In the News

ISEPP Leadership Changes

10/18/2015        In the News 0 Comments

On October 11, 2015 the ISEPP Board of Directors held elections for the following leadership positions of Executive Director, Chairperson of the Board, and new Board members.

ChuckRubyChuck Ruby, Ph.D., was unanimously elected to assume the position of Executive Director effective immediately. Chuck joined ISEPP (ICSPP) about 10 years ago and since 2013, had held the position of Chairperson of the Board. He is the Director and General Manager of the Pinnacle Center for Mental Health and Human Relations, a group private practice in southern Maryland. He is also a member of Psychologists for Social Responsibility, a nonprofit volunteer organization seeking to apply psychological knowledge and expertise to promote peace, social justice, and human rights.

DominicRiccioReplacing Chuck as Chairperson of the Board is Dominick Riccio, Ph.D. Dominick held the position of Executive Director from 2002 to 2008, and from 2013 to 2015. He has been with ISEPP (ICSPP) for many years. He is a clinical psychologist and psychoanalyst in private practice in New York City. He has been a supervisor and training analyst at various psychoanalytic institutes.  He is past co-founder and clinical director of Encounter, Inc., a prototype drug rehabilitation for teenagers. He has previously served as both president and vice-president of the Association for Modern Psychoanalysis, as well as founder and executive director of the Institute for the Treatment and Research of Psychosomatic Disorder.

Three new Board members were also elected.

JoanneJoan Cacciatore, Ph.D., has worked with people who are affected by traumatic death, particularly the death of a child, for nearly 20 years. She uses non-traditional, mindfulness-based approaches such as trauma focused psychoeducation, fully present narration, emotion-focused imaginal dialogue, symbols-metaphor-and-rituals, bibliotherapy, ecotherapy, meditation, yoga, and shinrin-yoku. She is also a professor & researcher at Arizona State University and the founder of the MISS Foundation, an international nonprofit organization with 75 chapters around the world aiding parents whose children have died or are dying.

Mary-Neal-Vieten-179x300Mary Vieten, Ph.D., ABPP, is a psychologist and U.S. Navy Commander with the Select Reserves. She has a private practice in southern Maryland where she serves clients who are military, paramilitary, veterans, and civilians who are exposed to high risk environments like police work and combat situations. She encourages clients to pursue trauma recovery work outside the medical model and educates them on the dangers and ineffectiveness of psychiatric drug treatment. Mary is ISEPP's Director of Operation Speak Up, an effort to critique and challenge the government's medical model treatment of those who suffer from traumatic experiences. In furtherance of this, she recently partnered with Melwood, a non-profit organization devoted to assisting people with disabilities, to develop and run a free week-long retreat for veterans and active duty military using this non-medical model.

nhunterNoel Hunter, M.A., M.S., is a clinical psychology doctoral candidate set to graduate in May 2016. She has over 40 publications and presentations on the topic of trauma and psychosis, barriers to humanistic approaches to suffering, and the need for major systemic change in all areas of mental health. Recently, she completed her dissertation of first-person perspectives on what is helpful and harmful in the treatment of severe dissociative states. Noel is also on the Board of Directors for Hearing Voices Network-USA, was previously the "experts-by-experience" Chair for ISPS, and is a blogger at madinamerica.com. Her own personal experiences and her passion for social justice fuel her outspoken nature and drive for change. To keep it real, however, she spends much of her time performing improv comedy in NYC.

NAMI Increases Stigma

10/11/2015        In the News 0 Comments

miaw-bannerby William Schultz, Doctoral Student, Minnesota School of Professional Psychology


The first full week of October (October 4th – 10th) is “Mental Illness Awareness Week” (MIAW). The primary purposes of MIAW are to fight stigma, provide educational material to the public, and to push for better mental health care. The National Alliance on Mental Illness (NAMI) has energetically promoted MIAW. This isn’t surprising since NAMI’s goals are to fight stigma, raise awareness, and provide education about “mental illness” to mental health patients, the public, and policy makers (NAMI, 2015a). But NAMI’s efforts may, in fact, be making the matter worse.

No doubt the stated NAMI goals are important. Millions of individuals suffer from significant emotional and mental distress (often called mental illness or psychological disorders – terminology I dislike but will use for clarity in what follows). Lack of awareness, as well as stigma surrounding psychological disorders, contribute to these individuals not seeking the assistance of mental health professionals (Bharadwaj, Pai, & Suziedeltye, 2015). This is unfortunate because many forms of psychological disorders can be significantly diminished through treatment. For example, Khan, Faucett, Lichtenberg, Kirsch, and Brown (2012) conducted a meta-analysis of hundreds of studies. Their meta-analysis found that the depressive symptoms of patients who participated in psychotherapy decreased by about 50%. On the other hand, the depressive symptoms of patients on a waiting list only decreased by about 10%. This finding led Khan et al. (2012) to argue “engaging in treatment is critical to improvement” (p. 9).  

Since treatment is important, and reducing stigma is thought to increase treatment seeking, it’s not surprising that for some time mental health advocacy organizations have done their best to try to reduce stigma. But NAMI's misstep is to promote a biological etiology of psychological disorders (Corrigan & Watson, 2004). The underlying idea behind this approach is that there will be less blame associated with psychological disorders if patients and the public conceptualize psychological disorders as biological illnesses (Corrigan et al., 2000). For example, if biological etiologies of depression were embraced, the public may view someone experiencing depression as chemically-imbalanced or genetically predisposed instead of weak willed or lazy. It’s thought that stigma can be diminished by decreasing or removing the element of moral blame associated with being weak willed or lazy. 

NAMI has a long history of ostensibly fighting stigma by claiming that psychological disorders are a biological, medical illness like cancer or diabetes (Angermeyer, Holzinger, Carta, & Schomerus, 2011; Deacon, 2013; Kvaale, Haslam, & Gottdiener, 2013; Lebowitz & Ahn, 2012). For example, a study by University of Michigan researchers found that NAMI’s web site information about depression emphasized biological etiologies (Hansell et al., 2011). While depression treatment centers, universities, and government websites generally provided approximately proportional descriptions of biological and psychosocial causes of depression, NAMI’s website – like pharmaceutical company websites -- focused much more on biological causes. While treatment centers, universities, and governments provided balanced explanations or even explanations that emphasized psychosocial causes, “The NAMI Website, for example, showed a 9:1 ratio in biological to psychosocial content about depression” (Hansell et al., 2011, p. 387). This sort of finding probably goes a far way of explaining why the first treatment option listed for the majority of the mental health conditions on NAMI’s “Fact Sheet Library” is medication (NAMI, 2015b) – though Hansell et al. (2011) suggested that the emphasis on biological etiologies “may in part reflect NAMI’s close relationship with pharmaceutical companies” (p. 387). 

If an accurate reflection of reality, NAMIs approach seems coherent. That is, if emphasizing biological etiologies can diminish stigma and diminishing stigma can lead to improved treatment outcomes, then NAMI’s approach seems to have some plausibility. 

However, NAMI’s perspective on psychological disorders is troublesome for at least three reasons:

First, biological etiologies of psychological disorders do not necessarily decrease stigma. In fact, a large body of evidence suggests that biological etiologies of mental illness can increase stigma associated with many psychological disorders (Schomerus, Matschinger, & Angermeyer, 2014; Speerforck, Schomerus, Pruess, & Angermeyer, 2014). One prominent explanation for this finding is that although biological etiologies may diminish moral blame, they increase the perceived dangerousness and difference of those experiencing mental illness.  

Second, emphasizing biological etiologies implies that biological interventions (e.g., medications) are the preferred treatment (Deacon, 2013; Kemp, J. J., Lickel, J. J., & Deacon, 2014; Read, Cartwright, Gibson, Shiels, & Magliano, 2015). This is concerning because substantial evidence suggests that very often medications do not provide significantly superior treatment benefits for psychological disorders when compared to psychotherapy (Cuijpers, Sijbrandij, Koole, Andersson, Beekman, & Reynolds, 2013; Harrow, Jobe, & Faull, 2012; Khan et al., 2012) and medications have a long list of negative effects, some of them very serious (Andrews, Thomson, Amstadter, & Neale, 2012; Kirsch, 2014; Moncrieff, 2009; Moncrieff 2013).

Third, emphasizing biological etiologies can have significant clinical impacts. Individuals who endorse a primarily or exclusively biological etiology of psychological disorders have increased prognostic pessimism, probably because they’ve accepted an essentialist account of their identity which leads them to believe they have little ability to modify their subjective experience (Lebowitz, 2014; Schultz, 2016). Increased prognostic pessimism is an important clinical factor because individuals’ expectancies for improvement is a significant contributor to their actual improvement. Individuals who expect to do better, do better (Constantino, 2012). 

To sum up, MIAW has a great chance to educate the public about the prevalence, causes, and treatment options for psychological disorders. I hope this short piece shows that the perspective adopted by NAMI is not comprehensive and probably harmful to clients. 

But what about stigma? Well, as I wrote previously: “… a biological understanding of psychological disorders is not the only way to combat stigma. We can adopt a compassionate attitude toward those struggling with [psychological disorders] even if we don’t also accept the view that their [psychological disorders are] biologically determined. For example, individuals [with psychological disorders] may simply not know other ways to manage their emotions or they may be dealing with a variety of stressors which overwhelm their ability to cope in a more adaptive way. Neither of these views suggests that the proper attitude is to judge and chastise individuals…as being weak willed” (Schultz, 2015).

References

Andrews, P. W., Thomson Jr, J. A., Amstadter, A., & Neale, M. C. (2012). Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good. Frontiers in Psychology3, 117.

Angermeyer, M. C., Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. The British Journal of Psychiatry199(5), 367-372.

Bharadwaj, P., Pai, M. M., & Suziedelyte, A. (2015). Mental Health Stigma (No. w21240). National Bureau of Economic Research.

Constantino, M. J. (2012). Believing is seeing: an evolving research program on patients' psychotherapy expectations. Psychotherapy Research, 22(2), 127-138.

Corrigan, P. W., River, L. P., Lundin, R. K., Wasowski, K. U., Campion, J., Mathisen, J., Goldstein, H., Bergman, M., Gagnon, C., & Kubiak, M. A. (2000). Stigmatizing attributions about mental illness. Journal of Community Psychology28(1), 91-102.

Corrigan, P. W., & Watson, A. C. (2004). At issue: Stop the stigma: call mental illness a brain disease. Schizophrenia Bulletin30(3), 477-479.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons. World Psychiatry12(2), 137-148.

Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review33(7), 846-861.

Hansell, J., Bailin, A. P., Franke, K. A., Kraft, J. M., Wu, H. Y., Dolsen, M. R., Harley, V. S., & Kazi, N. F. (2011). Conceptually sound thinking about depression: An Internet survey and its implications. Professional Psychology: Research and Practice42(5), 382-390.

Harrow, M., Jobe, T. H., & Faull, R. N. (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine42(10), 2145-2155.

Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals' perceptions of their depressive symptoms. Behaviour Research and Therapy56, 47-52.

Khan, A., Faucett, J., Lichtenberg, P., Kirsch, I., & Brown, W. A. (2012). A systematic review of comparative efficacy of treatments and controls for depression. PloS one7(7), e41778.

Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review33(6), 782-794.

Lebowitz, M. S. (2014). Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences. Clinical Psychology: Science and Practice21(1), 67-83.

Lebowitz, M. S., & Ahn, W. K. (2012). Combining biomedical accounts of mental disorders with treatability information to reduce mental illness stigma. Psychiatric Services63(5), 496-499.

Moncrieff, J. (2008). The myth of the chemical cure: A critique of psychiatric drug treatment. New York, NY: Palgrave Macmillan.

Moncrieff, J. (2013). The bitterest pills: The troubling story of antipsychotic drugs. New York, NY: Palgrave Macmillan.

National Alliance on Mental Illness. (2015a). About NAMI. Retrieved from https://www.nami.org/About-NAMI

National Alliance on Mental Illness. (2015b). Fact sheet library. Retrieved from https://www.nami.org/Learn-More/Fact-Sheet-Library

Read, J., Cartwright, C., Gibson, K., Shiels, C., & Magliano, L. (2015). Beliefs of people taking antidepressants about the causes of their own depression. Journal of Affective Disorders174, 150-156.

Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2014). Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychological Medicine44(02), 303-314.

Schultz, W. E. R. (2015) Binge eating and genetics. Retrieved from https://www.madinamerica.com/2015/08/binge-eating-and-genetics/

Schultz, W. E. R. (2016). Neuroessentialism: Theoretical and clinical considerations. The Journal of Humanistic Psychology. Accepted for publication.

Speerforck, S., Schomerus, G., Pruess, S., & Angermeyer, M. C. (2014). Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: Is the concept of a chemical imbalance beneficial?. Journal of Affective Disorders168, 224-228.

 

ISEPP Sadly Loses One of its Best

10/6/2015        In the News 0 Comments

Hansenby Rick Winking


We received word here at ISEPP that one of our favorite members had passed. Ben Hansen, alias Dr. Bonkers, ended his struggle with bladder cancer on September 14th. He was 60 years old and fought the good fight until the end, refusing any medication and dying pain free and peacefully at home with the help of Hospice of Michigan.

We all know that psychiatry is a joke. We know that scientifically, they don’t have a leg to stand on. It was Ben Hansen and his Bonkers Institute for Nearly Genuine Research that really helped put this in focus for us. He used past ads for medications from psychiatric journals to point out the absurdity of psychiatry's past. He used current ads and articles to show that nothing has really changed in the past 100 years…..old wine in new bottles or as they say in the military, “SSDD.”

I have been a student and critic of psychiatry for over twenty years and thought I knew a lot. Then along comes Dr. Bonkers. I found myself marveling at some of the stuff he dug up and thinking to myself “Wow! These guys have a history of this that is even crazier than I thought.”

Thorazine for Hiccups? With Partnership for a Drug Free America getting psychiatrists to look for drug abuse in their patients and help stop America’s drug problem? Drugs for deviant sexual behavior? Dr. Bonkers found all of this.

Noam Chomsky defined Anarchism as “A tendency in the history of human thought and action which seeks to identify coercive, authoritarian and hierarchic structures of all kinds and to challenge their legitimacy – and if they cannot justify their legitimacy, which is quite commonly the case, to work to undermine them and expand the scope of freedom.”

Using this definition, Ben was one of my all-time favorite anarchists. I would refer doubters to the Dr. Bonker’s web site and their response was usually one of “These ads and articles can’t be real!” …..and another hole was poked in the psychiatric Zeppelin. He did not live long enough to see the Zeppelin crash and burn but he most assuredly poked some major holes in it. I was informed that the site will stay up in the future. Let’s keep sending the doubters there.

 Let’s do it for Ben!

Here We Go Again – Mass Shooting

10/2/2015        In the News 0 Comments

mercerChuck Ruby, Ph.D.


In these early hours after Chris Mercer’s mass shooting at the Oregon community college, it would be easy to blame the rampage on “mental illness”. As has happened all too often in the past, news reports zero in on whether the shooter suffered from this fictitious disease (for example, see http://www.cbsnews.com/news/mass-shootings-and-the-mental-health-connection/). Such unjustified analyses and reactions to these terrible events serves as nothing more than a distraction from the actual factors associated with violent behavior and prevents the development of viable policies to make our society safer (See ISEPP Public Statement: The Role of Mental Illness in Violent Behavior). But perhaps more problematic, it also sets up a false dichotomy that certain kinds of people commit these acts and the rest of us are not prone to such violence. It sends us on a crusade to find these defective souls, to brand them with mental illness diagnoses, and then to provide them with “treatment” to rid them of their infection. Screening tools used to identify these people are notoriously in error and result in huge false alarm predictions, meaning that the great majority of those identified would never have committed a violent act. So, thousands and thousands of people, including children, would be subjected to this flawed assessment and then herded into the traditional psychiatric corral and subjected to all its demeaning, dehumanizing, and debilitating harms. Ironically, it is this very process that can actually increase the chances that violent behavior will occur (See ISEPP White Paper: Psychiatric Drugs and Violence). In short, we continue to look for the demon within, rather than the actual causes of violence.

Psychiatric Tragedy

9/21/2015        In the News 2 Comments

crackNoel Hunter, Doctoral Student


A recent article in the Washington Post, entitled “Her brain tormented her, and doctors could not understand why.” was a heart-wrenching story of a troubled young woman who suffered greatly in her final years before dying at the young age of 23 due to a reaction to a prescription drug. This story is a haunting example of the all-too-common tragic outcomes of people who suffer from extreme states of human distress. Unfortunately, the Post’s rhetorical tale, which is based on misinformation, extreme reductionism, and a distortion of research, only adds to the tragedy of Ms. Pam Tusiani.

The Post’s first error is in taking as fact the idea that extreme emotions, suicidal thoughts, and seemingly strange ideas and behaviors are “symptoms” of a medical, biological disease. The problem is exemplified in the statement: “What was once thought to be the result of child abuse or a manifestation of post-traumatic stress is now its own complex personality disorder. And it’s deadly”. This statement is somewhat incomprehensible considering that “personality disorder” is simply a label and nothing more. It doesn’t describe a “disease”; it describes a problem. 

At no point does the author express how or why a post-traumatic reaction suddenly was re-conceptualized as a “deadly” disease according to his resources (assuming he has any). In fact, research does continue to show that up to 92% of individuals labeled with borderline personality disorder (BPD) have experienced some kind of childhood abuse1. In addition, they are more likely to have experienced sexual abuse, specifically, and they have a greater number of perpetrators than people labeled with other kinds of psychiatric diagnoses. Dismissing off-hand the post-traumatic nature of the problem called BPD is an egregious error and not based on the scientific research. Further, the biological evidence the author cites as proof of “disease” (i.e., problems in the amygdala and “fight or flight” reactions) are precisely those that occur in individuals who have experienced extreme, chronic stress and/or trauma such as child abuse. But it must be emphasized that these biological consequences do not cause BPD. They are natural human reactions to intense and chronic stress of any kind. Presenting them as evidence of disease is like saying concussions are evidence that playing football is a disease.

With this in mind, then, one must first wonder what “cure” all the medical doctors are looking for? Have they read the work of Bessel van der Kolk, M.D. or Marsha Linehan, Ph.D.? Have they read any of the extensive studies showing the effectiveness of trauma-focused therapy, dialectical behavior therapy, yoga, meditation, somatic therapies, and others? What is this biological cure so many are seeking? Perhaps they may start by increasing efforts to prevent and ameliorate child abuse.

Second, giving the benefit of the doubt that DSM-defined categories are true diseases that exist in nature separate from the subjectivity of the person making said diagnosis (which is a dubious assumption), the author discusses the case of a young woman diagnosed with BPD, yet goes on to state: “We barely understand a healthy brain, so how are we to understand one haunted by psychosis?” This statement is a glaring error in even the most rudimentary understanding of psychiatric problems, for one would be hard pressed to find a clinician who deemed BPD to be a characterized by psychosis. However, the author may be saved by the fact that DSM-diagnostic categories lack validity and reliability anyways (the Director of the National Institute of Mental Health said so in 2013) and there are, in fact, no distinct lines that can define any one person’s experience completely.

Another error in research reporting is the author’s claim that “The suicide rate is higher for people with BPD than for those with major depression and schizophrenia; about 4 to 9 percent kill themselves”. In fact, the commonly cited estimate for suicide in persons diagnosed with schizophrenia is 10% to 13%, with approximately two to five times that rate attempting suicide3, 4. Additionally, approximately two thirds of all cases of suicide include the occurrence of “depression” 5, 6. The overall message should be that people who suffer, and suffer deeply, are more likely to commit suicide. Why make erroneous comparisons that are not even backed up by resources?

Perhaps the greatest error within this article is the complete disregard for the long-standing iatrogenic effects her so-called “treatment” may have had.  The author’s own statement should have raised huge, waving red flags: “She was on a laundry list of medication”. Many of these that are listed, including Paxil, Prozac, and Zoloft, are known to create an increased risk of suicide, violence, and agitation, especially in young adults and adolescents. Even more importantly, a recent study showed that pharmacotherapy for BPD “is not supported by the current literature” and that “polypharmacy should be avoided whenever possible”, recommending psychotherapy is the first-line treatment for BPD7. Another disregarded potential exacerbating factor is the internalized stigma, shame, and helplessness that comes from being told one has a “brain disease” instead of having the source of her pain recognized and addressed. She was in and out of hospitals, an experience that has been shown to directly create post-traumatic phenomena in those with the most severe problems, such as psychosis8. Lastly, many of the drugs that Ms. Tusiani was on are also shown to create psychotic experiences. Yet, not once does the author acknowledge or explore these clearly evident possibilities. Even the fact that the young woman died as a direct result of taking the antidepressant Parnate does not lead to an investigation of how this “laundry list” of drugs might have affected her. Instead, the subject is put to rest by blaming it on the fact that the drug was prescribed in a treatment center that was providing unlicensed medical care. Would the outcome have been any better if the center had that license? 

The story of Ms. Tusiani and her fatal experiences with inner turmoil and ineffective treatments is one that should be heard by an audience much larger than that served by the Washington Post. However, her story also deserves to be told with the integrity and fortuitousness of a critical journalist unafraid to ask the important questions. The family of Ms. Tusiani is understandably angered and determined to ensure that others do not have to endure the misfortunes that became their daughter. Such prevention begins by looking at the evidence that stares us directly in the eyes.

References:

  1. 1. Zanarini, M. C., Williams, A. A., Lewis, R. E., Reich, R. B., et al. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. The American Journal of Psychiatry, 154, 1101-1106.
  2. 2. Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M. (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder. The American Journal of Psychiatry, 147(8), 1008-1012.
  3. 3. Siris, S. (2001). Suicide and schizophrenia. Journal of Psychopharmacology, 15, 127-135.
  4. 4. Caldwell, C. B., & Gottesman, I. I. (1990). Schizophrenics kill themselves too: A review of risk factors for suicide. Schizophrenia Bulletin, 16, 571-589.
  5. 5. Conwell, Y., Duberstein, P. R., Cox, C., Herrmann, J. H., Forbes, N. T., & Caine, E. D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153, 1001-1008.
  6. 6. Henriksson, M., Aro, H., Marttunen, M., Heikkinen, M., Isometsa, E., Kuoppasalmi, L., & Lonnqvist, J. (1993). Mental disorders and comorbidity in suicide. American Journal of Psychiatry, 150, 935-940.
  7. 7. Francois, D., Roth, S. D., & Klingman, D. (2015). The efficacy of pharmacotherapy for borderline personality disorder: A review of the available randomized controlled trials. Psychiatric Annals, 45, 431-437.
  8. 8. Berry, K., Ford, S., Jellicoe-Jones, L., & Haddock, G. (2013). PTSD symptoms associated with the experience of psychosis and hospitalization: A review of the literature. Clinical Psychology Review, 33, 526-538.

The Failure of NIMH

9/16/2015        In the News 1 Comment

InselChuck Ruby, Ph.D.


Dr. Thomas Insel, the head of the National Institute of Mental Health (NIMH), has announced he is stepping down after serving in the position for the past 13 years (see http://www.nytimes.com/2015/09/16/health/tom-insel-national-institute-of-mental-health-resign.html). Dr. Insel’s main impact was to reorient the focus of NIMH toward a biological approach to the understanding of mental disorders, especially the serious ones. During his tenure, NIMH’s budget has been about $1.5 billion annually, with the great majority of those dollars going to research on the biology of mental disorders.

Dr. Insel’s appointment to the NIMH, along with his shift in focus, came on the heels of George H. W. Bush’s Decade of the Brain in the 1990’s, that was promised to unlock the mysteries of psychiatric problems by uncovering the biology and genetics of disordered brain functioning. President Obama more recently boosted this focus in his Brain Initiative in 2013, although perhaps too late for Dr. Insel. Nevertheless, this shift in focus was touted as a more scientific approach to diagnosing and understanding brain disorder, bringing psychiatry in line with the other medical sciences like neurology and cardiology.

It was under Dr. Insel’s tutelage that NIMH initiated the Research Domain Criteria (RDoC) program, which is intended to replace the current psychiatric diagnostic system of the DSM series, by building a bottom up system of diagnoses based on brain scan and genetic technology showing dysfunctioning brain biology for each disorder. Dr. Insel launched this program after publicly announcing in 2013 that the prevailing DSM diagnostic scheme was seriously flawed (DSM continues to be used today!).

Despite all the billions and all the rhetoric about how we are almost to the point of unlocking the biological secrets of mental disorder, we still have no reliable or valid biological marker. All we have are pretty brain scan pictures and genetic data showing what we already knew: biology changes, depending on how the body is used. This is true for mental disorders as it is for any human activity, including thinking, imagining, running, singing, and crying. But even with all this research, not one biological marker has been discovered that would enable diagnostic decisions. One would wonder if this is the reason for Dr. Insel’s departure. Have the failed research attempts convinced him to throw in the towel?

Regardless of Dr. Insel’s motivation for leaving, NIMH is left with a problem. It has been assumed the reason they haven’t found the “Rosetta stone” of biological psychiatry is that their research is either underfunded, inadequate, or they just aren’t looking in the right direction. Frequent chants of “we’re almost there!” echo from their halls, but this claim is unjustified. No other scientific research endeavor would continue along such a long line of failed attempts, hoping for the tide to turn “soon”. Other areas of research would have long since abandoned such theories that are not supported by the evidence.

NIMH has overlooked the real reason for not finding the stone: mental disorders (even the “serious” ones) are not brain diseases. In all the decades of scientific research, there has been no reliable evidence that supports the theory of mental disorders as caused by bodily pathology. Therefore, there is neither a disease to diagnose, nor biological marker to find. So-called “mental disorders” or “mental illness” or “mental disease”, whatever interchangeable term is used, are natural human reactions to the vicissitudes of life. Trying to jam these square pegs into the round holes of medicine does nothing but harm people, strip them of their dignity and humanity, and funnel them into a psychiatric pipeline of disability and despair.

The billions poured into brain scan research has acted as a subterfuge. It is like a house built upon a very weak foundation. The house may look impressive, and sell at a high rate. But if its occupants insist on living in it without checking the condition of the foundation, it will soon crumble under its own weight and trap all inside.

Dangerous Legislation

9/1/2015        In the News 0 Comments

US News

Al Galves, Ph.D.


A recent edition of U.S. News and World Report highlights the provisions of two bills in Congress that claim to enhance the mental health system in our country. See here for the report.

But a more critical examination of these bills shows us they are both dangerous.

God knows we need to improve our mental health system, especially our ability to help people who are diagnosed with serious mental illnesses1. One piece of evidence is the following underreported fact: The great majority of people who have shot up schools, workplaces, movie theaters, churches and families have been patients in the mental health system and the system has failed them.

The Federal government is a major source of funding for mental health services, spending about $72,000,000,000 in 20142. Thus, the Federal government has an opportunity to improve the mental health system. These two bills in Congress are designed to improve the system. By far the more important one is HR 2646, the Helping Families in Mental Health Crisis Act. It was introduced by Representative Tim Murphy (R-PA).

If enacted in its present form, HR 2646 will make our mental health system more punitive, oppressive and medicalized. By defunding and downgrading programs that help people recover from the states of being that are associated with diagnoses of serious mental illnesses, the bill goes in exactly the wrong direction. Here is what HR 2646 does:

It increases the scope and breadth of court-ordered (involuntary) outpatient psychiatric treatment by providing funds to states for spreading it and requiring states to adopt such laws by conditioning receipt of Federal funds for community mental health centers on such adoption;

It emasculates the recovery-oriented, consumer-involved initiatives of the Substance Abuse and Mental Health Systems Administration (SAMHSA) by placing SAMHSA under a newly-created Assistant Secretary for Mental Health and Substance Abuse and preventing SAMHSA from establishing any program or project not explicitly authorized or required by Congressional statute.  This puts in jeopardy the efforts to train recovered peers and establish peer specialists as an integral part of the community mental health system, the annual Alternatives conference and the spreading of Emotional CPR;

It terminates funding for the National Empowerment Center and the National Coalition for Mental Health Recovery, both organizations which develop and promote recovery-oriented approaches and the incorporation of recovered peers into the mental health system;

It increases funding for biopsychiatric treatment and research by giving control over the $400,000,000 annual appropriation for community mental health centers to the Assistant Secretary and giving increased funds for brain research to the National Institutes for Mental Health. The bill stipulates that these funds can be used only for "evidence-based practices". This can be used to abandon recovery-oriented approaches which are clearly effective but have not been subjected to rigorous research; and,

It weakens the ability of the protection and advocacy agencies to protect the human rights of persons diagnosed with mental disorders by prohibiting them from "counseling an individual with serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of the individual's caregiver."

Here are some other problems with the bill:

It downgrades and weakens the federal agency most supportive of recovery, peer support and community integration;

It places much more emphasis on medical treatment rather than on supporting the empowerment and recovery of persons through their active participation in their recovery and community;

It promotes a narrow, professionally-focused system of care in stark contrast to current thinking in healthcare which is moving rapidly to implement patient-centered care, shared decision-making and self-management of chronic conditions;

It ignores the significant role of toxic stress and trauma and precludes interventions which have been proven to be effective in helping people who suffer from those experiences;

It will keep people in clinical revolving doors rather than moving forward with their lives; and,

It expands the use of forced treatment which harms rather than helps people.

The Murphy bill, as it is called, reinforces and expands the mainstream standard of care. That standard of care has led to a dramatic increase in the number of Americans who receive Social Security Disability due to a mental illness3. The Murphy bill enfranchises a system of care which uses drugs as the primary modality of "treatment", an approach which harms rather than helps people. The fact that most of the billions of dollars spent by the Federal government on mental healthcare harms rather than helps people is tragic. This bill would make that tragedy even more widespread and entrenched than it is today.

What would a good mental health bill look like? It would close the gap that has been created by the $4,000,000,000 reduction in state funding for community mental health over the past 5 years. It would promote and expand alternatives to the mainstream standard of care such as Soteria-type sanctuary houses, open dialogue approaches, the Hearing Voices Network of support groups, peer-run crisis respite programs, peer bridgers, supportive employment, housing first and peer-directed training such as WRAP, Emotional CPR and Intentional Peer Support.

1The term "mental illness" is being used in this article in order to facilitate a discussion between people with extremely varied conceptions of what "mental illness" is. There are big problems with the term "mental illness". Although many “mental illnesses” are illnesses in the sense that they impair the ability of people to function well, to live full and satisfying lives, the states of being that are diagnosed as “mental illnesses” are much more than illnesses. They are also wake-up calls, opportunities for learning and growth, numinous experiences of connection with the divine and moves towards reconstitution of selves which have been discounted, abused and traumatized. To see them just as illnesses and disorders is a damaging distortion.

2Substance Abuse and Mental Health Services Administration. (2008). Projections of National Expenditures for Mental Health Services and Substance Abuse Treatment, 2004-2014, Garfield, R.L. (2011). Mental Health Financing in the United States: A Primer. Kaiser Commission on Medicaid and the Uninsured.

3Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. New York: Crown Publishers.

Brain Scans and PTSD

8/16/2015        In the News 0 Comments

scanMary Vieten, Ph.D., ABPP

A recent study claiming that brain scans can help predict a person's response to SSRI drug treatment for PTSD is flawed from the start.

Brain scans to diagnose or determine the treatment of poorly defined constructs with very little inter-rater reliability and as little validity (e.g., all mental illness diagnoses) is yet another example of scientists who are forging ahead with sophisticated research that is based on the assumption that “mental illnesses” are in fact real illnesses and that they are discrete, scientifically identifiable diagnoses.

The fact is, anyone who was placed in the PTSD positive group in this study was put into that group in the exact same way every “mental illness” patient gets categorized, labeled, branded: some combination of interview (or symptom checklist) and self report.  Nothing objective, scientific, or medical is involved.  Hundreds of ways in which this could go wrong.  Every participant could have ended up in another diagnostic category, or no category at all.

Science isn’t supposed to work this way.  Variables should be clearly, independently identifiable.  The streptococci bacteria, the cancer cell, the fracture, death: no issues with reliability or validity here.  The problem is that we are pathologizing undesirable aspects of the  normal range of human experience, and pretending we have identified real illness that we can see on a brain scan.  An intelligent observer should be torn between the scandal of resources being used in this way, and the serious lack of critical thinking skills among our research scientists.

More Fiction Than Fact

7/27/2015        In the News 1 Comment

depressionWilliam Schultz, Doctoral student, Minnesota School of Professional Psychology


A recent piece by CNN health presented the “truth” about eight depression myths. The author of the piece, Dr. Iliades, pointed out some facts. It is true that depression may sometimes be difficult to treat. It is also true that depression does not always present as sadness. However, Dr. Iliades presented more fiction than fact. See the full article here.

First, he characterized depression as a “real disease” which implies a biological, bottom-up pathology, such as cancer. A common public understanding is that depression is a “brain disease” caused by a “chemical imbalance”. This is misleading. Many medical diseases, like cancer or diabetes, can be identified with bio-markers and clinical tests. But in mental health, “we don’t have rigorously tested, reproducible, clinically actionably biomarkers for any psychiatric disorder (Insel, 2014, p. 395) and there is little scientific evidence that depression is caused by a chemical imbalance (Schultz, 2015). Psychological disorders are different than typical biological diseases. This distinction is important. Thinking of psychological disorders as biological diseases can have negative effects on how well clients believe they will do in treatment and this, in turn, can have negative effects on client’s clinical outcomes (Lebowitz, 2014).

Second, Dr. Iliades argued that it’s a myth antidepressants don’t work. This depends on what he means by “work”. Well established evidence shows that antidepressants do not treat depression better than placebos in a clinically significant way (Moncrieff & Kirsch, 2015).

Third, Dr. Iliades asserted that shock therapy (ECT) may sound scary but it isn’t. In fact, he claimed it’s “86% effective.” That’s not right. The available evidence suggests only 10 – 35% of patients will experience enduring positive outcomes from ECT treatment (Fosse & Read, 2013). Even this percentage range is highly dubious because it’s based on studies that do not have a placebo group. When ECT is compared to simulated ECT, there’s no significant difference in enduring treatment effects (Fosse & Read, 2013). And ECT is scary. Researchers don’t know how it works to produce its purported therapeutic effects (McCall, Andrade, & Sienaert, 2014) and it has a variety of significant negative effects on the brain (van Daalen‐Smith, Adam, Breggin, & LeFrançois, 2014).

Fourth. Dr. Iliades claimed that antidepressants are safe. Safe is a relative term. Antidepressants have a large variety of negative side-effects, from negative effects on the heart to sexual dysfunction. Some researchers have argued that these side-effects outweigh the benefits (Andrews, Thomson, Amstadter, & Neale, 2012).

Fifth, Dr. Iliades argued that antidepressants combined with psychotherapy is probably the best treatment for individuals with depression. But research has shown that psychotherapy alone performs as well as psychotherapy plus medication (Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012). As Kirsch (2014) put it, “When different treatments are equally effective, choice should be based on risk and harm, and of all of these treatments, antidepressant drugs are the riskiest and most harmful” (p. 132).

Finally, Dr. Iliades breezed through a section on the difference between depression and bereavement. The distinction he mentioned was vigorously debated by experts during the creation of the DSM-V (Wakefield & First, 2012). Needless to say, it is impossible for Dr. Iliades to give justice to the debate, much less to pronounce what feelings and experiences are and are not acceptable after the death of a loved one.

The truth about depression is our culture is far too quick to reach for a pill and far too slow to consider the social and psychological challenges underlying psychological disorders.

References

Andrews, P. W., Thomson Jr, J. A., Amstadter, A., & Neale, M. C. (2012). Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good. Frontiers in Psychology3, 117, 1-19.

Fosse, R., & Read, J. (2013). Electroconvulsive treatment: hypotheses about mechanisms of action. Frontiers in Psychiatry4, 94, 1-10.

Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry171(4), 395-397.

Khan, A., Faucett, J., Lichtenberg, P., Kirsch, I., & Brown, W. A. (2012). A systematic review of comparative efficacy of treatments and controls for depression. PLoS One7(7), e41778.

Kirsch, I. (2014). Antidepressants and the placebo effect. Zeitschrift für Psychologie222(3), 128-134.

Lebowitz, M. S. (2014). Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences. Clinical Psychology: Science and Practice, 21(1), 67-83.

McCall, W. V., Andrade, C., & Sienaert, P. (2014). Searching for the Mechanism (s) of ECT’s Therapeutic Effect. The Journal of ECT30(2), 87-89.

Moncrieff, J., & Kirsch, I. (2015). Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contemporary Clinical Trials43, 60-62.

Schultz, W. (2015). The chemical imbalance hypothesis: an evaluation of the evidence. Ethical Human Psychology and Psychiatry, 17(1).

van Daalen‐Smith, C., Adam, S., Breggin, P., & LeFrançois, B. A. (2014). The Utmost Discretion: How Presumed Prudence Leaves Children Susceptible to Electroshock. Children & Society28(3), 205-217.

Wakefield, J. C., & First, M. B. (2012). Validity of the bereavement exclusion to major depression: does the empirical evidence support the proposal to eliminate the exclusion in DSM‐5?. World Psychiatry11(1), 3-10.

Bacteria does not cause depression

4/9/2015        In the News 0 Comments

WDDTY

Chuck Ruby, Ph.D.


A recent article published by What Doctors Don't Tell You (WDDTY) demonstrates a great misunderstanding about what "causes" mental disorders. It claims that intestinal bacteria problems are a cause of depression. However, this is confusing real illness and the fake mental illnesses. See the WDDTY article here.

There are all sorts of pathological conditions of the body that mimic what are conventionally considered mental illness. For instance, low thyroid hormone levels can cause lethargy, typically confused with depression. Likewise, brain tumors can cause uncharacteristic behaviors and feelings that are diagnosed as psychosis. But these two examples, and the many others having to do with nutritional deficiencies, mold and toxin exposure, and ingestion of other chemicals, to mention just a few, have nothing to do with so-called "mental illness". They are conditions of real bodily pathology that we experience in a whole host of behavioral, cognitive, and emotional ways, just like we react to a bad cold with lethargy and disinterest.

Diagnosing a person with depression because his/her gut bacteria is out of whack it tantamount to diagnosing a person with Generalized Anxiety Disorder because she/he drank 12 cups of coffee. Both of these examples display the symptoms of real illness, not the oxymoronic "mental illness".

"Mental illness" is oxymoronic because the mind, being an abstract concept without physical substance, cannot become ill. Illness is reserved for physical things that go awry. Obviously we use the illness concept as metaphor, as in a "sick economy", or "diseased society", but we are clear these are metaphor. No one in their right mind would consider these real illness to be treated with medication or surgery. If "mental illness" was ever used solely as metaphor this way, it has long lost that metaphorical understanding. It is considered among conventional mental health professionals as really illness.

In fact, those things traditionally referred to as mental illness have to do with personal, spiritual, economic, existential, and political conundrums that we all face from time to time. They has nothing to do with real health or illness.