Al Galves, Ph.D.

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

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

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

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

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

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

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

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

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

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

Here are some other problems with the bill:

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

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

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

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

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

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

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

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

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

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

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

Mary Vieten, Ph.D., ABPP

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

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

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

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

William Schultz, Doctoral student, Minnesota School of Professional Psychology

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

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

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

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

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

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

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

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

References

Andrews, P. W., Thomson Jr, J. A., Amstadter, A., & Neale, M. C. (2012). Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good. Frontiers in Psychology, 3, 117, 1-19.

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

Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry, 171(4), 395-397.

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

Kirsch, I. (2014). Antidepressants and the placebo effect. Zeitschrift für Psychologie, 222(3), 128-134.

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

McCall, W. V., Andrade, C., & Sienaert, P. (2014). Searching for the Mechanism (s) of ECT’s Therapeutic Effect. The Journal of ECT, 30(2), 87-89.

Moncrieff, J., & Kirsch, I. (2015). Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contemporary Clinical Trials, 43, 60-62.

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

van Daalen‐Smith, C., Adam, S., Breggin, P., & LeFrançois, B. A. (2014). The Utmost Discretion: How Presumed Prudence Leaves Children Susceptible to Electroshock. Children & Society, 28(3), 205-217.

Wakefield, J. C., & First, M. B. (2012). Validity of the bereavement exclusion to major depression: does the empirical evidence support the proposal to eliminate the exclusion in DSM‐5?. World Psychiatry, 11(1), 3-10.

Chuck Ruby, Ph.D.

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

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

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

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

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

Randy Cima, Ph.D.

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

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

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

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

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

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

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

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

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

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

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

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

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

David Healy, M.D.

The crash last week of the Germanwings plane has shocked many.  In view of the apparent mental health record of the co-pilot Andreas Lubitz, questions have been asked about the screening policies of airlines.  The focus has generally been on the conditions pilots may have or the arguments they might be having with partners or other situational factors that might make them unstable.

Continue reading here

Chuck Ruby, Ph.D.

The WebMD study here is just as flawed as previous "breakthroughs" about biological markers for depression. It is misleading and weak because it is built upon a very flimsy assumption that depression is a disease rather than an understandable reaction to a life situation. The assumption is presented early in the article with a sleight of hand and repeated with the use of biological, medical, and illness words, giving the impression that depression is a disease. Yet, despite this assumption, no evidence is ever given to demonstrate the disease nature of depression. That's because there isn't any such evidence.

The absurdity of this also rests on the fact that depression is conventionally diagnosed by using a checklist of reported symptoms and behaviors. The checklist is contained the the psychiatric "bible", the DSM. Nowhere in that checklist is any mention of laboratory tests. That's because there is no bodily malfunctioning to test, as there is in diabetes, where a real disease process is happening.

The blood tests in this article do not identify disease or in any other way a malfunctioning of the body or brain. These tests merely demonstrate that human experiences (including depression) are accompanied by bodily "happenings". But this also happens with singing, crying. laughing, and playing golf. Those activities have their own "biological markers". The point here is that biological markers do not necessarily equal disease.

Imagine the absurdity of an article that says biomarkers have been found to diagnose "Athletic Deficit Disorder". Those biomarkers are identified as less muscle tone, smaller muscle mass, overweight, and shorter limb structures. Scans show decreased blood flow to the muscles, and probably differences in genetic markers. This would make sense only if we assume "ADD" (as above) is a disease to be diagnosed.

This article reports on research that adds to a long line of attempts to take basically existential human struggles and turn them into illnesses by showing biological correlates of the struggles. Damage will be done by using such biomarkers to screen people for depression, and then bear down on them with the coercive weight and authority of the psychiatric-industrial complex.