Tag 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.

 

From Asylums to Recovery -A Critique of a Mental Health America Documentary

By Marvin Ross

I just recently came across a documentary on Youtube put out by Mental Health America called From Asylums to Recovery – a celebration of the so called consumer survivor, anti-psychiatry movement in the US and beyond. After showing some images of the horrific conditions that people were forced to live in in asylums, we are greeted with the statement that in the late 1950’s and early 1960’s, there were 550,000 people locked up in asylums. Many, the documentary goes on to say, were locked up by their families and the courts because no one believed that those with mental illness could recover.

Horrific conditions did exist and no one can deny that but people were in the institutions because they could not usually recover in those days. Recover isn’t even the right word which really should be that their symptoms could not be dealt with appropriately. Recover really means to be cured and that is not possible for illnesses like schizophrenia and bipolar disorder.

The doc then states that today there are about 50,000 people in psychiatric facilities and that the system has improved. This reduction, they claim, is the result of 100 years of patient/consumer/survivor advocacy. The documentary then goes on to try to explain how this reduction in patients and improvement came about by interviewing many of those who were involved in the consumer/survivor movement.

What is missing, of course, is that from the early 1960’s on, new medications came along that, for the first time, could treat the worst of the symptoms of schizophrenia, bipolar disorder and major depression. In fact, the first anti-psychotic, chlopromazine, was discovered in the 1950’s and its first North American use was in Montreal in 1954.

That was the beginning and over the years, more anti--psychotics were developed so that doctors now can experiment to find the one that works best for a particular patient.

Lithium, the gold standard treatment for bipolar was first used in 1954 but not introduced into the US until the 1970’s. The US was late to the game as it was the 50th country to start using this agent to treat bipolar disorder.

Anti-depressant drugs to treat major depressive disorder began about 1957 with the appearance of the MAO inhibitors. This class of drugs had their problems with interactions with some food products such as cheese. However, other classes of drugs such as the tricyclic antidepressants, the SSRI’s and now other agents like ketamine are in use.

Those in asylums were able to have the worst of their symptoms treated successfully and to be released from hospital. Mental Health America fails to mention any of this and attributes the emptying of hospitals to the works of the consumer survivors and anti-psychiatry advocates. The problem, however, was that governments were too anxious to release people without first setting up proper community resources to aid and assist those being discharged.

Known as deinstitutionalization, the process has resulted in sick people being left in the community to fare for themselves. As a result, many of the homeless and those incarcerated are suffering from untreated mental illness. Is being homeless or in jail an improvement on the asylums of old? I think not!

All of this (drug development and deinstitutionalization) is ignored in this documentary designed to celebrate the 100+ years that MHA has existed. It began life in 1909 as the National Committee for Mental Hygiene. An organization that has been around for that long I would hope would have more understanding of mental illness than displayed in this documentary. The popular media, in my opinion, displays a greater understanding.

If you are a fan of the TV series Homeland, and have not seen season 7 then stop here unless you want the ending. The protagonist, Carrie Mathison, is a CIA agent with bipolar disorder. In this season, she is captured by the Russians and held prisoner before eventually being exchanged for a Russian spy held by the Americans.

As part of her torture, the Russians withhold her bipolar meds. After a significant time without medication, Carrie is returned to the US in the state that anyone who understands mental illness and the role of medications would understand. She is an incoherent mess and basket case. If Hollywood can understand this, why can an agency involved in the mental health field not understand 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.

Psychiatric Refugees? Give me a Break!

By Marvin Ross

For years, we’ve had a small group of very vocal people who call themselves psychiatric survivors — people who have had psychiatric treatment, do not agree with it and consider that they have survived it. Now, thanks to CBC radio, we have someone dubbed a psychiatric refugee — a woman who fled British Columbia for Ontario to escape her involuntary status in a B.C. hospital. And, it was said, she is not the only so-called refugee.

Comparing yourself to people who survived a genocide like the Holocaust or saying that you are comparable to Syrians and others fleeing in leaky, dangerous boats from war is absurd. But what is also absurd is the story that this anonymous person called Sarah by the CBC told. It is just not logical but it is being used to justify the Charter challenge to the B.C. Mental Health Act that I suggested was misguided.

People deserve to know and to understand what the Mental Health Act is about. They deserve to know the processes that are in place to commit someone against their will and to treat them. And they need to know the safeguards that are in place to prevent excesses and protect the rights of the individual. These are never explained.

First, I encourage you to listen to the interview. To begin with, Sarah said that she went to the emergency at a hospital with her mother because of troubling life events and she wanted help. She was admitted, she said, voluntarily but then her status was changed to involuntary.

Now, for her to have been declared involuntary, she would have had to have satisfied all four of these criteria (page 18 of the guide):

  • Is suffering from a mental disorder that seriously impairs her ability to react appropriately to her environment or to associate with others;
  • Requires psychiatric treatment in or through a designated facility;
  • Requires care, supervision and control in or through a designated facility to prevent her substantial mental or physical deterioration or for her own protection or the protection of others; and
  • Is not suitable as a voluntary patient.

If she was involuntary, a licensed physician must have assessed her and certified that she met the criteria. Then, another independent physician conducted an examination with the same criteria to extend the stay beyond 48 hours.

( See form 4 where the reasons for the involuntary decision must be listed.)

At the end of one month, she would be examined again to determine if she still met the involuntary admission criteria and the proper form would be filled out to extend her stay a further month (page 20 of the guide). If she no longer needed to be involuntary during this period, the doctor can cancel it and she can always appeal her status to a review board at any time.

Once a patient has been deemed involuntary, they are given a form 5 (consent to treatment) (page 173), which explains to them what treatment is being given. Note that Sarah told the CBC that no one ever discussed treatment with her. They had to.

In addition, Sarah’s rights would have been explained to her and she would be given a form 13 to sign (page 182). She did say she had to sign something but she was not sure what it was. The person having her sign would have told her that she had a right to a lawyer, that she would be regularly examined by a doctor to ensure she was being held appropriately, informed that she could apply to a review board to assess her capacity, go to court to challenge the doctor’s decision and/or request a second opinion from a different doctor.

Next, she would be given a form 15 (page 186) to fill out so that she could nominate a near relative to be informed of her status. She did say that her mother went to the emergency with her so I have to ask where her mother was in all this. Surely she would have been liaising with the hospital staff over diagnoses and treatments. While her mother would have no authority under the act, most doctors do encourage family participation. During the CBC interview, Sarah said that she wished her mother could be involved in her treatment and there is nothing in the act that says she can’t be.

Sarah told the CBC that she absconded during a smoke break and that a form 21 (page 193) had been filled out. That form obligates a peace officer to return her to hospital. Sarah said she went to police in Calgary and told them, and that they called her psychiatrist but they did not hold her for return. The form 21 is only valid within British Columbia, but if 60 days had expired, it would not be valid and she would be deemed discharged.

There are so many holes in what she told the CBC that cast doubt on all she said. It is important for people to understand, particularly in light of the court challenge, what protections there are for an individual who is involuntary. This is not something that anyone takes lightly and is done for the best interest of the patient and for society.

The infamous Vince Li, who beheaded Tim McLean on a Greyhound bus, was initially picked up by Toronto Police in 2004 and taken to hospital. He left hospital against medical advice as there was no mechanism with which to keep him.

Imagine what would have happened if he had been treated initially? Tim McLean would be alive, his family would not have suffered the pain and anguish they did, and the first Mountie on scene might not have developed severe PTSD and eventually taken his own life.

As for Vince Li, he has done so well on treatment that he is now living in a halfway house. I can only guess at the pain he must feel knowing what he did while psychotic and that he would not likely have done if he had been properly treated at the outset.

Vancouver resident Erin Hawkes has written extensively on how the so-called forced treatment had saved her life. She has written in the National Post, numerous times in the Huffington Post and in the Tyee.

The CBC should interview her as well on the court challenge and they should do better fact-checking. If the plaintiffs in this Charter challenge call Sarah as a witness, we will see how well her story holds up to cross-examination.

Note: this first appeared in the Huffington Post on September 26. One person criticized me for attacking mothers which is not what I intended. I pointed out that Sarah’s mother has gone to the ER with her and I likely had input. When I asked where she was, it was a comment directed towards Sarah who said that she wished her mother could have been involved and I suspect she was. I realize that not all doctors and mental health staff are open to families but enough are. My own experience as a family member is that I have always been involved.

Anti-Psychiatry Bold and Profane

By Dr David Laing Dawson

Let me make a simple bold and somewhat profane statement about anti-psychiatry. Which I take to mean, really, anti-medical-pharmaceutical-psychiatry.

When I entered medical school and later psychiatry, I would have been content to believe that all these psychiatric illnesses were entirely “psychological” in origin and form. It was the 1960’s so I was even quite ready to believe that all this insanity was really a sane response to an insane world.

Insanity is fascinating. I have spent hours talking with, listening to people who believe the CIA is watching them, their phones are bugged, the television sends them messages, they are emissaries of God, the voices tell them they must kill someone, they are controlled by radar, Xrays, Radio waves, microchips, which in turn are controlled by the police, shadowy evil figures, particular races, the CIA, the Mafia, Martians and Venusians. The devil has figured in many of these conversations. God in many others.

I have talked with people who fear to leave the house, who keep the blinds down lest the watchers watch them, people who can’t cross an open patch of land, people who must count the ceiling tiles, who must pray every time they think a bad thought, people who must have every sequence of action and thought end in an even number.

I have talked with people too depressed to talk, to move, to shit, to piss. I have talked with people too agitated, too distraught, too full of dread to sit. I have talked to people who assumed I came from either God or The Devil or both or either. I have talked to people who could not complete a single sentence without it wandering elsewhere. I have written questions on paper for people who feared to talk at all. I have talked with people who keep their eyes on the door, or on the ground.

I write fiction and plays. Dreaming up historic, family, life event, and even intrauterine causes for mental illness is fascinating. I have entered a patient’s delusions. I have explained to a woman who thought her self to be Queen that I was the Prime Minister and therefore, in our parliamentary democracy, someone she could listen to. I have talked to “the illegitimate son of Adolf Hitler”, to a man who could “whistle up the wind”, and to women who set themselves on fire. I have talked with a man who killed two children and then their mother.

I would actually be content (but for the suffering from depression of my own mother) to have these people in humane mental hospitals, fed and clothed and active and cared for and available for me to talk with, explore, dialogue with, interpret, help to find a psychological cause, a trauma, a series of adverse childhood experiences that might explain their perceptions of reality. In fact I have done all of these. I have sat next to a manic with arm on her chair to comfort without touching, on a mattress on the floor with a man wanting to kill somebody, in parking lots and back porches. I have talked with a “King of Kings.”

It is fascinating. It is human. It is dramatic. It is sometimes comedic. It can provide me with wonderful fodder for my fiction, my plays.

But I am also a doctor. And as much as I romantically like the idea of being an Alienist, living in the manor house of the large Asylum and dining with the “lunatics”, or setting them free to roam a Grecian Isle, I must try my best to relieve their suffering. And, it seems, that from the mid 1960’s, just when I entered this field of psychiatry, we began to develop pharmaceutical agents that actually work, that relieve suffering, that restore functioning, that control these terrible illnesses.

My patients want their suffering relieved. They want their function restored. They want their illnesses controlled.

So, my anti-psychiatry friends, I must continue to prescribe drugs, relieve suffering, help restore functioning, and forgo the psychoanalytic pleasures, the philosophical, poetic explorations, the mad interpretations, just as I must insist on vaccinations for all children, and forgo all the wonderful and fanciful spiritual and moral interpretations of spots, and fevers, and delirium of the early 19th century.

The “Logic” of Anti-Psychiatry

by Marvin Ross

Our last couple of blogs have generated considerable criticism from the anti-psychiatry folks on Facebook. Not unexpected, of course, and I do enjoy (to a point) debating with them. I know that nothing that I or others say will sway them but it is important to expose them. If left unchallenged, they may influence some who are not as well educated in the realities of serious mental illness. And, for far too long, those shrill and hostile voices have made politicians cautious to implement reforms.

My blog on belief systems and anti-psychiatry I modified slightly and redid on Huffington Post. They gave the headline as Anti-Psychiatry Folks Cannot Ignore That Medication Saves Lives A much better head than mine.

One comment this received on Facebook included this:

How many people have you treated, Marvin, that your blogging is somehow more accurate than Robert Whitaker’s journalism? He spoke with psychiatrists and other mental health professionals too, many of which (sic) prescribe medications and are involved in Mad in America.

My reply:

Neither Mr Whitaker nor I have treated anyone as neither of us are doctors. I’m a simple medical journalist like he is but I also have a family member with schizophrenia so I have first hand experience into what the disease is like when it is not treated and the difference that properly prescribed medication makes. I too have talked to many psychiatrists.

The reply

Having a family member who is diagnosed with schizophrenia is not first-hand experience. It is second-hand perception, at best, depending on how much one is trusted. The person with the diagnosis is the only person with first-hand experience…not doctors, not family members.

Now I do agree that those of us who have never experienced a disease do not know exactly what it is like. But that does not mean that medical specialists do not know how best to treat based on the currently available research and the guidelines established by experts in the field. That goes for psychiatric diseases, cancer and all other diseases humans contract. And Robert Whitaker is not in step with mainstream medicine given how many have criticized him.

I don’t know all the people involved in Mad in America but I do know one – Dr Bonnie Kaplan. She is a psychologist at the University of Calgary and the leading “researcher” on The Truehope product called EM Power +. She gives a continuing education course on Mad in America on Nutrition and Mental Health where the value of EM Power + (EMP) is talked about.

To one person who posted in the discussion to her program, Dr Kaplan had this to say:

I do not see why people should not take one of the mineral/vitamin supplements that emanate from the two Alberta companies, but I cannot figure out the context for your question. If you want to discuss offline, my email is kaplan@XXXX. The appropriateness and the dose of these formulas can vary with the individual.

The two companies are Truehope and the offshoot Hardy Nutritional which was formed when the two founding partners – Tony Stephan and David Hardy – dissolved their partnership.

In 2002, Dr Kaplan’s research trial on EMP at the University of Calgary was shut down by Health Canada because it failed to meet the proper standards for a clinical trial.

The blog Neurocritic entitled one of its articles as EMPowered to Kill as one man with schizophrenia went off his meds to take EMP and brutally killed his father in a psychotic state. I have written on this case as well in Huffington Post. Health Canada has declared the product a health hazard on two occasions. I have written critical article about this in various publications and an e-book with Dr Terry Polevoy and a former Health Canada investigator and now private detective in Calgary, Ron Reinold, called Pig Pills.

The vice-president of Truehope is David Stephan who made headlines around the globe when he and his wife were convicted in the death of their toddler from untreated meningitis by a jury in Lethbridge Alberta. Both had worked as well at the Truehope call centre advising customers on their treatment. You can listen to some calls that were made to the call centre here

Dr Kaplan gives lectures where she tells the audience not to google her name (slide 3). She even went so far as to bring professional misconduct charges against Dr Terry Polevoy with the College of Physicians and Surgeons of Ontario because he criticized her work.

She is one of the people involved with Mr Whitaker on Mad in America.

Dr Dawson’s last blog on anti- depressants and benzodiazapines also received a great deal of criticism. A favourite is:

Yeah, I like to get all of my information about psych drugs, withdrawal, discontinuation, and side effects from someone’s hypothetical idea of what it should look like without their having any clue at all what actually happens when people stop or start psych drugs.

And

who wrote this drivel? – It’s not even remotely accurate

I suggested to this last person that they look at the byline to see who wrote it and then look at his bio which is on the blog. I also suggested that they state what specific statement he made that they considered wrong and to provide me with evidence from research to back it up. Nothing. And Dr Dawson has worked in psychiatric hospitals in three Canadian provinces, in the UK, was chief of psychiatry in one and has been treating patients for close to 50 years.

When I suggested to someone that prescription drugs are monitored by regulatory bodies and removed from the market if their are problems, I was met with disbelief that anything is monitored. After I posted the link to the 35 drugs removed from the market by the FDA, there was no comment. Some are psychiatric drugs and two were drugs that I took for arthritis that I had no problem with and were very effective. No comment.

And no one commented when I posted this video of the author of My Schizophrenic Life.

Addendum to Belief Systems, Mad in America and Anti-psychiatry

By Dr David Laing Dawson and Marvin Ross

Reading the comments to this blog and others of ours, there is a lot of a-historic and naive thinking. Recently, someone posted my Huffington Post blog on Open Dialogue in Finland to the Spotlight on Mental Health group set up by the Boston Globe to foster discussion of their series on the sad state of mental illness treatment and care in Massachusetts. One person criticized it claiming that I had no right to comment because I have never been to Finland, and the Finnish psychiatrist I quoted had no right to be critical because he had never been to Lapland. This is part of what that person said:

That paper by Marvin Ross is written around totally wrong information:

1) Marvin Ross has never been to Lapland to check what he wrote; thus he does not know what he speaks about…

2) The psychiatrist whom he telephoned in Helsinki, i.e. some 800 km from Lapland, had never been either…How she knew any of that I do not know.

One person commented on this blog that 10 times as many people diagnosed with schizophrenia die in the first year post diagnosis than 100 years ago and that olanzapine has killed 200,000 people worldwide.

Taking data from a number of public sources, Dr. Dawson put these statistics together:

Some American Statistics

1880

Total population: 50,000,000

A total of 91,959 “insane persons” were identified, of which 41,083 were living at home, 40,942 were in “hospitals and asylums for the insane,” 9,302 were in almshouses, and only 397 were in jails. The total number of prisoners in all jails and prisons was 58,609, so that severely mentally ill inmates constituted only 0.7 percent of the population of jails and prisons.

Average Life expectancy for entire population: low 40’s for whites

Low 30’s for blacks

2016

2016 total population: 324,000,000

Average life expectancy: men 76, women 81 (lower than Canada and most of Europe, lower still for minority groups. Much of this improvement from 1880 by preventing childhood diseases.)

U. S. Prison population : 2,200,000 (2014)

Or 716 per 100,000 American citizens are in prison. (a seven fold increase from 1880)

Mentally ill in prison estimated/measured to be 30% to over 50%

So 700,000 to over one million mentally ill are incarcerated in US prisons.

Incarceration in jail reduces life expectancy by roughly a factor of 10 years for every 5 years incarcerated. (all inmates)

Estimates/measurements of homeless in the USA:  1.5 to 2 million.

Estimates of homeless mentally ill range from 30% to over 50%.

So 500,000 to one million mentally ill are either homeless or living in shelters.

The homeless mentally ill are not receiving consistent psychiatric treatment. The incarcerated mentally ill may be receiving some limited treatment.

Adding this up:

One to two million mentally ill people are either homeless or  incarcerated in prison in the USA.

A high proportion of people with severe mental illness live in poverty.

Severe mental illness without treatment confers higher risks and co-morbidities for several serious diseases, such as cardio vascular disease. People with severe mental illness have a much higher risk of cigarette smoking and poor diet.

Untreated depression, bipolar disorder, and schizophrenia confer a much higher risk of suicide.

Homelessness and incarceration in and of itself reduces life expectancy by a considerable number of years. Neither of these groups is consistently receiving psychiatric treatment.

Psychiatric drugs do have side effects. (as do all pharmaceuticals) In a good outpatient or inpatient facility these can be monitored and treatment adjusted in partnership with patients.

But the real causes of contemporary poor life expectancy of the seriously mentally ill can be found in:

  • The illness itself untreated
  • Reduction and closing of hospitals.
  • Incarceration in jails and prisons
  • Poor or no housing. Homelessness
  • Poverty
  • Poor diet. Illicit drug use. Smoking.
  • Stigma leading to isolation and victimization
  • Poor, inadequate, or limited health care
  • Absence of good consistent psychiatric treatment.

And the overall cost of not providing good early consistent psychiatric treatment in both inpatient and outpatient facilities is calculated in the following article:

http://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/

Psychiatry, Eugenics and Mad In America Scare Tactics – Part I

By Marvin Ross

Much of what I read on the Robert Whitaker website, Mad in America, stretches logic but this newest blog has to be one of the biggest stretches I’ve seen. Dr Robert Berezin, a US psychiatrist, warns that psychiatry is moving closer and closer to eugenics.

As defined by dictionary.com “eugenics is a word that made everyone at the event uncomfortable. … The very subject evokes dark visions of forced sterilization and the eugenics horrors of the early 20th century. … The study of hereditary improvement of the human race by controlled selective breeding.”

The most famous proponent of eugenics was Adolph Hitler who wanted a pure Aryan race but the subject has been advocated by many in recent history in an attempt to eradicate debilitating diseases. In fact, one could say that the reason for amniocentesis is to do just that. Sampling of the amniotic fluid of pregnant women can predict such things as Down’s Syndrome. And some parents will opt for abortion if Down’s is found but many do not.

Amniocentesis can also predict such genetic conditions as Tay Sachs Disease where the infant usually only lasts to about age 4. But, nowhere in the article by Dr Berezin does he actually show that modern psychiatry is planning to eliminate anyone who suffers from schizophrenia or any other psychiatric disorder.

What he talks about is the fact that genetics is being employed to try to understand these conditions better. He states that:

The accepted (and dangerous) belief is that psychiatry deals with brain diseases – inherited brain diseases. We are back to absolute genetic determinism. Today’s extremely bad science is employed to validate not only the idea that schizophrenia and manic-depression are genetic brain diseases, but that depression, anxiety, phobias, psychopathy, and alcoholism are caused by bad genes

I have no idea why he considers the genetic research to be bad science other than he does not agree with it. So what if he doesn’t. He does state that “The temperamental digestion of trauma into our personalities is the source of psychiatric conditions.” But, as Dr David Laing Dawson has written on this blog:

Childhood deprivation and childhood trauma, severe and real trauma, can lead to a lifetime of struggle, failure, depression, dysthymia, emotional pain, addictions, alcoholism, fear, emotional dysregulation, failed relationships, an increase in suicide risk, and sometimes a purpose, a mission in life to help others. But not a persistent psychotic illness. On the other hand teenagers developing schizophrenia apart from a protective family are vulnerable, vulnerable to predators and bullies. So we often find a small association between schizophrenia and trauma, but not a causative relationship.

Dr Berezin’s concern does not come from anything that anyone has said about aborting fetuses that genetic testing proves will be born with schizophrenia or bipolar disorder or any serious psychiatric condition. And the reason for that is that genetics and the understanding of the causes of these diseases is nowhere near a point that this can be demonstrated with 100% accuracy. Science is a long way from getting to that point if it ever is able to.

Suggesting that these research avenues will lead to abortion, eugenics or something similar is absurd and nothing but scare tactics perpetrated by someone who does not agree with the causation theories being investigated. If these avenues lead nowhere and it is discovered that science has been on the wrong path, then science will self correct. Attempting to generate unfounded fear is counterproductive.

Next Part II by Dr David Laing Dawson

A Subjective Unscientific Analysis of Anti-Psychiatry Advocates

By Marvin Ross

Many of my Huffington Post Blogs attract some very nasty comments from the various anti-psychiatry adherents. The same applies to the blogs by my colleague Susan Inman and we get some on this blog. The Boston Globe award winning Spotlight Team featured in the film Spotlight, just did a series of articles on the sad state of mental health care in Massachusetts. Wanting to foster dialogue, they set up a Facebook Page for comments. And did they ever get comments!

I’ve been looking at more than my fair share of these comments over the years but decided to try to categorize them. So here goes.

1. I was badly treated, mistreated, misdiagnosed therefore all of psychiatry is evil. In some cases, this alleged mistreatment occurred over 50 years ago. I do believe that this happened in most cases and it should not have happened but it did. Personally, I’ve run into (or family members have) some very incompetent and inept treatment by doctors and/or hospitals. This has occurred in inpatient stays, visits to doctors or in emergency rooms. And some of these misadventures have been serious but I do not spend my time denouncing all hospitals, all doctors or all Emergency Rooms. What I have done is to complain to the appropriate authorities. And most of the time I’m successful.

As my English mom used to say, “don’t throw the baby out with the bathwater”

  2. The other very common cry is that I got help and recovered therefore everyone can recover and if they can’t, it is because the docs are bad or are trying to keep people sick to make money and peddle drugs. I’m sure there is an error term in logic where you extrapolate your particular situation to everyone. That is what these critics are doing. It is like saying I survived prostate cancer which has a 5 year survival of 98.8% so that someone with pancreatic cancer can too. Pancreatic cancer only  has a 4% 5 year survival rate. It is not the same nor is say mild anxiety comparable to treatment resistant schizophrenia. Stop mixing apples and oranges.

3. Involuntary treatment for those who are so sick that they pose a danger to themselves, others, or will deteriorate further without involuntary committal means that the state will lock up, drug and keep everyone indefinitely. None of these fears are true so learn what is entailed and get over it. And when I post a video or an article by someone like Erin Hawkes who went through about a dozen involuntary treatments till a pharmaceutical agent was found that removed her delusions, stop insulting her as some have done by calling her a victim and that she is suffering from Stockholm Syndrome.

How will you learn if you refuse to listen to other opinions?

What I suspect that these involuntary opponents do not understand is that people are not locked up without just cause or forever. There are safeguards in place to ensure regular reviews and appeals. In Ontario a few years ago, a group of so called psychiatric survivors challenged the constitutionality of community treatment orders and supplied the courts with affidavits from people who found them to be bad. This is what I wrote about that in the Huffington Post:

Justice Belobaba only had to look at the affidavit that the plaintiffs filed as part of their attack on CTOs to get an idea of how well they can work. Amy Ness had, prior to being put on a CTO, been involuntarily committed for showing violent behaviour in 2004. In 2007, while hospitalized, Ms. Ness kicked her mother in the back and hit her repeatedly. Then, in 2009, Ms. Ness grabbed a large kitchen knife and marched upstairs toward her mother after discovering a magazine about schizophrenia. In another incident, Ms. Ness kicked and punched the emergency department psychiatrist. By the time she was given a CTO in 2009, she had five hospitalizations.

Since then, while on a CTO, the judge pointed out, she takes her medication and sees her case worker on a regular basis. She has not been hospitalized, she maintains her housing and she works as a volunteer, has a job and takes courses. She does think, however, that the CTO is an attack on her personal dignity.

Herschel Hardin, a civil libertarian once wrote that:

“The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness – free them from the Bastille of their psychoses – and restore their dignity, their free will and the meaningful exercise of their liberties.”

A psychiatrist I know who is a libertarian (someone who believes that people should be allowed to do and say what they want without any interference from the government) told me that when your brain is immersed in psychoses, you are not capable of doing or saying what you want. Therefore, he was fully supportive of involuntary treatment so that people could get to the position where they had the capacity to do what they want.

4. And then we come to what Dr Joe Schwarcz on his radio show, Dr Joe, calls scientific illiteracy. He used that in his July 10 interview with my colleague, Dr Terry Polevoy, in a discussion on EM Power + and the conviction of the Stephans for failing to provide the necessities of life for their child who died of bacterial meningitis. They refused all conventional medical care, gave him vitamins, herbal products and echinacea till the poor little toddler stopped breathing.

There was a case of scientific illiteracy in that the parents are totally opposed to vaccinations and work for a  company that encourages people with mental illnesses to go off meds in favour of their proprietary vitamins. They had no idea why they were convicted, lashed out at the jury who convicted them and then, at their sentencing hearing, the wife shocked even her own lawyer when she told the court that the Crown had used a phony autopsy report as evidence.

Other examples are that anti-depressants cause violence and suicide. Violence possibly in those under 24 according to a large Swedish study but not in adults. However, the authors state that these findings need validation. There is no definitive proof of this and no evidence of increased violence in adults.

As for anti-depressants causing suicide, a warning that this might be a concern was posted on the labels. Doctors were advised to be cautious when prescribing these for depressed young people.Consequently, this resulted in an increase in suicide attempts.

“Evidence now shows that antidepressant prescription rates dropped precipitously beginning with the public health advisory in March 2004, which preceded the black box warning in October 2004. Since the initial public health advisory, antidepressant prescriptions for children and adolescents decreased, with a consequent increase (14%) in incidence of suicide in these populations.”

On my to-read list is Ordinarily Well The Case for Antidepressants by psychiatrist Peter D Kramer. Kramer is the author of Listening to Prozac and, in this new book, he continues with proof that antidepressants do work and are not simply placebos. Not only do they work, but they are life savers.

In the New York Times review by Scott Stossel, the reviewer points out that when Kramer first began visiting psychiatric wards in the 1970’s, they were filled with people suffering what was then known as “end-state depression”. These were depressed patients in what appeared to be psychotic catatonic states.

Patients like that have not been seen for decades which he attributes to the aggressive use of antidepressants.

And, lest we forget, there is also the common view that the chronicity of psychiatric disorders are caused by the drugs that doctors force on their patients. People love to quote the work of Martin Harrow in Chicago but I suspect that many have not actually read his studies. Some people, he found,  did better after going off anti-psychotics over time than those who continued with their use but that is not surprising. It has always been known that some people improve while others have chronic problems and still others are not able to be helped with anything.

What they do not realize is that in Harrow’s study, 79 per cent and 64 per cent of the patients were on medication at 10- and 15-year follow ups. And that Harrow points out 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. And 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.

So stop with the reference to Harrow that no one needs meds. And stop also with promoting Open Dialogue when, first, it has never been empirically validated and second, many of their patients are on medication.

5. Regrettably, many of these people lack any civility whatsoever. People are entitled to offer their comments but they should not do so anonymously. And they should show some respect for those who have different views. I’m told that some have been banned from the Spotlight Facebook page and I’ve just banned one anonymous person who posts here for his/her personal attacks. I mentioned above that Erin has been called a willing victim and one who suffers with the Stockholm syndrome for her video and her article. Refute the points she makes but leave the insults aside.

And, one post that I removed from the After Her Brain Broke page on Susan Inman in response to he video What Families Need From the Mental Health System claimed that Susan keeps her daughter locked up and ill and that she likely suffers from Munchausen by proxy.

 

The American Psychiatric Association Annual Conference 2015 and Silly Season

newer meBy Marvin Ross with an Addendum by Dr David Laing Dawson

This year, the American Psychiatric Association (APA) is having its annual conference in Toronto starting May 16 and, again, they are being picketed. While most Canadians are enjoying the first long weekend of summer opening cottages, having picnics, planting their gardens and enjoying the fireworks –a hold over from our colonial heritage celebrating the birthday of Queen Victoria – anti-psychiatrists are marching.

Strangely, this is not an unusual event. The APA is the only medical organization that is regularly picketed and this year, opponents of electroconvulsive shock therapy (ECT), are gathering at Toronto’s City Hall Square to march across the street to the Sheraton Hotel. This is a rather curious locale since the conference is at the Metro Convention Centre about a mile from the hotel.

According to the facebook manifesto “this psychiatric organization constantly deceives, minimizes and generally lies about the devastating trauma, permanent memory loss and brain damage caused by electroshock. It actively promotes ECT and holds continuing education courses, funded by Big Pharma, at all its annual meetings.”

It goes on to say that “In its 2007 official policy position statement, the APA claims, “Electroconvulsive therapy is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients.”

The APA and The National Institute for Health and Care Excellence (NICE) in the UK do not endorse the use of ECT based on a whim or without proper evidence and they do not recommend it for everyone. ECT is used for rapid improvement, in the short term, of these symptoms

  • Severe depressive illness or refractory depression.
  • Catatonia.
  • A prolonged or severe episode of mania.

It should only be used if other treatment options have failed or the condition is potentially life-threatening (eg, personal distress, social impairment or high suicide risk).

A metaanalysis published in 2014 that compared ECT with the newer transcranial magnetic stimulation concluded that ECT is the leading therapeutic modality for patients with treatment resistant depression.

ECT can be helpful! Now I would join the protesters if psychiatrists dragged unsuspecting patients out of their hospital beds, hustled them down the hall to a room where they attached electrodes to their heads and zapped them with electricity.

But this does not happen!

There is this thing know as informed consent and every patient, or their substitute decision maker if they are not competent, signs one. Before a doctor can treat – be it ECT or pumping toxic chemicals into the body to rid it of cancer – the patient must understand the potential risks and benefits of the treatment before consenting to it. With ECT, the patient is in extreme distress, nothing else has helped and they are desperate for relief.

For some stranger like those marching at the Sheraton Hotel in Toronto to think they can decide what is good or not good for a patient takes an enormous amount of chutzpah.

A Personal View of ECT from Dr David Laing Dawson

The year was 1969. I was a psychiatric resident in a new open-door nicely appointed psychiatric ward and I didn’t think much of ECT. It had been overused in the past, but all specialties of medicine have a history of finding a treatment that works (finally!) and then over-using it, from antibiotics to every kind of surgery. Still, it just felt wrong to induce a seizure, a convulsion, to fix a mental disorder, especially when we had no clue why it actually worked.

So I avoided using ECT, and had managed without it for about a year and a half.

And then a man in his twenties was admitted to my care. He was thin, almost emaciated, and not talking. He had been living in a small room in the back of his parents’ downtown apartment and had gradually ceased to look after himself or get out of bed. Now he lay on his back in a hospital bed. He did not speak. He made no eye contact.

I sat beside him and talked. Nothing. Over time I gave him several medications and then withdrew them. Nothing. I hauled him out of bed each day for a week, and, holding his arm, walked him around the hospital ward. Nothing. We could keep him hydrated with some nutrients but he was still not eating.

So it came down to ECT. Six treatments. His mood brightened. He made eye contact. He ate. He talked to me. He remained my patient for a few months, moving to the day hospital and then outpatients. Because he now talked with me I could figure out what medications might keep him well.

And for five years after that, every year, I received a Christmas card from him thanking me.

And today, perhaps with thanks to Jack Nicholson, of all the treatments and procedures administered by modern medicine for serious illness, ECT is one of the safest, most effective, and very carefully restricted and monitored.