This is a brutal interview on the fraud and failure of psychiatry. The only question remaining is whether the field can reform or whether it will die (gradually or with a bang). Highlights from the article:
One, the low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable. It is too easy for critics and the public to point to the scientific findings that contradict it.
Second, a number of pharmaceutical companies have shut down their research into psychiatric drugs [see Science, 2010], and they are doing so because, as they note, there is a lack of science providing good molecular targets for drug development. Even the drug companies are moving away from the chemical-imbalance story, and thus, what we are seeing now is the public collapse of a fabrication, which can no longer be maintained.
I think this challenging of the validity of DSM is, in many ways, potentially much more of a paradigm-changer than are the scientific reports that detail how the medications may be causing long-term harm. Our current drug-based paradigm of care, which presents drugs as treatments for the symptoms of a “disease,” stems from DSM III. The APA [American Psychiatric Association] and its leaders boasted that when DSM III was published in 1980, that the field had now adopted a “medical model,” and thus its manual was now “scientific” in kind.
In fact, the APA had adopted a “disease model,” and if you carefully read the DSM III manual, you saw that the authors acknowledged that very few of the diagnoses had been “validated.” The APA’s hope and expectation was that future research would validate the disorders, but that hasn’t happened. Researchers haven’t identified a characteristic pathology for the major mental disorders; no specific genes for the disorders have been found; and there isn’t evidence that neatly separates one disorder from the next. The “disease model,” as a basis for making psychiatric diagnoses, has failed.
We are now witnessing, in Insel’s statements and those by Allen Frances, an acknowledgment of this failure. And here is why this is potentially such a paradigm-changer: The foundation of any medical specialty begins with its diagnostic manual, which should be both reliable and valid. If the disorders listed in a manual haven’t been validated, then you can’t conclude they are “real,” in the sense of the disorders being unique illnesses, and the diagnoses being useful for prescribing an appropriate treatment.
Thus, when Insel states that the disorders haven’t been validated, he is stating that the entire edifice that modern psychiatry is built upon is flawed, and unsupported by science. This is like the King of Psychiatry saying that the discipline has no clothes. If the public loses faith in the DSM and comes to see it as unscientific, then psychiatry has a real credibility problem on its hands, and that could prove to be fertile ground for real change.
Even as the intellectual foundation for our drug-based paradigm of care is collapsing, starting with the diagnostics, our society’s use of these medications is increasing; the percentage of children and youth being medicated is increasing; and states are expanding their authority to forcibly treat people in outpatient settings with antipsychotics drugs. Disability numbers due to mental illness go up and up, and we don’t see that as reason to change either. History does show that paradigms of psychiatric care can change, but, in a big-picture sense, I don’t know how much is really changing here in the United States.
I think we have to appreciate this fact: any medical specialty has guild interests, meaning that it needs to protect the market value of its treatments. If it is going to abandon one form of treatment, it needs to be able to replace it with another. It can’t change if there is no replacement in the offing.
When the APA published DSM III, it basically ceded talk therapy to psychologists, counselors, social workers and so forth. Psychiatry’s three domains, in the marketplace, were diagnostics, research and the prescribing of drugs. Now, 34 years later, we see that its diagnostics are being dismissed as invalid; its research has failed to identify the biology of mental disorders to validate its diagnostics; and its drug treatments are increasingly being seen as not very effective or even harmful. That is the story of a profession that has reason to feel insecure about its place in the marketplace.
Yet…this is why it is going to be so hard for psychiatry to reform. Diagnosis and the prescribing of drugs constitute the main function of psychiatrists today in our society. From a guild perspective, the profession needs to maintain the public’s belief in the value of that function. So I don’t believe it will be possible for psychiatry to change unless it identifies a new function that would be marketable, so to speak. Psychiatry needs to identify a change that would be consistent with its interests as a guild.
This is shocking:
It’s called Haldol. The generic name is haloperidol.
It’s classified as an “anti-psychotic.”
You’ll read that Haldol is being phased out in the US, but “PM: The Essential Resource for Pharma Marketers” reports that Haldol accounts for 5% of anti-psychotic prescriptions handed out between 2010 and 2011.
That’s 2.7 million prescriptions for Haldol. In one year, in the US.
The major and frequent adverse effects of the drug? Akathisia (the irresistible and painful impulse to keep moving, the inability to sit still), dystonia (severe muscle contractions that twist the body grotesquely), and Parkinsonism.
In short, torture.
All three of these effects can indicate motor brain damage.
Here is a quote from a news-medical.net article, “Haloperidol—What Is Haloperidol?”:
“There are multiple reports from Soviet dissidents, including medical staff, on the use of haloperidol in the Soviet Union for punitive purposes or simply to break the prisoners’ will. Notable dissidents that were administered haloperidol as part of their court ordered treatment were Sergei Kovalev and Leonid Plyushch.”
From the same article, there is this blockbuster statement:
“Haloperidol has been used for its sedating effects during the deportations of aliens by the United States Immigration and Customs Enforcement (ICE). During 2002-2008, federal immigration personnel used haloperidol to sedate 356 deportees. By 2008, follow[ing] court challenges over the practice, haloperidol was given to only 3 detainees. Following lawsuits, U.S. officials changed the procedure so that it is done only by the recommendation of medical personnel and under court order.”
In his landmark book, Toxic Psychiatry, Dr. Peter Breggin quotes Leonid Plyushch, a scientist and political dissenter in the USSR, who escaped to the US: “[In a Soviet prison, after dosing with a small amount of Haldol] I was horrified to see how I deteriorated intellectually, morally and emotionally from day to day. My interest in political problems quickly disappeared, then my interest in scientific problems, and then my interest in my wife and children.”
In the 1960s and 70s, Haldol was given to “angry black men” in America, after laying on the justification that they were suffering from schizophrenia.
Here is a quote from the 2012 edition of Virtual Mentor, the American Medical Association Journal of Ethics. It concerns a pharmaceutical ad that ran in the May 1974 issue of the Archives of General Psychiatry:
“…in the ad, an angry African American man shakes his fist menacingly…the text above the image…’Assaultive and belligerent?’ ‘Cooperation often begins with Haldol.’”
Yes it does. Cooperation begins with the torture delivered by Haldol.
Parents, know your rights about ADHD and childhood “mental disorders”
Psychiatric dogmatism is preventing progress in the field of mental health and ruining lives. Comments from a few professionals with some integrity:
From Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist:
It seems not to be interested in discussing the serious harm its drugs can do to both physical and mental health, and in taking the steps necessary to minimise this harm. The profession appears to believe that if it keeps quiet about these inconvenient findings, and discusses them as little as possible, the fuss will blow over and nothing need change.
People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labelled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes. This does not mean that taking antipsychotics is not sometimes useful and worthwhile, despite these effects, but it does mean we have to be very cautious indeed about using them.
This study [Wunderink et al] should fundamentally change the way antipsychotics are used. These are not innocuous drugs, and people should be given the opportunity to see if they can manage without them, both during an acute psychotic episode and after recovery from one. If psychiatrists had not forgotten the lessons of the past, and if they had been prepared to acknowledge what they saw the drugs doing with their own eyes, this would have come about long ago.
And some analysis from the article:
Whilst all of Dr. Moncrieff’s writing is compelling, it was this last quote that particularly caught my attention, and caused me to articulate the following questions:
- Why have psychiatrists not acknowledged what they saw the drugs doing with their own eyes?
- How did it come to be that highly educated and intelligent people became so enamored of their professional dogma that they failed to recognize the damage that neuroleptic drugs were doing and continue to do?
- And, with particular reference to the last decade or so, how have they been able to participate, apparently with clear consciences, in the huge increase in the use of these products, even to children as young as 2 years?
In my view the answers to these questions fall into two general categories: self-interest and fear.
For the past fifty or sixty years, the prescribing of psychopharmaceutical products has brought considerable benefit to the psychiatric profession. Firstly, it has provided them a good living ($190,000 per annum in the US) for relatively non-taxing work (15- minute med checks). Secondly, it has boosted their perceived status in the eyes of other medical practitioners.
It’s largely forgotten now, but during the 60′s and even into the 70′s, psychiatrists were widely regarded by the medical community as a coterie of quacks who delved endlessly and pointlessly into such chimerical abstractions as unconscious impulses, Oedipus complexes, ids, etc… Today psychiatrists prescribe drugs, have their own medical journals which often have pictures of brain scans, and conduct randomized controlled trials. They’ve become “respectable,” or at least somewhat respectable, and they recognize that this respectability is intrinsically dependent on their symbiotic relationship with pharma.
The kind of fear that I’m talking about here might more correctly be termed peer pressure—the fear of being ostracized or marginalized by one’s professional colleagues. In my interactions with psychiatrists during my career, I gained the impression that in medical colleges there’s relatively little emphasis placed on discussion and opinions, and relatively high emphasis on absorbing the facts as passed down by the academics. Other disciplines stress discourse and debate, especially at doctoral level, but medicine leans towards a traditional didactic model and conformity to orthodoxy. I’m not saying that this is necessarily a bad thing. Four years of medical school passes quickly, and there’s a lot of factual material to be learned. But the inevitable result is that medical practitioners tend to be followers of orthodoxy rather than innovators. The rationale is that the academic researchers will pursue the innovations, and the toilers in the field will follow protocol.
It’s almost as if there’s a macabre conspiracy of silence among psychiatrists concerning the spuriousness of their concepts and the damage they inflict on their clients. In their “hearts” they all know that it’s there, and that it’s enormous, but no one is allowed to talk about it. No one is allowed to wake the monster, because they intuitively know that the monster will devour them all.
Disturbing report from a New York Times editorial. But then, we’ve known this all along.
Recent data from the Centers for Disease Control and Prevention showed that 15 percent of high-school-age children had been diagnosed with the disorder and that the number of children taking medication for it had soared to 3.5 million, up from 600,000 in 1990. Many of these children, it appears, had been diagnosed by unskilled doctors based on dubious symptoms.
A two-decade campaign by pharmaceutical companies promoting the pills to doctors, educators and parents was described by Alan Schwarz in The Times on Sunday. The tactics were brazen, often misleading and sometimes deceitful. Shire, an Irish company that makes Adderall and other A.D.H.D. medications, recently subsidized 50,000 copies of a comic book in which superheroes tell children that “Medicines may make it easier to pay attention and control your behavior!” Advertising on television and in popular magazines has sought to persuade mothers that Adderall cannot only unleash a child’s innate intelligence but make the child more amenable to chores like taking out the garbage.
The potential dangers should not be ignored. The drugs can lead to addiction, and, in rare cases, psychosis, suicidal thoughts and hallucinations, as well as anxiety, difficulty sleeping and loss of appetite. On Tuesday, the Food and Drug Administration warned that some A.D.H.D. medications, including Ritalin, Concerta, and Strattera, may, in rare instances, cause prolonged and sometimes painful erections known as priapism in males of any age, including children, teens and adults.
So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. Prominent doctors get paid by drug companies to deliver upbeat messages to their colleagues at forums where they typically exaggerate the effectiveness of the drugs and downplay their side effects. Organizations that advocate on behalf of patients often do so with money supplied by drug companies, including the makers of A.D.H.D. stimulants. Medical researchers paid by drug companies have published studies on the benefits of the drugs, and medical journals in a position to question their findings profit greatly from advertising of A.D.H.D. drugs.
The F.D.A. has cited every major A.D.H.D. drug, including the stimulants Adderall, Concerta, Focalin and Vyvanse, for false and misleading advertising since 2000, some of them multiple times. The companies, when challenged, typically stop those misleading claims, but the overall impact appears marginal. The number of prescriptions for A.D.H.D. drugs for adults ages 20 to 39 nearly tripled between 2007 and 2012, and sales of stimulant medications in 2012 were more than five times higher than a decade earlier.
Curbing the upsurge in diagnoses and unwarranted drug treatments will require more aggressive action by the F.D.A. and the Federal Trade Commission, which share duties in this area. It will also require that doctors and patients recognize that the pills have downsides and should not be prescribed or used routinely to alleviate every case of carelessness, poor grades in school or impulsive behavior.
This is about the cleanest statement of the fraud of psychiatric drugs and the “chemical imbalance” theory I’ve seen. Includes some interesting history of the development of psychiatric drugs. From The New Yorker:
In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder.
In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.
In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamine—and thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, “rode, in his nightshirt, to a nearby village, singing lustily.” He added, “This was not really a very good PR exercise for the hospital.” But it was the inspiration for Kuhn and his team to reason that “if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also?” Under the brand name Tofranil, imipramine went on to become the first antidepressant—and one of the first blockbuster psychiatric drugs.
American researchers were also interested in antihistamines. In 1957, Leo Sternbach, a chemist for Hoffmann-La Roche who had spent his career researching them, was about to throw away the last of a series of compounds he had been testing that had proven to be pharmacologically inert. But in the interest of completeness, he was convinced to test the last sample. “We thought the expected negative pharmacological results would cap our work on this series of compounds,” one of his colleagues later recounted. But the drug turned out to have muscle-relaxing and sedative properties. Instead of becoming the last in a list of failures, it became the first in a series of spectacular successes—the benzodiazepenes, of which Sternbach’s Librium and Valium were the flagships.
By 1960, the major classes of psychiatric drugs—among them, mood stabilizers, antipsychotics, antidepressants, and anti-anxiety drugs, known as anxiolytics—had been discovered and were on their way to becoming a seventy-billion-dollar market. Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not).
That didn’t stop drug makers and doctors from claiming that they knew. Drawing on another mostly serendipitous discovery of the fifties—that the brain did not conduct its business by sending sparks from neuron to neuron, as scientists previously thought, but rather by sending chemical messengers across synapses—they fashioned an explanation: mental illness was the result of imbalances among these neurotransmitters, which the drugs treated in the same way that insulin treats diabetes.
The appeal of this account is obvious: it combines ancient notions of illness (specifically, the idea that sickness resulted from imbalanced humors) with the modern understanding of the molecular culprits that make us suffer—germs. It held out the hope that mental illness could be treated in the same way as pneumonia or hypertension: with a single pill. Drug companies wasted no time in promulgating it. Merck, the manufacturer of Elavil, commissioned the psychiatrist Frank Ayd to write a book called Recognizing the Depressed Patient, in which he extolled the “chemical revolution in psychiatry” and urged doctors to reassure patients they weren’t losing their minds, but rather suffering a “common illness” with a “physical basis” and a pharmacological cure. Merck sent Ayd’s book to fifty thousand doctors around the country. In 1965, Joseph Schildkraut, a psychiatrist at the National Institute of Mental Health, reverse-engineered antidepressants and offered an actual theory: at least when it came to depression, the imbalances were to be found in the neurotransmitters he thought were affected by the drugs, dopamine and norepinephrine. Seven years after antidepressants were invented, and five years after Ayd asserted that depression was a chemical problem, psychiatrists finally had a precise, scientific explanation for why they worked. The paper quickly became one of the most cited articles in the medical literature.
But Schildkraut was wrong. Within a few years, as technology expanded our ability to peer into the brain, it became clear that antidepressants act mostly by increasing the availability of the neurotransmitter serotonin—rather than dopamine and norepinephrine, as previously thought. A new generation of antidepressants—the selective serotonin reuptake inhibitors (S.S.R.I.s), including Prozac, Zoloft, and Paxil—was developed to target it. The ability to claim that the drugs targeted a specific chemical imbalance was a marketing boon as well, assuring consumers that the drugs had a scientific basis. By the mid-nineties, antidepressants were the best-selling class of prescription medications in the country. Psychiatry appeared to have found magic bullets of its own.
The serotonin-imbalance theory, however, has turned out to be just as inaccurate as Schildkraut’s. While S.S.R.I.s surely alter serotonin metabolism, those changes do not explain why the drugs work, nor do they explain why they have proven to be no more effective than placebos in clinical trials. Within a decade of Prozac’s approval by the F.D.A. in 1987, scientists had concluded that serotonin was only a finger pointing at one’s mood—that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied. The ensuing research has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.
Despite their continued failure to understand how psychiatric drugs work, doctors continue to tell patients that their troubles are the result of chemical imbalances in their brains. As Frank Ayd pointed out, this explanation helps reassure patients even as it encourages them to take their medicine, and it fits in perfectly with our expectation that doctors will seek out and destroy the chemical villains responsible for all of our suffering, both physical and mental. The theory may not work as science, but it is a devastatingly effective myth.
Whether or not truthiness, as one might call it, is good medicine remains to be seen. No one knows how important placebo effects are to successful treatment, or how exactly to implement them, a topic Michael Specter wrote about in the magazine in 2011. But the dry pipeline of new drugs bemoaned by Friedman is an indication that the drug industry has begun to lose faith in the myth it did so much to create. As Steven Hyman, the former head of the National Institute of Mental Health, wrote last year, the notion that “disease mechanisms could … be inferred from drug action” has succeeded mostly in “capturing the imagination of researchers” and has become “something of a scientific curse.” Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist. And the result, as Friedman put it, is that “it is hard to think of a single truly novel psychotropic drug that has emerged in the last thirty years.”
Despite the BRAIN initiative recently announced by the Obama Administration, and the N.I.M.H.’s renewed efforts to stimulate research on the neurocircuitry of mental disorder, there is nothing on the horizon with which to replace the old story. Without a new explanatory framework, drug-company scientists don’t even know where to begin, so it makes no sense for the industry to stay in the psychiatric-drug business. And if loyalists like Hyman and Friedman continue to say out loud what they have been saying to each other for many years—that, as Friedman told Times readers, “just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease”—then consumers might also lose faith in the myth of the chemical imbalance.
Stats on the psychiatric drugging of children under five years old
Interesting take on psychiatry as a secular religion.
It’s still early days in clinical trials, and this may never make it mainstream due to the outrageous financial requirements to achieve FDA approval, but this could be an important result nonetheless.
A new study published in the journal Phytotherapy Research has confirmed for the first time in a randomized, controlled clinical trial that the primary polyphenol in turmeric known as curcumin is both safe and effective in treating serious states of depression.
The research was performed at the Department of Pharmacology, Government Medical College, Bhavnagar, Gujarat, India, and involved patients diagnosed with major depressive disorder (MDD). The objective of the trial was to compare the efficacy and safety of curcumin with fluoxetine (Prozac) in 60 patients diagnosed with MDD. Subjects were randomized to receive either a six week treatment with fluoxetine (20 mg) and curcumin (1000 mg) individually or their combination.
Success of the treatment was evaluated using the 17-item Hamilton Depression Rating Scale (HAM-D17). The results were reported as follows:
We observed that curcumin was well tolerated by all the patients. The proportion of responders as measured by the HAM-D17 scale was higher in the combination group (77.8%) than in the fluoxetine [Prozac] (64.7%) and the curcumin (62.5%) groups; however, these data were not statistically significant (P = 0.58). Interestingly, the mean change in HAM-D17 score at the end of six weeks was comparable in all three groups (P = 0.77). This study provides first clinical evidence that curcumin may be used as an effective and safe modality for treatment in patients with MDD without concurrent suicidal ideation or other psychotic disorders. [emphasis added]