Is a mental illness like diabetes? 02/21/2012
Posted by altmentalities in Mental Health Awareness, Survivor Voices.Tags: biopsychiatry, diabetes, medication compliance, mental health, schizohprenia, stigma
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Having a mental illness is like having diabetes.
It is the most resounding mantra of mainstream mental health. I probably heard it hundreds of times in the first few months of my employment in the mental health system; investigating the true meaning of this phrase was literally my entryway into critcal thinking about mental health care in our society.
What does it really mean when someone (almost inevitably a professional) says this?
They say it means a reduction of stigma — for if mental illness is like diabetes, it’s nobody’s fault, right? Just a biological fact of life for some folks.
Paradoxically, they say it means there’s something fundamentally flawed and wrong about your brain, your neurochemistry. They say this chemical imbalance can only be corrected with lifelong medication compliance. Adherence to the doctor’s orders gauruntees you a good life (or the best possible under such conditions); non-compliance is a recipe for disaster.
Is this comparison of mental illness to diabetes in any way useful, or is it misleading and inherently stigmatizing?
Let’s let someone who has truly lived this metaphor, experiencing it first hand as a pschiatric survivor, answer the question for us.
The following are excerpts from a brilliant essay published anonymously in 2006 in the Schizophrenia Bulletin. The author, who reports a diagnosis of “schizoaffective disorder,” explains eloquently and succinctly why, for him/her at least…
Having a mental illness is NOT like having diabetes.
The Hospital Experience:
A diabetes patient in hospital can expect a clean, hygienic ward peopled by staff who treat the patient with respect, as an equal, who explain the illness and the treatment regime, and who co-opt the patient as an important agent in his or her own recovery. A psychiatric patient, however, might well find a ward that is rundown and peopled by staff who do not seem to have the same expectations of respect for patients and of a generally good professional working relationship between staff and patients. A psychiatric patient might instead, as I did in one of my hospitalizations, find staff who avoided talking to the patients as far as possible and whose only interaction with patients was to give commands.
The author is not the only one to have observed this trend of the division between staff and “patients” in mental hospitals. See this fascinating study for more.
Stigma:
Schizoaffective disorder rips straight into the heart of the family, causing shame, anger, guilt, and self-blame from parents and siblings, as well as casting blame on the patient. Parents ask, where did I go wrong, and patients ask, if I had had a different upbringing could I have avoided this disease? With diabetes, however, there is no sense of blame, guilt, or shame; rather, people hear the diagnosis, learn (perhaps over time) about the condition, and come to accept the limitations of the condition.
In (naturally occurring) diabetes, there is no place for blame. It doesn’t appear to be a particularly useful or therapeutic concept. I find myself thinking that the same is probably true of mental illness. There’s a firestorm of protest going on over at Mad In America right now about Michael Cornwall’s supposed blaming of families for the mental illness of their children (the article which stirred up so much criticism happens to be one of his best — I highly recommend you check it out).
Ultimately, I think we are best served by abandoning the conecpt of blame altogether. One commenter there put it so well:
I think that the problem of laying the blame on families is better resolved by getting the blame out of the equation rather than getting families out of it. It’s not about who did what to whom; it’s about understanding that we become who we are within the relationships that are important to us, so understanding them is part of understanding who we are. I think it’s when we take those relationships out of the equation that people start to look broken or crazy or mean.
So the first step is to get rid of blame. The next is to understand the significance of the relationships.
Kermit Cole, commenter at Mad In America; emphasis added
And now back to our anonymous author…
Treatment:
Diabetes treatment does not require the same sacrifice of personal privacy that nonmedical treatment for schizoaffective disorder does… Diabetes medicine does not change who a person is; it does not turn one into a zombie, negating the highs as it flattens out the lows; it does not change the way one operates or, in fact, change what it is to be that person. Medicine for schizoaffective disorder does.
Finally, the author suggests an alternative metaphor:
If I could choose a replacement analogy, I would say schizoaffective disorder is like a whirlwind: it comes out of nowhere, strips you naked and sucks you dry, and swiftly vanishes, leaving you empty and shaken but alive, wondering if it really did happen and whether, and how soon, it will come back again.
Reflections on time spent as a “researcher” in the field of children’s mental health 02/16/2012
Posted by altmentalities in "An Insider's Perspective", Children's Mental Health, Mental Health Research.Tags: children's mental health, program evaluation, SAMHSA, system of care
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For two years, I worked full time in the field of children’s mental health program evaluation and research as a “Research Project Coordinator.” My boss, the “Principal Investigator,” and I had been contracted to implement a standardized, predetermined program evaluation of what is called a “system of care” – a program that coordinates and delivers services to children with mental health challenges. The system of care had been set up with money from SAMHSA [Substance Abuse and Mental Health Services Administration], part of the Department of Health and Human Services.
Any community that received funds from SAMHSA to start one of these “systems of care” – and there were over 144 of them! – had to agree to implement the full data collection protocol, which required in-depth multiple choice interviews be administered to about 250 families. Researchers were also expected to access extensive school records, court records, and medical records from the community mental health center. Again, these research methods were implemented over and over, in every one of those 144 funded communities.
In short, the “Children’s Mental Health Initiative” (as SAMHSA calls it) is the largest standardized children’s mental health research project ever conducted. The datasets collected by this massive undertaking – nearly 20 years’ worth of data on tens of thousands of families – are owned by the government and managed by a contracted firm called ICF International, which, oddly enough, also has extensive contracts with the Departments of Defense and Homeland Security. Go figure.
So that was the project, and I was its local coordinator. I worked extensively with the regulatory agencies that protect human research subjects’ rights to get their approval for our proposed “research methods.” I called potential participants and, following the script, assured them that being in the study was a chance for “their voice to be heard” and to “ensure that other children with challenges like their child’s could get services, too.” I conducted interviews with mothers, grandmothers, uncles, and the children themselves (when they were old enough to be in the study). I attended children’s mental health research conferences where we presented our data and listened to other communities present theirs’. I attended numerous meetings in our designated area of evaluation (the community, we always called it), listening to social workers and other helping professionals talk endless circles around the project, its goals, its implementation, and something they called sustainability.
Sustainability inspired complicated emotions in these folks. Each and every person employed by the system of care would lose his job in 5 years (that’s when the federal funding ran out), if the specter of sustainability was not made more substantial.
Now, a federally funded “system of care” is a real gravy train. A community mental health center thus financed can easily employ twice as many, perhaps even three times as many, social workers and “helping professionals” as before. Some people were literally paid to do nothing more than exist and lend the program more credibility by their impressive titles; the “Technical Assistance Coordinator” and “Social Marketing Associate” come to mind. And then there were the fantastic perks: free trips to “conferences” at lovely resort destinations (how’s Tampa in late February/early March sound?), fancy business lunches provided on a near weekly basis (they call it “community engagement”), and, best of all, business cards that say you’re making a difference in children’s lives – a real boost to the self-esteem, which is priceless, isn’t it?
Most of the staff seemed to know that they couldn’t keep riding the gravy train forever, but the burning question – would they even have jobs in 5 years? – had to be answered. So sustainability was a real presence in those meetings, a creditor who couldn’t be evaded forever, or a god that must be appeased.
But what’s the one thing that nobody – not even the gods – can question? SCIENCE. It’s objective. It’s proven. It’s Fact. Science as published in peer-reviewed, “scholarly” articles, as glossily summarized in abstracts and press releases, as cited by thousands who have never read the research in its entirety. If you choose to discount it, then you’re an irrational being, not worthy of consideration.
So science, in the form of program evaluation, was the answer to the sustainability question. The system of care needed research that “proved” it was “effective,” that justified its continued existence, and that generated visually stimulating graphs with lines that went up (it really was that simple). With their irrefutable SCIENCE in hand, they would apply for new grants, secure renewed funding, and keep the gravy train chugging along. This was not just the local solution to the sustainability problem – it was national and it was built right into the Children’s Mental Health Initiative by SAMHSA from the very beginning.
This, by the way, is a classic example of a synthetic Hegelian dialectic put in place by an institution to achieve its pre-determined goals with a semblance of grassroots mobilization; otherwise known as the “problem-reaction-solution” paradigm. In this case, it went something like this:
- Problem: in 5 years you won’t have a job
- Reaction: I can’t miss a mortgage payment! What do I do?
- Solution: justify the continued existence of your job by participating in and encouraging a truly massive data collection initiative, the depths and true purpose of which you know nothing about, an undertaking that under different circumstances you might question critically…
It hits home at a very personal level. The threat of losing your job is literally a threat to your survival (and in the case of most of these employees, a threat to the survival of their children). Animal — and maternal — instincts are activated, and critical thinking is no longer a part of the equation.
A critical thinker would question the protocol that SAMHSA gave us. Is it appropriate to ask a parent to “list 5 things you don’t like about your child,” or “True or False: I turned out to be a worse parent than I thought,” (as we did in every interview)? Is this “data” of any scientific value whatsoever? Why must the protocol as a whole be so incredibly negative, pathologizing, and stigmatizing? What is all this data really for, and what is the true purpose of the data collection exercise?
Such questions were taboo. If someone insisted on asking them anyway, they were met with simple, pat answers, such as “it [the protocol] is not perfect, but it will help us help kids.”
We were doing it in the name of job security. We were doing it to survive. Problem-Reaction-Solution.
In countless meetings, workshops, and teleconferences, our mission as evaluators and “research scientists” was made clear to us: we needed to prove that the system of care was effective to ensure more funding, on both the local and national levels.
Obviously, with this being the setup, bias in our research was maximized from the very beginning. In the script I read to potential participants in the study (which was “officially approved” by the Human Subjects Institutional Review Board), I was instructed to say: “We’re hoping to prove that the system of care works. That way, similar programs can be funded in the future.” From the first moment of contact, participants were notified what outcomes we, the researchers, expected.
Amazingly, many families would agree to the first interview. Few agreed to a second, however (there were supposed to be 5 per family; one every 6 months). They knew something was up.
Nevertheless, the data collection project went forward more or less as planned – continues on nationally to this day.
And so I return, now, to those questions I wasn’t allowed to ask at the time: What was all that data really for?
Sometimes we said it was to prove that the system of care improved outcomes for children and families involved in it, but that’s not the answer. Wouldn’t we have stopped to ask the families what “improvement” meant to them if that were the nature of our quest?
Other times, when we professionals were talking amongst ourselves, we said it was to secure more funding; but that could easily have been achieved with far less data then we collected during the burdensome, 2 ½ hour long interviews. The annual report to Congress, the supposed culmination of our efforts, was usually only 15-20 pages long, with only very small portions of the data we collected represented in its primary colored pie graphs.
Why did SAMHSA need to win our compliance with this effort so clearly deserving of critique?
What is the true purpose of the data collection enterprise?
Finding deeper meanings in the language of mental health 02/14/2012
Posted by altmentalities in Philosophy/Spirituality.Tags: Cartesian split, Eduardo Duran, John Perry, psychiatrist, psychology, therapy
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[Some of this comes from an earlier post, but it’s worth re-visiting because of the inherent power of words. They are the way we outline the self-fulfilling prophecies that direct the course of our lives. Why not chart a course towards sincerity and truth?]
Examining the language of mental health:
A word is like a promise; a failure to deliver a kind of betrayal. What does the language of mental health promise?
THERAPY
“waiting upon” or “a service done” (θεραπεία, therapeia). This original meaning is highly significant, as John Perry explains:
The original meaning of the Greek word therapeia was a “waiting upon” or “a service done” to the gods, with implications of tending, nurturing, caring, and being an attendant; in time the word was applied to medical care. The original connotation is pertinent to the handling of acute “psychotic” episodes, since the persons undergoing them are in a state of being overwhelmed by images of gods and other mythic elements. Hence a therapist does well to “be an attendant” (therapeutes) upon these mythic images so as to foster their work. “Treatment” strives to stop what is happening, while “therapy” attempts to move with the underlying process and help achieve the creative aim implicit in it.
- John Weir Perry in Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process [emphasis added]
PSYCHOLOGY
“study of the soul” (ψυχή, psukhē, meaning “breath”, “spirit”, or “soul”); and (-λογία -logia, translated as “study of” or “research”)
PSYCHOLOGIST
“one who studies the soul” (ψυχή, psukhē, meaning “breath”, “spirit”, or “soul”); and (-λογία -logia, translated as “study of” or “research”)
PSYCHOPATHOLOGY
“study of soul suffering” (ψυχή, psukhē, meaning “breath”, “spirit”, or “soul”); (πάθος, pathos, “feeling, suffering”); and (-λογία, -logia; translated as “study of” or “research”).
PSYCHIATRIST
“soul healer” (ψυχή, psukhē, meaning “breath; spirit; soul”); and (ἰατρεία, iatreia, meaning “healing”)
Quite a disparity between the literal meanings of the words and meanings the mental health profession imbues them with today. What is the significance of this gap between historical meaning and present-day usage? Eduardo Duran attempts to answer the question:
The literal definition of our profession [psychology] has deep roots that are enmeshed with spiritual metaphor…
Most of the root metaphors required for the task at hand have existed in the psychological profession for millennia. A simple linear approach to this would yield the question, “What happened to cause us to lose the essential meaning of our root metaphor?” Through the process of the so-called enlightenment and the Cartesian splitting of the world, we literally have done just that. We have been split off from our world-soul. It follows that if the healer is split from her soul, she will not be able to facilitate the integration of soul in her patients. Is it possible that our profession also has been infected by the “vampire’s bite” imposed by the Cartesian objectification of the life-world? Objectification of the life-world into a subject-object relationship helps us to rationalize away the reality of the soul.
(Eduard Duran, Healing the Soul Wound, p 19)
An essential part of the “scientific” training for young psychology/psychiatry/counseling grad students is a total denial of the spiritual (implicitly or explicitly, the message is that a true scientist must, by definition, be an atheist, and that faith is a foolish and primitive superstition). You’d be hard pressed to find a mainstream mental health professional willing to call himself a “soul healer” or a “student of the soul” in English, though in Greek the claim is proudly printed on their business cards. Most are not even cognizant that these are the titles they are claiming for themselves.
What implications does dishonesty in the root metaphor have for the trust that is vital to establishing a therapeutic relationship?
And the most important question of all:
What kind of evil is it for an entire profession that doesn’t believe in the concept of a soul to literally claim to be “soul healers”?
Kids answer the question “What is art?” 02/11/2012
Posted by altmentalities in Children's Mental Health, Philosophy/Spirituality.Tags: Cartesian split, life is art, middle school, what is art?
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I spend some amount of time every week in middle and high schools, teaching private music lessons to students there.
In one particular middle school, I pass a display of students’ answers to the question “What is Art?” as I leave the building. I don’t think I’ve successfully made it out yet without stopping to look at their varied answers — once for almost an hour, usually for 10 minutes or so. They’re arresting in their beauty, simplicity, depth. I wanted to share some of their responses (anonymized, of course) with you.
Being heard, expressing yourself:
[Art is a way to be heard from the heart or mind!]
[Everything created by the human mind, and hand that expresses you.]
Interesting — in both of these, reference is made to the mind and the body (body being referred to as “heart” and “hand,” respectively). Art is not a product of just one or the other; it transcends the Cartesian split.
[Art is the definition of a person's emotions that he has written so others can see how he felt through his artwork.]
Art is semantic, it speaks through a language of symbols. A painting of a haystack is not about a haystack, it’s about what the haystack represents, and how the author felt about the haystack, how the haystack feels in the larger context of the world.
[A way to express your feelings. Art is Life. Life is art.]
I can’t help but wonder why this one’s author decided to cross out “Life is art.” It looks like she wrote it in pencil, outlined in marker, and then crossed it out and replaced it with the statement (in marker only — definitive) “Art is Life.”
Coloring the world:
[I find art something to make the world bright.]
[Art is colorful yet can Be Black and White.]
Paradoxical. But there is truth to be found in paradox.
[Pictures of your Imagination]
Human:
[Art is Any human talent or Skill.]
The act of living, doing what you do well with confidence and joy, is Art.
[Being unique.]
Being you. Being human.
I hear people say, so often, “I could never be/have been an artist. I’m just not artistic.” But every action has artistic potential! If done in a human way, a mindful way, a right way. I think this is called “the aesthetics of being.” But I suppose it is called many other things, too.
And my personal favorite:
[Art doesn't have to appeal to everyone to be a good piece of art.]
I might add — art doesn’t have to appeal to anyone but you to be a good piece of art. Being human in your own special way doesn’t have to appeal to anyone else, either.
Can you see now why I have so much trouble making it out of the building?
New “research” claiming antidepressants don’t cause suicidality in children is fraudulent 02/07/2012
Posted by altmentalities in Mental Health Research, Pharmaceuticals.Tags: antidepressants, black box warning, Eli Lilly & Co., FDA, Peter Breggin, Prozac, Robert D. Gibbons, SSRIs, suicide
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Meet Dr. Robert D. Gibbons:
He’s a “research scientist.” A published author. A professor of psychiatry. An honored faculty member at the University of Chicago.
And he’s recently published one of the most dishonest and fradulent bits of “research” I have ever seen.
In his newest article, “Suicidal Thoughts and Behavior with Antidepressant Treatment: Reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine,” published yesterday in the Archives of General Psychiatry, he claims to have proven…
(drumroll please)
SSRIs do NOT cause an increased risk of suicide in children.
In spite of all of the following…
- the FDA’s 2004 analysis of 9 selective serotonin reuptake inhibitors [SSRIs] and numerous Adverse Drug Reports [ADRs], and their subsequent insistence on black box warnings for all SSRIs about the risk of suicide in children and young adults taking these drugs…
- the independent research of numerous others…
- the testimony at congressional hearings and the overall abundance of anecdotal data from families who will never be whole again because a loved one not predisposed to suicide suddenly committed the act in a violent and brutal way after beginning SSRI “therapy” (Here are a few people’s stories, shared during a congressional hearing in 1991. There are many, many more)…
- the data from the drug companies’ own trials [see below] …
…Gibbons boldly declares that “no evidence of increased suicide risk was observed in youths receiving active medication [SSRIs].”
I heard it this morning on NPR’s Morning Edition. Hundreds of thousands of other Americans did, too.
And it is a deadly falsehood.
Let me be quick about this, because time is of the essence. If even one child’s physician does as Gibbons urges and …
[reassess] the risk-benefit estimation for using antidepressants for major depressive disorder in all ages…
- Gibbons, in his Archives of General Psychiatry article
… a life could be lost, and that’s no exaggeration. Because the fact of the matter is
SSRIs DO increase the risk of suicide in children
(and adults, too, for that matter), and pharmaceutical companies have known it from the very beginning. This is true of multiple companies, but it is very well documented in the case of Eli Lilly.
They’ve known it all along
1. From the beginning, Eli Lilly executives noted Prozac’s (fluoxetine) propensity to cause agitation, aka akathisia, which research suggests is the causative factor in SSRI-related suicides. It was recognized that akathisia put trial participants at increased risk for suicide. This internal memo from the late 80s (later obtained by Peter Breggin through the “Freedom of Information Act”) is rather instructive:
Some patients have converted from severe depression to agitation within a few days. In one case the agitation was marked and the patient had to be taken off the drugs. In future studies, the use of benzodiazepines [tranquilizers] to control agitation will be permitted.
- Ray Fuller, “inventor” of Prozac, in internal Eli Lilly memo
Permitted by Lilly, not the FDA, I might add.
Which brings me to my next point…
2. Lilly introduced the use of tranquilizers during the clinical trials to counteract the agitating and stimulating effects of Prozac. This, of course, is not allowed by FDA regulations.
And furthermore:
After Eli Lilly submitted all of its clinical trials to the FDA, the agency’s evaluation showed Prozac to have little or no benefit, especially when the illegitimately tranquilized patients were removed from the clinical trial data… Instead of throwing out the bogus trials, negating any possibility of Prozac being approved, the accommodating federal agency allowed the tranquilized patients to be counted as if they were legitimate participants in the drug trials. Then, and only then, did the clinical trials demonstrate effectiveness for Prozac – and even that was marginal at best.
- Peter Breggin, in Medication Madness, chapter 18: “Drug Companies on Trial”
But there’s more…
3. Lilly routinely masked suicide and suicidal ideation in the clinical trials by calling it something else.
An Eli Lilly internal memo written in 1990 (again obtained by Dr. Peter Breggin through the FOIA) reveals that Lilly researchers openly acknowledged employing this tactic. From Claude Bouchy, a German employee, to Leigh Thompson in the United States:
Finally, on a very simple and non scientific basis, I personally wonder whether we are really helping the credibility of an excellent ADE [Adverse Drug Event] system by calling “overdose” what a physician reports as suicide attempt and calling “depression” what a physician reports as suicide ideation…Of course by the end of the day we will do what we are told to do…
- Eli Lilly employee and Prozac research Claude Bouchy in 1990 [emphasis added]
So, Lilly researchers routinely labeled suicidal ideation as “depression” in their adverse event reports during the clinical trials. Remember that as you read this:
From my FOIA inquiries to the FDA, I had found that the initial drafts of the Prozac label had listed “depression” and “abnormal thoughts” as two of the three most commonly reported adverse reactions…
- Peter Breggin, in Medication Madness, chapter 18: “Drug Companies on Trial” [emphasis added]
Let me get this straight: Lilly researchers were instructed to mask incidents of suicidality and suicidal ideation by calling them “depression.” And then “depression” was reported as one of the top 3 adverse effects of Prozac?
Interestingly, at least one Lilly researcher could not escape the ethical and moral consequences of this action. In a second 1990 memo, Bouchy expressed these sentiments:
I do not think I could explain to the BGA [German regulatory agency], to a judge, to a reporter or even to my family why we would do this especially on the sensitive issue of suicide and suicide ideation.
- Eli Lilly employee and Prozac researcher Claude Bouchy in 1990
5. And, when all else failed, Lilly just threw out the suicide data altogether.
In 2005, several more Eli Lilly documents were forwarded by an anonymous source to a highly esteemed medical publication, the British Medical Journal. The most damning of all of these, from 1985, was an internal analysis of one of the early Prozac placebo-controlled clinical trials that showed a significant increase in suicide attempts for the subjects taking Prozac.
12 suicide attempts were found in the Prozac group, compared to one in each of the control groups (one control group received placebo; the other received a tricyclic antidepressant). The company’s hired research consultants simply decided to throw out six of the 12 suicide attempts. Of course, this still leaves a 6:1 ratio between Prozac and control groups’ incidences of suicide…
Why am I telling you all this?
First, it is proof that even Lilly’s very biased trials, even her own paid “researchers,” could not hide the fact that Prozac does indeed increase the risk of suicidality amongst the people who take it.
And, second, because Gibbons reports in his article that he used 3 datasets, one of which was
The “complete longitudinal data for RCTs [randomized control trials] of fluoxetine hydrochloride conducted by Eli Lilly & Co.”
In other words, his assertion that “there is no evidence of increased suicide risk … in youths receiving active medication [SSRIs]” is based on the faulty data described above. In fact, he proudly boasts that he used “all industry trials of Prozac!”
This study avoided the problem of publications being biased in favor of positive clinical trials by examining all industry trials of fluoxetine and venlafaxine.
- Gibbons, in his Archives of General Psychiatry article
Gibbons claims that from the combined 3 datasets (including the Prozac clinical trials) “there were relatively few suicide attempts and suicides (a total of 20 attempts and 2 suicides in 21 patients among 9185 patients across all age cohorts and drugs).” But we know from just the few snippets posted above that in one study of one drug [Prozac] 12 suicide attempts were recorded.
The numbers simply do not add up.
Revealingly, Gibbons goes on to report that:
An additional 6 suicidal events were identified from AERs [Adverse Event Reports], 4 attempts and 2 suicides… of the 2 suicides one was by an adult receiving fluoxetine and the other was a geriatric patient receiving placebo.
- Gibbons, in his Archives of General Psychiatry article
Very well. But how many “overdoses” were there?
Funny—he doesn’t say.
A little more on Gibbons
As it turns out, he’s been advocating for the use of antidepressants in children for a long time.
Even after the FDA released its black box warning in 2004 regarding this class of drugs’ propensity to cause suicidal ideation in children, Gibbons was arguing for continued, widespread prescription of these drugs.
In his 2007 Psychiatric Times article, “SSRI Prescribing Rates and Adolescent Suicide: Is the Black Box Hurting or Helping?,” (which draws almost exclusively on data from another “scholarly” article of his with equally dubious origins) Gibbons loudly proclaims:
The effect of the black-box warning has been to lower antidepressant prescription rates, which in turn has resulted in more untreated depression and a corresponding increase in suicide rates for children and adolescents. The FDA sought to improve treatment of depression, but an overall decline in diagnosis and treatment of depression implies that the black-box warning did not achieve this goal, and the decline is consistent with the possibility that the black-box warning has had the opposite effect.
- Gibbons (2007) “SSRI Prescribing Rates and Adolescent Suicide: Is the Black Box Hurting or Helping?”
Did I mention his “proof” for this assertion has dubious origins?
As the New York Times reported about a week later, the study Gibbons cited (his own) was – plain and simple – fraudulent.
While suicide rates for Americans ages 19 and under rose 14 percent in 2004, the number of prescriptions for antidepressants in that group was basically unchanged and did not drop substantially, according to data from the study.
“There doesn’t seem to be any evidence of a statistically significant association between suicide rates and prescription rates provided in the paper” for the years after the F.D.A. warnings, said Thomas R. Ten Have, a professor of biostatistics at the University of Pennsylvania.
- from the 2007 NYT article “Experts Question Study on Youth Suicide Rates”
Gibbons did do some fancy maneuvering in an attempt to rebut this critique of his “work” about a year later – which fell flat, it seems — but it is beyond the scope of this article to follow the trail much further than we already have.
In Conclusion…
Gibbons has a history of publishing academic articles based on faulty datasets. He also has a history of drawing false conclusions from those faulty datasets.
In other words, he just makes shit up.
And it’s all in support of his favorite cause: getting kids to use antidepressants, and getting physicians, parents, and everyone else to re-evaluate “the risk-benefit estimation for using antidepressants.”
You know what? I agree with him. Let’s all evaluate the “risk-benefit estimation” together, shall we?
What are the risks of allowing Lilly and other SSRI producers to run their clinical trials in such a blatantly immoral and fraudulent fashion?
What are the risks of allowing pharmaceutical companies to hide, for years, the overwhelming evidence that SSRIs cause suicidality?
And what are the benefits of letting one man – with a proven track record of fraudulent research in the service of pharmaceutical companies – re-open the debate on what is essentially a dead (and deadly) issue?
Antidepressants cause suicide and suicidal ideation in patients of all ages, children included.
End of story.
And no fanciful, fraudulent “meta-analysis” of the faultiest clinical trials ever conducted is going to change that.
Depression: a message the mind-body sends 02/06/2012
Posted by altmentalities in Recovery Story.Tags: chemical imbalance, crisis, depression, mind-body split, survival
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In response to my critique of the newest edition of the biopsychiatric model of depression (as publicized by NPR), a commentor asked me…
“Do you have ideas about why certain people are prone to depression or any other mental condition?”
Yes, I do. Here follows my honest, subjective, and throughly “inexpert” opinion:
DEPRESSION. Have you ever experienced it?
I’ve never had my experience of it validated by a diagnosing professional; nevertheless there have been somewhat lengthy periods of my life where I felt nothing but “corrosive apathy” for everyone and everything around me. I was shocked… shocked and sickened and horrified… by the cult of death that is our society. It was a black hole I fell into and had a lot of trouble digging myself out of again. This mainly occurred when childhood, adolescence, and extended adolescence were over and it was time to face facts outside the bubble I had grown accustomed to.
Was there something wrong? Yes, and no. EVERYTHING was wrong… and so nothing was wrong. If that makes sense. I began to think that something was wrong with me specifically when I saw most everybody else was still carrying on and enjoying the very things that made me so sick, sick, sick.
But there was nothing “wrong” with me in the pathological sense. Really, it’s just that my bubble popped and theirs’ were (and perhaps are) still intact.
The point I’m trying to make is that we’re ALL “pre-disposed” to this kind of depression. It’s sort of a natural reaction to the state of our society, as far as I’m concerned. And to me, this “depression” is a MESSAGE. Something needs to be addressed, and resolved, inside yourself, if you feel this way. Depression is the furthest thing possible from a “biological” problem. It is a SPIRITUAL problem.
Psychiatry actually does recognize this, or it once did – their recognition is buried in the language, the etymology. So what does it say about the profession that they will now do anything to deny this idea?
Dealing with depression as a biological pathology is extremely problematic to me because it is a way to avoid taking responsibility. It’s a way of saying “Shut up, mind-body. I don’t want to hear what you have to say.” That kind of attitude is not sustainable, because in order for the mind-body to carry out its mission (homeostasis), it WILL be heard. And if it has to SHOUT, then so be it.
Crisis is not a necessary part of change. You can address issues before there is no other choice. And then your response can be more measured, gradual, and successful. In times of crisis you do whatever you have to do to survive, and you do it as quickly as possible. This usually doesn’t turn out as well as it could if your intellect were more involved in the process.
This is why the quick fix of [insert chemical imbalance theory/chemical HERE] is so galvanizing: many who are grasping at it are doing so from an animal-in-crisis mentality. And when the crisis moment has passed they are spellbound by the chemical, ushering in a whole new era of problems, crises, and equally unsuccessful quick fixes.
Perhaps you are thinking that I was “depressed” but not “clinically depressed.” Meaning, I suppose, that my experience of depression was not as “bad” as “truly depressed” peoples’. I don’t know. I can’t get inside their heads. I guess I “got better,” so at the very least we can agree that it was not chronic. But it was also not medicated. Are those two facts connected? There is good reason to think they may be.
Regardless, the experience of “depression” (or whatever you want to call it) was, for me, an important part of growing up, finding a more wholesome and healthy path through life. I received the message, and then I made some serious changes in the way I was doing things in response to the message.
If I had instead suppressed the messages that my mind-body was sending me, I believe they would only have gotten stronger and louder, until I was forced to hear.
“He that hath ears to hear, let him hear.” Very good advice, I think. And there is so much to listen to.
Demonizing the unconscious is a mistake! — thoughts from Jung 02/03/2012
Posted by altmentalities in Philosophy/Spirituality, Quotes.Tags: Cartesian split, mind-body, Carl Jung, psyche, unconscious, homeostasis, Modern Man In Search of A Soul, Joseph Stella
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From Carl Jung’s Modern Man In Search of A Soul:
“People [have made] a very dangerous monster out of the unconscious, that really very natural thing. As if all that is good, reasonable, beautiful and worth living for had taken up its abode in consciousness! Have the horros of the World War really not opened our eyes? Are we still unable to see that man’s conscious mind is even more devilish and perverse than the unconscious?
The unconscious is not a demonic monster, but a thing of nature that is perfectly neutral as far as moral sense, aesthetic taste and intellectual judgement go. It is dangerous only when our conscious attitude towards it becomes hopelessly false. And this danger grows in the measure that we practice repressions.
But as soon as the patient begins to assimilate the contents that were previously unconscious, the danger from the side of the unconscious diminishes. As the process of assimilation goes on, it puts an end to the dissociation of the presonality and to the anxiety that attends and inspires the separation of the two realms of the psyche…
The unconscious itself does not harbour explosive materials, but it may become explosive owing to the repressions exercised by a self-sufficient, or cowardly, conscious outlook.”
[emphasis added]
It is so easy to fear the unconscious. That’s where our Shadow hides, after all. All those nasty things we don’t want to know about ourselves and instead would prefer to project onto others. It’s worth noting that the Shadow has a positive aspect, too — the unrealized creative potential that waits inside of us. If we demonize the unconscious, we demonize this as well. [check out this article for more on integrating/relating to both negative and positive aspects of the Shadow]
Just like the Cartesian split between mind and body, a split in the psyche between conscious and unconscious can have disastrous consequences, and it simply is not sustainable in the long run. Sooner or later, your being will alert you to the fact that it is what it is — not what you want it to be or what you’ve been told it should be. It is what it is.
I truly believe that the key to wellness is integration. Breaking down the barriers that our conditioning has constructed, and accepting ourselves as whole people, human beings with a continuity of existence inside us that cannot be compartmentalized.
This brings us to another concept Jung mentions in the book that I really like:
The psyche is a self-regulating system that maintains itself in equilibrium as the body does. Each process that goes too far immediately and inevitably calls forth a compensatory activity… The relation between conscious and unconscious is compensatory.
In other words homeostasis exists in both body and mind (or in the mind-body… as those of us who oppose the Cartesian split like to say!).
***
The artwork in this post is by Joseph Stella, an Italian immigrant to New York City who painted industrial America of the early 20th century. To me it speaks very strongly of the split created by modern, industrialized, urban life, and the bridges we must build ourselves over such divides.
And that just goes to show the subjective nature of the interpretation of art!
NPR resurrects “chemical-imbalance-causes-depression” theory, because it wanted to live 01/31/2012
Posted by altmentalities in Mental Health News, Mental Health Research, Pharmaceuticals.Tags: chemical imbalance, chemical imbalance in the brain, depression, ketamine, NPR, Prozac, selective serotonin reuptake inhibitors, SSRIs
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Did you hear this? I heard it, too. The whole mental health blogosphere heard it. And, understandably, we got excited.
FINALLY — the truth comes out on a major news network (NPR): a so-called “serotonin imbalance” in the brain has never been scientifically linked with depression, and this false theory was used for years to sell SSRIs (selective serotonin reuptake inhibitors – modern antidepressants) to a lot of people out there as a scientifically proven, biological cure to their biopsychiatric problems. Meanwhile, news of the appalling “side” effects of the drugs (suicidal and homicidal ideation in at the very least 5% of patients) was squelched, and literally thousands of people lost their lives in SSRI-related suicides and homicides.
After hearing all this, one would assume that we were done with that whole “chemical-imbalance-in-the-brain-causes-depression” thing. We have established that the theory is false. It’s a dead (and deathly) issue. Right?
WRONG.
Turns out that little NPR piece is part of a series. The second installment of which ran on “Morning Edition” today.
And the biopsychiatric idea that a chemical imbalance of some kind MUST cause depression – and that ameliorating this chemically/pharmaceutically must therefore CURE depression – is alive and well. In only a week’s time, NPR has managed to resurrect it. You see, it wanted to live. Or at the very least, pharma wants it to.
I Wanted To Live
“’I Wanted To Live’: New Depression Drugs Offer Hope For Toughest Cases” is the name of the piece, and it is a simple reiteration of the serotonin/Prozac storyline, only with a new neurotransmitter/miracle drug combo: glutamate/Ketamine.
Zarate [a “research scientist”] sees depression as a bit like a leaky faucet in the brain. There are different ways to stop the leak, he says. “You can go straight to the faucet and you can fix it,” he says. “Or you can go to the water plant and shut down the water plant. The end result will be the same.”
The current antidepressants act in a way that is like shutting down the water plant, Zarate says. It takes a long time for the water to stop flowing through the miles of pipes that eventually lead to the leaky faucet.
He thinks the reason is that these drugs act primarily on the brain chemicals serotonin, norepinephrine and dopamine. Ketamine acts on a chemical called glutamate, which is much closer to the problem, Zarate says.
- from the NPR story “I Wanted to Live.”
So let me get this straight:
Last week we learned that a serotonin imbalance in the brain does not cause depression. Scientists were confused on this point for some unspecified length of time because Prozac, a miracle/blockbuster drug that somehow “cures” depression, raises serotonin levels in the brain. Scientists understandably put two and two together and assumed that higher serotonin levels = no depression because Prozac presumably also = no depression. (Never mind that Prozac and other SSRIs have since been proven to be no better than placebo).
At some point, scientists figured out their theory was incorrect, or at best oversimplified to the point of being false [a distinction they insist on making!], but they continued to present it to patients as fact “for the patients’ own good” so the patients would take their meds. Which scientists still insisted “worked” to “cure” depression. (Again, no better than placebo.)
One week later, in the next installment of the series, we learn two things:
1. NPR has changed the story about serotonin – now it does work to cure depression by addressing problems in brain chemistry. [Never mind what they said last week!]
Traditional antidepressants like Prozac work on a group of chemical messengers in the brain called the serotonin system. Researchers once thought that a lack of serotonin was the cause of depression, and that these drugs worked simply by boosting serotonin levels.
Recent research suggests a more complicated explanation. Serotonin drugs work by stimulating the birth of new neurons, which eventually form new connections in the brain. But creating new neurons takes time — a few weeks, at least — which is thought to explain the delay in responding to antidepressant medications.
- from “I Wanted to Live.”
It works, but it works real slow.
2. This new drug – ketamine – works, too, but it works BETTER and FASTER!
Ketamine, in contrast, activates a different chemical system in the brain — the glutamate system. Researcher Ron Duman at Yale thinks ketamine rapidly increases the communication among existing neurons by creating new connections. This is a quicker process than waiting for new neurons to form and accomplishes the same goal of enhancing brain circuit activity.
- from “I Wanted to Live.”
I need hardly add that the author of this story did not cite any of the research studies referred to above. He did, however, include these pretty pictures which successfully distracted my attention from the lack of documentation for his outrageous claims by looking so very “scientific” and “official.”
Look at the pretty pseudoscience!
Just kidding. I’d like to see proof, not pictures.
Hope
The story’s headline promises to give us hope. Here is what the author has to offer, at the close:
The goal of the NIH [National Institutes of Health] experiments with ketamine, riluzole and scopolamine is to identify compounds that pharmaceutical companies can use as molecular models to develop an entirely new class of antidepressants… Drug companies have taken notice. Several are now working on glutamate drugs for depression.
- from “I Wanted to Live.”
I guess we’re supposed to hope that pharma can patent this new chemical and sell it using a recycling of the old SSRI pitch? (As NPR has already begun to do for them…)
Are we supposed to hope that drug companies will conduct fair research trials on this new class of antidepressants, that they will accurately report the results of these trials, that they will be ethical in addressing concerns about adverse drug events in or out of court?
Let me try that on for size….
Nope. I don’t feel hopeful. Not in the least bit.
I’d rather hope for something else.
I hope I never again have to hear another repetition of this ridiculous, thousand-fold lie about mere “chemical imbalances” being the cause of this thing we call “depression.” (Or any “mental illness,” for that matter.)
I hope that people dealing with depression will be allowed to make their own, fully informed choices about treatment.
I hope they will be told the truth – that antidepressant drugs have been proven to cement depression into a chronic state, when an unmedicated and honest interaction with the problem often allows it to pass and to then stay in the past. [more on all of that here.]
I hope that their family members and friends will be their cheerleaders and confidants, and they will find wholesome and healthy ways to address the root causes that their depression arises from.
Because depression is not merely “of the body,” a simple biological imbalance and nothing more. It is a mind-body phenomenon, it is subjectively real, it is connected to the world, and it is oftentimes a message about the world.
A message we should each process, understand, and integrate in our own way, in our own time.
Thoughts from John Perry on psychosis as vision, schizophrenia as process, and healing as the natural result 01/30/2012
Posted by altmentalities in Philosophy/Spirituality, Treatments.Tags: Diabasis, healing, John Perry, Jung, Loren Mosher, psychosis, schizophrenia, Soteria House
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I’m sure most of you are already familiar with the work of Dr. Loren Mosher at Soteria House (if not, this is my favorite article about it).
His is the most famous of these un-medicated, peer support-based treatment approaches for first break (or not) schizophrenia. It also happens to be the best documented, scientifically; and what excellent documentation it is! 85-90% of “acute sufferers” were able to return to the community and did not suffer relapse.
John Weir Perry
But, as I have been delighted to learn recently, his is by no means the only iteration of this treatment model. Another pioneer in this field – a friend and contemporary of Mosher’s, in fact – was the Jungian John Weir Perry. His treatment center, called Diabasis, operated in San Francisco in the 70s. Heavily influenced by Jungian approaches to psychosis (Perry did study with him in Switzerland) and Chinese philosophy, Diabasis was a place for schizophrenics to process their internal Apocalypse with the loving support of the laypeople staffed by the project. Medication was, for the most part, avoided, as were restraints and coercion of any kind.
Today I stumbled upon an extensive and fascinating interview with John Weir Perry about the nature of psychosis and “schizophrenia” and the approach of Diabasis to these phenomena. I’ve pasted a few of my favorite excerpts below, but you can also download the entire thing here.
On Diabasis and the healing nature of a supportive, home-like environment:
One has to let the visionary process unfold itself spontaneously.
Under these conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for a lot of bedlam with all this “madness” going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they’d settle down very soon into a state of coherency and clarity… The calming effect of a supportive environment is truly amazing!
Now throughout all this there was nothing scheduled, nothing mandatory. It was all informal… You see, we wanted them to be in this house of their own free will. They had to realise their own desire to belong in the house, and they did.
So this whole approach is essentially one of releasing, rather than suppression. We allowed everything and encouraged its expression — not towards chaos, but toward communication! Communication tends to order.
[emphasis added]
Schizophrenia as a self-healing process:
“Schizophrenia” is a self-healing process – one in which, specifically, the pathological complexes dissolve themselves. The whole schizophrenic turmoil is really a self-organising, healing experience. It’s like a molten state. Everything seems to be made of free energy, an inner free play of imagery through which the alienated psyche spontaneously re-organises itself – in such a way that the conscious ego is brought back into communication with the unconscious again…
It [psychosis] is like the mythological image in a perfect stained-glass window being smashed, and all the bits and pieces being scattered. The effect is very colourful, but it’s very hard to discern how the pieces belong to each other. Any attempt to make sense of it is an exercise in abstraction from the actual experience. The important thing is to find the process running through it all.
[emphasis added]
“Chronic schizophrenia” – a cultural construct:
[Interviewer:] So are you saying that the reason we have so-called “chronic schizophrenia” in our society, – where a person is medicated, distressed or hospitalized for decades – is really cultural? A society which refuses to understand the healing nature of the phenomenon?
Yes, it seems so. Of course, there are some unusual cases where the individual simply can’t handle the impact of all this unconscious content, or doesn’t know what to do with it, and freaks out. But from my experience at Diabasis, I’ve seen so many people go the other way that I really do feel “chronic schizophrenia” is created by society’s negative response to what is actually a perfectly natural and healthy process.
Goal of Perry’s treatment approach:
The tendency [amongst first break schizophrenics]… is to concretise all the symbolic stuff and believe there are enemies out there, and that the walls are wired, that there are people with guns at the window, and subversive political parties trying to do things, or that one is being watched because one is the head of some organisation and everybody knows it. All of that is a mistaken, “concretistic” tendency to take too literally things whose correct meaning is actually symbolic.
So yes, the therapeutic goal is to achieve that attitude which perceives the symbolic nature of the ideation which belongs to the inner reality. Now, the inner reality is real! It’s very important to grant it that reality, but not to get the two realities mixed up. That’s the trick! Actually, for most people it’s surprisingly easy…
The average person tends to go along with the inner journey and to realise – well, they do need to be reminded – but once they’re reminded, they tend to quickly perceive that it is a spiritual test, or a symbolic test, and not the actual end of the actual world.
[emphasis added]
Again, the full interview with Perry is available here.
If you’re intrigued by Diabasis and would like to know more, Perry wrote a book called The Far Side of Madness about the program. Additionally, Michael Cornwall over at Mad In America is blogging about his experience with the program. I suggest you check out what he has to say about it as well!
“Cancer is Serious Business” – watch this film! 01/26/2012
Posted by altmentalities in Pharmaceuticals, Treatments.Tags: anti-neoplastons, cancer, chemotherapy, Dr. Burzynski, FDA, pharma
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Psychotropic drugs are the top sellers for pharma. But cancer drugs – specifically those involved in chemotherapy – are big money makers, too. Very serious business.
You know the business model – pharma comes up with a drug to “treat” a specific condition that just happens to cause that condition. Anti-depressants cause suicidal ideation, anti-psychotics cause psychosis, mood stabilizers cause mania, anti-convulsants cause seizures.
It’s no different outside the world of mental health, folks. Cancer drugs (chemotherapy) are radioactive, carcinogenic. By their very nature, they increase the likelihood of cancerous growth. Nevertheless, (literally) poisonous and deadly cancer drugs from the 70s and 80s continue to sell like hotcakes to desperate families who are told there’s no other option, never mind the cure is in most cases far worse than the cancer itself!
A highly unethical, but nevertheless enriching business model for pharma and friends.
But what happens when an independent inventor – unassociated with any pharmaceutical company — discovers a cheaper therapy with significantly higher efficacy and virtually no side effects?
This simply cannot be allowed.
They [pharma, FDA, National Cancer Institute, etc.] do everything in their power to crush that man out of existence. And if that doesn’t work [it didn’t], then they try to steal his invention! And if that doesn’t work, well they do it all over again until sheer exhaustion sets in.
I’m talking about Dr. Stanislav Burzynski, the inventor and sole patent-holder on a set of chemicals which he calls “anti-neoplastons.” Derived from healthy human urine, the anti-neoplastons are made up of peptides and amino acids lacking in cancer patients. Astonishingly, anti-neoplaston therapy has significantly better results than chemotherapy. How much better?
Take cancer of the brainstem glioma, most commonly found in children, with a near 100% death rate. Chemotherapy has been shown to cure [cure being defined as living 5 years after diagnosis] .9% of patients. Anti-neoplastons?
Almost 25%.
Whoa.
There’s a lot more to tell, but I don’t want to spoil the film for you.
I hope you enjoy this as much as I did!
PS – for interested parties there are shorter excerpts from the film, as well as full access to all source documents available on Burzynski’s website.
