Category Archives: Anti-psychiatry

Debunking Another Anti-Psychiatry Myth – A Review of The Great Pretender

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Image by Gerd Altmann from Pixabay

Marvin Ross

One of the main beliefs of the anti-psychiatry advocates is that mental illness does not exist. They love to cite the fact that there are no objective tests for mental illness like blood work but that is also a feature of many conditions that they do not dispute exist – Alzheimers and other forms of dementia and Parkinson’s come to mind.

The other contention is that psychiatrists cannot differentiate between the sane and the insane. I have to admit that I was not aware that this belief came about as the result of a “study” done by psychologist David Rosenhan published in Science in 1973. Rosenhan got himself admitted to a psychiatric hospital where he was diagnosed with schizophrenia based on telling the doctors he heard voices.

He claimed that this was the only symptom he presented with and, once admitted, he began to act as he normally did and was soon discharged with the diagnosis of schizophrenia in remission. Rosenhan then recruited a number of other sane pseudopatients who got themselves admitted to various other hospitals around the US where they too were diagnosed with schizophrenia save for one who was diagnosed manic depressive.

This 2017 video explains how the experiment was conducted and the results:

The study made a huge impact at the time although Rosenhan quickly dropped the topic and went on to do other work. He was offered a book contract with a generous advance but he failed to finish the book and the publisher sued to recover the money.

Thanks to the incredible investigative work of Susanna Cahalan in her book The Great Pretender, proof is provided that the study was highly flawed. Ms Cahalan obtained Rosenhan’s notes and found them to be sloppy to the point of being unprofessional and even unethical. He made errors about the length of time spent in hospital and even the capacity of one hospital. He claimed a hospital had 8000 patients when it only had 1510.

The published study had very exact percentages for staff time spent in various activities with patients but one of the pseudopatients interviewed by Ms Cahalan told her that no data was collected. The data presented in the study contained such statements as attendants spent only an average of 11.3 % of their time outside the cage (staff desk) while doctors spent only 2% of their time where they paused and chatted with patients.

These are very specific figures and yet there was no explanation as to how they were derived and calculated.

Dr Rosenhan initially went undercover to Haverford Hospital in the Philadelphia area and claimed that his data was not used in the study but, in fact, it was. Cahalan was able to obtain the actual medical record for his time in hospital and discovered that the symptoms he complained of were far more extensive than simply saying he heard voices.

The actual record showed that he told the doctors that he was sensitive to radio signals, that he could hear what others were thinking and that he tried to drown out the noises by putting copper pots over his ears. The use of copper pots is similar to schizophrenic patients covering their heads with tinfoil to protect against the rays aimed at them from outer space. He also said that being in hospital could better insulate out the noises. He also confeseed to being suicidal.

Ms Cahalan concluded that Dr Rosenhan intentionally distorted the facts for his paper.

One of his critics at the time, Dr Robert Spitzer, corresponded at great length with Rosenham  and was so outraged that he was motivated to develop an updated version of the DSM (version III). Spitzer quoted another physician who stated that:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

If you describe symptoms that encompass all the markers of schizophrenia to a psychiatrist then you can expect them to diagnose you with schizophrenia.

There was a 9th psuedopatient in the research who wanted to emphasize the positive aspects of his 19 day stay in hospital but there is a footnote in the study saying that this data was excluded. Turns out that it was not excluded. The author found a draft paper of 9 pseudopatients and then the published paper with a footnote saying the 9th was removed.

Despite being removed, the numbers did not change. The average length of stay, the number of pills dispensed remained the same and the time that nurses spent with the patients did not change. If you remove one subject from a small sample size, the numbers will change but they did not in this case. Had the editors of Science been aware of these transgressions, Cahalan said, they would not have published the paper.

Research is essential for advancing our knowledge by investigating new areas or, and this is crucial as well, in replicating earlier studies to demonstrate their veracity. Studies that find negative results are also important but many have been suppressed. Since January 2018, those conducting clinical trials have been compelled by law to report all results even if negative. This was enacted to ensure that doctors and patients could determine if treatments were safe and effective and arose because it was not unusual for pharmaceutical companies to suppress data that did not support the efficacy of a drug under development.

But, as Science reported, many are not doing this and there has been no enforcement for their failure.

Research study results often involve a great deal of hype and publicity which is good for the researchers and their institutions. Promotions result and grant money flows so deception is common. The website, retraction watch, hosts a database of the flawed research that has had to be retracted and that is just the tip of the iceberg. I personally came across a research study from the Institute for Clinical Evaluative Science in Toronto which reported that doctors in Ontario were failing to abide by prescribing guidelines. The problem was that the guidelines came out after the research was complete. The researcher and the director refused to admit error but the editor of the journal it was to be published in made them add a correction. That correction was not conveyed to the many media outlets that reported on the flawed conclusion.

Cahalan does touch on these problems with research and cited the Reproducibility Project at the University of Virginia. An attempt was made to reproduce the results of 100 social psychology experiments and fewer than half could be replicated.

The most famous of psychology experiments also conducted at Stanford, The Prison Experiment, has also been exposed as a sham in a very detailed expose in Medium.

Research is crucial but findings need to be replicated and the lay audiences should be wary of basing beliefs on the results of only one study particularly if there is a great deal of media hype surrounding it.

 

Anti-Psychiatry

By Dr David Laing Dawson

As a personal addendum to Marvin’s piece:

In the years before I studied medicine and then entered psychiatry, the mental hospitals, the Asylums, were full. I believe the largest in North America housed about 13,000 patients. There were no effective treatments (with the exception of ECT) though many things were tried, from field work and prayer to cold baths, spinning chairs, and insulin coma. These Asylums themselves grew from an increasing social awareness, acceptance of social responsibility, and recognition of the need for the state to look after the intellectually, cognitively, emotionally, and socially disabled among us. (roughly 1850 to 1990)

The doctors, the Alienists, and then the psychiatrists were given wide latitude to hold, to keep, and to treat.

Curiously I do not recall any active anti-psychiatry movement then or through the years 1960 to 2000 (with the exception of Scientology). And it was through those years that actually effective treatments were developed. And by effective I mean scientifically proven to be effective.

I can now prescribe something that quells mania in a few days, that pulls someone from a stuporous depression in two weeks, that reduces panic attacks, that eliminates the excruciating pain of agitated depression, that tempers debilitating obsessions and compulsions and that gradually returns the insane to a state of sanity – if my patient will let me.

And it is now, again curiously, at a time when psychiatrists do have effective tools to treat mental illness and when they are very restricted in any use of these treatments without explicit consent and when those Asylums have been reduced to a tenth the capacity they once had, that an anti-psychiatry movement has developed.

I have to conclude that the motivation for this anti-psychiatry movement is not the welfare of others but of professional rivalry and fear. And like some other attitudes today (anti-vaccination, anti-global alliances, pro-alternative medicine, anti-fluoridation), it has to be based on memory loss – that is, a profound memory loss of childhood death from diphtheria, WWI & II, the crippling polio epidemics of the 1950’s, the rotten teeth of the average kid in 1930, and the wards of catatonic or raving and tormented souls in the lunatic Asylums, and, before that, in the jails and stockades, tied to poles, or expelled from villages.

Of course there is much to discuss in the liberal arts and social sciences about how societies have defined normal and abnormal, and all the forces at play in each Era, and about the uses and abuses of power, and about the benefits of capitalism (all effective modern medicines have been developed within capitalist systems) and the horrors of unregulated capitalism.

And these (along with the philosophy of science and the successes and limitations of the disease model of human ailments) can all be discussed and investigated within schools of social work and medicine in an academic fashion without prejudice. In fact, a really good academic question to ask would be: Why is there now a strong anti-psychiatry, anti-vaccination movement? Is it related to the anti-science zeitgeist of Trump world? Is it a failure to teach real history? Is it fear of a loss of the sense of a perfect God-made homunculous within each of us? Is it the fault of the internet? Have our entertainments (think Dr. House, Hannibal Lecter, and Jack Nicholson receiving ECT) overwhelmed our perception of reality?

Or is it just some social workers and psychologists wanting more power and status?

 

Cockamamie Views From Anti-Psychiatric Advocate

By Marvin Ross

Bonnie Burstow, the anti-psychiatry scholarship donor at the University of Toronto, gave a lecture in December on her book called Psychiatry and the Business of Madness. The lecture is on youtube for those of you who have the stomach to watch it. I managed 38 minutes of the hour talk and it is so full of absurdities that, frankly, it defies reality.

I recently wrote about her scholarship on the Huffington Post and that was followed by a number of other critiques of that endeavour – none favourable. Tom Blackwell, the National Post medical writer, called it an affront to science that could do harm. “This is a case where academic freedom should be quashed,” Edward Shorter, a U of T professor and expert in the history of psychiatry, told Blackwell. Dr. Joel Paris, a McGill University psychiatrist, is quoted saying he is ashamed of the University.

I can only imagine what they would have said if they saw this lecture so allow me to summarize the first half and point out the errors.

Bonnie begins by saying that psychiatry is so inherently wrong that it just cannot continue. She points out that psychiatrists are so powerful that they are the only ones in society who have the right to take away someone’s freedom. They have king like power like those of the 16th and 17th centuries who had the power to exile citizens forever.

Now she says these views are based on thousands of interviews and attending 15 consent and capacity board hearings. If she really did attend those meetings, she could not believe what she said and by equating shrinks to autocratic monarchs, she suggests that there is no recourse to anything they do. Each jurisdiction allows for holding someone for observation and the rules differ but are all basically the same. For the purpose of this blog, I will comment on Ontario since Bonnie lives in Ontario as do I.

To begin with, psychiatrists are not the only ones to have the power to put someone in the hospital for observation. Any MD can do that based on very specific criteria. It is not arbitrary. The initial period is for 72 hours only after which the person is to be discharged, or can agree to remain voluntarily. If they still pose a threat to themselves or others, they can be held for a further 2 week period but that cannot be ordered by the doctor who originally signed the 72 hour committal. A second doctor must agree that it is necessary and sign the forms.

The patient is then told by the patient rights advocate that they can appeal if they do not agree and they will be supplied with a legal aid lawyer. This results in a capacity hearing before a board 15 of which Bonnie attended.

This is hardly imprisoning anyone nor is it done without respect for individual rights. Bonnie describes this as bringing the weight of the entire state, police, hospitals, families, universities who have been all sucked into this system. At the very centre of this conspiracy are the big pharma companies.

To illustrate what she calls the lack of substance to psychiatry, she recounts the experiences of her friend, Amy. For about 30 years, Amy has periodically taken off all her clothes and run down the street pounding on doors yelling “emergency, emergency”. Concerned homeowners call the cops who come and take her to hospital where she is locked up for a period of time. This has happened in various jurisdictions all over North America and Bonnie feels it is ridiculous. Her activities are simply “outside our comfort zone” so we define her as dangerous and sick. Bonnie does not even think people should call the cops.

I don’t know about you but if this happened in my neighbourhood, I’d call 9-1-1. I’m not sure what I would think but escaping a rapist would come to mind, or an abusive spouse or having been held against her will would be at the top of my thinking. The police are best able to deal with that. If they can find no reasonable reason for this behaviour, then of course they would take her to the emergency room.

This example led her to talk about violence of the mentally ill and a long discussion on the impossibility of psychiatrists being able to predict who may or may not become violent. She is correct on that score but her argument that is often heard about those with mental illness never being violent is absurd. Those who are untreated and those who are untreated and substance abusers are at far greater risk of violence than others. This link from the Treatment Advocacy Centre lists all the studies that demonstrate this fact.

She then goes on to talk about how mass shootings involve people who are often on psych meds and that it is the meds that likely cause these shootings. Psychiatrist Joe Pierre writing in Psychology Today argues that “In the vast majority of cases, we don’t have access to their medical records and we certainly don’t know if the medications, even if prescribed or otherwise obtained, were actually being taken.”

“And then, of course, there’s the issue of correlation vs. causality. After all, I’m fairly certain all known mass murderers were drinkers of tap water, which has also been linked to violent outbursts.”

At this point, Professor Burstow switches into “refuting” the concept of mental illness. She states that only a body can have an illness. A mind cannot be ill as it is only used for thinking. I kid you not! That is what she said.

She then goes on to say that the hallmarks of paranoid schizophrenia are paranoia and delusions of grandeur. What happens to the paranoia and the grandeur when the person dies and there is just a corpse. She asks her audience if any of them have ever seen a corpse with delusions and, since no one has, schizophrenia fails the test of an illness.

What can anyone say when confronted with this? Professor Burstow has failed the test of physiology. The brain is an organ that allows us the ability to think, speak, make decisions, and so on. Does she have any idea how it is that we can think in the first place? Obviously not. This summary provides an overview of the differences in the brains of those with schizophrenia compared to normal brains. There are numerous differences.

And this is a study showing the abnormalities in the brain of autopsied people with schizophrenia. Which of these abnormalities results in paranoia and delusions of grandeur is not known but the brains are different.

I gave up when she began talking about the longitudinal studies by Harrow in Chicago. This researcher followed a group of people with schizophrenia for 20 years and checked on them every five. What he found was that some people were able to go off meds and do well and they were doing better than those on meds. I’ve written about this a number of times and, in one of my Huffington Post blogs, I had this to say:

79 per cent and 64 per cent of the patients were on medication at 10- and 15-year follow ups. Those who were not on medication, did better on the outcome measures than those who were on but would that not be expected? Why they stopped the medication or were removed from it by their doctors was not explained, but we can presume that it was because they did not need the medication. In fact, Harrow states that not all schizophrenia patients are alike and that one treatment fits all is “not consonant with the current data or with clinical experience.” His data suggests that there are unique differences in those who can go off medications compared to those who cannot. In a paper Harrow just published in March, he points out that it is not possible to predict who may be able to go off medication and those who need the long term treatment. Intensified research is needed.

It just isn’t that simple, Bonnie. She did go on but I could not take anymore so ended there.