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SAMHSA calls for a vote on “noteworthy accomplishments” in behavioral health — let’s raise our voices! 02/29/2012

Posted by ALT in Mental Health Policy and Inititatives, Treatments.
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3 comments

As they occasionally do, SAMHSA [Substance Abuse and Mental Health Services Administration] is holding one of their “periodic stakeholder engagement” demonstrations (in the form of an online vote).  They want to hear what we have to say! 

Maybe.

By staring very intently at your face, it appears that I am listening to you. Is it working? Goooooood.

Not sure what really comes from these voting sessions, exactly, as I’ve never followed one from beginning to end.  I do know that most people who receive a formal invitation from SAMHSA to vote have jobs funded by SAMHSA and are obviously putting their mouths where the money is (like so; and like so). 

Nevertheless, every taxpayer is a “stakeholder,” and therefore allowed to vote.  So consider yourselves officially invited to answer (or vote for other people’s answers to) SAMHSA’s question:

What do you think are some of the most noteworthy accomplishments and changes in the behavioral health field over the past several years?

I was pleased to see that, so far, the winner by far of the voting is this entry from a Mad In America blogger about 10 peer support alternatives to traditional psychiatry that lead to healing and wellness.  Including the harm reduction approach to decreasing medication!  Love it.

Also mentioned was the Open Dialogue approach (more on that here; there’s also a lovely documentary about it).  And the idea of viewing mental illness as distress rather than disease – meaning of course that distress passes, is a situational part of life, while disease is chronic and biological. 

Needless to say, I voted for all of the above.  I encourage you to go vote for your favorites, whatever they may be!

NOT my favorite

I was distressed, appalled, shocked to see that one of the other frontrunners was “Court-ordered Outpatient Therapy.”  As a noteworthy accomplishment in the field of behavioral health.

WHAT? 

This, of course, includes court-ordered, non-consensual electroshock therapy (like that of Elizabeth Ellis) and anti-psychotic injections (like that of Christina Walko).  It constitutes a major violation of some of the most basic human rights we know. 

This is an advancement?

In the description, we are informed that

Court ordered Outpatient treatment is the other option to keep people safe by giving probate judges the authority to order treatment. Any person or family member can petition the court via a downloadable affidavit as to the condition of a loved one to effect this treatment by whatever measure necessary.

- Ingrid Silvian, who contributed the “Court-ordered outpatient Therapy” item to SAMHSA’s vote

Lovely.  A family member who cares can join the psychiatrists who care in making sure a loved one gets plenty of Janssen injections of long-acting antipsychotics (or whatever brand the doctor/courts order, I suppose).

I was incredibly moved by the comments of a woman named Cathy Levin in response to this.  First, she shares her personal story:

I once had a court order to take medication, but I was able to leave the town and move to a big city because no one prevented me. In the big city, there was public transportation and I went back to school to study basic English writing under a scholarship from a mental health program. I worked for 12 years. Recently applied for a scholarship to study art at a prestigious art school. Had my state had IO, I would have been forced to stay in the town where the state hospital was, where I gotten court ordered medications, I would spent 9-2pm M-F at day treatment, gotten injections of meds bi-weekly at the CMHC, and slept the rest of my life away.

-Cathy Levin, in response to “Court-ordered Outpatient Therapy” in the SAMHSA stakeholder engagement vote

And next, she says something very profound (and Foucauldian!) about the treatment of the mentally ill in society:

It’s like medicating the canaries in the coal mine. When poor people keep going crazy in the streets it is a sign that something is wrong with society. These are the canaries in the coal mines who indicate life as we live it today is toxic.

-Cathy Levin

Hurrah for the canaries in the coal mine!  May their processes be the catalyst for a community-wide transformation, a vision of a healthier, more balanced way of being!

Is a mental illness like diabetes? 02/21/2012

Posted by ALT in Mental Health Awareness, Survivor Voices.
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8 comments

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 ALT in "An Insider's Perspective", Children's Mental Health, Mental Health Research.
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3 comments

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 ALT in Philosophy/Spirituality.
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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 ALT in Children's Mental Health, Philosophy/Spirituality.
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1 comment so far

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 ALT in Mental Health Research, Pharmaceuticals.
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2 comments

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 ALT in Recovery Story.
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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 ALT in Philosophy/Spirituality, Quotes.
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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!

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