Category Archives: Treatment

Follow Up on Smoking and Serious Mental llness and Psychiatry in Scandinavia

By Marvin Ross with an addendum by Dr David Laing Dawson

My blog on smoking turned out to be one of the most widely read blogs that we’ve done. I had made the point that people with schizophrenia have a shortened life expectancy of about 20 years compared to a shortened life expectancy from smoking of about 10 years. One of the reasons for the shortened life expectancy not involving smoking is the poor medical preventive care that these people receive from the health system.

Of course, there are those who argue that the treatment for schizophrenia – prescription medication – is a leading cause of death. I’ve just come across a paper from Sweden on real life mortality in a cohort of close to 30,000 patients. Data was collected on the period from 2006 to 2013 on all cause mortality among those with schizophrenia aged 16-64.

What the study found was that the use of long acting injecting anti-psychotics resulted in a mortality that was 30% lower than that for oral agents. Long acting paliparidone turned out to have the lowest mortality followed by oral aripiprazole. However, the use of any antipsychotics resulted in less mortality than not taking them. So much for the anti-medication faction who, in my opinion, have a great deal in common with anti-vaxxers.

My blog on open dialogue and the medication free units in Norway also resulted in a number of comments. Hakon Heimer pointed out that a recent article in Psychiatry Online found that “The present data on Open Dialogue are insufficient to warrant calls for further research on the program other than those projects that are currently under way.” The editorial on the research of Open Dialogue stated that “Unfortunately, the results of this review are underwhelming.”

Heimer is founder, project director, and executive editor of Schizophrenia Research Forum, an online knowledge environment for researchers, which is part of the Brain and Behavior Research Foundation. He also advises the National Institute of Mental Health in the US.

And then, I received this:

Linking up the mind emotions abuse illness and recovery

what a piece of dirt article , where is the bin, , how can anyone even accept the current system unless you a child abuser yourself… that all mentallness comes from and what the psychiatrist see all day, and then go hunting brain cells for 50 years and not do a thing,,,, if im wrong, show me or fuck of you bit of filth, or comment, the bomb is ready to blow, the troop are getting in place and the abusers just keep on abusing cause thats what abuse does

Not the first time I’ve had something like this nor will it be the last.

ADDENDUM:

Some other factors supporting these conclusions, including the lowest mortality being found with bi-weekly or monthly injections (vs pills):

Non adherence with oral antipsychotics is high. Depending on the definition of non-adherence, it is found in studies to be 20 to 40%, and underestimated by psychiatrists.

Non adherence with antipsychotic treatment results, for people suffering from schizophrenia, in higher rates of:

  • relapse
  • re-hospitalization
  • emergency visits
  • violence
  • being victims of violence and other crimes
  • arrest
  • incarceration
  • homelessness
  • suicide
  • Inattention to other health matters.

Thus the striking improvement in mortality with injectable antipsychotic medication could be simply attributed to improved compliance with pharmacological treatment.

However, non-compliance with all medications is a major problem. According to one study, about 1/3 of patients do not take all the pills they are prescribed while another 1/3 do not take what is prescribed at all.

For the Sake of Society, Focus on Recent not Ancient History

By Dr David Laing Dawson

Perhaps in High School the curriculum should discard all ancient history, the dreary lives of Mesopotamians, the bible stories, the British Empire, the kings of this country and that country, and instead focus on recent history. The realities of recent history. How we lived and what we knew, and didn’t know, with special emphasis on the last 100 years.

I know for most teenagers, surviving and living in the present is paramount. They have little use for things that don’t seem to impact their own lives at this moment. But we could try.

And we could try to preserve that history and keep it visible. Perhaps in front of the city hall we should do away with statues of old queens and put up instead reminders of the epidemics of polio, measles, small pox, pertussis, chicken pox, the things and luxuries people didn’t have a mere 75 years ago, methods of communication and ways of living.

The names of wealthy donors now take the place of the names of pioneers of yesterday. In Hamilton the Henderson Hospital is now the Juravinski. Nora Henderson was a local pioneer in maternal, prenatal and perinatal care. At the time, in this rich part of the world, the infant mortality and maternal mortality rates were equal to those of present day poorest African nations. We should not forget this.

Over the past 150 years there have been many eureka moments in the advancement of medicine and the maintenance of health. Dramatic discoveries with incontrovertible evidence that something works. To name a few: treatment for some cancers, antibiotics, clean water supply separated from sewage, fluoridating water, iodizing salt, and vaccinations, with vaccinations being perhaps the biggest and broadest reaching discovery of them all. (the discovery that dead or attenuated viruses and bacteria can provoke our immune systems to prevent the same live viruses and bacteria from harming us).

And there have been remarkable improvements in the treatment of many chronic conditions such as Cystic Fibrosis, AIDS, some leukemias, hepatitis, serious mental illness, seizure disorders, trauma and injury….

All of these improvements have been the product of science and medicine, not homeopathy or naturopathy.

Dramatic eureka moments have become scarce. More often today medicine struggles with the equations of early detection, invasive treatment, the balance of positive effects vs negative effects of intervention, genetics and life style: e.g lowering blood pressure by a few points by engaging in the right amount and kind of exercise, losing an inch of waist size, to salt or not to salt food, and which is best at which age: two to four alcohol drinks per day or none? vs. taking pills to lower blood pressure.

My left knee is a candidate for replacement, or, or, I could keep my weight down and ride my bicycle almost every day.

For the first time in a century the children born today in North America do not have longer life expectancy than their parents. Some suggest this may actually decrease. The causes for this are obesity, life style, social determinants of health (poverty), addictions, and increase in suicide rate. And, even more dramatically, if the trend continues, the cause of much lower life expectancy for the babies born today will be the anti-science and anti-vaccination attitudes.

Right at this moment nurses and doctors are using a vaccine developed in Canada to stop the spread of Ebola, a disease that has the potential of spreading world wide and causing the kind of population decimation previously caused by the black plague and small pox.

Coming in January: Mind You The Realities of Mental Illness A Compilation of Articles from the Blog Mind You

We have decided to publish a book on the best of our mental illness blogs over the past 4 and a bit years. The book will be available in print and e-book formats everywhere in early 2019.

Below is the introduction:

We began this blog in October 2014 in order to provide commentary on the state of mental illness and its treatment for the lay public. What we provide is a viewpoint from that of a psychiatrist with many years of experience (David Laing Dawson) and a family member of someone who does have schizophrenia (Marvin Ross). Aside from his personal experience (or lived experience as it is commonly referred to), he is also a medical writer, advocate and publisher of books that take a unique look at mental illness.

To date, we have had close to 75,000 views and have been read in 151 different countries since 2014.

We also write on other topics but these are the ones on mental illness covering topics like recovery, treatments, suicide, addictions, and alternative treatments (or pseudo science).

When we began, we had this to say of our purpose:

 Welcome to the launch of Mind You. While we intend to post on mental illness,mental health and life, we decided on the name Mind You to reflect that not everything is black and white. There are ideas and opinions but then mind you, on the other hand, one can say…….

And that is what we would like to reflect. Ideas about mental illness,health and life that can be debated and discussed so that we can come to a higher understanding of the issues. And, we have separated out mental illness from mental health because, despite their often interchangeability, they are distinct.

The National Alliance on Mental Illness defines mental illness as a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a  diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder.

On the other hand, the World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. That is quite different from mental illness.

Unfortunately there is a tendency to confuse these and organizations like the Mental Health Commission of Canada have a tendency to talk about mental health issues and problems which are not the same as mental illnesses.

 Both Dr David Laing Dawson and I (Marvin Ross) will be posting on a regular basis on a variety of topics.

The posts we have selected for this volume are the most widely read over the past 4 years.

Mind You, ISBN 978-1-927637-31-9, 193 pages distributed by Ingram

 

The Continuing Proof of the Efficacy of Anti-Psychotics

By Marvin Ross

Despite the protestation from the anti-psychiatry advocates, medication for schizophrenia works and another study has just been published to support that position. A new study based on a nationwide data of all patients hospitalized for schizophrenia in Finland from 1972 to 2014 found that the lowest risk of rehospitalization or death was lowest for those who remained on medication for the full length of time.

The risk of death was 174% to 214% higher among patients who never started taking antipsychotics or stopped using them within one year of their first hospitalization in comparison with patients who consistently took medications for up to 16.4 years.

It should be pointed out that this is real life data rather than a clinical trial involving a total of 8,738 people.

What is particularly significant for me in this study is that it is from Finland which is the home in one isolated part of that country (Lapland) to the alternative Open Dialogue espoused by the anti-psychiatry folks including journalist Robert Whitaker of Mad In America fame. Whitaker claims that 80% of those treated with Open Dialogue are cured without need for drugs.

I wrote about Open Dialogue very critically back in 2013 in Huffington Post and pointed out that there is very little research to demonstrate its efficacy. I actually asked a Finish psychiatrist, Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki about Open Dialogue.

This was his answer:

“I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like “80 per cent do well without antipsychotics” are derived from studies which lack control group, blinding and independent assessment of outcomes.”

He went on to say that:

“most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

As for the claim that psychiatric hospital beds in Finland have been emptied, he said “in our official statistics, the use of hospital beds for schizophrenia do not differ between the area with the Open Dialogue approach and the rest of the country.”

My blogging associate, Dr David Laing Dawson also wrote about Open Dialogue in this forum with very skeptical view. He stated that the director of the program admitted that about 30% of the patients in Open Dialogue are prescribed medication so arguing that medication is not used is not correct.

At the time my article appeared in Huffington Post, someone on Mad In America agreed with me that there was insufficient evidence on the efficacy of Open Dialogue and said that a US study was set to begin in, I think, Boston. I did find a completed study on Open Dialogue done by Dr Christopher Gordon. His study involved 16 patients and he states at the outset that

“Since this was not a randomized clinical trial and there was no control group, we cannot say that these outcomes were better than standard care, but we can assert that they were solidly in line with what is hoped for and expected in standard care.”

In the paper that is in a legitimate psychiatric publication, he states that of the 16, two dropped out and a further 3 had disappeared at the end of the study so no data is available for them. This is a study of 11 people who completed the one year term.

He then points out that:

“Of note, four individuals had six short-term psychiatric hospitalizations (two involuntary).”

and that:

“three of the six individuals who were not on antipsychotics at program entry started antipsychotics. Of the eight already on antipsychotics, four had no change in their medication, and four elected to stop during the year. Both groups of four had similar outcomes and continued to be followed in treatment. Shared decision making and toleration of uncertainty contributed to these choices.

Hardly the success he suggests if the goal was to help them get well without medication.

But, coming up at the end of May in Toronto we have a conference with Robert Whitaker and others on Shifting the Narrative on Mental Health from the psychiatric disease model to the relational/recovery model, and on the challenges that are stacked against that eventuality.

Now I would say that the challenges against that shift are science but they define it as “The challenges and resistances to progressive change are of an ideological, macro-economic nature guaranteeing a protracted and difficult struggle for recovery advocates.”

Is This The End of the Mental Health Commission?

By Marvin Ross

In December, I wrote a blog pointing out that the Mental Health Commission of Canada should be disbanded. Those of you who follow my writing on Huffington Post know that this has been a constant theme of mine over the past few years. Last Fall, the Federal Health Minister set up an inquiry into what they called Pan Canadian Health Organizations (PCHOs). These are federally mandated groups established to carry out specific tasks in health across the country when, in fact, health care comes under provincial rather than  federal jurisdiction.

The review was to evaluate the role and relevance of these groups in advancing federal health policy objectives and meeting national goals. One of the PCHOs is the Mental Health Commission and my advocacy colleague Lembi Buchanan and I submitted a brief on the Commission through the Best Medicines Coalition.

With amazing speed for a government report, the findings were just released. Much to our delight, the Commission recommended that the Mental Health Commission either be ended or radically altered.

The basic premise for health care in the 21st Century as outlined by the World Health Organization and endorsed by most countries including Canada is that it be people centred. “It puts people at the centre of the health system and promotes care that is universal, equitable, and integrated. The framework emphasizes a seamless connection to other sectors, notably those focused on the social determinants of health. This framework also promotes providing a continuum of care that requires high-performing primary care.”

The conclusion the reviewers reached about the Mental Health Commission of Canada is that “Mental health is now “out of the shadows”. The integration of mental health care services into the core of Canadian health systems requires a different type of leadership, capable of driving a bottom-up approach in which patients and families, providers, researchers, and the broader mental health community come together to break down silos.”

As a positive, the report states that “The MHCC has been particularly effective in developing strategies around mental health, along with initiatives and campaigns to increase awareness and reduce stigma. It has made great strides in delivering on its objectives and helped to bring mental health “out of the shadows at last.” It has also created valuable contacts and built trust among its closest stakeholders.”

It did develop a mental health strategy mostly ignored and it did help to raise the awareness of mental illness. However, the report states that:

“The need to build greater capacity in Canada on mental health is still as pressing today as it was when the MHCC was established. What has changed, however, partly as a result of the advocacy work undertaken by the Commission, is the overarching policy goal. What Canada needs today is the complete and seamless integration of mental health into the continuum of public health care. What Canadians want is public coverage of proven mental health services and treatments, beyond physicians and hospitals. To be successful, those services must be integrated with primary care and supports for physical health, rather than isolated from them. We came to the conclusion that MHCC, in its present form and with its current orientation, is not the best instrument to achieve the objective of integrating mental health into Medicare.

They then state that these goals might be achievable if the MHCC changed itself but suggest that to accomplish this they would have to engage “health leaders at provincial and territorial levels in joint decision-making over service funding and quality standards; a different “knowledge base” in support of evidence-informed advice and performance evaluation; and a different, more flexible, and less centralized structure.”

This, in fact, is one of the many criticisms I’ve made over the years. The MHCC churns out papers but has zero influence in decision making and that is exactly what is needed. Policy papers are fine but they need to be implemented and the MHCC has yet to accomplish that from what I’ve seen. The report concludes in its section on the MHCC that “It is because mental health is so critically important to Canadians- and their governments- that a new approach is now needed.”

I was impressed with the team tasked with this job and I’m impressed with the speed in which it produced its report (October 2017 to March 2018). Let us hope that the Health Minister implements the recommendations.

And, a documentary we did on schizophrenia

Ontario’s Flawed Mental Health System and the Failure of the Current Provincial Government

By Marvin Ross

stone of madness

I recently came across an excellent assessment of the very bad mental health system in Ontario that prefers to have people receive services in the forensic stream rather than before they get to that point. The assessment was not published but was obtained under Freedom of Information.

That led me to write this on Huffington Post – Ontario Has Failed to Provide Adequate Resources for Mental Illness. 

After that appeared, the Hamilton Spectator did a feature on a young man named Ross Biancale with the head I’ve already written his obituary: Mom struggles to save son from himself. This sad but true recounting of what it takes to get someone service in Ontario illustrated all the points that I made in my Huffington Post blog. Below is my explanation for this mess.

The reason that Ross Biancale and thousands like him are falling through the cracks of the mental health system (the Spectator, January 23) is easily explained and easily fixed. They have not been fixed because the Liberal government has no interest in doing so.

Justice Richard D Schneider ran the Toronto Mental Health Court for years and then completed a report for the Department of Justice called The Mentally Ill: How They Became Enmeshed in the Criminal Justice System and How We Might Get Them Out in 2015. That report only saw light of day because of a CBC Freedom of Information request.

Justice Schneider points out that the main fault is the Ontario Mental Health Act and the conditions required for an involuntary committal to hospital. Under the current legislation, someone who is exhibiting all the signs of illness, listening to the voices of Martians in his head while denying he is ill, cannot be hospitalized without consent. Neither the police nor the Justice of the Peace will help hospitalize that person if they do not believe there is “clear evidence that he is dangerous to himself or others”. And, even if he is admitted, he is “discharged before he is stable” and “his condition deteriorates”.

Justice Schneider said “if the individual is not seen as dangerous to himself or others he is free to roam the streets ‘madder than a hatter’” And, in many cases, the person will come into conflict with the law and wind up in the vastly more expensive forensic psychiatric system.

The 1967 Ontario Mental Health Act allowed for someone to be admitted to hospital involuntarily if they were suffering from a mental disorder severe enough to warrant treatment in hospital for their own or others safety and they could be held for one month. That was changed in 1978 thanks to the civil libertarians to involuntary treatment only if the person had threatened or attempted to do harm to himself or others. The time held was lowered to 14 days.

Further, the 1967 Act considered that hospitalization meant treatment and people being held were treated. That changed in 1978 and someone could be held involuntarily but they did not have to agree to treatment.

Attempts have been made to change the Mental Health Act in Ontario and that was one of the recommendations of the 2008 all party Select Committee on Mental Health and Addictions. Recommendation 21 in that report states that the Ontario government should set up a task force within one year to “investigate and propose changes to Ontario’s mental health legislation and

policy pertaining to involuntary admission and treatment.”

That was 2008 and this is 2018 and the Liberal government still has not acted.

The other barrier to effective treatment mentioned in the Spectator article is our privacy legislation. If a person is over 18, they are an adult even if they live with their parents and are supported by them. Health care providers cannot talk to family without the permission of the ill person and, if they are paranoid, they may not grant permission.

The Select Committee also decided that the government should change the privacy legislation in recommendation 22. “The changes”, they said, “should ensure that family members and caregivers providing support to, and often living with, an individual with a mental illness or addiction have access to the personal health information necessary to provide that support, to prevent the further deterioration in the health of that individual, and to minimize the risk of serious psychological or physical harm.”

The 2013 Mental Health Commission of Canada report on caregivers made similar recommendations but, again, this is 2018 and Ontario has still done nothing.

These are issues that those of us with an interest in improved care for the mentally ill need to ask the candidates running in the upcoming provincial election.

 

How to Achieve Medication Compliance

By Dr David Laing Dawson

Anosognosia is an unwieldy word meaning lack of insight, or, literally in translation, `without- disease- knowledge`.  In the case of some brain injuries or stroke the brain may become quite specifically unaware of what is missing. The part of the brain that would perceive this is damaged. With mental illness, schizophrenia, bipolar, the apparent lack of insight  or denial of obvious impairment or implausible grandiosity may be more nuanced and variable. It may be part defensive in nature; it may be more a denial of the consequences imagined; it may be more about the power relationship at hand. Some of it may be merely human, the unwillingness to give up a longstanding belief, whether that be of the second coming,  CIA surveillance and persecution, or of being chosen, special, destined for greatness.  Some of it may be a distorted form of the normally complex parent – adult child relationship.

But almost every family with a severely mentally ill member must deal with, at least once, that time when the ill member claims to be fine when obviously not, and refuses to take medication or go for an appointment to the doctor.

How to approach this. What options do you have. Below is an outline for talks I have given on the subject:

Stage 1

  • Calm and slow
  • Non-threatening (posture, position (e.g. side by side), distance, tone, pace)
  • Aim for a negotiated reality. (not the acceptance of your reality)
  • i.e. He may not be willing to admit he is ill or delusional or needs medication but may be willing to agree that he is in trouble, anxious, not well, in pain, not sleeping, and that in the past the pills have helped with that. He may by his behavior be willing to take pills or come for an appointment as long as he doesn’t have to admit to need or illness.
  • Gently find out what he or she fears.
  • Gently find out what his objections are.
  • Allay these objections and seek a “negotiated reality”.
  • Stay away from labels, declarations, and you defining his reality.
  • Offer pill with glass of water without saying anything.

Stage 2

Family intervention, same tactics as above but with whole family or available members, or a specific family member with influence.

Stage 3

Ultimatums. (You can`t live here unless…..)

But before doing this you should assess the level of risk (provoking violence, and/or leaving and putting self at risk). Discuss in family plus with a professional. Must also assess realistically your tolerance for confrontation, anxiety, worry, guilt. And ultimatums are only effective if truly meant, if you are truly willing to carry through with the ultimatum. If the ultimatum works, do not reiterate it unnecessarily.

Stage 4.

Form 1, J.P., Court order, Police intervention.

Before doing this decide on desired outcome, assess odds of achieving this desired outcome as best as possible (i.e. is there a treatment that works? Will they keep him or her long enough? Does the trauma of this kind of intervention justify the long-term outcome?)

Having decided on desired outcome, use all resources to achieve this. Learn the wording of the Mental Health act to get desired outcome. Use this wording to your advantage. Find family mental health friendly lawyer. Discuss with the health professionals who will be receiving the family member.

Yes Virginia, Psychiatric Medication Does Work.

By Marvin Ross

As I’ve said so many times, anecdotes are not proof of anything but I am going to use one to demonstrate the efficacy of anti-depressants. The anti-medication people do nothing but give anecdotes of the dangers of psychiatric medications and the difficulties some have going off them. When research is cited, they usually attack it as being biased and/or funded by big pharma.

Research does show that for most and when prescribed properly, these pharmaceutical agents do help. As an example, I’m the power of attorney for someone with Alzheimer’s Disease. When he was first being assessed by a family doctor, he came out as being depressed on the Beck Depression Inventory. While he was under going evaluation, he was given anti-depressants which he only took rarely.

However, when he had his diagnosis confirmed by the geriatric psychiatrist, it was recommended that he go back on and stay on the anti-depressant to help with both his depression and his anxiety. In order to ensure compliance with that and the Alzheimer’s med, he was given a weekly blister pack. The pharmacist loaded the pills for each day and for the proper time.

He saw the psychiatrist a few months later and was assessed again on the Mini Mental Status Exam (MMSE). The psychiatrist noted that not only did he appear more relaxed and less anxious than at the previous session, but that his dementia score had improved slightly – not because his dementia was better but because he had less anxiety.

Then, a few months later, the home care co-ordinator showed up to do a reassessment. She called me amazed. My friend, she said, was far more relaxed and showed no signs of anxiety or agitation which were evident when she first assessed him. As she said, “he still does not know where he lives or what the date is, but he is very relaxed about everything”.

Yes, this is an anecdote that and not a definitive study but it is an example of the benefit of this class of drugs. For a list of the meta analytic studies done for anti-depressants that do show efficacy, visit this webpage. Check out the home page on that site for other resources. Thanks to Robert Powitzky for pointing me to it.

Anti-Psychiatry

By Marvin Ross

I really don’t get it – anti-psychiatry that is. I can understand that if someone has had a bad experience with a psychiatrist, they might be wary and hostile. After all, not all doctors are good and I have no doubt that most of us have run into a bad one over the course of our lives. I certainly have seen my share of rude, arrogant and stupid doctors from family practitioners to cardiologists but I do not condemn them all. I do not devote my energy to attacking emergency medicine because of a bad ER doc I’ve encountered.

A lot of the anti-psychiatrists I’ve encountered fall into this category. They’ve had a bad experience and generalize to all. But a lot of the others aren’t in this group. They are people who have decided that their time should be devoted to attacking psychiatry as their contribution to freedom of the individual or to the good of mankind. And, for the most part, they know very little of neuroscience, medicine or mental illness. If they truly want to make a difference, they should devote their time to advocating for better care and treatment for the seriously mentally ill or to help with the growing problem of refugees, world peace, homelessness, child poverty, and the list goes on.

For the most part, they are mistaken in their views of psychiatry as Mark Roseman pointed out so brilliantly in his review Deconstructing Psychiatry. I highly recommend that people read that. His analysis is far more detailed than mine but I would like to comment on a few of the common myths that he covers in more detail.

The one complaint that is common among the anti-psychiatry mob is that psychiatrists are controlling people who give an instant diagnosis and then force their patients to take toxic drugs.

People do not go to see psychiatrists by calling one up or walking into their offices. They need to be referred by a general practitioner or via a hospital like an emergency room. And they would only be referred to a psychiatrist if they had psychiatric problems that were beyond the expertise of the general practitioner. That referral would only be made after the general practitioner had ruled out non-psychiatric causes of the symptoms and behaviour.

Like all doctors, the psychiatrist will take a detailed history from the patient, consider possible diagnoses and recommend appropriate treatment. The treatment recommended is based on the professional guidelines outlining evidence based strategies. These are the practice guidelines used by the American Psychiatric Association. Similar guidelines are used in different countries. The cornerstones of any medical practice are to do no harm and to relieve suffering.

I often hear comments and criticisms that a psychiatrist put someone on toxic drugs that they were then forced to take for eternity. A comment to my blog on the anti-psychiatry scholarship at the University of Toronto stated “based on the results of a positive diagnosis (from a 15 minute questionnaire score) a patient (including young children) may receive powerful psychoactive drugs for years, the long term effects of which are not yet known.”

As I said above, the diagnosis is not based on a 15 minute questionnaire but on an extensive evaluation. And, regardless of the medical area, drugs are always (or should be) prescribed in the lowest dose for a short period of time and the patient brought back in for evaluation of efficacy and side effects. The goal is to find the lowest dose that is effective with minimal side effects. This is a process called drug titration.

If the drug is not effective or if it causes too many unwanted side effects, it will be changed. No one is forced to take a drug that does them little good in any discipline of medicine. Surely, the patient does have choice to continue with that doctor or not and to take the advice that is offered. People who see psychiatrists are not held captive.

When it comes to children, they are not seen in isolation as the anti-psych criticism I quoted above implied. They are seen with their families who, understandably, do not want their kids on powerful drugs. There are long discussions with the psychiatrist where all less invasive means are explored. When pharmaceuticals are prescribed, the parents are at complete liberty to stop them if they do not work or if they cause troublesome side effects. The children are not held captive by the psychiatrist and force fed pills against the wishes of the parents.

When a child does continue to take the medication it is because it is having a benefit and there are no troublesome side effects. I remember a mother who resisted Ritalin for her hyperactive child for years telling me how well it worked once she decided to give it a try. “I wish I had tried it much earlier”, she told me. “It would have saved so much grief.”

The anti-psychiatry bunch also assert that mental illnesses do not exist and cite the lack of any one definitive test to prove bipolar disorder, schizophrenia or other afflictions. Quite true but the same can be said for many other maladies. How about Parkinson’s as but one example. Doctors cannot measure the amount of dopamine in the brain (which is depleted in Parkinson’s) to definitively say that the person has the condition. They determine the presence of this condition based upon observing the person and his or her movements.

Alzheimer’s is another. Like with schizophrenia, it is diagnosed by eliminating all possible other reasons for the observed dementia and when none can be found, the diagnosis of Alzheimer’s is made. On autopsy, there will be found specific markers but no one ever gets an autopsy to prove that the doctor was correct. And rarely is anyone with schizophrenia autopsied on death but this is a lengthy list of the abnormalities that demonstrate that it is a disorder of the brain.

The anti-psychiatry group should be looked upon with the same disdain that sensible people look upon the anti-vax faction.