Mary 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.

William 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 Psychology, 3, 117, 1-19.

Fosse, R., & Read, J. (2013). Electroconvulsive treatment: hypotheses about mechanisms of action. Frontiers in Psychiatry, 4, 94, 1-10.

Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry, 171(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 One, 7(7), e41778.

Kirsch, I. (2014). Antidepressants and the placebo effect. Zeitschrift für Psychologie, 222(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 ECT, 30(2), 87-89.

Moncrieff, J., & Kirsch, I. (2015). Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contemporary Clinical Trials, 43, 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 & Society, 28(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 Psychiatry, 11(1), 3-10.

See CNN's coverage of Dr. Mary Vieten's Operation TOHIDU here.

See an expanded video of ISEPP member Mary Vieten, Ph.D. and the staff of Operation TOHIDU here.

Operation Speak Up just launched an online petition here. We ask that you sign it and share it widely.

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.

Mary Vieten, Ph.D., ABPP, has launched Operation Tohidu (see http://www.melwood. org/articles/articles/view/148). This is an effort to create a non-medical, non-psychiatric alternative for veterans and military members who suffer from war trauma. The second retreat was just completed and two additional ones are scheduled this Spring and Summer. It is getting very good responses from the participants. They are expressing relief that there is somewhere they can get help beside the VA and psychiatric drugging. It is receiving local media attention (see http://www.myfoxdc.com/Clip/11180158/veterans-ptsd-retreat-in-maryland). Great job Mary!

Jay Joseph’s new book, The Trouble with Twin Studies: A Reassessment of Twin Research in the Social and Behavioral Sciences (published by Routledge), is now available. The book approaches twin research from a critical perspective, including research produced by fields such as behavioral genetics, psychiatric genetics, psychology, and political science, with a special emphasis on studies of “reared-apart” twins. Although he has examined various aspects of twin research in two previous books, in his new book he examines the major issues in much greater detail, with a fresh perspective based on the latest research findings. In the process, he challenges the conclusions and theories of many of the world’s leading genetic researchers. While the book is intended mainly for use in academic settings, the major topics and controversies are described and analyzed in ways that are accessible to a wider audience. See Jay's website at: http://jayjoseph.net/publications.

Randy Cima, Ph.D.

I liked a lot of the article posted below by David Warmflash, and that’s not common, especially when the subject is autism. The author is an interesting man.  He describes himself as an astrobiologist, science writer, physician, and “starstuff that evolved into consciousness.”  He has written a number of articles for Discover Magazine, including Three Totally Mind-bending Implications of a Multidimensional Universe and How Close Are We to Start Trek Propulsion?  He has also written dozens of articles for the Genetic Literacy Project (GLP), including Space twins: Scott Kelly’s one-year space mission could yield genetic bounty, and Is dancing success ‘in your genes’?  Focused on agricultural and human biotechnology, the mission of GLP is to “disentangle science from ideology.”

What is David Warmflash’s conclusion about the cause of autism?  Well, according to Dr. Warmflash, it’s not vaccines, or fluoride, or genetically modified organisms (GMO’s), or glyphosate, or mercury - or cell phones.  Autism isn’t caused by telephone wires, the chemtrails of jet planes, or circumcision either, these last three new to me.

With the skeptical eye of a science enthusiast, he bravely takes on parents who, so frustrated with the misleading and contradictory information provided by self-promoting experts, have come to their own conclusions about autism and to hell with everyone else.  Who could blame them?

Warmflash asserts there is no epidemic.  Why, then, has the number of cases “exploded” in the past two decades?  Well, he says, look first at the ever-widening, ever-inclusive, diagnostic criteria.  Simply put, there are more children who “qualify” for the diagnosis, that’s why.  He referenced Three Reasons Not to Believe in an Autism Epidemic.  The National Institutes of Health (NIH) published this still relevant article ten years ago.  Since then, DSM V widened the criteria even more to create an even larger population of diagnosable ASD children – now in the millions.  (You can read the entire article here.)

Correlations and Associations - Warmflash does a good job of reminding us - and we need constant reminders - about the difference between statistical associations and correlations, and scientific causes.  With some disdain, he criticizes professional papers that tout a newly found association or correlation, and then imply a fundamental discovery of some kind.  Instead, he explains to us, the scientists found a statistical relationship between one variable and another, nothing more.  Still, either knowingly or unknowingly (I don’t know which is worse), often scientists, and their supporters, confuse correlation with cause.  The only outcome for this kind of science is a confused – and angry – public.  (More about correlations and associations here and here.)

Default Position When All Else Fails: It must be genetic - After explaining in detail why all other causes of autism go wanting - accurately as far as I’m concerned – Dr. Warmflash saves the last three paragraphs to explain why genetics is the cause of autism.  He starts with “However, most of the cause is probably genetic.”  He quotes from a recent JAMA Psychiatry article to support his conclusion.

What does “most of the cause” mean?  There are other causes?  The article he wrote said there were no other causes.  Also, and you may have already noticed, “probably” is not a word used in science.  I also read the abstract of the JAMA article he referred to:  Heritability of Autism Spectrum Disorder in a UK Population-Based Twin Sample, March 2015.  Here’s the first sentence from the section titled Results: “On all ASD measures, correlations among monozygotic twins (range, 0.77-0.99) were significantly higher than those for dizygotic twins (range, 0.22-0.65), giving heritability estimates of 56% to 95%.”  (You can read the entire article here.)

The study reveals there are correlations – yes, correlations – between some variables, for reasons left to scientific speculation.  This seems like a clear violation of the advice we received from Dr. Warmflash about correlations and causes.  Also, after reading the abstract, I knew I didn’t need to read the entire article.  There was nothing in it about causation, or they would have said so.

Summary - When it comes to behavioral medicine and behavioral genetics, and their usefulness in understanding autism, the results are nil. There are statistical correlations and associations aplenty, and for an internet-savvy, 24-hour news media, often just enough headline “science” to imply “this causes that,” and on to the next story.  As longtime opponents of the medical model, this isn’t new or surprising to ISEPP members.  Whether it’s ADHD, bi-polar disorder, schizophrenia, depression, or autism, there has never been a cause and effect relationship found by medicine or genetics for those, or any of the more than 400 “diseases” found in DSM V. So, if we’re left with “none of the above,” what does that mean?  Well, our experts continually tell us, the solution hasn’t been found yet, we’re close, so we’ll keep looking.  For a growing number of us, it means autism is not a medical disease, it’s not in our DNA, and it’s not a disability, defect, or disorder, so stop looking.  Are there ways to explain the often “bizarre,” self-harming, uncommunicative behavior for these otherwise delicate, artistic children without invoking medicine and genetics?  Of course there are, a number of ways.  For me, it’s a simple matter of temperament – and a unique defense by some unique, healthy children – for another time.

All things considered, this is a good article, and I’ll be quoting from it.  After reading a few more of his articles, I’m also following Dr. Warmflash on twitter.

Epidemics solicit causes; false epidemics solicit false causes. (From Three Reasons Not to Believe in an Autism Epidemic, National Institutes of Health, April 2005)

Autism: No, it’s not caused by glyphosate or circumcision, but is likely in our genes, David Warmflash | March 23, 2015 | Genetic Literacy Project

What causes autism? The causes are endless, and mounting, if the Internet is to believed as a reliable source. It’s variously: vaccines, GMOs, glyphosate, chemicals in our home, fluoride in water, telephone wires, cell phones and even chemtrails left by jet planes. Oh yes…and males should not be circumcised for there is strong links between boys going under the knife and cases of autism....read more here.

Thanks to Jonathan Leo & Jeffrey R. Lacasse for their article entitled, "The New York Times and the ADHD Epidemic", which details how one of the leading newspapers has helped perpetuate the explosion of ADHD.

There is now almost universal acknowledgement that too many children in the United States have been diagnosed with Attention Deficit Disorder (ADHD). Over the past decade, the age range for those diagnosed with ADHD has greatly expanded – in both directions. At one end of the spectrum, many adults are now labeled with “Adult ADHD,” and at the other end of the spectrum, more and more preschoolers are being diagnosed with ADHD. According to a recent CDC report, more than 10,000 toddlers, aged 2 to 3 years, are currently medicated for ADHD....