Fact Checking Psychiatry

Demystifying Mental Illness and Its Treatment

Demystifying Mental Illness and Its Treatment

by Al Galves, PhD


I have this desire to demystify mental illness.  Why is that?  What makes me want to demystify mental illness?  What makes me want to do it is my sense that over the past 20 or 30 years mental illness has taken on a mysterious quality.  It seems to me that people believe mental illness just comes on people, comes out of the blue, as if it is something alien to the person, something visited upon them, an alien visitation.

What makes me believe this is the case?  Here are three pieces of evidence:

The first is the case of Simon Biles.  Biles won the Olympic gold medal in female gymnastics at the 2018 winter games.  She was the best gymnast in the world.  At the 2022 winter games she was a member of the United States Olympic team.  She told her teammates that there was so much pressure on her that she was not going to be able to perform well and, therefore, was not going to perform.  In the aftermath of that decision, the word went out that she was suffering from a mental illness and everyone seemed to accept that.  But wait.  Why add the idea or belief that this is a mental illness?  What she did was perfectly understandable and “normal” without adding the trope of “mental illness” to it.  She was under a lot of stress, so much that it was going to affect her ability to perform.  What is the purpose of adding the idea of mental illness?  Does it take away some of her agency?  She couldn’t help it.  She was under the influence of a mental illness.  Does it absolve her of responsibility for her decision?  When the idea of “mental illness” is added to it, it takes on the patina of something other than a reasonable decision by a woman who is under a lot of pressure and believes it will affect her ability to perform well.

The second piece of evidence is a series of interviews I did.  This wasn’t a scientific sample.  I sat in the back of a coffee shop and offered to interview patrons about mental illness.  Some of the ten interviewees were friends.  I asked them what they thought caused mental illness.  All of them gave me some kind of physiological answer.  It was a brain disorder, a chemical imbalance, a genetic anomaly.  I then asked them what they thought had triggered the change in the brain, the chemistry, the genetics.  They hadn’t been mentally ill and then they were.  What had happened?  They all said something happened to the person.  But, I said, you just told me mental illness was caused by some physiological dynamic and now you’re telling me it is caused by something happening to the person.  What is it?  They were all non-plussed, taken aback, chastened.  So I asked them all the third question.  Do you think there is a difference between how a person is reacting to a life situation and to concerns she has about her life, on the one hand, and a diagnosable mental illness, on the other?  They all said “Yes”.

The third piece of evidence is reports I have read about the confusion of college students when they begin to feel down, depressed, agitated, manic, anxious.  When they begin to feel that way, they ask themselves: is this a response to my life situation, to what is going on in my life and my concerns about that or is this a mental illness?  They think there is a difference between those two things.
This is evidence of confusion in the general public about the nature of mental illness.  Is it a mysterious state of being that comes out of the blue, just happens to people and is caused by some kind of physiological dynamic?  Or is it a “normal” and understandable reaction to a person’s life situation, to concerns the person has about his life and himself, to what has happened to him?

This is not just an academic question.  How people understand the states of being, moods, emotions, thoughts, intentions and behaviors associated with diagnoses of mental illnesses is going to have a big impact on their lives.  It is going to determine how they understand themselves, how they manage themselves, the kind of treatment they seek.  And the kind of treatment they seek and receive is going to determine the degree to which they recover and go on to live healthy, productive and satisfying lives.

So there are two main ways in which we can understand the states of being, moods, thoughts, emotions and behaviors associated with diagnoses of mental illness.  We can understand them as caused by physiological dynamics, i.e. chemical imbalances, genetic anomalies, brain disorders, as coming out of the blue with no discernable connection to our lives or experiences, an alien visitation upon a person.  Or we can understand them as understandable and “normal” reactions to a person’s life experience, life situation and to concerns the person has about his or her life and self, i.e. as emotional distress, a life crisis, a difficult dilemma, a spiritual emergency, a manifestation of fear, terror and overwhelm.

What are the implications of those different ways of understanding mental illness?  For starters, there is a problem with understanding mental illness as essentially physiological in nature.  If you follow that belief out to its logical conclusion, you believe that human beings have no control over their thoughts, emotions, intentions, perceptions and behavior and, therefore, have no control over their lives.  The logic goes like this:

Mental illnesses are caused by brain disorders, chemical imbalances and genetic anomalies.

Mental illnesses are states of being, moods, emotions, thoughts, intentions and behaviors.

Therefore, states of being, moods, emotions, thoughts, intentions and behaviors are caused by brain disorders, chemical imbalances and genetic anomalies.

Human beings don’t have control over their brain function, biochemistry or genetic dynamics.

Therefore, human beings have no control over their states of being, moods, thoughts, intentions, emotions and behaviors.

Since human beings use their thoughts, emotions, intentions and behaviors to lead their lives, they have no control over their lives.

That is a very cynical and disempowering belief.  It takes away agency and leaves people at the mercy of forces over which they have no control.  It absolves people of responsibility for their lives and makes it less likely they will seek help in learning how to manage themselves in healthier ways.

If, on the other hand, people believe that mental illnesses are how they are reacting to their life situations and to concerns they have about themselves and their lives, they believe they do have control over their lives and are responsible for their behavior and are more likely to seek help in becoming healthier. 

Let me try to explain more about this idea that mental illnesses are how people are reacting to their life experience and life situation.  In order to be mentally healthy, people have to be able to love the way they want to love, express themselves the way they want to express themselves and enjoy life the way they want to enjoy life.  When they can’t do that, haven’t been able to do it for a long time and are afraid they’ll never be able to do it, when they suffer significant loss or feel extremely helpless and inadequate, they become agitated, manic, angry, panicked, obsessive, depressed, anxious and psychotic.  They become mentally ill.  There is nothing mysterious or alien about it.  It makes sense that when people are afraid they will never be able to live the way they want to live, afraid they are fundamentally flawed, inadequate, not smart, personable, strategic, connected enough to make it in this life, they would become depressed, anxious, panicky, manic, obsessive, unable to sleep, dissociated, even psychotic.  Of course, every human being is a unique individual so how a person reacts to her life situation and to concerns she has about herself and her life will be unique.  But the following are some general ideas about how life experiences and concerns are associated with mental illnesses:

Depression happens when a person loses something very valuable or has deep concerns about her life.  It doesn’t have to be the loss of a person.  It can also be the loss of a sense of security, a feeling of adequacy, a sense of certainty, a relationship, financial security, a job.  When a person has deep concerns about her life, depression can be helpful.  It forces the person to stop doing what they are doing, stop focusing outside in the world and, rather, take some time to focus inside, to deal in a serious way with issues of life. 

Social anxiety disorder happens when people don’t want to be around other people out of fear they will be rejected, put down, abused, misunderstood or fear about how they will react to any interaction.  In the case of one of my patients, her social anxiety was caused by the fact that, since she had been mistreated by people all of her life, she wanted to hurt other people and knew that wouldn’t work out well.

Mania occurs when a person has had a lot of pressure put on him to be very successful, exalted, outstanding and is unable to do that.  The manic episode gives the person the illusion of being very powerful, successful and exalted.  They can do anything and everything.  They are amazingly powerful, smart, capable. Or it may be a move out of the drudgery of everyday existence.  The person is tired of having to make the decisions we all have to make every day.  What am I going to do with my time, energy and money? The possibilities are endless.  But I can only do one thing at a time.  In a manic episode, the person believes he can do it all.  He doesn’t have to make those difficult choices.  For some people mania is an opportunity to get in touch with a divinity, with the divine nature of existence in which one doesn’t have to deal with the everyday world.

Panic disorder happens when a person is facing a difficult dilemma, a dilemma that doesn’t have a good solution.  It may have a better solution but not a good one.  It is such a difficult dilemma that the person doesn’t even want to be aware of it.  But the body is aware of it.  So the body gets revved up to deal with it and causes the symptoms of panic disorder.  Here’s an example - a woman came to see me with her husband.  She was suffering from panic attacks.  I asked her if there was anything going on in her life that could account for them.  She said “No.”  We kept on talking.  It turned out that her son was about to be involved in the invasion of Iraq.  He was a foot soldier, would be engaged in mortal battle, at serious risk of being killed.  When she said that she began to cry.  She cried for a long time.  I helped her to be aware of her fear, to be with it and give in to it.  She never came back in.

Obsessive-compulsive disorder happens when a person overcontrols what he can control as a way of repressing the fear of knowing that the things which can really hurt him are out of his control.  The obsessive behavior is a way of gaining the illusion of control.  The excessive hand washing, ordering and checking may be a way of dealing with the uncomfortable truth that we don’t have any control over the things that we really need to be afraid of.  We don’t, for example, have control over other drivers whose behavior may maim or kill us, over other kinds of accidents and disasters that are outside of our control, over the safety of an airplane flight when we are on one, even over dangerous illnesses such as heart attacks, strokes, cancer and diabetes.  So the repetitive behavior gives him the illusion of having control over things so that he doesn’t have to experience the discomfort of realizing that he actually doesn’t.

As for the intrusive thoughts, perhaps they are useful in that they enable a person to avoid having to take responsibility for making decisions and addressing the difficult, real problems of everyday life – dealing with love relationships, jobs, co-workers, bosses, children, financial difficulties, moral dilemmas, competing priorities.  Since we deal with these kinds of problems all the time, perhaps we lose sight of how difficult they can be.  They often involve conflict with other people.  They often require us to make decisions and choices that involve necessary losses and understandable regret.  Carl Jung one time defined mental illness as “the avoidance of suffering.”  Some human beings will go to great lengths to avoid dealing with the difficulties of the real world.

Post-Traumatic Stress Disorder (PTSD) happens when a person has an experience in which she thought she was going to die and was unable to fight back or escape.  The symptoms associated with PTSD - recurrent and intrusive recollections of the event, efforts to avoid, activities, places or people which arouse recollections of the event, feelings of detachment or estrangement from others, hypervigilance - appear to be designed to help the person avoid the psychic and physical pain of the traumatic experience and to avoid a reoccurrence of trauma.  They also appear to enable the person to relive the experience.  It makes sense that people would want to relive traumatic experience.  Typically, people who suffer trauma carry some (usually irrational) guilt about it, believing that they somehow contributed to it happening or that they could have done something about it.  Reliving the experience holds out the possibility of resolving the guilt or imagining a different outcome, somehow making more sense out of the incident and coming to a more realistic appraisal of it.

Psychosis happens when a person who has been hurt badly – discounted, dishonored, rejected, made to feel inadequate, abused physically, verbally, emotionally – attaches his psychic energy to a deeper, more powerful but imaginary part of his psyche.  That move which is initiated by a deeper, healthier part of the psyche than the rational part is a move towards survival, healing and recovery.  In the words of John Weir Perry, a psychologist who spent a lot of time trying to understand the psyches of persons diagnosed with schizophrenia, “the psychotic process puts this power-oriented form of the self through a transformation that awakens the potential for relationship and gives it its rightful place in the structure of the personality and in the style of life.”

What evidence is there to support this idea that mental illnesses are how people are reacting to their lives and to concerns they have about their lives and themselves?  Here is one piece of evidence.  People who have certain characteristics are more likely to be diagnosed with certain mental illnesses than other people.  So people who have the following characteristics are more likely or less likely to be diagnosed with depression than other people:

People who derive their sense of self-worth from social relationships and have experienced an interpersonal loss;

Women who use a ruminating style of thinking;

People who score low on self-esteem and high on stress;

Persons who score high on a Self-Defeating Personality Scale;

Persons who suffer from chronic pain;

Persons with more emotional strength and resiliency and a higher level of ego control are less likely to be depressed;

Persons who experienced poorer pre-morbid functioning – particularly adolescent social functioning.

The following are the characteristics of persons who are more likely to be diagnosed with bipolar disorder:

Difficulty in realistic goal-setting;

Low in persistence and conscientiousness, high in neuroticism and openness to experience on the Eysensenk Scale;

Low in self-complexity and, therefore, more susceptible to mood swings in response to live events – especially intensely dependent relationships which are disrupted;

Deficient in tasks  requiring response inhibition, delayed gratification and sustained attention;

The ability to hold antithetical and contradictory ideas or concepts in their minds at the same time;

Tendency to deny the experience and necessity of loss;

Tendency to see things as either black or white, good or bad, not able to see the greyness of things, thus vulnerable to extreme swings of mood in response to minor triggers in the environment;

Has been betrayed by a significant parent figure and is compelled to force the parent to love him again;

Has lost the esteem of a loved person and denies it through regression to a state of not having to make the choices that are required in maturation.

The following are the characteristics of people who are more likely to be diagnosed with psychosis than other people:

People who have suffered physical or sexual abuse, especially in childhood;

People who have experienced 7 or more adverse childhood experiences, i.e. childhood physical abuse, childhood sexual abuse, childhood emotional neglect, parental loss, mental illness in household, substance abuse in household, , criminality in household.

This is evidence that the experiences people have had and the personality characteristics which have resulted from those experiences have a significant impact on their chances of being diagnosed with a mental illness. This is evidence that the states of being, moods, behaviors, thoughts, intentions and emotions associated with diagnoses of mental illness are not alien visitations.  They are understandable and meaningful reactions to peoples’ life experiences, life situations and concerns they have about their lives, the world and themselves.

There is another reason why how people understand mental illness makes a difference.  How they understand mental illness determines the kind of treatment they seek.  If they think it is an alien visitation, something that came out of the blue, the result of a chemical imbalance, brain disorder or genetic anomaly, they are likely to seek treatment in the form of medication and less likely to seek treatment in the form of psychotherapy.  If they think it has something to do with their life and concerns they have about their life and themselves, they are more likely to seek psychotherapy for treatment.

In my opinion, the benefit-risk ratio of treatment with psychotherapy is much better than the benefit-risk ratio of treatment with medication (Full Disclosure: I am a psychotherapist).  Here is my assessment of those benefit-risk ratios:

Psychiatric medication may help you feel better, more alive or be less agitated and more grounded.  (But one might ask if it is a good idea to feel good when you have lost something very valuable or your life is a mess). On the risk side, you are likely to experience numbing of emotions, sexual dysfunction, akathisia, increased risk of suicide and violence and, in the case of antipsychotics, tardive dyskinesia (Parkinson’s) brain shrinkage, cognitive impairment, increased risk of diabetes and early death.  When and if you stop using the medication you are likely to relapse and/or have a difficult time withdrawing.

Effective psychotherapy will help you to learn about yourself and begin the lifelong task of developing a good relationship with yourself.  It may help you learn how to use your thoughts, emotions, intentions, perceptions and behavior to live more the way you want to live and provide you with self-management skills and knowledge you can use for the rest of your life.  On the risk side, you may go through some painful feelings, go down the wrong path for a while and waste some time and money.

On balance, it seems to me that the potential benefits of psychotherapy are so large that it becomes the much better option.

There is evidence that treatment with psychotherapy is more effective than treatment with medicine.  In the case of depression patients treated with psychotherapy and medicine report similar levels of improvement but the ones treated with psychotherapy have a much lower relapse rate and their improvement is more long-lasting.  In the case of people experiencing psychosis the evidence tells us that people who never take the medicine or stop taking it have a much higher rate of recovery than people who take the medicine and stay on it.

This battle between people who believe mental illnesses are essentially physiological and those who believe they are psychological has been going on for 250 years.  Given the present state of scientific sophistication, we are not able to determine through scientific investigation which is the most scientifically valid way of understanding mental illness.  Therefore, perhaps the best answer to this dilemma is one suggested by Bradley Lewis in his book Moving Beyond Prozac, DSM and the New Psychiatry: The Birth of Postpsychiatry.  When faced with research findings for which there are various interpretations, Lewis says, we should choose the interpretation which is associated with the best outcomes for patients.  We should take a practical approach in the good, old tradition of American pragmatism.

If we did that, we would clearly choose to understand the states of being, moods, thoughts, emotions, intentions and behaviors associated with the diagnoses of mental illnesses as reactions to life experiences and life circumstances and concerns that people have about their lives and themselves and we would treat them with various forms of psychotherapy.


Dr. Galves is a clinical psychologist in New Mexico and Colorado. He has worked as a psychotherapist in community mental health centers, in health clinics, and as a school psychologist in public schools. He is a board member of MindFreedom International and the author of Harness Your Dark Side:  Mastering Jealousy, Rage, Frustration and Other Negative Emotions. Dr. Galves was the ISEPP Executive Director from 2011 to 2013.

 

Another Misleading Report: ADHD Increases Risk of Dementia

Another Misleading Report: ADHD Increases Risk of Dementia

by Chuck Ruby, PhD


An October 2023 JAMA Network Open article titled “Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia” concludes that an “adult ADHD diagnosis was associated with a 2.77-fold increased dementia risk” and there was “no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication.” In this study, more than 100,000 subjects were followed over a 17-year period and identified as having been diagnosed with ADHD, dementia, or both ADHD and dementia during that time.

The study was also covered by the Washington Post with the headline: “Adult ADHD may take a toll on the brain.” The Post article also pointed out the claim that stimulant drugs can lessen the risk.

This is one of many such announcements by professional journals and public news outlets that are misleading and that perpetuate the myth of mental illness as a brain disorder. Based on the data in this study, it is not justified, and might very well be harmful, to publicly proclaim that those who have been diagnosed with ADHD are at increased risk of getting dementia as a result of some negative affect that ADHD has on the brain. Not only does it encourage the false belief that ADHD is a real neurodevelopmental disorder - some kind of brain dysfunction - similar to dementia, it also promotes alarm and leads people to think stimulant drugs can prevent dementia for those who have been diagnosed with ADHD. 

There are two serious problems with the study’s conclusions. The first is that correlation does not equal causation. We are continually cautioned about this; nevertheless, many people, especially the lay public, hear causal implications in correlational results. In the present study, the manner in which the information is presented clearly suggests that ADHD causes an increased risk of dementia. But this is not a justified interpretation. Whereas they could have something to do with each other (see below), it also could be that ADHD and dementia have nothing to do with each other. Instead, they could be spuriously correlated because of their independent association with other variables. Consider as examples the many strong yet spurious (and quite silly) correlations at http://www.tylervigen.com/spurious-correlations.

Furthermore, the study reported a 2.77-fold increased dementia risk. This means those who were diagnosed with ADHD had a 177% higher risk of getting dementia than those who were not diagnosed with ADHD. However, the 177% is misleading. Whereas it is accurate, it is a relative risk figure. In other words, it is measuring the difference between two relatively low absolute risk figures: a 7% risk of dementia for those never diagnosed with ADHD; and 13.2% risk for those diagnosed with ADHD.* In actuality, the absolute percentage point increase for those diagnosed with ADHD is only 6.2%, a far less serious message than saying there is a 177% increase in the risk.

The second problem is that the symptoms of dementia are very similar to the diagnostic criteria of ADHD. This weakens the confidence we can have that a diagnosis of either is accurate and has resulted in discriminative validity problems. See https://www.frontiersin.org/articles/10.3389/fnagi.2017.00260/full and https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pnp.784. Think about how much overlap there is among the following symptoms (from the Mayo Clinic website for dementia and ADHD) and how a practitioner could interpret them as indicative of either problem. 

Dementia ADHD
Trouble with planning and organizing Disorganization and problems prioritizing; poor planning
Agitation and inappropriate behavior Hot temper and impulsiveness, low frustration tolerance
Confusion and disorientation and trouble performing complex tasks Problems focusing on task and problems following through and completing tasks
Personality changes Frequent mood swings
Anxiety Excessive activity or restlessness

 

In other words, someone who is developing dementia might be mistakenly diagnosed with ADHD. Likewise, someone who doesn’t have dementia, but who is demonstrating the criteria for ADHD, might be mistakenly diagnosed with dementia. This would explain the correlation between the two found in the JAMA study. In essence, rather than interpreting the correlation as indicative of one condition increasing the risk of the other, one is the other. 

Relatedly, the finding of no increased dementia risk for those diagnosed with ADHD and who used stimulant drugs, merely demonstrates that stimulants increase one’s attention abilities. They help one focus better on tasks. But that is what stimulants do - for all people. Anyone who is a coffee aficionado knows this. Those who used stimulant drugs would have artificially enhanced their attention capacity to the point of reaching sub-threshold levels of ADHD criteria, and thus, it would be less probable that they would have been mistaken as dementia patients.

These kind of studies, whether they are about ADHD, depression, bipolar disorder, or any other mental disorder category, are replete with similar problems. Those problems are based largely in how language is used to imply that mental disorder is some type of “dysfunction within the individual,” as is claimed in the DSM (p. 20), how this “disease-ifies” common difficulties, and how statistics are used to inflate the practical importance of the results. We must be on guard to call out these announcements. 

*The 177% increased risk is based on the adjusted hazard ratio of 2.77 presented in the study, even though the actual relative risk increase between the absolute risks of dementia for those diagnosed with ADHD and those with no diagnosis is 189% (13.2% / 7%).


Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

What Is Disease/Illness?

What Is Disease/Illness?

by Chuck Ruby, PhD


The thrust of the argument in The Social Construction of “Disease,” about whether disease/illness is a normative or naturalist matter is off the mark. The article argues that a definition based on social norms can be legitimate, and that physiological defect doesn’t need to be present in order for something to be considered a disease or illness. But the crucial question isn’t how to define disease/illness, it is whether those who claim to treat disease/illness, however defined, are qualified to do so and what are the social implications. From the article:

“Normativists argue that the classification of a condition as a disorder depends in an essential way on some sort of evaluative judgement. Naturalists argue that this classification depends primarily on natural facts, such as facts about statistical deviation from species typical functioning or failure of mechanisms to perform functions for which they are naturally selected.”

This essentially says disease/illness can be based in societal judgments about appropriate experiences and behaviors. But it sets up a distracting dichotomy between those who argue in favor of disease being defined with social norms (normativist) or disease being defined with evidence of physiological dysfunction (naturalist). It obscures the far more important issue that both normativist and naturalist approaches are evaluative judgments in themselves about the proper role of medical professionals. It comes down to what a society wants the medical profession to handle, even if the problem being handled has nothing to do with defects of bodily functioning. 

I addressed this in my book, Smoke and Mirrors, with the intent of pointing out its crucial effects on critical psychology and psychiatry efforts:

“It must be remembered that definitions are not absolute or “God-given.” They all reflect the values of those doing the defining. So if we, as a society, value the idea that any feelings of unease brought on by life struggles are illnesses to be subjected to medical forms of oversight and care, even without evidence or theory of disease processes underlying those feelings of unease, then “mental illness” would rightly fit the definition of illness and I would stop writing this book.” (p.4.)

So the important point is, regardless of how we define disease and illness, do we want medical professionals to apply supposed medical expertise to those problems. If we are to value medical professionals treating people not only for physiological dysfunction but also for being emotionally distraught or acting in unwanted ways, then so be it. But let the buyer beware. We would be opening the door for medical professionals to morph into moral guides - no, not just guides, but rulers.

Furthermore, so-called mental illness has a different status than other illness with the former allegedly involving mental compromise. If this weren’t the case, there would be no reason to distinguish it as a separate kind of illness. In other words, the story goes that those so afflicted do not have the full benefit of a healthy mind, thus, decision-making is suspect. And this is without any evidence of a dysfunctional brain or other physiological structure, as there is with Alzheimer’s disease, lead poisoning, and hypothyroidism. Psychiatrists (and other clinical professionals) would then have society’s permission to act as paternalistic monitors, judging people for their experiences and actions, and prescribing (demanding) “corrective” experiences and actions.

Therefore, those who would invite a medical professional to treat them for a mental illness are essentially risking their right to self-determination. The cherished principles of informed consent and “first do no harm” go out the window with mental illness. This is not to say that all people diagnosed mentally ill are denied that right to self-determination. But, it would be very naive to think it is a guarantee. Our experiences have shown us that the right is frequently and capriciously denied, especially when the prescribed treatment is ineffective. The moral guide takes charge of that person’s decision-making.


Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

ISEPP’s 25th Annual Conference – Afterword

ISEPP’s 25th Annual Conference – Afterword

by Chuck Ruby, PhD, ISEPP Executive Director


With another year's conference come and gone, my thoughts about it, and ISEPP in general, have swirled about me like the wake of a familiar and powerful ship passing by. I thought I'd pen these swirling thoughts, just to help me capture them more clearly for myself but also for the benefit of others. I would be grateful to hear your thoughts too.

ISEPP was created many years ago with the primary purpose of offering a haven to those of us who disagree with and rebel against the orthodoxy of the bio-medical-pathology model of human suffering and all the harmful consequences of such a model. We are professionals who recognize non-medical, safe, and respectful ways to help people in the throes of despair and confusion. We are also the consuming public who seek help, merely demanding that we be treated with basic dignity and not viewed as defective annoyances to be silenced or taken away and secluded out of sight. 

This was the 25th time we've convened for camaraderie, expression, and reassurance that each of us is not alone in our difficult struggle with mainstream psychiatry and the clinical versions of psychology, social work, counseling, and yes, even sometimes coaching. Each time, we hear from phenomenal speakers, telling us about the continuing harm of the orthodox model. Each time, we hear how baseless that model is - how the emperor wears no clothes. Each time, we hear about how this model is an ideology, not a science. Each time, we hear about alternative ways to help our fellow humans who face, as we all do, the inevitable challenges of living a human life. Each time we hear the message that human suffering is not a sickness, abnormality, defect, deficiency, or dysfunction. It is an expression of meaningful living.

During this most recent conference, we once again shared our criticisms of this failed, yet still entrenched, model:

David Healy, MD, FRCPsych, addressed the so-called gold-standard randomized controlled trials (RCTs) as a problem in plain sight, suggesting that their results are scientifically illiterate. They tell us something about the average effects of a treatment and this may be useful for regulators called on to license a drug. But no person seeking our help is average.

Arnold Cantú, LCSW, presented his comprehensive critique of the DSM and his ideas about a replacement framework, borrowing from the field of social work, and accompanied by examples of how the field can move away from the biomedical model. He proposed the development of an alternative non-medicalized, psychosocial, and codified descriptive problem-based taxonomy as an alternative.

David Walker, PhD, shared some of the ways Native Americans continue to survive and thrive in the face of innumerable adversities and oppression. He presented the “Twelve Virtues of Níix Ttáwaxt” (neek TAUwaukT, "good growth to maturity") as a means of support for the wellbeing of Native American youth as well as for all people regardless of background.

Lynn Cunningham introduced the film Medicating Normal. After viewing it, three of the "stars" of the film, David Cohen, PhD, Mary Neal Vieten, PhD, ABPP, and Angie Peacock, MSW, CPC, discussed their experiences making the film and their views on the present-day system's continued reliance on chemical means as the first line of offense to subdue normal emotional distress.

Angie Peacock, MSW, CPC, later presented her experiences as a patient in this system, eventually abandoning it, along with its psychiatric drugs. She described the challenges of doing so, including self-doubt and judgments from others. She encourages people who choose to follow in her footsteps, to redefine their relationships with the “experts” and re-conceptualize their life experiences that have been labeled "symptoms."

The conference culminated with a captivating discussion between Joe Tarantolo, MD and David Cohen, PhD, a long-time psychiatrist and long-time social work academic, respectively. They tried to delineate how, in the current era of "evidence-based psychotherapy" and "behavioral health," the two disciplines approach a variety of topics related to diagnoses, psychotherapy, and the very nature of human suffering.

Yet, despite the value of these conference presentations, as well as our long history of other powerful and uplifting experiences during our annual gathering, the orthodoxy is still firmly in place, calling the shots about people's rights to self-determination. Under the guise of healthcare, that orthodoxy dictates morally-derived standards of appropriate ways to act, feel, and think. Moreover, when we step outside the boundaries of those vague moral norms, we are at risk of losing our very essence of self and freedom by being subjected to long-term and coercive chemical (and less so, electrical and surgical) abuses, and involuntary confinement away from the very support systems so vital for restoration. Both of these reactions by the orthodoxy do nothing but exacerbate the problem by forcing further escape from the realities in our worlds - seeing escape as the answer, rather than engagement with our worlds despite the pain. Escaping merely serves to further distance us from possible solutions that would eventually reap a sense of meaning and contentment.

What are we to do? We have run the gamut from Congressional contact, peer-reviewed research and writings, consumer-driven demands for rights, one-on-one contact with other professionals and potential consumers, and both mainstream and social media attempts to share our critique with the rest of the world. But is it working? We try to stay connected to other like-minded organizations, and have considered the possibility of coalescing into one large consortium that can speak against these insults with a louder and more powerful voice against mainstream psychiatry. But are these organizations able, or willing, to put away parochial interests for the benefit of this strategy of a unified voice? Or, are we so diverse in our organizing principles that finding solidarity is nearly impossible.

As we get ready for ISEPP's 26th Annual Conference (tentatively set for Virginia Beach in the fall of 2024), I want to reflect on where we've been and how we can (and if we can) adjust ISEPP to have a greater impact on the current state of the clinical industries. I think such an organizational refinement that is based on historical experiences is needed for any group, if that group wants to retain, and even extend, its significance.


Chuck Ruby, Ph.D., is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

On the Human Rights of “Mental” People

On the Human Rights of “Mental” People

by Niall McLaren, MBBS, FRANZCP


Over the weekend, I forced myself to watch the final lectures in the "ADHD Masterclass" series issued by the college of psychiatrists in October 2022. Anything I could say now would probably be actionable so I'll think about it for a while. Since then, and much more interesting, I watched the launch of the joint WHO and UN Human Rights Commission guidelines on human rights and mental health legislation. Yes, it's dry and out there but... it's so important. This is the definitive statement from the most authoritative agencies in the world on how mental health acts are to be shaped and written. Speakers, who included the Director-General of the WHO and the HR Commissioner, saw three areas that needed urgent attention:

1. The world-wide reliance on detention and involuntary treatment in institutions rather than voluntary, community-based preventive care;



2. Closely associated, the dominance of the so-called "biomedical model" which debases the human experience; and



3. The failure to allow people with mental disorders be involved in decision-making.



Until these matters are rectified, nothing will change. Institutions will continue to gobble up the bulk of the mental health budget despite deteriorating mental health statistics; more and more people will become dependent on (i.e. addicted to) psychiatric drugs for life, with all their dire complications; and ever-growing legions of people around the world will be converted into shuffling queues of drug-addled, disempowered numbers. And we can be sure that any changes to the status quo will provoke a mighty shriek of outrage from psychiatrists, who will (correctly) feel they are losing their autonomy (read: power to do what they like to whom they like with no fear of recrimination; see New Zealand's shameful Lake Alice scandal).

The guidelines are over 200 pages and arrived late last night so I haven't done more than flick through them, but I want to focus on point 2 above, the "biomedical model." I put this in quotes because, ten years ago this month, my paper Psychiatry as Ideology,1 showed that no psychiatrist, psychologist, philosopher or neuroscientist had ever written anything that would amount to an explanation of mental disorder as a biological disturbance of brain function, i.e. a "biomedical" model. Despite billions of dollars spent on basic biological research in psychiatry, it is also true that nobody has written anything of interest since that could remotely fill that gap.2 I have challenged a number of influential psychiatrists to produce their so-called model but, after that challenge, there is a deathly silence, broken only by the sound of the lids slamming shut on their rabbit holes. There is only one conclusion to be drawn from this "omission":

Modern psychiatry is driven, not by a scientific model of mental disorder as a biological disturbance of brain function, but by an ideology which dictates that mentally-disturbed people are less than human and can be treated as such.

How did this come about? Why does the UN even need to produce guidelines saying "The mentally-troubled have rights, too"? By coincidence, I have just submitted a paper for publication that addresses exactly that point. It follows on from a discussion on the philosophical doctrine of positivism. As a reminder, positivism is the foundation of western science as it exists today. While the underlying notions had been bumping around for several hundred years, the doctrine burst on the scene nearly a century ago as "the scientific conception of the world"3.

Its goal was to eliminate all the airy-fairy stuff from science, to strip it down to its essentials by starting with just the evidence that could be positively confirmed - in brief, "If we can't see it and measure it, it doesn't exist." Any facts used to build a science had to be in the here and now, real observations of something tangible that could be checked and confirmed, even by people who didn't want to believe it. The new conception of science was that it had to be independent of anything we humans would like to believe about ourselves and the universe. Thus, they resolved the conflict between different religions by rejecting them all as "unprovable metaphysics." Trouble is, metaphysics is the branch of philosophy which deals with ultimate questions, such as the nature of being, the concept of mind or of causation, and so on, so we can't escape it. People who say "I make no metaphysical assumptions" are, in fact, making a very big one.

As it happened, when the positivist manifesto was proclaimed in 1929, medicine was already a long way down the objectivist path. Physicians were aware that the microscope and the pathology laboratory were revealing far more than the Bible or other religious texts ever would, so they didn't need much urging to join the movement. But, and this is a very big but, if unobservables can't form the basis of a science, and the mind is in principle unobservable, how can we talk about disturbances of the mind without lurching into "unprovable metaphysics"? For biology and general medicine, the problem was quickly solved by the psychological field known as behaviorism.

This started with a bang in 1913 when an American psychologist, John B. Watson, declared that all talk of the mind was strangling psychology by leading into unprovable arguments.4 Therefore, he declared, we will expel the mind from the science of psychology. Instead of "metaphysical musing" (aka "armchair philosophy"), observable behaviour will become the necessary and sufficient evidence to explain human activity ('necessary' means we can't explain humans without it, and 'sufficient' says that we need nothing more).

Without knowing very much about it, Watson proposed that the principle of conditioning, discovered by the Russian psychologist, Ivan Pavlov, would be the building block for a new scientific psychology. Equipped with the concept of the conditioned reflex, behaviorist psychologists were ready to explain everything. Ever since, generations of students have been taught about conditioning and reinforcement and so on, with just one small problem: there's no truth in any of it.

Ivan Pavlov was not a psychologist, he was a physiologist and he didn't think much of psychologists. In the second last paper published in his long life time,5 he described them as little more than a bunch of amateurs. Second, he didn't describe a process of conditioning, he described a technique for studying physiological actions, such as salivation in the dog. As a process, conditioning doesn't exist; the whole thing is a myth but it sounded very impressive so people were able to string it out for the next 75 years. Finally, it doesn't explain anything. To say that somebody has been "conditioned" to do something says no more than "That person does just that." Pavlov himself knew all this: "I reject point blank and have a strong dislike for any theory which claims a complete inclusion of all that makes up our subjective world" (p. 122). That is, he did not believe the doctrine of behaviorism could explain human mental life. But he died soon after and his prescient paper was completely ignored by the very people who were so keen to talk about "Pavlovian conditioning."

Meantime, on a planet far far away, psychiatrists were happily messing with people's brains and minds. Messing with brains, as in shocking them with various chemicals and electricity, or cutting them as in "leucotomy/lobotomy" (see PBS American Experience: The Lobotomist); messing with minds as in "You've got a bad case of penis envy, my good woman." Now if psychiatry wanted to join the happy scientific throng (read: get all the benefits), it had to abandon any notion that it could meaningfully talk about the mind, so out it went. Human mentality joined religion in the waste paper bin out the back. In the new psychiatry, when a person says "I feel so sad and hopeless, I may as well be dead," he's actually talking in metaphor. It's the same as saying "The sun's going down." No, the sun isn't going anywhere, that's just an impression that our science shows to be false.

Same with emotions: when a person says "I'm anxious," all she's doing is indicating in her quaint human way that her neurotransmitters are playing up. As a good positivist, the psychiatrist recognises this and, without letting his emotions or her prejudices get in the way, prescribes treatment to fix those pesky imbalanced chemicals. What the patient says is not to be taken at face value, it doesn't invite an emotional response as it is simply an indicator of the true state of affairs beneath the surface. The patient, of course, can't possibly know about but the keen-eyed and sharp-witted psychiatrist does: "Yes dear, of course you're sad, that's the nature of your illness, so here's your tablets, come back in a month next please." To put it differently, psychiatry removed any and all spiritual element from mental disorder. And that will provoke another howl of outrage, so we'll pause to consider it.

The concept of humans as spiritual creatures goes back forever: recent findings in South Africa indicate that a small hominin called Homo naledi, which was separate from our lineage, was ritually burying its dead 300,000 years ago. Maybe the little creatures had some religious sense, maybe they didn't, but humans do, centred around the notion of a spirit or soul, something above and beyond the "mere meat" of the body and brain. Now this is where it gets a bit murky because practically every human who has ever lived thinks of spirits or souls as having magical properties, such as immortality, or being able to act on the world without being part of it. Science can't deal with magical properties so this is precisely what positivism is designed to eradicate. For naive positivists, such as the Vienna Circle in 1929 or psychiatrists in 2023, mental = spiritual = magical = nonsense.

From that flows the idea that mentally-troubled people don't need to be taken at face value. For example, if they talk about their feelings, they're talking nonsense, especially when they're saying "I feel you people aren't listening. I don't want to be in your stinking hospital, I don't want your drugs and shock treatment. I want my clothes back and I want somebody who knows how to listen. I want to be treated with respect." And this is exactly what the UN is saying: the field of mental disorder has been coopted for purposes that suit the state and the psychiatric industry, not for purposes that suit the sufferers. Therefore this needs to be rectified. Now, not in the nebulous future. And, with their guidelines, they show just how it is to be done, except psychiatry isn't listening.

The institution of psychiatry is continuing along its old path of medicalising normality, of reducing psychosocial factors to tokens, of paying lip-service to the concepts of the Universal Declaration of Human Rights and the Convention on the Rights of People with Disabilities, and so on. We see this in the three lectures sponsored by the Royal Australian and New Zealand College of Psychiatrists which aim to put 5% of children on dangerous and addictive drugs without any understanding of what has happened to those children. 80% of people started on ADHD drugs as teenagers and young adults choose to stop them within five years. Doesn't that say something? Psychiatry claims to be "evidence-based." Isn't that evidence of something? Yes, it is evidence of selectively filtering the evidence to get rid of all the material that doesn't confirm your position. Similarly, where is the evidence that locking innocent people up in the very long term and drugging them insensible is better than other forms of management, or even no management at all? There is no evidence, that's why the UN says it's time to stop and reconsider.

My paper argues that we can write a science of mental disorder which gives full credit to the idea of humans as mentally-capable beings (I use the word spirituality but with no supernatural connotations). It is not meaningless to claim that mental symptoms can and do arise purely as the result of psychological and social pressures in a perfectly healthy brain. We need to reintegrate the concept of humans as mental/spiritual beings into psychiatry, as the first step to implementing a human-centred, rights-based approach to mental disorder.

While psychiatrists can wave the positivist manifesto (which none of them have read) at their critics, then we're in for a long, hard slog to change things. We may as well start now.

1 McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.
doi: 10.1891/1559-4343.15.1.7
2McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge.
3Hahn H, Neurath O, Carnap R (1929). The Scientific Conception of the World: The Vienna Circle. Ernst Mach Society, University of Vienna.
4Watson JB. Psychology as the behaviourist views it. Psychological Review, 1913; 20:158-177.
5Pavlov IP (1932). The reply of a physiologist to psychologists. Psychological Review, 39:91-127.


Niall (Jock) McLaren is an Australian psychiatrist who recently retired after 50 years of practice. He has extensive experience in military, forensic and remote area psychiatry, all at the rough and unglamorous end of psychiatry. As a specialist, he went back to university to study philosophy and has published a number of monographs on the application of the philosophy of science to mental disorder, most recently brought together as the biocognitive model for psychiatry. This is based in the concept of natural dualism, and provides a working model for mental disorder as a primary psychological matter, with no reason to suspect brain pathology. He lives in the rural outskirts of Brisbane with his family and keeps busy growing trees.

How’s Business?

How’s Business?

by Randy Cima, PhD


Business has never been better, thanks for asking. As long as the public — you and I — continue to demand newer and better quick-fix chemicals, we act as a sales force for this huge industry. The peddling of psychiatric chemicals, like all businesses, is subject to market pressure. Right now, there is continuing pressure to create more and more chemicals for more and more of our discomforts. Our demand is met, happily, by Big Pharma’s supply.

Here’s an example. ADHD (Attention Deficit Hyperactive Disorder) has been increasing five to six percent a year for the past few decades. Currently, there are more than six million children nationwide diagnosed with this brain disorder1. That means — like no other country on earth — one of every ten American children between the ages of 3 and 17 can be prescribed “speed” (central nervous system stimulants) to “treat” their ADHD.

And there’s this. In their unending quest to expand their customer base, about two decades ago psychiatry and their Big Pharma cohorts started funding studies to convince us this fake condition was somehow infecting adults too. Like the well-oiled machine it is, it has worked stupendously well. From MedMD, July 13, 2022:

It’s estimated that adult ADHD affects more than 8 million adults (or up to 5% of Americans). Many of them don’t even know it. Several studies suggest less than 20% of adults with ADHD are aware that they have it. And only about a fourth of those who do know are getting treatment for it.2

That’s a total of 14 million people with this preposterous diagnosis. And, as if not already enough, Big Pharma and knowledgeable professionals routinely caution us at every turn, to make sure we understand, and to make sure we let our family, friends, and neighbors know, there’s likely many, many, many others who are “un-diagnosed,” and “unreported.” So please, dear customer, keep spreading the word.

Your psychiatrist can choose from 61 different chemicals for ADHD — with more on the horizon. There are 78 chemicals for depression, and there are 15 kinds of depression. Antipsychotics? 26. There are 12 chemicals to treat autism, the most maligned of all children (see A Story About Autism: here). Anxiety disorder of some sort? There are 188 chemicals in 9 different “topics” to help you if you are too anxious. Anxiety relief, as you can tell, is a big seller.3

Market Size
Let’s take a quick picture of the growth of this industry in the past 70 years.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is psychiatry’s book of fictitious diseases.4 In 1952, there were 106 diseases. In 1968, the second edition of DSM was published, and there were 182. The third edition, published in 1980, named 265, and then revised in 1987 to 292. In 1994, the fourth edition of the DSM increased the number of psychiatric diseases to 410 diseases.5

The DSM 5 was released in 2013. It was designed to replace its 20-year-old, very dated predecessor. Since its release 10 years ago — and even before its release — DSM 5 had been roundly criticized by nearly everyone, including psychiatrists and other mental health professionals, the NIH (National Institutes of Health), and the British Psychological Society (who do not use it), to name a few. They have good reasons to criticize this scientific debacle. (You can read more about this here.) The newest edition, DSM 5TR, has expanded the number of diseases even more.

Every professional I’ve known in the past 45 years uses the DSM as a billing device, nothing else. It has no therapeutic value. It doesn’t provide any treatment suggestions and it doesn’t provide any clues to etiology — a fancy word for the pseudo-causes of these pseudo-diseases. The DSM only provides a name and number to the mental health professional, or agency, so they can bill their insurance provider. Once a diagnosis is chosen, no professional I’ve known ever refers to the DSM again. There’s no reason to do so.

However, as a billing device, it is essential. Everyone uses it. By everyone I mean local, state, and federal governments, big business, non-profits, academia, all mental health providers, all hospitals, all schools — everyone. Without a diagnosis from the DSM, treatment cannot be funded by private or public insurance providers. So, as you can see, it pays to be in the book.

How do you get in the book?
Very briefly. After completing rigorous scientific requirements, a Big Pharma company presents a new disease for consideration to the carefully selected, 28-member DSM Task Force of the American Psychiatric Association (APA). Then, the 28 members vote. Majority wins. If you win, a new disease is born, and is now eligible to be funded by insurance companies, including Medicare. If you’re not successful this year, fear not. You can submit again next year

Given the huge financial advantages for having one of your disorders selected to be in the book, there’s a lot of controversy about this process, not the least of which is this:

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest. Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.6

Who are the winners?
Academia and Big Pharma are the winners, and it’s very competitive. Universities and massive corporations stand in line to reap the rewards. If you can get an unwanted behavior proclaimed a disease by the disease proclaimers, then doctors, universities and corporations will be enriched because, well, we all stand in another line, so we can give them fistfuls of money for their products.

You should also know this. Big Pharma’s most important customer is the psychiatrist, not you. Psychiatrists are the ones who push their products to us. While these companies aim their endless advertisements to entice you, it’s the psychiatrist who grants permission. Big Pharma “field reps” are forever enticing doctors to try their latest concoction, or to provide them with evidence their old concoctions are even effective with other false disorders. The math is easy. More diagnoses, more prescriptions. Big Pharma and the medical profession work in tandem towards a mutually beneficial end.

Where Are We Going?
I trust you know by now, psychiatry in America is a vibrant commodity. That makes you a consumer. By the time you finish this book, you will be much more adept at asking questions about those chemicals your psychiatrist is prescribing for you or your child, and you will be much more able to measure the psychiatrist’s answers. By the way, you can purchase these chemicals — where else — at the local chemical store. As you already know, chemicals can be very, very expensive, especially those requiring a note from a medic.

You can, of course, purchase the same chemicals from a variety of illegal sources, and they are everywhere. They will be able to provide you with one or more of the 10 or so illegal chemicals you can’t buy over the counter, with or without a note from your doctor. You may be surprised to learn the chemicals found at your drugstore and the chemicals found at your corner connection are exactly the same. Exactly. Others are so similar chemically only a chemist could tell you the difference. The effects on a human being are identical. And please recall, it’s the chemical’s physiological effects we are interested in, whether legal or illegal.

1https://www.cdc.gov/ncbddd/adhd/data.html

2https://www.webmd.com/add-adhd/adult-adhd-facts-statistics#:~:text=ADHD%20is%20among%20the%20most,aware%20that%20they%20have%20it.

3See Drugs.com: https://www.drugs.com

4Or: disorders, deficiencies, delays, disabilities, derangements, disturbances, dysfunctions.

5https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#Early_versions_(20th_century)

6https://en.wikipedia.org/wiki/DSM-5#Financial_Conflicts_of_Interest_and_Perverse_Dependencies


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.

Read All About It, Miracle Cures In Psychiatry….

Read All About It, Miracle Cures In Psychiatry….

by Niall McLaren, MBBS, FRANZCP


At the end of this past May, the American Psychiatric Association (APA, not to be confused with their competition, the American Psychological Association, also APA) held their annual jamboree in San Francisco. The theme was Innovate, Collaborate, Motivate: Charting the Future of Mental Health. This is huge, something over 12,000 attendees and lots more demonstrating on the pavement outside who weren't allowed in. There were over 600 presentations of a dozen different types, all on the same topic (no criticism, of course): Mental Disorder is Brain Disorder.

It's also Big Business, costing members over US$1,100, but it is much bigger business for the drug companies. They could get a 23-page prospectus outlining the mouth-watering business opportunities of having an advertising stand in the convention centre . Starting with a 10'x10' booth, about 9 square meters, costs ranged from US$3,700 for the four days, to about US$18,000. Who pays this sort of money? Everybody: drug companies, device manufacturers (ECT etc), book publishers, IT companies, recruiting agencies, hospital and insurance companies, universities, the military ... There's money in psychiatry, that's for sure.

And for those of us too disadvantaged or churlish to attend, there were daily briefings direct to your email box from Psychiatric Times and others, all breathlessly announcing yet another stirring advance in the War on Mental Disorder. For example, anorexia and bulimia have now been targeted by the people who make "neuromodulatory" devices, magnetic field generators for transcranial and what is called deep brain stimulation. These machines aren't cheap, they start at about US$40,000 and quickly go up but the real expense is running them (staff, facilities, etc), which is why TCMS is so expensive.

The article mentioned a number of papers over the past few years where these machines had been used, but the studies were generally poor quality with small numbers and indifferent results. Compounding it, there was no agreement over which deep parts of the brain should be stimulated, although all researchers were sure that they were on the right track. Nonetheless, the author was optimistic that more research would be helpful. There was, of course, no discussion of why eating disorders should be regarded as brain disorders needing physical treatment of the brain, and not primary psychological problems for which talking is the correct approach. Mainstream psychiatry, which the APA conference represents, doesn't believe in mental causes of mental disorder, it's all physical, meaning lots of physical treatment and no time wasted on idle chat. That's why all the drug and device manufacturers and etc. flock to the APA annual conference: "There's money in them thar ills." (Sorry, bad joke).

Just to prove that there's nothing new under the sun, we have been treated to the latest, er, considered treatment for ADHD. Diet. This is true. Fifty years after the Feingold Diet was quietly smothered and buried by the manufacturers of stimulant drugs, we learn that diet is back:

There has been increasing interest in the role that diet and supplements play in the treatment of attention-deficit/hyperactivity disorder (ADHD) symptoms, from patients and researchers alike.

For those too young to remember the 1970s, the Fiengold Diet was developed by a Dr Feingold from California, a paediatric allergist who decided that what is now called ADHD represents an allergy to chemicals in the diet (unsurprisingly, that's what allergists do). The chemicals he chose were the group of salicylates, natural and artificial. Salicylic acid, universally known as aspirin, was originally discovered in the bark of willow trees (Latin name: Salix) but similar chemicals are widespread in nature. Dr Feingold, who graduated in 1924, decided that these were the offending agents and devised a diet that would eliminate them. He published a couple of books on the subject, including the best-selling The Feingold Diet for Hyperactive Children (1973), and immediately achieved near-superstar status among his devoted fan base. He died in 1982, just as the results were coming: the diet had no scientific basis and the results were woeful.

Unfortunately, Dr F. had based all his ideas on what was the original research on natural salicylates, from the late 19th century. All the figures were wrong, which meant his diet was little better than a random elimination diet. It was also difficult to follow as it put a lot of work on mothers preparing special meals at home and lunches for school but, most important, it was boring and the kids didn't keep to it. Finally, well-funded research (sponsored mainly by drug companies) soon found it was essentially useless but you couldn't tell the mothers. No way. Back when our children were still having birthday parties, each round of invitations would result in a dozen messages saying we had to make sure their little darlings didn't go near the red cordial, chocolate ice cream, little red saveloys (for some reason, they're called Cheerios here) and so on. As though we could stop them. But we had plenty of land and a pool so the kids could run screaming through the bush and jump in and out of the pool all afternoon, then sleep on the way home in the car, meaning the parents were happy and thought we'd done wonders.

But as I said, diets are back, which is generally an indicator that there is growing awareness the magic drugs aren't doing what they're supposed to do. This time, the prime offender isn't salicylates, it's... wait for it ... the Western diet of hamburgers, chips and fizzy drinks. Researchers have noted that as the diet of highly processed food, with high levels of salt, sugar and fat, spreads around the world, so the incidence of obesity in children rises, and in adults, along with diabetes, high blood pressure, bowel cancer, heart disease. And arthritis. Mustn't forget the relentless increase in arthritis of hips, knees and low back in the 150kg bodies designed for 70kg.

The researchers considered all sorts of possibilities, including what is known as the gut biome, meaning the trillions of bacteria that normally live in the large bowel. With a diet high in fibre and complex natural sugars, and low in animal protein and fat diet, i.e. the diet of hunter-gatherers, the large bowel has a stable population of fairly harmless bugs who mostly behave themselves and contribute to digestion. However, with the high fat/sugar/salt, low physical activity diet that is gradually taking over, the bowel flora changes dramatically. The nice bugs get shoved aside and nasties take over, leading to all sorts of odd chemicals flowing into the body. These include inflammatory chemicals such as cytokines, hence psychiatry's interest in whether mental disorder is due to these chemicals affecting the brain (there's no evidence for it yet but that doesn't stop anybody).

They also looked at some more way-out causes, including heavy metal intoxication (aka poisoning). These include chromium, lead, mercury, arsenic, nickel, manganese and selenium, all of which are found in the air, dust and water of mining and industrial cities. Entire generations of children have been exposed to these elements, even though they have long been known to be toxic to developing brains, lead in particular. Once absorbed, heavy metals stay in the body long term and many are concentrated in nervous tissues. Chronic low-grade lead poisoning in children, often starting during pregnancy and breast-feeding, results in measurable loss of IQ, as well as behaviour disturbances which, with a bit of massage, can meet the criteria for ADHD. Higher levels of lead poisoning, of course, are even more serious with mental impairment and coordination problems, up to coma, convulsions and death, so it's very serious.

However, it's rarely a problem of the wealthy as heavy metal poisoning is largely a problem of poor and minority children whose parents have to live and work near mines and refineries. The city of Flint, a post-industrial wasteland in Michigan, had a large scale experiment a few years ago when the city decided to save money by using water from the Flint River rather than from dams inland. The river is acid, so it dissolved the lead in the ancient water pipes that they'd never quite got around to replacing (Flint is poor and black), which meant the water was dangerous. However, in order to prevent public panic, the city authorities kindly suppressed the news. In Australia, refineries in Mt Isa (Qld) and Whyalla (SA) have been spewing tons of these chemicals into the air for decades. When the risks were finally made public, mothers were given helpful advice from health departments:

Don't wear shoes inside. Wash outdoor toys often. Don't hang washing out if there's a northwesterly blowing. In fact, try not to be outside at all if there's a northwesterly. Don't vacuum while your children are in the room. Don't drink rainwater. Or cook with it. Especially don't use it to make baby's formula. Don't let toddlers put their hands in their mouths or play on the grass.

These people were serious. Trouble is, the diagnosis of ADHD is not made so much in poor or disadvantaged children (unless they're in state care) as in middle to upper socioeconomic groups, so that doesn't work. Yes, heavy metal poisoning is a major public health issue in many parts of the world; no, it has absolutely nothing whatsoever to do with the "epidemic" of ADHD in Western countries; no, that news will not deter the brigades of concerned parents who will demand their little darlings be tested, at huge public expense, for heavy metals; and yes, the researchers end their little paper with a call for more research (read: more money):
... more research is required in order to better understand the efficacy and underlying mechanisms of dietary strategies for ADHD.

So while they're chasing the effects of bowel bugs on brains, have they given any thought to the possibility that so-called ADHD may have something to do with parenting? With the school environment? With family pathology producing just plain unhappy kids? Of course not, what a silly suggestion, everybody knows it's biological. Anyway, there's no money in that.
For children, their diet just is a parenting matter. Yes, there are pressures affecting what poorer parents can give their children but the fact that advertisers can spend taxpayer-subsidised millions on boosting the latest McRooster burger with cola and chips has to be taken into account. Also there are massive subsidies in the US for farmers to grow corn, which is then converted to vast quantities of corn syrup which has to be sold to cover the costs of the subsidies. Corn syrup is very high in sugar (about 780gm per litre, meaning the sticky goo is an astounding 78% pure sugar). It goes into everything. If you buy any ready-made food of any sort in the US, it's dripping with corn syrup. That is the sort of food the poor buy just because it keeps the kids quiet, especially in cold weather.

McDonalds used to give plastic toys with what they called their "Happy Meal": why didn't they hand out free medicine measures and other useful things? That's not their job, they reply: "Our job is to satisfy our shareholders." Sure, and the community and government pick up the bits (for tax purposes, McDonalds Australia is domiciled overseas and pays itself hundreds of millions a year in "royalties," thereby reducing its tax bill; the rest are just as bad).

So back to the APA annual gabfest. The entire orientation is directed at finding a biological "cause" for mental troubles, when common sense says the quality of life must have something to do with it. And that's modern psychiatry: as I have said (many times, in fact), modern psychiatry does not have a science of mental disorder. Instead, it is an ideology of mental disorder, a cluster of beliefs or a false or unproven narrative put about by the controlling elite for the purpose of safeguarding their interests. Because if they relax for one minute and allow that, yes, life experiences (including being detained and treated against one's will) may have something to do with mental disorder, then hordes of psychologists, social workers and other pond life will swarm in and the power elite will lose control of what they see as their industry.

The ADHD industry is more or less emblematic of everything that is wrong with psychiatry. If you can think of something that psychiatrists have got wrong or are doing wrong, it'll be in there. That's not a very flattering assessment of modern psychiatry; if somebody can prove me wrong, we'll publish it.


Niall (Jock) McLaren is an Australian psychiatrist who recently retired after 50 years of practice. He has extensive experience in military, forensic and remote area psychiatry, all at the rough and unglamorous end of psychiatry. As a specialist, he went back to university to study philosophy and has published a number of monographs on the application of the philosophy of science to mental disorder, most recently brought together as the biocognitive model for psychiatry. This is based in the concept of natural dualism, and provides a working model for mental disorder as a primary psychological matter, with no reason to suspect brain pathology. He lives in the rural outskirts of Brisbane with his family and keeps busy growing trees.

Talk About Downers: The Insidious and Cruel Psychiatric Practice of Medicating Sadness and Despair

Talk About Downers: The Insidious and Cruel Psychiatric Practice of Medicating Sadness and Despair

by Randy Cima, Ph.D.


Briefly
Psychiatry sells us four kinds of chemicals for our psychiatric disorders. Three chemicals really, though they have been experimenting for decades to find a use for the fourth, to no avail, so far.1 Each of the four has distinguishable, physiological effects on all earthlings, healthy or otherwise.

The four kinds of chemicals, and their effects, are: (1) Tranquilizers (downers), (2) Stimulants (uppers), (3) Analgesics (anesthetics/pain relief), and (4) Hallucinogens (consciousness altering), each with their own story.

This story is about psychiatry’s misuse of the first of these — tranquilizers — or what is commonly known as “downers.”

Downers
The first man-made tranquilizer, Chlorpromazine (CPZ), became available to the public in 1954. It was popular among professionals due to its ease of use and versatility — they used it for everything — and it was a huge financial boon to Big Pharma. By the mid-1960’s fifty million people around the planet had used CPZ. The formula was in place. (See Zombie Theory Part 3.2)

Since then, psychiatric science has simply reimagined the many ways they can produce, develop, and market similar tranquilizers. They have also used a variety of different names for these same chemicals during the past 70 years, including SSRI’s, benzodiazepines, antidepressants, anti-psychotics, anxiolytics, and many, many more. Regardless of terminology, they are all tranquilizers, and represent one of several kinds of central nervous system depressants.

In varying degrees, tranquilizers slow down our breathing, our heartbeat, and in general, our physical activity, including brain activity. Within a short period of time after ingesting a tranquilizer of some kind, you can feel your muscles relax and tensions lessen. Your life-stressors seem less impactful, and there’s even a sense of euphoria for a short period of time. You feel a little better than you did, for a while. And that, dear reader, is the dirty little secret no one talks about. This is how they “work,” and why they really don’t work at all.

Another thought or two
I think about half of adults (I’m guessing) who take these “meds” understand the particular tranquilizer they’re taking is just that: a tranquilizer. Because of the pressures of life, they seek tranquility. They like the calming effects of the pill, at least in the beginning. If someone takes Prozac as a way to find some tranquility for six months to help get over a divorce or another life stressor, and if in this way it works for them, that’s okay with me. It is a tranquilizer, not medicine. Some people consume alcohol to lower their stress and anxiety. Others exercise or meditate. There are a variety of ways to ease stressful, ongoing life situations.

Some take a tranquilizer — or two — when necessary. If, as the stress decreases, and use of the tranquilizer decreases too, then it’s no-harm-no foul as far as I’m concerned. Please be cautious. There are physical risks for using a tranquilizer too often, or for too long. They are toxic, they can become habitual, and they do not “treat a brain disease.” They provide us tranquility for stress and anxiety in our lives. With or without these cautions, as an adult, it’s your business.

However, for the other half (more or less), this is about life and death. They are desperate. They are not seeking tranquility. They are thinking about ending their life if they don’t feel better soon. A doctor — and society in general — convinces them they have a disease that is causing their deep depression and can only be helped with one, or more, of the many, many tranquilizers — downers — from which doctors have to choose.

With this introduction, and with these thoughts in mind, please consider the following story.

···

Insidious and Cruel
Imagine you’re a 30 something young man or woman, and you’ve been fighting a deep sadness for a few years. Life has dealt you a few blows. You have reason to be depressed. As a result, you’ve been isolating yourself for some time. You feel you’re a burden to the few friends and family members you still see. There’s no joy in your life. You have no energy, and no need for energy. Days are becoming more and more burdensome. Your thoughts and feelings are as dark as your mood. You try to exercise and mingle, like you’ve been advised, but you just don’t feel like it. You don’t want to be around anyone.

You started therapy a year ago. It helped for a while. You like your therapist and you confide in him. He knows you’ve had thoughts of ending your life, among other things. You were optimistic when you started. But now, it’s been a year, and you feel worse. Your therapist is frustrated too. You know he cares about you. He reminds you he suggested you see a psychiatrist six months earlier, but you declined. Maybe he’s right. Maybe there is something biological going on, you concede. After all, that’s what everyone has been telling you for a very long time. Your friends and family love you, and they all want you to get some medical help.

You’re desperate enough now. You haven’t really told anyone just how bad you feel, and how often you think about ending your life. You now prefer isolation. You’re depressed all the time, from the moment you get up in the morning until you go to bed, only to face another restless night. You’re still young, but you look old and you feel old. The future will only provide more of the same. So, with the prayers and support of family and friends, you’re finally willing to go to a doctor to address this long held, sinking feeling. You must put a stop to your overwhelming despair, and an end to those thoughts of self-harm. More and more often, in your most private thoughts, suicide is becoming a better option. You make an appointment.

You meet your psychiatrist. She already knows about you. You were referred by your therapist. You thought you were going to have a conversation about your life. Instead, it’s an interview. Within 20 minutes — maybe 30 — she tells you you’re clinically depressed, maybe bi-polar. She takes some time explaining, as best she could, how this medication will help treat the brain disease that is causing your depression. She gives you a prescription to treat your symptoms — she already told you there’s no cure for the brain disease you have. She gives you Zoloft, or Prozac, or Xanax, or another SSRI or benzodiazepine. In short, she tells you to ingest a particular dose of a particular tranquilizer.

You go home to follow doctor’s orders. You’re at least relieved to know you have something that can be treated — finally. Nothing has changed in your life, of course, but you take your first tranquilizer in the morning, and again in the evening. You’re trying to be optimistic.

It’s been two weeks, and you don’t feel any better. You were expecting something in the first week. The doctor warned you that you could feel worse before you feel better — it’s common she said — and she was right. You feel worse. You’re even more lethargic, less energetic, and your mood is worse too, and so are your thoughts and feelings. You call the office like the doctor told you, and you report the side effects of the tranquilizer. The office tells you it’s normal.

In the meantime, life happens, and other life stressors occur. You’re getting overwhelmed again. Perhaps you waited too long to see a psychiatrist. Perhaps your disease is that hard to manage. This time, a few weeks later, you go to the office. The doctor changes the dose to see if that works. If that doesn’t help, she told you, she may try another tranquilizer in a few months. You can’t wait a few months.

On your own, desperately, you double the dose of your tranquilizer. Nothing. You’re not even frightened anymore. You’re numb. You’ve taken more than you should, and it just makes you feel more depressed, more lethargic, more alone. You’ve confirmed, in your own mind, what you thought was true anyway. Therapy didn’t help and the doctor’s medicine has made it worse. There is no help coming. You’re destined to more misery, and you know you’re a constant worry to those who love you. Everyone will be better off, eventually, you reason. With a deep sorrow, and with a sense of peace, you make, given the circumstances, a principled, private decision. You end your story.

I think this is insidious and cruel. Do you?

1 The use of hallucinogens has been the subject of many experimental studies for many decades, with little to no results. Yet, the pursuit continues. Here’s the latest study from Johns Hopkins Medicine: Psychedelics Research and Psilocybin Therapyhttps://www.hopkinsmedicine.org/psychiatry/research/psychedelics-research.html

2 Zombie Theory Part 3: https://medium.com/@randycima/the-zombie-theory-part-3-3573b3920cc5


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.

The “Benzo-Disease” Is Widespread – And Getting Worse

The “Benzo-Disease” Is Widespread – And Getting Worse

by Professor Bob Johnson


IGNORANCE OF THE MIND, is no excuse. It’s all too easy to get lost in too many mental machinations – how the mind works, where it comes from, what makes it tick. These are questions we’ll never fully know the answer to. But that doesn’t mean we can’t do anything. The way through is to grasp those bits we can understand and make the most of them – it’s what every doctor and every healthcare worker in the world does, all day long. They don’t know ALL the answers – nobody does – but given enough thought, care, and experience, they, and we, can make a significant difference. And when it comes to psychiatric drugs, we all need to take careful note, and then do something about it, urgently, because otherwise it will continue to get even worse than it is at present. 

A PILL FOR EVERY ILL, sounds wonderful – but every pill has side-effects, some very toxic indeed. So we need to take far more care. We love the idea that we can pop a pill and all our troubles will be over – alcohol has been our favourite social ‘tranquiliser’, our go-to sedative, for millennia. Even today, people grab a gin and tonic, at the slightest stress. BUT what if your very own doctor prescribed a G & T, three times a day – what would you think of that? Because it happens. And it happens all too often – watch. 

I was once invited to travel to North Wales to give a talk to GP trainees on how they could do better. I told them that too many doctors’ prescriptions amounted to taking alcohol three times a day – it went down well with the ‘students’, but the organisers were horrified, so they didn’t invite me back. That’s the trouble – doctors, and I am one – don’t like to hear of their mistakes, especially when they didn’t know they were doing them. But that doesn’t stop the damage. And the sooner we all wake up, and tell the medical profession to take a good long hard look at itself, the better. And if the doctors don’t do it themselves, we’ll need to raise such a rumpus, they can’t ignore it. 

Now when you're dealing with problems of the mind, before you get mired in a whole lot of mud, it’s best to stick to hard, well known and obvious medical facts. This is the key to unpicking the notion that mental problems are beyond explanation. Some are, and some aren’t. Best to stick to the ones we can understand.

So let’s begin with alcohol. This has been around for yonks. It eases social frictions, and affords some sort of (temporary) peace-of-mind – but it comes with an obvious cost, indeed a number of them. Everyone knows that alcohol carries serious medical risks. Not everyone listens, but the facts are indisputable. This indisputability is unusual when discussing mental troubles, but it’s perfectly true. 

More people know more about the ‘side-effects’ of alcohol than of any other drug you care to name. And alcohol is a drug – it impacts on your mind, whoever you are. So the thing to look out for is – do doctors recommend it? Could they be prescribing ‘alcohol-substitutes’? Because if they are – they, and we, need to wake up fast, and make doing so illegal. 

IN SUM, alcohol is well known to produce four major problems. They are (1) addiction, (2) anti-social behaviour, (3) brain damage, and (4) the DTs. 

Now bear in mind that, though we are discussing alcohol, the fact is that nearly all the other drugs which work on the mind, do so in a surprisingly similar way. This happens to be one of the simpler aspects of the human mind. Chemicals which impact on it, via the brain, almost invariably follow identical pathways, remarkably closely. The way the brain copes with alcohol, is exactly the same way it does for far too many ‘psychiatric’ drugs. Benzos especially. 

Take the four ‘risks’ alcohol poses, in turn. Bear in mind that the crucial difference between prescribed drugs and alcohol is that the decision to take alcohol, or not, is entirely OURS. Taking alcohol can never come with the authority of the medical profession, because they and we, all know better. A doctor who prescribed habit-forming drugs, including alcohol, would face serious medical reprimands – and rightly so. 

Starting with (1) addiction. Again this can get complicated very quickly, so keeping things as simple as possible, let’s just say that addiction happens when it seems like you can’t do without something. It could be any number of things, but alcohol is well known to induce this implacable ‘longing’. ‘Where’s my next drink?’ becomes the overriding question for far too many alcoholics. When alcohol becomes more important than anything else – then you know you're addicted. Bear in mind that if a prescribed drug ever became this important, then something has gone seriously wrong medically. To be rendered unable to face life without your ‘medical fix’, is a disaster for both doctor and patient alike. And again, sadly enough, it happens. 

(2) Anti-social behaviour – this hardly needs emphasising. ‘Drunk and disorderly’ is too well known to be doubted. The technical term is ‘disinhibition’. The person afflicted loses all social sense. Violence is commonplace. Many lives, especially of those you live with, can be seriously scarred. What if this were to happen, not because you chose to become drunk – but because you followed orthodox medical advice, like any ordinary citizen should be able to, and battered those you love ‘by mistake’, or under the influence. Again doctors should bear full responsibility, and be prepared to pay extensive compensation – if this ever happened because of a drug, a psychiatric drug, they had recommended and prescribed. Again, this does happen, and it’s time notice was taken of it, such that it became illegal. 

(3) Brain damage – in the Paris metro, they used to put up glass cages with cirrhotic livers in them, to warn passengers that alcohol pickles the liver. Of course we use alcohol in the kitchen for precisely the same reason – it alters the chemicals involved, and the items thus pickled last longer. So why is it a surprise that this drug has a similar impact on our very own brain tissue? It does. It can be proved to. And so, worse for all of us, do too many psychiatric drugs. For many years now, it has been well known from brainscan work, that some psychiatric drugs actually shrink brain tissue1 – your brain gets smaller when you take these pernicious, but prescribed, drugs – wow. Indeed a study of Swedish conscripts2 showed that those who had been prescribed so-called ‘anti-psychotics’ as teenagers developed dementia sooner than those who weren’t. The records followed them for ~37 years. Doctors making dementia worse? How can this be tolerated? Dementia is increasing all the time – some see it as our next, and worst, ‘epidemic’. Here’s a known causative factor that’s been ignored for far too long. Time for concerted action – now. 

Finally, (4) the DTs. Pink elephants are traditionally what drunkards see when their supply is cut off. Known as the DTs, short for Delirium Tremens, or ‘shaking deliriums’, it is closely similar to ‘going cold turkey’. The brain has got used to a certain level of chemical assault, and it reacts, badly, when the supply stops. I join an emailing list of some 350 psychiatrists from around the world, and they give heart-rending accounts of how difficult some people find coming off, not alcohol, but doctor-prescribed pills. Some of these drugs have a chemical action which seems to seek out the weakest spot. Coming off them requires extraordinary care and skill. Play it wrong, or too quickly – and the symptoms that afflict you are vastly worse than the original disease. This is doctors making matters worse – a whole bunch of symptoms come into being, when you actually try and stop swallowing the very tablets that the doctor has advised you to take. Never stop psychiatric drugs abruptly. What a dreadful thing to have to say. But it’s today’s medical fact of life. And it will continue until we get the medical profession to wake up to what it is doing. Alcohol three times a day might even give you fewer side-effects than this. 

BUT WHAT IF THESE HARMFUL DRUGS DON’T HELP? Study their effects over 20 years, and you find they don’t. Look at the graph below3. The red are those duly taking their prescribed medication – those not, are in the green. You end up far worse, if you do what the doctor says – wow, indeed.

Pasted Graphic.jpg

IN CONCLUSION – Am I the only one trying to whistle-blow here? Indeed not. The Myth Of The Chemical Cure is a book published in 2007, fully 16 years ago, by Dr Joanna MonCrieff, a well established university lecturer in psychiatry. She concludes (last page) – ‘It helps to lift the veil of medical jargon, exposing our ‘miracle cures’ as psychoactive chemicals, which distort normal brain function by producing a state of intoxication’. Here the overlap between psychiatrists’ drugs and alcohol comes home to roost. How long do we have to wait? The whole issue has been competently discussed by the celebrated science journalist, Robert Whitaker – his 2015 book says it all: Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform4. This was written in conjunction with the Harvard Center for Ethics. It has had zero impact on established psychiatry. You begin to wonder what will. What we’re talking about here is the tip of a toxic ice-berg. The ‘Benzo- Disease’ is widespread – and getting worse – time for action, time for laws, time we shifted this medical incubus. And if not us, who?

1 Moncrieff, J. (2007). The myth of the chemical cure: A critique of psychiatric drug treatment. New York: Palgrave Macmillan.

2 Nordström, P., Nordström, A., Eriksson, M., Wahlund, L., & Gustafson, Y. (2013). Risk factors in late adolescence for young-onset dementia in men, a nationwide cohort study. JAMA Intern. Med., 173(17), 1612-1618. doi:10.1001/jamainternmed.2013.9079.

3 Harrow, M., Jobe, T. H., & Faull, R. N. (2014). Does Treatment of Schizophrenia with Antipsychotic Medications Eliminate or Reduce Psychosis? A 20-Year Multi-Follow-Up Study. Psychological Medicine, 1-10.

4 Whitaker, R., & Cosgrove, L. (Contributor). (2015). Psychiatry under the influence: Institutional corruption, social injury, and prescriptions for reform. New York: Palgrave Macmillan.


Dr. Bob Johnson is a consultant psychiatrist, currently on the UK GMC specialty register, with a special interest and expertise in the long term effects of trauma, and how to remedy them. He initially trained in the Therapeutic Community Approach, followed by two years in a New York State hospital. For 20 years, he was a Family Doctor in Tameside, Lancashire, UK, exploring family structures and uncovering the dire impact trauma has on cognition. Then, as a prison psychiatrist in Parkhurst Prison, UK, from 1991 to 1996. He worked with 50 murderers, entailing up to 2000 hours of unaccompanied consultations, with some 700 hours videotaped, working out with them why they killed. He is currently publishing a series of philosophy papers, clarifying the philosophical basis for this, with particular reference to psychiatric reform, social stability, and planetary health. His book, Friendless Childhoods Explain War, is coming out in July 2023 by Waterside Press UK.

 

Challenge Sidestepped

Challenge Sidestepped

by Chuck Ruby, Ph.D.


An interesting exchange has taken place between psychiatrist and Psychiatric Times author Awais Aftab, M.D. and journalist Robert Whitaker of Mad in America (MIA). The initial trigger was MIA’s March 27th review of a JAMA Psychiatry article that reported how psychiatry has failed to publicize data about treatment success rates over time.

A day after MIA's review, Aftab responded on his "Psychiatry at the Margins" blog, claiming that the MIA review was worded in a way that misrepresented the JAMA Psychiatry article. The title, and essence, of MIA's review was that psychiatry had "no evidence that psychiatric treatments produce 'successful outcomes,'" when the JAMA Psychiatry article actually said:

...success rate trends are rarely reported in psychiatric journals or in other mental health or behavioral medicine journals. This makes it difficult to determine whether psychiatric treatment outcomes are improving over time, stagnating, or perhaps even regressing.

The MIA review language, whether intended or not, does seem to imply that a lack of psychiatric treatment success rates over time is the same as there being no evidence of treatment success. This is contrary to the "absence of evidence is not evidence of absence" idea.

However, absence of evidence regarding this matter is astounding. In science, those who make a claim (such as the often-advertised assertion that psychiatric treatment is increasingly effective and safe over time) are obligated to provide the evidence to support that claim. As the JAMA Psychiatry article confirms, psychiatry has failed to do so. This doesn't mean the evidence isn't "out there" somewhere. But it is a flaw of reasoning, and a threat to consumers' rights and safety, to assume it is.

MIA was on spot in challenging why psychiatry hasn't established these success rates like other medical specialties have. Psychiatry is not exactly a new specialty, having existed for over two centuries, and since its foundation, it has steadily increased its impact and control over millions of lives with chemical, electrical, and surgical treatments for illnesses that it has a very hard time defining or even finding. 

In response to Aftab, Whitaker replied on April 6th, clarifying MIA’s original purpose and mission and further detailing the reasoning used in the MIA review and how important it was to address the problem that psychiatry has not provided trend data about treatment success. As part of his reply, Whitaker cited a litany of psychiatric research to date as a backdrop, which at the least, makes one seriously question the effectiveness and safety of psychiatric treatments, and why trend data is missing.

Aftab again replied to Whitaker on April 9th. But this time, his comments redirected away from the issue of psychiatry's lack of success rate trend data and, instead, he unfortunately seemed to go to lengths to belittle Whitaker and MIA.

He first described Whitaker's thoughtful and comprehensive reply of April 6th as “long-winded” and a “double down in the defense of” the original MIA review. He further suggested it would have been better if, instead of replying to Aftab’s March 28th blog, Whitaker just remained quiet, distanced MIA from the review, or reacted with contrition. This is a familiar reaction by mainstream psychiatry; they seem to only respect criticism that doesn’t seriously attack its foundations.

After this initial disparaging salvo, Aftab then launched into a false equivalency, claiming that both the institution of psychiatry and MIA are guilty of the sin of misleading the public. He pushed even further and resorted to the political red herring ploy of attacking the accuser, saying whatever the institution of psychiatry is guilty of, it doesn’t “absolve MIA of its sins and shortcomings.” This turning of the tables and pointing the finger back at Whitaker and MIA avoids the challenge of the March 27th review, which was about psychiatry’s empirical shortcomings of its widely claimed treatment successes over time. Challenge sidestepped.

Aftab further tries to marginalize Whitaker, condescendingly declaring that he “held some rather naïve ideas about psychiatry in the 1990s through no fault of his own.” Aftab is making the incredulous claim that Whitaker, an award-winning investigative journalist and part of a Pulitzer Prize finalist team, who has covered medicine and science for over 30 years, just doesn’t understand the complexities of psychiatric research. This is another ploy by mainstream psychiatry - when serious criticism comes, just discount it as naïveté. Aftab tops it all off by casting Whitaker and MIA aside with the charge of having “anti-epistemology” blinders.

Aftab spends considerable time (“long-winded”?) exploring questionable charges that Whitaker’s and MIA’s work (and presumably everyone else that challenges psychiatry’s orthodox standing) is contaminated with “trapped priors,” ideas of “progress narratives,” “epistemic echo chambers,” “intentionally selective” research coverage, and “ideological conflicts of interest.” It is ironic that these are the very things that have corrupted institutional psychiatry. Eventually, Aftab punctuates his mocking of Whitaker and MIA by insinuating they are conspiracy theorists.

Institutional psychiatry at its essence, not just its research and practice, is fundamentally flawed. It makes the assumption that emotional distress, suffering, difficult behaviors, and unusual thoughts are its proper target. Given that over 200 years of efforts have produced no evidence that these problems are the result of brain/body pathology that can be medically assessed and treated, it is not surprising that psychiatry cannot present medical success rate trend data. 

In quoting a previous blog of mine:

...research that conforms to proper design, methodology, and analysis to tease out confounding variables of effect and increase confidence in the results, has shown that traditional psychiatric treatment is either ineffective, only marginally effective, only temporarily effective, is "treatment that works," or is "efficacious in reducing symptoms." The latter two outcomes are examples of the ubiquitous medicalese commonly used by the mainstream to portray psychiatry's work as medical science. But in the case of prescribed drugs and ECT, the medicalese merely describes the psychoactive effects of chemicals and electricity and how they can act as tranquilizing (or energizing) agents, pushing someone to the point of not being as troubled by real life problems and, thus, not complaining about those problems, giving the false impression of some type of resolution.

Furthermore, those “successes” are presented in isolation, without the context of the longer term harm brought on by repeated treatment of that sort, just like what happens with long term illicit and recreational drug use. A quick snort of cocaine can rejuvenate an exhausted soul, a stiff drink can settle one's angst after a grueling week, and LSD can open up new possibilities. But daily lines of cocaine, stiff drinks, and acid trips can ruin lives, while they do little to address the important human challenges that we all face.

In order to correct this flaw, one of two things must happen. On one hand, psychiatry can abandon the role of the moral arbiter that anoints certain behaviors and experiences as abnormal, sick, inappropriate, but still medical matters, along with attempts to “treat” these transgressions. It can then stick with problems that are due to bodily pathology.

On the other hand, psychiatry can openly announce that it wants to be that moral arbiter, expanding medicine’s role to the extent that the Church did centuries ago in applying a religious model to human suffering. Until psychiatry makes this choice, it will continue to dance the psychiatry two-step, switching from one foot to the other, as it tries to obscure its failures that result from this fundamental flaw, yet continuing to claim professional standing without the evidence.

Again, to quote my previous blog entry, psychiatry is:

…a presumed medical specialty that has no reputable theory about the alleged internal dysfunction that causes mental illness, that has no biomarkers with which to diagnose those illnesses, that has no treatments that correct deficiencies of bodily systems responsible for those illnesses, yet that has a long history of coercing people to act, think, and feel in accordance with an ill-defined and ever-changing set of moral standards.


Chuck Ruby, Ph.D., is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.