"The Illusions of Psychiatry"

[ellenrr]

Former editor-in-chief of New England Journal of Medicine, Marcia Angell, reviews these books:

The Emperor’s New Drugs: Exploding the Antidepressant Myth
by Irving Kirsch

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis
by Daniel Carlat


Recommended reading for anyone who believes in the myth of
"chemical imbalance" as the basis for so-called mental illness.

Daniel Carlat, who treats patients with drugs, candidly says "his work consists of asking patients a series of questions about their symptoms to see whether they match up with any of the disorders in the DSM. This matching exercise, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels.” Often patients meet criteria for more than one diagnosis, because there is overlap in symptoms. For example, difficulty concentrating is a criterion for more than one disorder. One of Carlat’s patients ended up with seven separate diagnoses. “We target discrete symptoms with treatments, and other drugs are piled on top to treat side effects.” A typical patient, he says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa)."

"The pharmaceutical industry influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective. What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects. The apparent prevalence of “juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of “autism” increased from one in five hundred children to one in ninety over the same decade. Ten percent of ten-year-old boys now take daily stimulants for ADHD—”attention deficit/hyperactivity disorder”—and 500,000 children take antipsychotic drugs."


http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

[patrice]

1. Drugs are easier and cheaper than actually helping one another. nt

[damntexdem]

2. Drugs really did bring about a revolution in mental health treatment, but ...

the pharmaceutical industry is not there to treat but to profit off of pushing drugs.

[xchrom]

3. Drugs have done a lot of good for me in my time.

But I've also had to try a lot of drugs that didn't work.

What I've always wanted & never been able to get was analysis.
Most talk therapy modalities have been effective only for short periods.

[Tunkamerica]

4. Drugs

[ananda]

5. Psychiatry is nothing but a sleazy drug pushing business.

It isn't about healing the mind at all.

[Deep13]

6. Bullshit.

Psychiatry has helped me and many others tremendously. The psychotherapy helped, of course, but nothing controls anxiety and depression like drugs. I will never go back to the way I was.

[xchrom]

9. +1

[laconicsax]

10. It's funny, really.

People who actually have to deal with major/severe depression on a daily basis and have found anti-depressants an effective treatment seem to be the only people who don't buy into the whole "The Secret" mentality of the whole "cure yourself through imagining yourself happy" anti-pharmaceutical garbage.

Don't you just love being told that it's your own damn fault that you're depressed?

[HuckleB]

12. +1,000,000,000 ...

[shireen]

16. +1 too

i get really annoyed when i hear the psychiatry does not work crap.

[drokhole]

7. The documentary "Feed Your Head" covers this subject rather well...

http://store.documentarychannel.com/Feed-Your-Head-p/1065.htm

What causes mental illness? Are we, indeed, what we eat? "FEED YOUR HEAD" is a documentary that looks at this question. Psychiatrists Abram Hoffer and Humphry Osmond met in Saskatchewan in 1951, and embarked on a quest to do what traditional psychiatry deemed impossible: to find a cure for schizophrenia. Their work spawned a number of directions for research, many of which are only gaining acceptance in wider circles now. Their primary contribution to psychiatry was a theory about treating people suffering from mental illness using nutrition. Hoffer and Osmond set out to prove that the symptoms of schizophrenia could be controlled with healthy, unprocessed food and large doses of vitamins.

Linus Pauling was an American scientist, peace activist, two-time Nobel Prize winning author and educator. Pauling & Hoffer became friends and together advocated for mega-doses of niacin, vitamin C and other nutrients in the treatment of all kinds of disease. Pauling came up with the name “Orthomolecular” for this new, yet ancient, form of treatment. Orthomolecular means “the right molecules in the right amounts.” Hoffer, Osmond and Pauling were way ahead of their time. Their work coincided with a general movement towards de-institutionalization in mental health, releasing patients back into the community with no real support system.

At the same time, economic changes were bringing budget cuts to all aspects of health care in North America. This was also the dawn of the age of Big Pharma. Multi-national pharmaceutical corporations sprung up in the 1950s and 60s, introducing new anti-psychotic drugs that made it possible to control, if not actually help, the mentally ill. Consumers put their faith in the idea of the “magic bullet” and since then, psychiatry has been largely controlled by the pharmaceutical industry. For their efforts, Hoffer, Osmond, Pauling & hundreds of like-minded doctors were condemned by their peers. The tide is turning: a growing wave of consumer demand is driving an orthomolecular resurgence. Doctors and patients are being slowly won over by a simple idea that makes more sense every day. WE ARE WHAT WE EAT.

[mopinko]

34. so how do you explain the clear evidence of genetic links?

my dad grew up eating the healthiest of foods, grown in their garden, shot in the woods, homemade. hell, the closest he came to processed food was home canned tomatoes. yet he developed bi-polar. probably inherited it from his father, who we don't know enough to guess about.
my sister has it, my daughter has it. they all had completely different diets. so, where is the connection to diet?

[knowbody0]

8. and no one even speaks of the broken spirit

or attempts to heal it. an absolute atrocity, imho. to numb and subdue the life force of a child. how ridiculous. I had a foster child with impulse control problems and it was deemed he needed ritalin to remain in school. he was five and born addicted to heroin and had fetal alcohol syndrome. the entire left side of his face went slack, downturned mouth, droopy eye and cheek. he cried a lonely moanful cry through the night. I secretly stopped the drugs and put him in taekwondo.

I adopted him and his two sisters. he thrived in school, is now in college, head cashier at a target store and drives a bmw.

so there.

[laconicsax]

11. Yes, the problem is overbroad DSM criteria and industry pressure.

Anti-depressants, especially SSRIs, are overprescribed to people for whom the drugs will not work. Unfortunately, anti-medicine folks who don't understand how medications need to actually work before being approved latch onto reports that the drugs don't work for everyone as proof that the don't work at all, are part of an "evul conspiracy," and that faith-healing bullshit like "The Secret" and other CAM scams are the only effective way.

[sense]

13. Anti-depressants don't work for people who

don't have major depression. They are no better than placebo and have some pretty severe side effects that are depressing in themselves such as weight gain and loss of sex drive.

http://www.theepochtimes.com/n2/health/do-you-have-depression-57602.html

http://www.newsweek.com/2010/01/28/the-depressing-news-about-antidepressants.html

[LeftishBrit]

15. True...

just as antibiotics don't work for people who don't have bacterial infections.

The problem in both cases is the misapplication of drugs for conditions for which they're not appropriate, not that they are never useful, or that the conditions that they treat are imaginary, as suggested by some of the sources in the OP.

[LeftishBrit]

14. It's true that these drugs are often over-prescribed ...

And probably even more in America than in the UK. (Certainly there are far fewer kids here on Ritalin.)

It's easier to prescribe a tablet than to devote time to finding out more about what is wrong in a particular case.

But this does not mean that NO ONE needs psychiatric drugs, or that mental illness is just a myth, or that chemical imbalances have nothing to do with it. There are many people who have been saved from suicide by the right drugs, for example.

In a way it's a bit like the situation with antibiotics. At a certain time, doctors were prescribing antibiotics for all sorts of conditions like colds, for which antibiotics are unnecessary and don't work. This had risks for the individuals, as all drugs can have side effects; and also contributed to the increase in antibiotic-resistant bacteria. But many people have had their lives saved by antibiotic treatment for diseases such as pneumonia and TB and meningitis; and a lot more people would die young if there were no antibiotics.

So people should not swallow pills like sweets, but they should not reject the importance of drugs for many serious illnesses, whether psychiatric, infectious, or in other categories. And in particular people should not dismiss mental illness as imaginary. It exists and is an important source of pain for many.

[ellenrr]

20. Could you pls provide some evidence for your belief that mental illness is caused by a

chemical imbalance?

Scientific evidence, unbaised evidence, not evidence produced by researchers in the pay of big pharma.

[Odin2005]

21. Yup, Seratonin doesn't exist! It's a conspiracy by Big Pharma! *SARCASM*

[LeftishBrit]

23. Which scientists or organizations would you consider as sufficiently 'unbiased'? '

Would researchers at universities and hospitals in countries with single-payer healthcare be OK sources for you, or would you consider them too as 'in the pay of big pharma'?

[ellenrr]

27. I would consider those researchers not in the pocket of Big Pharma,

and if you look at any of the references of my earlier post -
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x106098
msg #11
you will see there is no scientific evidence for the chemical imbalance theory nor for the serotonin.

Forget the part about big pharma if that bothers you, the point is look at the evidence.

[LeftishBrit]

31. Here's a link to an article that summarizes the evidence

http://www.ncbi.nlm.nih.gov/pubmed/7508830

And another relevant one:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764545/

A gene associated with serotonin transport is linked with risk for depression:

http://www.medscape.com/viewarticle/735478

And it's not only antidepressant drugs that are being investigated from the point of view of their influences on serotonin; the theory that omega 3 fatty acids may have a beneficial effect on depression comes from their influence on serotonin (now being tested).

What IS true is that it's unlikely that serotonin levels are the ONLY factor in depression. There are likely to be quite a few things involved.

It isn't the 'big pharma bit' that worries me; it's the idea that is often promulgated that depression isn't a real illness, and that depressed people just have to pull themselves together and 'think positively'.

[HuckleB]

32. +1

Thanks for the taking the time to put that together. I just don't have the energy for this discussion anymore.

[Jim__]

17. In Part I of this review, there is a discussion of how double-blind tests may break down.

Here's a link to Part I.

At this point in the review, they are discussing Kirsch's book:

It is important that clinical trials, particularly those dealing with subjective conditions like depression, remain double-blind, with neither patients nor doctors knowing whether or not they are getting a placebo. That prevents both patients and doctors from imagining improvements that are not there, something that is more likely if they believe the agent being administered is an active drug instead of a placebo. Faced with his findings that nearly any pill with side effects was slightly more effective in treating depression than an inert placebo, Kirsch speculated that the presence of side effects in individuals receiving drugs enabled them to guess correctly that they were getting active treatment—and this was borne out by interviews with patients and doctors—which made them more likely to report improvement. He suggests that the reason antidepressants appear to work better in relieving severe depression than in less severe cases is that patients with severe symptoms are likely to be on higher doses and therefore experience more side effects.

To further investigate whether side effects bias responses, Kirsch looked at some trials that employed “active” placebos instead of inert ones. An active placebo is one that itself produces side effects, such as atropine—a drug that selectively blocks the action of certain types of nerve fibers. Although not an antidepressant, atropine causes, among other things, a noticeably dry mouth. In trials using atropine as the placebo, there was no difference between the antidepressant and the active placebo. Everyone had side effects of one type or another, and everyone reported the same level of improvement. Kirsch reported a number of other odd findings in clinical trials of antidepressants, including the fact that there is no dose-response curve—that is, high doses worked no better than low ones—which is extremely unlikely for truly effective drugs. “Putting all this together,” writes Kirsch,

leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing “regular” placebos to “extra-strength” placebos.

That is a startling conclusion that flies in the face of widely accepted medical opinion, but Kirsch reaches it in a careful, logical way. Psychiatrists who use antidepressants—and that’s most of them—and patients who take them might insist that they know from clinical experience that the drugs work. But anecdotes are known to be a treacherous way to evaluate medical treatments, since they are so subject to bias; they can suggest hypotheses to be studied, but they cannot prove them. That is why the development of the double-blind, randomized, placebo-controlled clinical trial in the middle of the past century was such an important advance in medical science. Anecdotes about leeches or laetrile or megadoses of vitamin C, or any number of other popular treatments, could not stand up to the scrutiny of well-designed trials. Kirsch is a faithful proponent of the scientific method, and his voice therefore brings a welcome objectivity to a subject often swayed by anecdotes, emotions, or, as we will see, self-interest.

Kirsch's book also discusses bias in the published literature:

Kirsch and his colleagues used the Freedom of Information Act to obtain FDA reviews of all placebo-controlled clinical trials, whether positive or negative, submitted for the initial approval of the six most widely used antidepressant drugs approved between 1987 and 1999—Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor. This was a better data set than the one used in his previous study, not only because it included negative studies but because the FDA sets uniform quality standards for the trials it reviews and not all of the published research in Kirsch’s earlier study had been submitted to the FDA as part of a drug approval application.

Altogether, there were forty-two trials of the six drugs. Most of them were negative. Overall, placebos were 82 percent as effective as the drugs, as measured by the Hamilton Depression Scale (HAM-D), a widely used score of symptoms of depression. The average difference between drug and placebo was only 1.8 points on the HAM-D, a difference that, while statistically significant, was clinically meaningless. The results were much the same for all six drugs: they were all equally unimpressive. Yet because the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants.

[hedgehog]

18. I'd like to counter with a thought experiment:

Many, many people with depression/anxiety disorders go through a series of combinations of medications, dosages, etc. before finding the right drug(s). Let us suppose that any single drug might be suitable for 10% of the people with depression.

If you have a random group, only 10% will respond.

But - if you could identify the people with that particular problem, gave them all the drug, then you'd get a 100% response.

In effect- that's what happens. Good doctors work with their patients to fine tune the treatment.

Thus, people who are skeptical of these drugs point to the random tests and say they don't work. People who find the right combo get their lives back.

another measure of effectiveness - many (most) of these drugs have some side effects. Why would people take drugs that can cause weight gain and/or loss of libido unless taking the drugs meant a net improvement in health?

[Jim__]

19. I'm not sure what your thought experiment is meant to counter.

My post had 2 main points taken from the review:

1. Under certain conditions, double-blind tests may break down. Patients and doctors, based on their own statements, know who is taking the treatment drug. This is a violation of the basic assumption of a double-blind test, and, as such, can invalidate the entire test.
   
2. The scientific literature on pharmaceuticals is biased. This is a serious concern because it indicates that when doctors turn to the literature for information, all that can be found is, effectively, corporate advertising.
   

As to what you are saying about treatment, my reading of the review is that a large part of the problem is that the emphasis is not on identifying actual causes and treatments of disease, but on marketing pharmaceuticals. It's more about the system than about individual doctors.

[mopinko]

35. awful lot of docs would be throwing away the trust of their

patients if the drugs did not eventually help. not something any doc, let alone a shrink, would throw away. or survive without.

[Sgent]

26. That's of course possible

but your trusting one (admittedly respected) researcher to summarize hundred's of studies, which all contradict him.

IN addition, you don't need much of a study to see that certain drugs (haldol, etc.) work very well in certain situations (mania, etc.). By default, this makes the OP's claim that all drugs are worthless invalid.

[Jim__]

28. You claim that hundreds of studies contradict Dr Kirsch's findings.

His findings that I listed were:

It is important that clinical trials, particularly those dealing with subjective conditions like depression, remain double-blind, with neither patients nor doctors knowing whether or not they are getting a placebo. That prevents both patients and doctors from imagining improvements that are not there, something that is more likely if they believe the agent being administered is an active drug instead of a placebo. Faced with his findings that nearly any pill with side effects was slightly more effective in treating depression than an inert placebo, Kirsch speculated that the presence of side effects in individuals receiving drugs enabled them to guess correctly that they were getting active treatment—and this was borne out by interviews with patients and doctors—which made them more likely to report improvement. ...

To further investigate whether side effects bias responses, Kirsch looked at some trials that employed “active” placebos instead of inert ones. An active placebo is one that itself produces side effects, such as atropine—a drug that selectively blocks the action of certain types of nerve fibers. Although not an antidepressant, atropine causes, among other things, a noticeably dry mouth. In trials using atropine as the placebo, there was no difference between the antidepressant and the active placebo. Everyone had side effects of one type or another, and everyone reported the same level of improvement. Kirsch reported a number of other odd findings in clinical trials of antidepressants, including the fact that there is no dose-response curve—that is, high doses worked no better than low ones—which is extremely unlikely for truly effective drugs. “Putting all this together,” writes Kirsch, ...

Can you cite any studies that contradict those findings?

As to your claim: By default, this makes the OP's claim that all drugs are worthless invalid.

I don't see where the OP makes such a claim.

[Odin2005]

22. RIGHT, it was only a coincidence my panic attacks stopped when I started taking Paxil.

What a load of garbage.

[CanSocDem]

24. One man's garbage....etc

"Psychiatrists who use antidepressants—and that’s most of them—and patients who take them might insist that they know from clinical experience that the drugs work. But anecdotes are known to be a treacherous way to evaluate medical treatments, since they are so subject to bias;..."



From Jim's post
.

[laconicsax]

30. Drugs have to undergo clinical trials befor being being approved for use.

If they aren't shown to be effective, they aren't approved.

[HuckleB]

33. Hogwash!

Pure hogwash!

;)

[Crunchy Frog]

25. Anecdotal.

:shrug:

[laconicsax]

29. Interesting...

A drug is shown in double-blind clinical trials to have an effect, yet someone's report of experiencing that effect from the same drug is merely anecdotal?

I guess you can't rely on reports of pain-relief from ibuprofen users.