, is inspiring as a model for change. I think it clearly is.

    I should note too that Israel is a diverse country in the politics of its citizens, much as the United States is a diverse country in the politics of its citizens. The idea of condemning the people creating Soteria because of the politics of the country might also be seen as a glass-house type thing: I am sure there are plenty of readers who would criticize much of the United States’ foreign policy. But would we then not write about a Soteria effort in the United States because of criticism of its national politics?

    The point I am trying to make is this: MIA doesn’t want to get involved in left-right politics in the U.S., regardless of our private feelings, and we are applying that same standard to other countries. Naitonal politics is not our thing.

    And here is what I experienced in Israel: thoughtful people (with many different political ideas, by the way, about their own country), trying to create a humane type of care, which minimizes use of psychiatric drugs, which is precisely a model that I wish we would adopt in the United States.

    In the world of mental health, that is an initiative that I found inspiring, and solidly within the mission of MIA to write of hopeful alternatives in the U.S. and other countries.

    And so, if there are criticisms of me personally, i have asked Emily to leave those up, or put them back up. But I don’t think going back and forth about national politics in Israel is helpful to the discussion at hand here, which is the creating of a Soteria movement in another country.

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  • I appreciate all the comments here. In response to streetphotobeing, on how one needs personal experience of antipsychotics and forced treatment etc. ito really understand what that is like, I of course agree. I would never think that I would know what that is truly like; all I can do is try to record,in this instance of Soteria, what it was like for the residents there. That’s what I tried to do here, and in large part by letting the residents speak for themselves.

    In response to Lawrence, and your statement that psychiatry’s aim is not to get people better, this leads to truly one of the strangest aspects of modern psychiatry. As is well known, once psychiatry adopted its disease model with the publication of DSM III, it began promoting the idea that people diagnosed with a “serious” disorder had a chronic illness, and thus the best that could be expected was that the disease could be “managed,” with the drugs like insulin for diabetes. And then if someone recovered completely off meds, the profession would say that person never really had the disease.

    In other words, the profession conceptualized mental disorders as chronic, and sure enough, with that conception in place and with their regular use of psychiatric drugs, the disorders now run a much more chronic course, and “recovery rates” for schizophrenia are now worse than ever. I would think than a medical discipline would be appalled by the declining recovery rates, but for some reason, psychiatry–as a guild–doesn’t seem particularly bothered by it at all. Perhaps you can write about why that is so in one of your coming blogs.

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  • Thanks Richard. I appreciate the comments. In response to your questions:

    1) That this would become a centerpiece of Israel psychiatry: Well, imagine if you have a network of stabilizing houses or Soteria houses that serve as a first-line treatment for people who otherwise would be hospitalized, and if–as is the case with the Soteria houses I visited–people were not regularly put on psychiatric drugs, or could taper from drugs they were on. I think if that became the regular form of treatment, replacing the usual hospital care, that would become the centerpiece of any country’s psychiatry, compared to today. Imagine if something like that happened in the U.S. You would have thousands of such homes, and the use of drugs would be totally different. Wouldn’t you call that a paradigms shift, and worthy of describing as a centerpiece of a changed psychiatry?

    2) Placebo effect: I think what Pesach Lichtenberg is referring to here, and I probably should have made this clearer, is that if you give a person something that gives them reason to believe they will get better, that belief can have a therapeutic impact. And so that is part of what is happening here: in the house, there is an atmosphere that gives the resident “reason” to believe that he or she can get better. It’s an expansive use of the idea of a placebo, which usually is related to taking a pill, but that is what Pesach Lichtenberg is thinking here, I believe. But of course so much else is happening in the house too, beyond giving people a reason to think they can get better.

    3) Now as to the use of language (medications, psychiatric drugs). I am of course aware that “medication” has a different connotation than “psychiatric drug.” So why use medication at all, or use the words interchangeably? The reason is that part of this story is a rethinking, by some of those who prescribe these drugs, of what they consider “medication.” The residents also may refer to them as “medications,” even if the “medications” make them feel worse. So, in a story like this, where you are reporting on a form of care that involves questioning the drugs, then I think it is important to use language that reflects how the people in the story talk about the drugs. It helps bring the reader into the context of language that exists in Israel, and among the people in the story, at this time.

    I hope that makes sense. A report of this sort should, in my opinion, reflect the context of language by the people in the story, and not the language that I might otherwise use.

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  • Sparkytus:

    The NNT is used to assess the benefit/risk equation of a treatment. In this instance, 59% of the group are non-responders, and thus they have been exposed to the adverse effects of neuroleptics without any benefit. They are thus among the harm group. As you write: “If I give 100 patients antipsychotics and 41 respond then, as you say, 59 are now at risk of adverse effects for no discernible gain.

    But you also have to add in to this harmed group those who would have responded without access to drugs (percentage of placebo responders.) They are also in the harmed group because they are now exposed UNNECESSARILY to the adverse effects of the drugs.

    So total harmed group is 59% plus 24%, or 83%.

    Another way to conceptualize the NNT numbers would be this. Imagine 80% of all patients with a certain disease respond to the treatment. This is a very effective treatment, right? Well, if 80% of all such patients also respond to placebo, then you have a treatment that produces no additional gain in response rates, yet all patients are exposed to the adverse effects of the treatment. Under NNT calculations, 100% of the patients would be seen as harmed. The 80% who would have responded to placebo, and the 20% of non-responders–all patients have been unnecessarily exposed to the adverse effects of the treatment, given that the response rate between treatment and placebo is the same.

    I hope this makes sense,

    Bob

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  • Bonnie,

    There are several reasons for my adopting a “critical psychiatry” stance rather than an “antipsychiatry stance.”

    One, the very term “antipsychiatry” calls up an ideological opposition to psychiatry. I never had such an opposition. My whole thinking on this subject developed out of a simple desire to see if psychiatry and its treatments were “working” for people, and also if psychiatry was telling an honest story about its treatments. In other words, a critical–in the meaning of taking a close look at psychiatry’s story–examination of the evidence. I still feel that way about the subject; it is what is inside me.

    Second, I think psychiatry uses the term “antipsychiatry” to its advantage. It says to the public, there is an “ideological” group opposed to psychiatry, and so it can now present itself to the public as the “scientific” group, battling an “anti” group that is non-scientific.

    Third, a critical psychiatry perspective keeps the spotlight on psychiatry’s behavior and treatments: Has it validated the disorders? Do its drug treatments improve lives over the long term? Does it conduct honest trials of its treatments? Is it an honest in its presentations to the public?

    And that’s where I think the public focus needs to be. If the public takes a “critical” look at psychiatry, what will it find? In contrast, psychiatry uses the “antipsychiatry” label to dismiss criticisms as coming from a group with an unscientific antipathy toward the field. From the public’s point of view, psychiatry continues to wear the cloak of science in such debates.

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  • Thank you Phil for the kind words, and for another keenly argued post.

    There was a time that I rather naively hoped that psychiatry could reform itself. The hope arose from seeing other areas of medicine change their ways when studies showed what they were doing was harmful or of no benefit (although of course all of medicine can be resistant to changing practices; they are happy to say they are practicing “evidence-based” medicine when the evidence fits with what they are already doing.) And so I “hoped” (as opposed to believed) that the psychiatric profession, when confronted with evidence from its own research, that its drugs were doing more harm than good over the long-term, could be the spur for wholesale reform. After all, how could a medical profession insist on treatments that were worsening long-term outcomes? The profession also had to confront the fact that its chemical imbalance story had never panned out, and that decades of research had failed to validate any of its disorders as discrete diseases. But I no longer believe that psychiatry will reform itself and change its ways. As an institution, the profession has its belief system, and as you say, psychiatry’s current societal legitimacy–and its own self-perceived legitimacy–is wed to the disease model it has promoted, and if that model falls, then why do we need “medical doctors” residing over this domain of our live?

    But I do believe that a “critical psychiatry” perspective–which on its surface does suggest the hope that psychiatry can reform itself– helps promote, to the general public, an understanding that will lead more and more people to reject psychiatry as it exists today. It is a perspective that reveals that psychiatry has sold us a false narrative ever since it adopted its “everything is a disease” model with DSM III, and that the published articles in psychiatry said to support that disease model–such as Goff’s article, the recent article claiming that youth diagnosed with ADHD have smaller brains than normal–never hold up under close review. You and I had the same immediate response to the Goff article; we knew it would be filled with spin and biased reporting of the available data re long-term outcomes.

    Moreover, for me, I think a critical psychiatry perspective makes it harder for the defenders of psychiatry to brush aside such “deconstructions” of its science with the public claim that this comes from people with an animus toward psychiatry. Lieberman still makes such a claim, but he is such a ridiculous person, and so I think that in terms of generating public understanding of the problems with psychiatry, it is a useful perspective. It says to the public, can we please just look at the facts.

    And thus the hope I now have: that an ever-growing percentage of the American population will come to see psychiatry and its disease model as discredited, and simply turn elsewhere for leadership in this realm. And as you note, this is indeed happening, both in the U.S. and abroad. The recent United Nations Report by Danius Puras is an example of this growing societal rejection of modern psychiatry and its disease model, and I see it too in the affiliate Mad in America sites that are forming: Mad in America Hispano-hablante, Mad in Brasil, a Mad in Finland that is now being put together, and a possible Mad in Asia.

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  • Kindred Spirit, you bring up a really important point.. There are no studies that I know of on the long-term effects of antipsychotics when they are used for other purposes, bipolar, autism, and so forth. They get tested in the most haphazard way, over the short term and often as an “adjunct” therapy, and even in the short term adjunct trials, they don’t provide much of a “benefit” in terms of symptomatology. If I remember correctly, when they tested one of the atypicals for “autism,” they concluded it doesn’t cause much akathisia in this youth, although there was a note that the autistic youth had to “self-report” they were feeling anxious, rather than have doctors look for it. But really, all this use of antipsychotics for other purposes is really just the result of a marketing campaign, and made possible because antidepressants may not really work for many people, the “mood stabilizing” agents for bipolar aren’t effective for so many, and so forth.

    I hae a hard time imagining that long-term use of antipsychotics is good for youth diagnosed with autism. But it’s easy for me to imagine that it does a great deal of harm for youth so diagnosed and so treated.

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  • Randal,

    They do discuss the Wunderink study, in a section on tapering/discontinuation. They discuss it regarding whether there is a subset of people who can do okay when tapered down to a low dose/no dose, and incorporate the Wunderink study into a conclusion that: A subgroup of patients, which may be as large as 20%, may maintain remission or partial remission for extended periods off medication.

    So they are not presenting it as a referendum on the long-term merits of antipsychotics in general, but whether a percentage of patients can get down to a low dose. While there is a tone in Lieberman’s article of dismissing this as significant, they present this data correctly.

    However, in terms of looking at Wunderink as providing information regarding the long-term effects of antipsychotics, you need to analyze the study in a different way, which I did in The Case against Antipsychotics, and thus, since they cited that article as raising concerns about the long-term merits of antipsychotics, they were aware of.

    The group randomized to the tapering arm, were more likely to be off the drugs long-term, or down to a very low dose. But after that initial tapering moment, it became a naturalistic study, with people in the drug-maintained group free to go off. And so what you want to do is analyze long-term outcomes for all patients according to medication usage, and if you do that, you find that the low-dose, off medication had much better outcomes on all domains that were measured.

    When analyzed in that way, as a naturalistic study following an initial moment of tapering, it provides yet another longitudinal finding that tells of medicated patients doing worse than those off antipsychotics (or down to a very low dose.) But LIeberman and colleagues don’t mention that data at all, and so once again, they avoiding presenting longitudinal data that supports the conclusion that antipsychotics worsen long-term outcomes.

    I chose not to discuss this in this article just for space purposes, as the article was already so long, and this one needed extra space to show why they treated Wunderink in the way they did.

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  • Thanks for all the comments. A few notes:

    Matt, I had thought about making a photo of Jeffrey Lieberman the featured image, but then I found this one, of a psychiatrist in a white coat presenting a power point, as representative of the power dynamic in society, just as several of you have noted. This exemplifies the source of the information.

    Sylvain, your point about the makeup of patients in state hospitals prior to the 1950s is extremely important–a high percentage had known physical diseases. Syphilis, dementia, malnutrition, and lead poisoning, for instance. (David Healy has a fascinating presentation on how certain types of “madness” disappeared in lockstep with society converting to lead-free gasoline.) The mental hospitals were serving, in large part, as nursing homes for such patients, until they died. The reason for the patient population starting to decline after 1955 was really social policy. The states set this up a goal, particularly with first-episode patients. And then the real emptying of the mental hospitals began after Medicare is set up, and states could discharge their “chronic” patients to nursing homes, group homes, etc., and have the federal government pick up the cost. So the locus of “institutionalizing” such patients changed from the mental hospital to community sites, or other types of institutions. You’re right that this change in patient census has little to do with the introduction of neuroleptics.

    Samruck, this is the ultimate question: how do we change the public’s willing acceptance of psychiatry’s disease model narrative. It is a narrative that many in society are eager to adopt and accept . . . it fits the magic-bullet belief. And all I can say is that if people in the public can learn about the critique there is to be made about psychiatry, and how the conventional narrative is better described as a marketing story than a scientific one, then there is the hope of changing that narrative. When people learn about the collapse of the chemical imbalance story they often stop and think, what? Then why were we told this.

    Steve, regarding psychiatry “”adopting” the disease model with the publication of DSM–III, or “doubling-down” on it, I get your point.. But with Freudian theory, there was also the thought that some psychoses fit into the framework of a failure to adjust, as opposed to being a pathology. So there was a disease model element in DSM I and DSM II, but it mixed with the Freudian model too.

    I appreciate all the comments.

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  • I am just going to try to respond generally to this discussion, criticism, and what it says about MIA.

    First of, if you just read this list of comments, you will see that MIA allows for a vigorous discussion, including sharp criticism of MIA (and even disdain toward MIA.)

    Second, as Emmeline noted, nearly all of the bloggers are saying fine to keeping the comments turned on. And by having this option, this provides an understanding between us and the bloggers: we are not moderating critical comments, but only comments that run afoul of our general policy for maintaining what we would like to be a civil discussion. As such, I think the opt/in or out policy may help strengthen the site and the participation of commenters, because there is an understanding now by writers: there may be critical responses to an article.

    Thus, we are hardly engaged in creating a “safe zone that shuts down speech” or discussion. We are in essence doing the opposite: we are saying to writers, this can be a contentious place, but while we do try to keep the discussion civil, you have to be prepared to have your ideas and thoughts challenged.

    As for those few who may choose to turn off the comments, well here is the point: They weren’t going to continue blogging as is, and yet we think they have opinions worth hearing.

    For MIA as an organization, the “comments” section is both a blessing and a curse: The blessing it that there is often so much to be learned from the comments, and the discussions so often are quite thought provoking. So many of the comments are informed by knowledge of the scientific literature and by personal experience of many types–lived experience, professional experience, and so forth. The curse is that trying to keep the discussion “civil”, and thus to set some standard for moderating comments, is a near impossible task. It wears out our moderators and is a drain on our very limited financial resources, and it exposes MIA to criticism from all sides, including those who are eager to dismiss MIA and attack it.

    I don’t know how to ease the curse part of it, while keeping the blessing part. The opt-in, opt-out policy is an attempt at doing so, and we’ll see how it goes.

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  • As I have been traveling, I just came onto this conversation. I have to say it leaves me feeling disheartened.

    MIA’s mission is simple: We believe the current paradigm of care is harmful (and based on a “narrative of science” that is belied by the science,) and needs to be rethought. We believe that this “rethinking” should involve people with different experiences and different ideas: people with lived experience, professionals, family members, philosophers, social workers and so forth. It really is meant to be a forum for expressing diverse opinions, with the only unifying thought that the current paradigm needs to be rethought.

    Given this mission, we can be a place where people write about the goal of “abolishing psychiatry.” At the same time, we can have people write about how to “reform” psychiatry. And we can have discussions about how to think about “psychosis,” “diagnosis”” and so forth, and MIA’s position is meant to be this: WE DON’T HAVE THE ANSWERS. We only know that the current biological narrative that governs societal thinking about psychiatry and its treatments is a false one, and thus needs to be rethought. And that rethinking happens when a diversity of voices can be listened to and respected, even when the views may be different than one’s own.

    But we are struggling in this mission for the very reason that is articulated here: there are many, many people who have quit blogging on MIA, including people with lived experience and including people who come from a psychiatric survivor perspective, because they think the comments turn hostile too quickly (and personally so.) And our ability to moderate comments is an impossible task: it is so hard to say where to draw a line that tries to protect civil discourse and disagreement, without being seen as censoring comments.

    Our inability to manage this, to create an environment that promotes comments (which can be so important), and yet allows for writers to voice different opinions without feeling that it takes a “thick skin” to write on MIA, leaves me feeling disheartened, and feeling like we have failed. And I also believe this, unless we can be a forum for a diverse group of voices, then MIA will fail in its mission to help foster a new narrative about “mental health.”

    Allowing writers to turn off comments is an imperfect solution. I don’t like it. But if we are going to try to have a diverse group of writers here, it seems like a necessary step.

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  • Dear Sanneman, Indeed your thoughts have helped sharpen my thoughts, and I think this is really what needs to happen, that there should a public response, composed of many voices, related to this study. The discussion helps point out for all the many flaws of this study, and how it misleads the public (and many within the psychiatric community, who would see it as validating their belief that ADHD is a biological brain disorder.) Thank you for contributing to that discussion here.

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  • I appreciate all of this feedback, and that people are signing the petition. In response to sanneman, I am glad to hear that you and several scientists have written a letter to Lancet Psychiatry. As for the fact that “smaller” doesn’t necessarily implicate dysfunction, I of course agree. But I have to confess that of the two of us (Michael Corrigan and me), I was the one who argued against including that point, for I thought it would somehow be seen as a concession that this study showed that “smaller” brain size and altered structures were indeed common to those diagnosed with ADHD. It raised this response to the study: Even if the ADHD cohort had slight smaller brains, so what? What does that mean? A valid point, but I thought we should stay focused on the fact that the data didn’t show that smaller brain size is a distinguishing feature of ADHD (and thus didn’t raise the question of what might be the implications of having a “smaller brain.”) We also thought that the IQ data argued persuasively against any finding that the brain scans showed some sort of dysfunction. But others who have signed the petition have also made note of the “smaller doesn’t equal dysfunction” point and so this is a mea culpa on my part, for leaving that out. As for the confounding results from individual sites, we thought this was evidence that once again argued against their claim that individuals with ADHD have smaller brains, and thus provided yet another reason to see that their bottom line claims didn’t hold up.

    Again, I am very glad to hear that you have written a letter to Lancet Psychiatry that will be published.

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  • Thank you for all the comments and support.

    The redesign of the website is not complete, and so we appreciate all the comments here on how to improve it, such as archiving all of the comments from one individual.

    As far as being a forum for the voice of those with lived experience, that has always been a priority of ours, and we have had an editor, Emmeline, who has been devoted to bringing these stories to MIA in a way that gives them both power and clarity.

    Thanks again for all the support.

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  • Just a couple of notes. Oldhead, I was not commenting on whether Trump’s pre-elective behavior would justify a Nazi analogy. My point here, in this context of this discussion, was that Trump’s pre-elective behavior was welcomed and celebrated by White Supremacist groups; and that, in terms of how such groups treat civil liberties, we do have a historical reference. And so there is reason to think that if such sentiments are present in this election process, there can be reason to worry about the effect that this will have on civil liberties of those who have been hospitalized for a psychiatric reason, etc. And of course, with the expansion of outpatient commitment laws, the societal sentiment that it is okay to infringe on the civil liberties of people designated as “mentally ill” is already growing, and one can worry now about whether this election will further fuel this sentiment.

    As for Democratic/Republican arguments, that is not the context for this discussion. If Hilary had won, we would welcome blogs on how that might impact societal policies for those deemed “mentally ill,” and it is of course true that Democrats have supported expanded screening programs, the Murphy bill, etc, which are presented as “helping” people get treatment, and have been criticized here. So what we are interested in here is exploring societal behaviors/beliefs/policies that impact on this world of psychiatric systems in this country.

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  • As the founder of this website, I think I can say we have deliberately tried to be both non-political on general societal issues, but, at the same time, we do have obvious engagement in political issues related to this world of psychiatry. For instance, we obviously have given a lot of airtime to people arguing against forced treatment, and I even wrote such a blog against forced treatment. That is a political blog. MIA has given a lot of of airtime to people arguing against the Murphy Bill too, and so forth.

    And here, Noel’s blog is asking a “mental health” related question: In this post-Trump world, which is an accurate description of what awaits us, given that he is now the president elect, how does this reflect on societal understandings of sanity? I find this to be a good question. Regardless of how people voted or why, Trump, in his behaviors and comments, did put forth values of a very particular sort, related to immigrants, the treatment of women, the value of journalism in a society, etc. He spoke to crowds that cheered for Hilary to be locked up, which he is still willing to consider, for crowds to cheer Trump that Bitch, and for crowds that loudly booed journalists. He spoke about not accepting the election if he were to lose, and said it was rigged . . . if he lost. These are new norms that have now been accepted as permissable in a presidential election. Some readers of MIA may find these behaviors in a president acceptable, and others that may not. But they are new.

    I should note too that these post-Trump norms go against the larger ethical context of MIA, which emphasizes embracing diversity, respect for all people regardless of their gender, sexual preference, race, etc. There is a political sense to this website that oppression of people, the traumatizing of people, and making people afraid are societal wrongs that need to be fought against. This site has also published articles about the relationship between sexual assault and subsequent diagnosis of psychiatric disorders. And in the struggle against forced treatment and loss of civil liberties, any presidential election that elects a president who does stir such sentiments, so much so that we do have NEO-NAZI groups celebrating his election, then you have to wonder how this would affect those who get labeled “insane” in society. We all know that history; psychiatric patients were the first to be targeted for forced sterilization in Nazi Germany, and the first to be killed in mass.

    So there is a new normal in our society, regarding behavior that is seen as acceptable in our politics. At first, when I read Noel’s post, before it was published, I wondered if we wanted to wade into this possible political quagmire. But after a moment, I thought that it is quite right that we provide a forum for someone trying to make sense of this new world, and also note that so often “insanity” is seen as being out of sync with prevailing norms.

    In short, we avoided any sort of politics related to the election before the vote. But now that we have Trump as a president-elect, I think it is fine-and even important–that MIA is willing to provide a forum for blogs such as Noel’s, wondering how to make sense of this new world, and what it will mean for those who have been diagnosed with psychiatric disorders, forced into treatment, etc.

    Finally, I think the comments here serve a purpose too–they have been restrained, and I think people are actually listening to each other, even if they are not agreeing with one another, and the listening part speaks well of this community.

    I hope this makes sense to our readers. We are in a new world, with a new set of norms that was seen as acceptable in a presidential election, and we should be willing for people to explore what that will mean to one’s state of mind, to treatment of diverse groups in our society, and also to what societal policies–around forced treatment etc–that may ensue..

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  • To Johann Popper: You write that the difference in outcomes is due to the difference in severity at the start in the Harrow study. You need to read Harrow’s papers carefully. He groups patients into different “severity” categories–good prognosis schizophrenia, bad prognosis schizophrenia, and milder psychotic disorders–and in every case, the patients off medications had better long-term outcomes. Even more compelling, the people diagnosed with schizophrenia off medication had better long-term outcomes than those with milder disorders at the outset who stayed on antipsychotic medication. So the less severe at the outset who stayed on the drugs did worse than the more severe at the outset who got off the medication.

    There is much to be discussed and debated about the merits of the research. But to say I engage in “dishonest criticism” isn’t helpful when the data in Harrow is as I set forth above, and not as you claim here.

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