Cruise vs. the American Psychiatric Association

The leadership of the American Psychiatric Association is quite arrogant. They are so certain that they are right about the biological model of mental illness, even though it's not been proved, that they issue this statement in response to Tom Cruise's comments:

"Rigorous, published, peer-reviewed research clearly demonstrates that treatment (of mental illness) works," the APA statement said. "It is unfortunate that in the face of this remarkable scientific and clinical progress that a small number of individuals and groups persist in questioning its legitimacy."

First, I guess they forgot about the study that found that placebos work as well as anti-depressants. Second here are citations gathered right from the scientific literature that showing that this issue is far from decided (as compiled by mindfreedom.org):

Mental Health: A Report of the Surgeon General (1999) is explicit about the absence of any findings of specific pathophysiology:

p. 44: "The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify the illness."
p. 48: "It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms."

p. 49: "The precise causes (etiology) of mental disorders are not known."

p. 51: "All too frequently a biological change in the brain (a lesion) is purported to be the 'cause' of a mental disorder ... [but] The fact is that any simple association -- or correlation -- cannot and does not, by itself, mean causation."

p. 102: "Few lesions or physiologic abnormalities define the mental disorders, and for the most part their causes remain unknown."

In the third edition of Textbook of Clinical Psychiatry (1999), we find similar statements:

p. 43: "Although reliable criteria have been constructed for many psychiatric disorders, validation of the diagnostic categories as specific entities has not been established."

p. 51: Most of these [genetic studies] examine candidate genes in the serotonergic pathways, and have not found convincing evidence of an association."

In Andreasen and Black's (2001) Introductory Textbook of Psychiatry, we find, in the chapter on schizophrenia:

p. 23. "In the areas of pathophysiology and etiology, psychiatry has more uncharted territory than the rest of medicine...Much of the current investigative research in psychiatry is directed toward the goal of identifying the pathophysiology and etiology of major mental illnesses, but this goal has been achieved for only a few disorders (Alzheimer's disease, multi-infarct dementia, Huntington's disease, and substance-induced syndromes such as amphetamine-related psychosis or Wernicke-Korsakoff syndrome)."

p. 231: "In the absence of visible lesions and known pathogens, investigators have turned to the exploration of models that could explain the diversity of symptoms through a single cognitive mechanism."

p. 450: "Many candidate regions [of the brain] have been explored [for schizophrenia] but none have been confirmed."

The ironic thing is that I actually believe that medicine helps people under the right circumstances, it's forcing it on them that I object to. But this obnoxious, childish arrogance makes me doubt the APA more than I would otherwise. They are a professional organization, not a kid in the schoolyard. If they were confident of the past and their present, they wouldn't feel the need to speak in such a way. I think it's the ghosts of both Walter Freeman and Henry Cotton that makes the American Psychiatric Association so nervous.

A Poem by Carleton Hill

In 1947 my grandmother, Beulah Jones, had no idea what terrible things lay ahead in her life. At that time she simply wanted to be a writer. She had two poems published in a book called "Talent - Songwriters and Poets of 1947" under her nom de plume Carleton Hill. She was so proud of being published that she sent a copy, the one that I have, to her mother in Kansas with the inscription:

Dear Mom, Always thought I could do it; but, as yet, I haven't done much.

Good Lord, it doesn't get any sadder than that, does it? Poor thing. Anyway, there were two poems in this book and I would like to publish one of them here online so that she can finally reach the audience she wanted so badly to find in life.

A STATE OF UNPREPAREDNESS

To think of you in a garden,
A garden warmed with the sun of the afternoon
And jeweled with the dew of morning.

In our garden, for it is ours,
We have planted the seedlings of spring,
And, together, we wade in the heartway of summer.

To think of you is to exclude,
In all its completeness, the winter;
For before the winter, would come the autumn,
And I am not, nor shall I ever be,
In any measure prepared for the autumn.

Hey, not bad, Grandma. Not bad at all. And this woman was lobotomized a mere seven years later.

Psychiatrists and Gitmo

Today's New York Times published this statement in an article about the role of psychiatrists in interrogations at Guantanamo Bay, "... authors of an article published by The New England Journal of Medicine this week said their interviews with doctors who helped devise and supervise the interrogation regimen at Guantánamo showed that the program was explicitly designed to increase fear and distress among detainees as a means to obtaining intelligence."

Don't worry though. They weren't acting as physicians at the time. "Bryan Whitman, a senior Pentagon spokesman, declined to address the specifics in the accounts. But he suggested that the doctors advising interrogators were not covered by ethics strictures because they were not treating patients but rather were acting as behavioral scientists."

Remind me to stay the hell away from behavioral scientists.

I don't know why they need psychiatrists to help with the interrogations. It seems like any group of cruel adolescents could design the sessions which are described as, "including sleep deprivation, prolonged isolation, painful body positions, feigned suffocation, and beatings. " Not to mention peeing on Korans and sexual provocation.

"'Their [the psychiatrists] purpose was to help us break them,' one former interrogator told The Times earlier this year."

It is not good for psychiatrists to break their oath to "do no harm" because the government asks them to. I am reminded of the psychiatrists of the former Soviet Union whose real purpose was to assess the patient's political beliefs, often sending the recalcitrant to the psych hospital/gulag. What else will psychiatrists do to people if the government justifies it?

Picture this scene described by The Times, "The former interrogator said the ... doctors usually observed interrogations from behind a one-way mirror, but sometimes were also in the room with the detainee and interrogator."

In an ideal world abusers would be afraid that a physician or psychaitrist, bastions of ethical behavior, would see their crime and report them. Here in reality they are accomplicies hiding behind mirrors.

UPDATE: US acknowledges torture at Guantanamo and Iraq, Afghanistan: UN source

Were psychiatrists involved in outright torture, I wonder? Paging Dr. Mengele ...

Bill would force mentally ill to take their meds

AUGUSTA - The mental health community is divided over a proposed new law that would require some people with mental illness to take prescribed psychiatric medications or face involuntary admission to a state hospital.

The initiative, known as "community commitment," had all-but-unanimous bipartisan support in both the House and Senate during the recently adjourned legislative session, but has been held over for reconsideration because it would draw about $600,000 over the next two years from the state's bare-bones General Fund.

Lawmakers on the budget committee may approve the fiscal note when they reconvene in special session at the end of this month. If not, the bill will be reintroduced in the regular fall session.

The Maine chapter of the National Alliance for the Mentally Ill, a leading organization that advocates for patients' rights, has refused to take a position on the community commitment bill for fear of splintering its membership. A NAMI spokeswoman said last week that while some providers and family members see the measure as a way to keep people healthy and productive, others find it coercive and an infringement of personal rights.

link

The article also includes this bit of ficton which I think was made up by someone with an agenda:
----------
In New York, he said, the average length of stay in psychiatric hospitals has decreased from 50 days to 15 days, and there has been a 78 percent decrease in the number of inmates in the state's prisons and jails who have a diagnosed mental illness.
----------

An Oldie but a Goodie

Mindless and Deadly
Media hype on mental illness and violence

Extra! May/June 2001

By Phyllis Vine

Buried deep in a New York Times story (1/30/01) about the brutal murder of Dartmouth professors Susanne and Half Zantop, resides a common prejudice linking violence with mental illness. Speculating on the reason for the attack, the paper noted that Half Zantop "had once tried to help a mentally ill young man."

When two local youth were arrested--neither suffering from overt psychosis--the knee-jerk response seemed groundless. Yet the initial impression associating the crime with mental illness had already been molded.

When a Manhattan woman was assaulted with a brick by an unknown assailant, the New York Daily News (11/19/99) ran two-inch block letters across the front-page, demanding: "GET THE VIOLENT CRAZIES OFF OUR STREETS."

The New York Times (11/20/99) flayed the Daily News for its "throat-grabbing covers," but not for its erroneous assumptions. Daily News editor Brian Kates summarized the situation when he told a Times reporter that people assumed "the guy who did it was probably deranged. Obviously that remains to be seen."

When the eventual suspect turned out to be neither schizophrenic nor bi-polar, the pundits were hardly apologetic: "Drake turns out not to have been the insane box-dweller many thought an eventual brick-attack suspect would be," New York Post columnist Rod Dreher said (12/2/99). And some just kept hammering on the mentally ill; "Whatever Drake's mental condition might be, those loons on the loose who pose threats to the citizenry are still out there because of mental-illness policies that need to be revised," opined Daily News columnist Stanley Crouch (12/2/99).

Questionable causality

Despite the seemingly inextricable media link between mental illness and violence, scientific research has cast doubt on the causal connection. A three-year study, funded by the MacArthur Foundation and published in the Archives of General Psychiatry (5/98), compared discharged mental patients with others in their communities. For those without an alcohol or other drug problem, no difference in violence was found, the authors wrote: "There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse." When there was violence, it "most often took place at home," not in the larger community.

Despite some coverage of this study (it appeared in the New York Times under the misleading headline, "Studies of Mental Illness Show Links to Violence"--5/15/98), an opposing image persists in the press. Helping to keep the myths alive is the mantra of "1,000 homicides a year" chanted by the Treatment Advocacy Center (TAC).

TAC is a Beltway offshoot of the National Alliance for the Mentally Ill (NAMI), an advocacy group consisting largely consumers of mental health services and their families. Its funding comes almost entirely from the Theodore and Veda Stanley Family Foundation. Since the late 1980s, the Stanley Family has spent more than $20 million for research into the causes of schizophrenia and bi-polar illnesses, as well as the benefits of unconventional drug therapies. But the Stanley Foundation is not known for its scientific achievements as much as it is for its most prominent spokesperson, psychiatrist E. Fuller Torrey.

link to full story

Henry Cotton - The Most Frightening Psychiatrist

Few people know the story of Dr. Henry Cotton, one of the most monsterous psychiatrists in American history. A new book titled Madhouse: A Tragic Tale of Megalomania and Modern Medicine follows his ugly career. BMJ published the following review (Thank you to Sue Kelmsley for finding this one ...) :

Surgery may not be the most obvious treatment for mental illness. Surgeons are people who find it extremely rewarding to act and see the impact of their actions on their patients. However, operating on the body may not have very specific effects on a disordered mind. This fact has not hindered enthusiasts intervening surgically believing their outcomes to be positive. Such excesses have been tragic, as is well known in the history of lobotomy (see review of The Lobotomist in this week's BMJ).

Less well known is the phase of surgery on other parts of the body that preceded that on the brain itself. Madhouse is a biographical history of Henry Cotton (1876-1933), an eminent and notorious American psychiatrist, who believed that the cause of mental illness was the systemic effects of largely hidden chronic infections. Septic foci, therefore, must be searched for and eradicated. Particular attention was paid to the teeth and tonsils. Even if many people were sceptical about the causal connection, Cotton argued that detoxification was none the less beneficial, and that patients were relieved when they found that their mental condition was the result of poisoning by infection. Cotton's theory of focal infection may have met its demise because of the drastic, and not infrequently fatal, operation of colectomy.

This well written book emphasises the extent to which it is misleading to view Cotton as essentially a maverick. He received considerable support from the psychiatric profession. For example, he benefited from the interest and admiration of Adolf Meyer, regarded as the dean of American psychiatry in the first half of the 20th century. Meyer wrote Cotton's obituary, concluding that he had "an extraordinary record of achievement." Meyer suppressed a report of the poor outcome of Cotton's work in the forlorn hope that he could persuade Cotton to accept the reality of his results.

The entanglement of Meyer in this tale is significant as his psychobiological approach at least theoretically stands in contrast to Cotton's insistence that we have to recognise the physical nature of functional mental disturbance. For instance, Meyer regarded Cotton's claims as somewhat extreme, suggesting they went "beyond what I personally believe to be my experience." None the less, Meyer's justification for experimenting with the aggressive treatment was the results, complaining that there were not the resources to evaluate the procedures extensively.

We may think we are protected from the dangers and blindness of wish-fulfilling expectations in the era of the randomised controlled trial. However, simplistic and biologically reductionist accounts of mental disorder, which underpinned the work of Cotton, still sustain modern pharmacotherapy. For example, it is commonly said that psychotropic medication corrects chemical imbalances in the brain. This theory is as much without proof and requires as much faith and self deception as that of Cotton. Perhaps we can learn from our sense of outrage about the events described in this book. I think the lesson is that a psychosocial understanding of mental illness, if it is to be influential, needs also to have a strong ethical foundation.

---

D B Double, consultant psychiatrist^{1 1} Norfolk and Waveney Mental Health Partnership NHS Trust, Hellesdon Hospital, Norwich

Snake Phobias, Moodiness and a Battle in Psychiatry

This was in today's New York Times:

Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail. Although there is promising work in genetics and brain imaging, researchers are not likely to have anything resembling a blood test for a mental illness soon, leaving them with what they have always had: observations of behavior, and patients' answers to questions about how they feel and how severe their condition is.

No matter how many times I have asserted the above fact, I always have some joker who wants to argue that mental illness has long been proved to be biological, it has not.

The above quote appears in an article that discusses the debate within psychiatry on what defines "mental illness". Many psychiatrists realize that they sound like a bunch of self-serving bozos when they claim that such a large percentage of the population is mentally ill. Few lay people believe them. That is because we lay people are smarter than we look ...

Psychiatrists know that some in their ranks even want to define such things as common low-grade shyness as a biological disease - I assume these are the folks on the pharm company payrolls in one way or another since the proper treatment for these types of ailments is always medication. For biological psychiatrists there is no point in using talk therapy to help a shy person because "you can't talk to a disease".

That's why this particular article is misleading. It tells the story of a person whose career was nearly ruined by anxiety attacks as an example of how serious a mild mental condition can be. However it implies that the person was treated through talk therapy. I think that due to the destructive "biology only" trend that has overtaken the profession, it is far more likely that a person like that would be given medication and sent on their way.

You are all Crazy

Well, at least half of us are according to Harvard epidemiologist Ronald C. Kessler. He and his compatriots used questionnaires to determine that a whopping "20 percent qualified as being diagnosed for a psychiatric illness". Wow. Sounds like a lot of people need a lot of pills. There's more ... they also found that, "18 percent had a serious anxiety disorder; 10 percent depression or bipolar illness; 9 percent an impulse disorder; and 4 percent a severe problem with drugs or alcohol".

That's a lot of troubled people. One commentator noted:

"We can certainly do a lot more," added Dr. Peter Kramer, a professor of psychiatry at Brown University. Kramer, who also hosts the public radio show "The Infinite Mind," said, "human beings are built with glitches. Mental illness has been around forever.

Yes, psychiatry would like YOU to know that you are probably ill, have probably been ill for ages, and you will not get better without their medications. Hell, they even found that, "... 45 percent of those with psychiatric symptoms qualified for more than one disorder."

Damn - how have you made it this far without falling over and dying?

I decided to investigate the radio program "The Infinite Mind". I had never heard of it. What I found right on the front page of their website gave me a smile. It read:

Host Dr. Peter Kramer examines new research on the biology of depression including new findings showing depression is not only a disease that affects the balance of chemicals in the brain, but the anatomy of the brain, as well.

Ah, I see. They even have your standard depression patient story which ends with this statement:

Because she had already come up with so many theories -- believing at different times that depression was everything from God's curse to a byproduct of modern living -- when she felt better on medication and therefore had evidence that depression is biological, she signed onto the idea quite easily.

Except that it has been established that placebos can also perform the miracle that gave her so much relief.

*sigh*