Foreign Correspondents

Behind the apparent Biblical Authority of the Clinical Trial Literature in medicine lies an Inquisitional-like apparatus run by company PR agencies and agencies whose job it is to manage the perception of science - linking in academics - aimed at silencing dissent and ensuring that prescribing doctors continue to prescribe. It focusses most clearly on anyone who suggests that a brand-name drug might have significant adverse events.

One of the suggestions in the comments from my last post has really got my imagination going. Chaya Grossberg suggested that we can all edit Wikipedia entries. I went in and got surprised at how easy this was. Then I checked the hit rates on Wikipedia to see how big an impact this could have, and I was totally amazed.

John Foppes had been born with no arms, among a number of other serious congenital abnormalities.  Doctors questioned whether he would survive at all.  In his deeply motivating book, “What’s Your Excuse?  Making the Most Out of What You Have,” John describes his life of growing up with no arms into one of full independence, and his feelings of stigmatization and isolation even in the midst of support from others.  In the depths of his struggle, John also notes evident gratitude in what most perceived as a very unfair situation. 

Doctors in the 1950s and 1960s made psychiatric diagnoses on orphaned children that led to treatment with antipsychotic drugs, and one of the drivers of this seemed to be that the Church got more money from the State as a result. The doctors, of course, also got paid. This feels like a seriously corrupt nexus operating with near impunity on the basis that no one is going to be bothered to investigate the fate of some orphans.

Ever since I read Mad in America and later Anatomy of an Epidemic by Robert Whitaker, I have been wondering how to spread this knowledge to the masses and how to do this in a way that will make a difference to as many people as possible.

A growing appreciation of the importance of involving people in their own health care has seen the development of initiatives such as “patient-centred care.” Patient-centred care has been defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” While this definition seems reasonable enough, it appears to be very difficult to translate into practice; particularly in the area of mental health.

Last year I visited the United States on a Winston Churchill Travelling Fellowship to explore ‘alternative routes to mental health recovery’ and to visit a range of peer-led, alternatives to the medical model, with the aim of using the knowledge gained to help develop alternatives in the UK. Looking back, all the organisations and services I visited came about because groups of people in the US decided they wanted something different to conventional mental health services, and then decided to work to make that dream a reality.

A great deal of the information published on MadInAmerica is devoted to this very important question, so many constructive ideas are often presented. We think that nutrition and diet should always be part of the conversation.

I am a very optimistic psychologist, but with reason. For 25 years I've been working with people who have had psychological problems in every conceivable area. Many psychologists have problems with burnout, especially early in their careers. For me, this has been very different. By using the treatment techniques that I do, I feel anti-burned out. It is so gratifying to see people get out of their serious problems, that I look forward to every day of clinical work.

More than a year on from the release of DSM-5, a Medscape survey found that just under half of clinicians had switched to using the new manual. Most non-users cited practical reasons, typically explaining that the health care system where they work has not yet changed over to the DSM-5. Many, however, said that they had concerns about the reliability of the DSM, which at least partially accounted for their non-use. Throughout the controversies that surrounded the development and launch of the DSM-5 reliability has been a contested issue: the APA has insisted that the DSM-5 is very reliable, others have expressed doubts. Here I reconsider the issues: What is reliability? Does it matter? What did the DSM-5 field trials show?

In the light of the much trumpeted claims that recent research has identified genes for schizophrenia, it is important to review the track record of this type of endeavor. Despite thousands of studies costing millions of dollars, and endless predictions that the genetics of schizophrenia would shortly be revealed, the field has so far failed to identify any genes that substantially increase the risk of developing schizophrenia.

As Michael Fontaine's recent piece illustrates, history has a great deal to teach us about the nature of this complex thing called madness and how we, as a society, might respond to it better. It is not only fascinating to know that modern debates about the nature of ‘mental illness’ are reflected in ancient teachings, we can learn much from seeing the issues aired in a radically different social and historical context.

One of the most remarkable aspects of Robert Whitaker’s (2010) outstanding book Anatomy of an Epidemic was his comparative data that contrasted outcomes for mental disorders prior to the introduction of pharmacological treatments with outcomes for mental disorders after pharmacological treatments became the main, and often only, course of action. I have asked people in workshops to estimate who might be better off – someone diagnosed with what we now call bipolar disorder prior to the introduction of lithium or someone diagnosed after lithium became a standard treatment. Almost without exception workshoppers estimate that the people diagnosed before lithium was available do much worse. Whitaker’s data indicate exactly the opposite. It’s a staggering finding.

The idea that our more distressing emotions can best be understood as symptoms of physical illnesses is a pervasive, seductive but harmful myth. It means that our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change in how we understand mental health problems and in how we design and commission mental health services.

In June this year the BMJ published an article supposedly about how the Black Box Warning that antidepressants cause suicide had led to a drop in the use of the same antidepressants and an increase in suicides. The message was widely trumpeted in daily newspapers and other news outlets as well as the press office of Harvard University and the American Foundation for Suicide Prevention. In fact there had been no drop in the use of antidepressants and no increase in suicide rates or suicide act rates. The letters sent to the BMJ in response to the article wondering how such a shoddy piece of work could possibly have been published are worth reading – rarely is academic contempt so scathing.

It’s funny how things turn out. I would never have anticipated becoming interested in the way in which psychological treatment is provided to people. A benign comment by a manager at the beginning of my clinical psychology career, however, piqued my interest and things have never been the same since.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there. So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean?

We want to start an international initiative to promote the writing of recovery stories in every country, with the ultimate goal of sharing at an international level the most compelling ones from each country. Our proposal is born from an awareness that recovery stories are necessary today in order to give back to mental sufferance its meaning and transparency, to fight the biographical opacity of biological theories (the broken brain) and to guarantee decisional power to those who are offered (or imposed) mono-dimensional or dehumanizing treatments.

Would you accept money "with no strings attached" from a robber who, in the act of stealing, happened to kill some of his victims? Would you accept money that has been stolen? Would you accept sponsorships from tobacco companies for a meeting about lung diseases? Few doctors would. Why is it then that most doctors willingly accept sponsorships from drug companies that have earned much of their money illegally while being fully aware that their criminal activities have killed thousands of patients, the very people whose interests doctors are supposed to take care of?

The simple act of defining doctors or patients concerned about adverse events as “critics” is a rhetorical stroke that marginalizes concerns – makes you a one-percenter rather than one of the ninety-nine percent. The pharmaceutical market is the least free market on earth.

‘Psychiatric prejudice’ is a term being bandied about these days, mainly by aggrieved psychiatrists. Ordinary people, other doctors and medical students are all prejudiced, they say, because they do not appreciate that psychiatry is a proper medical activity, and critics of psychiatry are prejudiced because their analyses undermine this medical point of view. However, many people remain inclined to view the difficulties we label as mental disorders as understandable reactions to adverse life events or circumstances and, importantly, evidence suggests they are more, not less, tolerant of such situations. In my view, there is a role for medical expertise in helping people with mental health problems, but that does not mean we have to call those problems illnesses.

Sometimes regarded as “treatment,” psychiatric bullying and harassment can no longer be considered as such. During the past two decades, the often devastating effects of psychiatric bullying and harassment have evidenced themselves on the wellbeing of consumers, and the climate of mental health facilities.The advent of mandatory anti-bullying policies in schools and workplaces has shifted thinking towards an acceptance that bullying occurs, causes harm and should not be tolerated. Could the development of anti-psychiatric bullying policies in mental health institutions make psychiatric abuse visible and create a zero tolerance culture?

My name is Tristano Ajmone. I’m Italian and 42 years old. I consider myself a “psychiatric survivor” — a term by which I don’t merely mean that I’ve been through the psychiatric system and got out of it; I really mean that I’ve survived a psychiatric journey in which some of my comrades weren’t as fortunate as me, and they simply died along the way.

For almost two decades I was a victim of what I now am aware was psychiatric torture. I believe because I am a woman, it was easier to become a psychiatric victim and to be denied my right to be human. I got my first bolt of electricity just three days after childbirth on the thirtieth of January 1976. I continued to be electrocuted for the month of February until the middle of March, twelve more times while simultaneously being drugged into oblivion.

Denmark is now screening pregnant women for depression. Given the clear risks and the unclear benefits of antidepressants, the process of screening pregnant women for depression can take on a bizarre dimension. Here, Peter Gøtzsche imagines one of the conversations that might take place.