by Chuck Ruby, Ph.D.

A recent Medscape article reported the results of a study that concluded "...patients with depression can be subdivided into four biotypes defined by distinct patterns of dysfunctional connectivity in limbic and frontostriatal networks...." The study is complete with a litany of technical language and statistical analyses, along with very colorful charts and graphs, to once and for all prove that depression has biomarkers that can be used to diagnose and treat it.

But, all this fanfare obscures one important thing hiding in plain sight: Depression is not a real brain disease! Neither are any of the other 300 or so mental disorder categories. Depression is a natural and expected human reaction to emotional pain and at best is a metaphorical disease. It shouldn’t be treated as if it were a clinical or medical problem, and the people experiencing it shouldn’t be treated like patients. Yet this study is an example of how a curtain of complex technical and clinical jargon hides a reality that the devotees of this disease model of mental illness don’t want revealed. Let’s pull the curtain back and see what’s hiding behind it.

First, these kinds of studies come on the heels of the 2013 pronouncement by the Director of the National Institute of Mental Health (NIMH) that the still-in-use-today Diagnostic and Statistical Manual of Mental Disorders (DSM) is invalid and that a new diagnostic system needed to be developed from the ground up using brain scans to identify valid mental disorders rather than using symptom pictures. This study is an attempt to do just that. Yet the invalidity of the DSM is not the only problem here.

The bigger problem is that, as I said earlier, depression is not a real brain disease. The claim of disease is an a priori assumption, based on nothing. In this case “depression” is anointed as a disease at the outset (just because) and then it is discussed as if we all agree and that “biomarkers” can be used to diagnose it. But a “biomarker” is not the same as evidence of disease. The brain is “plastic”, in that it changes with use, and chronic use will result in more permanent change in both structure and activity levels. The fact that certain human experiences are accompanied by signature brain patterns merely reflects this fact. Such brain correlates of human behavior are not evidence of disease. Still, this concept of “biomarker” is used in order to give the impression of disease.

So given this, is it really that surprising to find different brain patterns in people who are having different types of depressive experiences? How is this a justification for describing those brain patterns as “abnormal connectivity”? The article also uses the phrases “reduced connectivity” and “hyperconnectivity” to give the same impression of dysfunction (disease). Similar to how the term “biomarker” implies disease when it really has nothing to do with disease, using the phrase “reduced connectivity” merely mean less activity, not some kind of defect in the connection between brain cells or circuits. And “hyperconnectivity” just means the particular brain areas are more active. This is linguistic sleight of hand, making it appear the brain activity in question is abnormal (diseased), when in fact, there is no such evidence of abnormality, dysfunction, or disease.

These kinds of studies will continue. But unless they come up with evidence (remember, we’re supposed to be scientific) of actual disease in the brain, the only thing they’ll demonstrate is that human activity affects brain patterns. But that is something we’ve known already for a long time. Of course, if they do find evidence of brain disease, we already have a medial specialty for that. It is called neurology.

by Frederick Ernst, Ph.D.

In a recent edition of the Wall Street Journal, Dr. Peter Kramer writes a defense of antidepressants and does a really nice job of convincing himself that what he is doing, prescribing drugs for people who are not ill, has merit. Unfortunately, he shared his thoughts with the Journal and, even more unfortunately, they published it.

The conclusions he has drawn are simply without merit. A science-informed reader would not have wasted time drifting past the first paragraph of this nonsense unless that reader was curious about the latest marketing-informed propaganda. So first, Dr. Kramer invents a new biochemical imbalance theory, one that not only has no support in science (like the one he’s trying to replace) but also has hardly even been mentioned in the literature of science. Brain resilience? This is a concept you can only find infrequently mentioned in connection with concussion or immune reaction. But according to Dr. Kramer, the “chemical properties of these drugs” (the SSRI’s) are inherently restoring resilience in the brain? (Please ignore here the evidence that these drugs are toxic and actually kill brain cells.)

“Little of the benefit comes from the classical placebo effect.” Says Dr. Kramer. He would be exactly correct if you believe more than 80% to be little. Drs. Joanna Moncrieff and Irving Kirsch should be invited to address this incredible statement! (see for instance http://www.contemporaryclinicaltrials.com/article/S1551-7144(15)30003-3/abstract). Further, Dr. Kramer exclaims, “I read the data with a doctorly eye.” That’s an interesting comment from a doctor identifying with a discipline that continues to wait for science to reveal validation of only one, a first, of its 350 so-called “mental” illnesses after 100 years of trying.

But, rest assured he will not abandon his authoritarian approach to the topic. He turns to a colleague to see if his experiences have been the same. And, of course, they both agree. Depression is getting better in those who are most depressed. Interestingly, and unintentionally, he provides the readers with a perfect example of why depression is not a brain disease that people wake up with one morning. Public health surveys (read, CDC science-based data) “are not fine-grained enough” so he turns to the ultimate science authorities… students and colleagues, and asks them what they see. And then, who does he describe as revealing evidence of this illness? Irma! A lady whose husband and daughter have died and, if things couldn’t get any worse, she now has heart disease. Sounds like an inexplicable endogenous depression to me. Clearly, one of her neurotransmitter systems has come down with something quite coincidentally following these three life events.

The lay public must be informed to understand that doctors are not trained as scientists. Skepticism is not promoted or even encouraged in the training of physicians and probably shouldn’t be. I certainly don’t want the surgeon for my emergency to be thinking about whether or not what he’s doing makes any sense. But of all medical specialties, psychiatry must be taught skeptically or it will never achieve the status of infectious disease medicine or cardiology, the leaders of science-based medicine.

A revolution in medical education is required for psychiatry to achieve the status of its peer disciplines. The foundational pillars of their discipline is marketing, with nearly unlimited underlying financial resources. Remove those dollars and this house of cards collapses under its own weight.

There simply is no science supporting these “treatments.” And, indeed, I will retract this statement in the most humiliating public way if any person on this planet can point to one study revealing that mental illness is an illness with a demonstrable underlying pathophysiology. Just one. Only one. Not much to ask. But as the subtitle of this article suggests, Dr. Peter D. Kramer has seen real benefits from antidepressants. That should be good enough for you.

All my sarcasm aside, the idea that human suffering and distress is a disease has not only long outlived any hoped-for usefulness, it has caused pervasive harm to our population. Mental illness portrayed as physical illness is a flawed idea based on a misconceived extension of metaphor resulting in irreparable harm to the world public. It’s time for a new paradigm and Dr. Kramer’s article is the exclamation point that I would add to the end of this sentence.

by Edward Dantes

Occasionally I stumble upon one of the dark side's websites (i.e. biological psychiatry), and usually find myself laughing or horrified or both. Today was no exception when I found this amusing article in the Psychiatric Times (http://www.psychiatrictimes.com/apa-2016-Schizophrenia/multidisciplinary-approach-first-episode-psychosis).

Here are a few quotes that stood out:

“To improve medication adherence, oral antipsychotic medication was transitioned to a long-acting injectable form.” - This Orwellian statement, so typical of out-of-touch psychiatrists who think they know what's best for “patients”, brings to mind Otsuka's new chip-implanted Abilify drug... it keeps giving me the thought that those aliens on Alpha Centauri are softening up the planet by drugging us all up in preparation for their invasion. Now what is that thought a symptom of?

“I will now review a case of a young man who came down with schizoaffective disorder...” - This made me laugh - poor guy, sounds like coming down with the common cold! I wonder what could cause someone to catch schizoaffective disorder? Is it airborne? Maybe it will become the new Zika or SARS... Hard to believe that psychiatrists are ignorant enough to use this type of language.

“A structured assessment of symptoms to clearly make a preliminary diagnosis and to be able to conclude on schizophrenia or psychosis..” - There are no symptoms of schizophrenia, because there is no such illness, nor is there a reliable or valid diagnosis named as such. To give psychiatrists credit, some of the more evolved ones are at least starting to tentatively admit that there is no singular schizophrenia and the disorganization and disorientation of psychosis is a continuum with many possible causes.

“The medical examination utilizing MRI imaging and laboratory blood tests is an important step in making the correct diagnosis so a young person is approached appropriately...” - What!? I guess psychiatrists are dreaming that they've come up with some way of using brain and blood scans to make valid diagnoses. Dream on. It's funny how serious sounding and clinical these psychiatrists try to make their terminology sound, when in fact what they are saying is absolute gibberish! There are no MRI imaging or laboratory blood tests that can be used in diagnosing.

The article creates a simulacrum of engaging and helping the person, but it's hard to effectively help when one is assuming the existence of a biologically-caused illness that just isn't there and drugging on that basis. As usual, in this article there is no discussion whatsoever of the lived experience of the case examples, no mention whatsoever of what the troubled person feels, wishes, hopes for, fears, or went through. Where is the humanity in the soulless, colorless T.S. Eliot-ian Wasteland of biological psychiatry?

It's such a shame that more US psychiatrists won't try Open Dialogue, learn about psychoanalytic or psychodynamic approaches, or other non-medical methods to helping people experiencing psychosis. Then their energy would be put toward something with a much better chance of understanding and helping. Meanwhile, more young people will be harmed by the lies about brain disease and the notion that they have to indefinitely take drugs that aren't even tested over the long term, and lead to a life time of disability and dependence.

ISEPP's past Executive Director, Al Galves, explains why attempts to reduce stigma is a failed attempt.

[embedyt] http://www.youtube.com/watch?v=OMXemauOE4k[/embedyt]

ISEPP participated in the worldwide screening of the "Healing Voices" documentary film. On April 29 and May 2, 2016, ISEPP hosted  the screening of a new 90-minute social action documentary about mental health called "Healing Voices" written and directed by PJ Moynihan of Digital Eyes Film. It screened in more than 120 locations across the US, Canada, UK, New Zealand, and Australia staring on April 29th. The documentary explores the experience commonly labeled as ‘psychosis’ through the stories of real-life individuals, and asks the question: What are we talking about when we talk about ‘mental illness’? The film follows three subjects – Oryx, Jen, Dan – over nearly five years, and features interviews with notable international experts including Robert Whitaker, Bruce Levine, Celia Brown, Will Hall, Marius Romme, and others, on the history of psychiatry and the rise of the ‘medical model’ of mental illness.

The ISEPP hosted screening took place at the College of Southern Maryland in La Plata, MD. There was a great turnout by students, faculty, and local residents. Many were unaware of the more humane way to approach this problem. A few participants were even interested in starting up a local Hearing Voices network!

Thanks to Digital Eyes for giving ISEPP this opportunity! 

by Chuck Ruby, Ph.D.

MIT Technology Review published a recent article entitled, "Military Funds Brain-Computer Interfaces to Control Feelings" describing research funded by the Defense Advanced Research Projects Agency (DARPA) that uses brain electrode implants to detect and prevent certain feelings and behaviors. The article says the goal is "to use brain implants to read, and then control, the emotions of mentally ill people". This is nothing less than Orwellian dystopia and brings to mind images of the 1970's novel and movie, The Stepford Wives. I have several questions.

One question to ask is how are we going to define “mentally ill people”? Just a quick look back over the changing, vague, and over-inclusive definitions of “mental illness”, to include the voting in and out of certain pet diagnoses, such as homosexuality, self-defeating personality disorder, asperger’s disorder, and attenuated psychosis syndrome, tells us that any unwanted behavior or experience can be dubbed “mental illness” depending on the desires of those in power. This usually means those on the diagnoses committees, heavily funded by pharmaceutical companies, and now with this line of research underway, the medical devices companies will soon chip in.

There have even been attempts to claim certain personal convictions such as liberalism, conservatism, and religiosity are signs of “mental illnesses”. Are we going to allow some authority to prevent us from having those convictions by identifying the brain circuits involved and zapping them?

Further complicating this is the dimensional rather than categorical reality of those things called “mental illness”. The problems addressed are human problems that everyone shares to varying degrees of severity. They aren't brain diseases. At what level of severity must one get to before being considered a candidate for this procedure? According to the article, these brain implants would only be considered for people who are truly debilitated and can’t be helped any other way. One psychiatrist involved in this research said, “This is never going to be a first-line option: ‘Oh, you have PTSD, let’s do surgery,’...It’s going to be for people who don’t respond to the other treatments.” Yeah right. We've heard that before.

Another question is whether these forms of "treatment" will be mandatory or voluntary. Given the poor track record our mental health industry has regarding the protection of human dignity and autonomy, I think I know the answer.

Well-intentioned as it may be, this research is a threat to us all. It conflates brain activation with lived experiences. The amygdala doesn't generate fear, people generate fear. The neurons in the amygdala just sit there and react as they are built to react when an adjoining neuron activates. They don't know what fear is. Fear is a meaningful human experience that tells us something may be a threat. Fear, as well as all other human emotions, are what make us human.

Considering the fact that there are nearly 100 billion neurons in the human brain and that feelings and behaviors involve several diverse areas of the brain in very complex ways, it is unlikely we are ever going to be able to achieve more than a crude approach to controlling people’s lived experiences and behaviors this way.

To save time and money, why don’t we just fit everyone with a shock collar at birth?

ISEPP has issue a public statement in the form of submitted recommendations at http://apacustomout.apa.org/commentCentral/default.aspx?site=43 in response to the American Psychological Association's (APA) Call for Comments: Proposed Language to Revise Standard 3.04 for the Ethics Code.

The APA is making changes to the ethical guidelines for psychologists in the wake of last year's independent investigation into collusion between APA and the U.S. Government regarding psychologists' involvement in enhanced interrogations, and the subsequent APA Council of Representatives' vote to ban psychologists from those national security activities. You can read ISEPP's recommended code changes at our here.

See here for a recent study by ISEPP’s Joanne Cacciatore on the effects of poverty and parental education on the experience of bereaved mothers. Her study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources.

by Chuck Ruby, Ph.D.

Investigators from the French Land Transport Accident Investigation Bureau (French acronym BEA), which has been investigating the March 2015 Germanwings crash, have recently recommended that world aviation agencies require mental health workers report pilots whose mental heath condition "could threaten public safety". This is an alarming mistake. See the NBC story here: http://www.nbcnews.com/storyline/german-plane-crash/germanwings-crash-bea-investigators-urge-new-rules-about-reporting-mental-n537416.

One of the most robust findings of research is that mental health professionals are not good at predicting others' future violence or harmful actions. There are clear risk factors that increase a person's likelihood of doing so, but they do not enable us to predict whether the behavior will occur. The best we can do is manage those risk factors in order to reduce the chances. Complying with BEA's recommendations and putting mental health workers in the position of making predictions, will result in a huge false alarm problem, destroying people's lives in the process, and ironically causing those who would benefit the most from help with emotional problems avoiding such help.

Many occupations require employee background evaluations in order to determine continued psychological suitability and readiness for the job. In addition to airline pilots, other examples are law enforcement officers, employees working in national security programs, and nuclear power plant workers. The employers in these settings have a reasonable interest in knowing their employees can be trusted. And employers can understandably err on the side of caution by denying employment when possible problems exist. But requiring a psychological evaluation for a suitability determination and requiring mental health workers to report people to the authorities are two different things.

A mental health worker, most likely some type of counselor in this situation, has a fiduciary obligation to the person being helped. The relationship between the counselor and the client is paramount, and the confidential nature of the relationship is at the core of this trust. Requiring the counselor to report people who "could threaten public safety" places the counselor in an ethical double bind. If the counselor reports, she or he damages the relationship and harms the person. If the counselor fails to report and the person commits some act, the counselor becomes the target of legal and ethical censure.

Attempting to determine who "could threaten public safety" is impossible. This could actually mean anyone. How many times have uncharacteristic acts of violence been committed by people who never showed any warning? It would be easy to predict future harm when a client makes a statement about intent to harm a specific person(s), but how often does that actually happen? Hardly ever. Besides, there are already laws and guidelines in place that require counselors to warn of such clear cases.

But other than these clear cases, where does the counselor draw the line? How much of a risk is needed prior to warning? How do we quantify that? Must we use standardized instruments to assess the level of risk? How valid and reliable are those instruments? The answer is: not very. With behavior that happens infrequently among the population, any assessment of risk will necessarily have very high false positive results or false alarms. This is just a matter of statistics. Violent behavior is no exception. For instance, the FBI reported a .4% base rate of violent crime in 2013, and this includes all types of violence, not just murders and assaults (see https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2013/crime-in-the-u.s.-2013/tables/1tabledatadecoverviewpdf/table_1_crime_in_the_united_states_by_volume_and_rate_per_100000_inhabitants_1994-2013.xls). With such a low base rate occurrence, even the most accurate assessment instrument is doomed to result in extremely high false alarms. In other words, the great majority of those identified as potentially dangerous and reported by counselors to aviation authorities, will never commit a dangerous act. But being reported as at risk for such behavior can ruin their lives and damage the value of professional help.

The slope is slippery. For what other occupations will this kind of big brother monitoring apply? Should counselors be required to report police officers? Teachers? Bus drivers? Investment bankers? Physicians? Who would report the counselors?

Toby Watson, Psy.D., recently submitted an ISEPP challenge to an FDA proposed rule to reclassify ECT so it can be used in "treating severe major depressive episode in patients 18 years of age and older who are treatment resistant or require a rapid response." You can read his challenge here.