Psychiatry Now Admits It's Been Wrong in Big Ways - But Can It Change?

Wednesday, 05 March 2014 10:05 By Bruce E Levine, Truthout | 


When I interviewed investigative reporter Robert Whitaker in 2010 after the publication of his book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, he was not exactly a beloved figure within the psychiatry establishment. Whitaker had documented evidence that standard drug treatments were making many patients worse over the long term, and he detailed the lack of science behind these treatments.

Whitaker's sincerity about seeking better treatment options, his command of the facts, and his lack of anti-drug dogma compelled all but the most dogmatic psychiatrists to take him seriously.

For Anatomy of an Epidemic, Whitaker won the 2010 Investigative Reporters and Editors Book Award for best investigative journalism. This and other acclaim made it difficult for establishment psychiatry to ignore him, so he was invited to speak at many of their bastions, including a Harvard Medical School Grand Rounds at Massachusetts General Hospital, where he faced hostile audiences. However, Whitaker's sincerity about seeking better treatment options, his command of the facts and his lack of anti-drug dogma compelled all but the most dogmatic psychiatrists to take him seriously.

In the past four years, the psychiatry establishment has pivoted from first ignoring Whitaker to then debating him and attempting to discredit him to currently agreeing with many of his conclusions. But will Whitaker's success in changing minds result in a change for the better in treatment practices?

I was curious about Whitaker's take on the recent U-turns by major figures in the psychiatry establishment with respect to antipsychotic drug treatment, the validity of the "chemical imbalance" theory of mental illness and the validity of the DSM, psychiatry's diagnostic bible. And I was curious about Whitaker's sense of psychiatry's future direction.

Bruce Levine: In 2013, the director of the National Institute of Mental Health (NIMH), Thomas Insel, announced - without mentioning you -  that he agreed with your conclusion that psychiatry's standard treatment for people diagnosed with schizophrenia and other psychoses needs to change so as to better reflect the diversity in this population. Citing long-term treatment studies that you had previously documented, Insel came to the same conclusion that you had: In the long-term, not all, but many individuals who have been diagnosed with psychosis actually do better without antipsychotic medication. Was it gratifying for you to see the US government's highest-ranking mental health official agreeing with you? 

Robert Whitaker: Shortly before Thomas Insel wrote that blog, I had posted my own on madinamerica.com, related to a recent study by Lex Wunderink from the Netherlands. Wunderink had followed patients diagnosed with a psychotic disorder for seven years, and he reported that those randomized, at an early date, to a treatment protocol that involved tapering down to a very low dose or withdrawing from the medication altogether had much higher recovery rates than those maintained on a regular dose of an antipsychotic.

I wrote that in the wake of Wunderink's randomized study, if psychiatry wanted to maintain its claim that its treatments were evidence-based, and thus maintain any sort of moral authority over this medical domain, then it needed to amend its treatment protocols for antipsychotics. I don't know if Dr. Insel read my blog, but his post did nevertheless serve as a reply, and as you write, he did basically come to the same conclusion that I had been writing about for some time.

I suppose I took some measure of personal gratification from his blog, for it did provide a sense of a public acknowledgment that I had indeed been "right." But more important, I felt a new sense of optimism, hopeful that maybe psychiatry would now really address this issue, which is so important to the lives of so many people. A short while ago, The New York Times published a feature story on Dr. Insel, noting that he had recently raised a question about the long-term use of antipsychotics, which had caused a stir in psychiatry because it contradicted conventional wisdom. That is a sign that perhaps a new discussion is really opening up.

In Anatomy of an Epidemic, you also discussed the pseudoscience behind the "chemical imbalance" theories of mental illness - theories that made it easy to sell psychiatric drugs. In the last few years, I've noticed establishment psychiatry figures doing some major backpedaling on these chemical imbalance theories. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, "In truth, the ‘chemical imbalance' notion was always a kind of urban legend - never a theory seriously propounded by well-informed psychiatrists." What's your take on this?

 

The "disease model," as a basis for making psychiatric diagnoses, has failed.

This is quite interesting and revealing, I would say. In a sense, Ronald Pies is right.Those psychiatrists who were "well informed" about investigations into the chemical imbalance theory of mental disorders knew it hadn't really panned out, with such findings dating back to the late 1970s and early 1980s. But why, then, did we as a society come to believe that mental disorders were due to chemical imbalances, which were then fixed by the drugs?

Dr. Pies puts the blame on the drug companies. But if you track the rise of this belief, it is easy to see that the American Psychiatric Association promoted it in some of their promotional materials to the public and that "well informed" psychiatrists often spoke of this metaphor in their interviews with the media. So what you find in this statement by Dr. Pies is a remarkable confession: Psychiatry, all along, knew that the evidence wasn't really there to support the chemical imbalance notion, that it was a hypothesis that hadn't panned out, and yet psychiatry failed to inform the public of that crucial fact.

The low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable.

By doing so, psychiatry allowed a "little white lie" to take hold in the public mind, which helped sell drugs and, of course, made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don't expect to be misled in such a basic way.

But why now? Why are we hearing these admissions from Dr. Pies and others now? I am not sure, but I think there are two reasons.

One, the low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable. It is too easy for critics and the public to point to the scientific findings that contradict it.

Second, a number of pharmaceutical companies have shut down their research into psychiatric drugs [see Science, 2010], and they are doing so because, as they note, there is a lack of science providing good molecular targets for drug development. Even the drug companies are moving away from the chemical-imbalance story, and thus, what we are seeing now is the public collapse of a fabrication, which can no longer be maintained. In the statement by Dr. Pies, you see an effort by psychiatry to distance itself from that fabrication, putting the blame instead on the drug companies.

Challenging the validity of DSM is, in many ways, potentially much more of a paradigm-changer than are the scientific reports that detail how the medications may be causing long-term harm.

And recently, establishment psychiatrists have even been challenging the validity of psychiatry's diagnostic bible, the DSM. Last year, NIMH director Insel, citing the DSM's lack of scientific validity, stated that the "NIMH will be re-orienting its research away from DSM categories." And psychiatrist Allen Frances, the former chair of the DSM-4 task force, has been talking about how the DSM is a money machine for drug companies ("Last Plea To DSM-5: Save Grief From the Drug Companies"), and Frances thoroughly trashed the DSM-5 in his 2013 book Saving Normal.

I think this challenging of the validity of DSM is, in many ways, potentially much more of a paradigm-changer than are the scientific reports that detail how the medications may be causing long-term harm. Our current drug-based paradigm of care, which presents drugs as treatments for the symptoms of a "disease," stems from DSM III. The APA [American Psychiatric Association] and its leaders boasted that when DSM III was published in 1980, that the field had now adopted a "medical model," and thus its manual was now "scientific" in kind.

In fact, the APA had adopted a "disease model," and if you carefully read the DSM III manual, you saw that the authors acknowledged that very few of the diagnoses had been "validated." The APA's hope and expectation was that future research would validate the disorders, but that hasn't happened. Researchers haven't identified a characteristic pathology for the major mental disorders; no specific genes for the disorders have been found; and there isn't evidence that neatly separates one disorder from the next. The "disease model," as a basis for making psychiatric diagnoses, has failed.

We are now witnessing, in Insel's statements and those by Allen Frances, an acknowledgment of this failure. And here is why this is potentially such a paradigm-changer: The foundation of any medical specialty begins with its diagnostic manual, which should be both reliable and valid. If the disorders listed in a manual haven't been validated, then you can't conclude they are "real," in the sense of the disorders being unique illnesses, and the diagnoses being useful for prescribing an appropriate treatment.

Thus, when Insel states that the disorders haven't been validated, he is stating that the entire edifice that modern psychiatry is built upon is flawed, and unsupported by science. This is like the King of Psychiatry saying that the discipline has no clothes. If the public loses faith in the DSM and comes to see it as unscientific, then psychiatry has a real credibility problem on its hands, and that could prove to be fertile ground for real change.

So do you feel you have accomplished your mission? And can dissident mental health professionals - who have for years been talking about invalid diagnoses, pseudoscientific theories of mental illness, and drug treatments that cause moderate and acute problems to become severe and chronic ones - now have reasons to be optimistic about their profession? Or are you pessimistic that the recent admissions of establishment psychiatry will result in substantive changes in treatment? 

My "mission" would be to see that our society would actually build a system of care that was truly "science" based, particularly in its use of psychiatric drugs.

This is a good question, and I vacillate in my personal response between guarded optimism and complete pessimism. From an intellectual, scientific standpoint, I think psychiatry is facing a deep crisis. There is an understanding, within psychiatric research circles, that the DSM diagnoses haven't, in fact, been validated. And, at the very least, there is a recognition that psychiatry's drug treatments are inadequate. In 2009, Insel wrote an article stating: "For too many people, antipsychotics and antidepressants are not effective, and even when they are helpful, they reduce symptoms without eliciting recovery." And I do think that my book Anatomy of an Epidemic has contributed to an awareness of the limitations of the drugs, and at least a discussion, in some psychiatric circles, that the drugs may be worsening long-term outcomes.

But in terms of accomplishing my mission, well, I guess my "mission" would be to see that our society would actually build a system of care that was truly science-based, particularly in its use of psychiatric drugs. I think this is such an important story for our society and one of extraordinary moral importance when it comes to medicating children and adolescents, none of whom could be said to have really "consented" to such treatment. I turned madinamerica.com into a webzine with the hope that by providing a forum for a community of writers interested in "rethinking psychiatry" and combining their voices with reports of research that provide a foundation for such rethinking, it could become a real force for change. We'll see if that happens, but our readership is steadily increasing.

I should note, as you say, that dissident mental health professionals have been plugging away at promoting such change for a long time. I hope that madinamerica.com is providing that community a forum for voicing their criticisms and making them known to a larger audience.

And now for why I can be so pessimistic. Even as the intellectual foundation for our drug-based paradigm of care is collapsing, starting with the diagnostics, our society's use of these medications is increasing; the percentage of children and youth being medicated is increasing; and states are expanding their authority to forcibly treat people in outpatient settings with antipsychotics drugs. Disability numbers due to mental illness go up and up, and we don't see that as reason to change either. History does show that paradigms of psychiatric care can change, but, in a big-picture sense, I don't know how much is really changing here in the United States.

I think dissident mental health professionals also have to confront this question. Can they be hopeful that their professions will change their ways, and their teachings? I think so, but there is so much that needs to be done.

Any medical specialty has guild interests, meaning that it needs to protect the market value of its treatments.

Is it really possible for psychiatry to reform in any meaningful way given their complete embrace of the "medical model of mental illness," their idea that emotional and behavioral problems are caused by a bio-chemical defect of some type? Can they really reform when their profession as a financial enterprise rests on drug prescribing, electroshock and other bio-chemical-electrical treatments? Can psychiatry do anything but pay lip service to a more holistic/integrative view that includes psychological, spiritual, social, cultural and political realities?

I think we have to appreciate this fact: any medical specialty has guild interests, meaning that it needs to protect the market value of its treatments. If it is going to abandon one form of treatment, it needs to be able to replace it with another. It can't change if there is no replacement in the offing.

When the APA published DSM III, it basically ceded talk therapy to psychologists, counselors, social workers and so forth. Psychiatry's three domains, in the marketplace, were diagnostics, research and the prescribing of drugs. Now, 34 years later, we see that its diagnostics are being dismissed as invalid; its research has failed to identify the biology of mental disorders to validate its diagnostics; and its drug treatments are increasingly being seen as not very effective or even harmful. That is the story of a profession that has reason to feel insecure about its place in the marketplace.

Yet, as you suggest, this is why it is going to be so hard for psychiatry to reform. Diagnosis and the prescribing of drugs constitute the main function of psychiatrists today in our society. From a guild perspective, the profession needs to maintain the public's belief in the value of that function. So I don't believe it will be possible for psychiatry to change unless it identifies a new function that would be marketable, so to speak. Psychiatry needs to identify a change that would be consistent with its interests as a guild.
The one faint possibility I see - and this may seem counterintuitive - is for psychiatry to become the profession that provides a critical view of psychiatric drugs. Family doctors do most of the prescribing of psychiatric drugs today, without any real sense of their risks and benefits, and so psychiatrists could stake out a role as being the experts who know how to use the drugs in a very selective, cautious manner, and the experts who know how to incorporate such drug treatment into a holistic, integrated form of care. If the public sees the drugs as quite problematic, as medications that can serve a purpose - but only if prescribed in a very nuanced way - then it will want to turn to physicians who understand well the problems with the drugs and their limitations.

That is what I think must happen for psychiatry to change. Psychiatry must see a financial benefit from a proposed change, one consistent with guild interests.  

Depression Chemical Imbalance Doesn’t Exist

Depression Chemical Imbalance Doesn’t Exist, Experts Say
by Elizabeth Renter
04/18/2013

What if you went to a crime ridden street corner, suffering from depression, and were told that a certain drug could change how you felt about things? What if you went to your doctor and were told the same thing? While the corner drug dealer and your physician might have different drugs in mind, they are essentially offering a similar solution—putting you in a “drug-induced” state to minimize your negative symptoms. Doctors, the media, and society say there is a chemical imbalance which causes depression, but a depression chemical imbalance doesn’t exist, experts say.

Dr. Joanna Moncrieff, a mental health expert from the department of mental health services at University College in London is taking a quite non-politically-correct approach in characterizing anti-depressants and other mental health drugs as just another dependency.

She says that although doctors, the media, and society in general has latched on to the idea that depression and anxiety, for example, are just evidence of a “chemical imbalance” in the brain, there is no hard evidence to support this.

“Scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.”

While many people are convinced this is indeed their problem and therefore are okay with being offered a drug to solve the “problem”, she says the problem is that we are minimizing the seriousness of taking drugs to solve a “mental disorder.”

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis. Psychoactive drugs make people feel different; they put people into an altered mental and physical state. They affect everyone, regardless of whether they have a mental disorder or not. Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce

She says that these drugs, like anti-depressants, often produce symptoms of other, illegal drugs. The difference—these are prescribed by medical professionals and marketed to the masses in a more acceptable way.

In decades past, there was a stigma associated with mental health drugs. While it’s debatable whether this stigma was justified, there’s little doubt that it did make people think twice about taking medication for depression.

Now, however, we are convinced that these drugs are correcting a defect in the brain. The drugs are correcting an “imbalance.” But the problem is, that imbalance has never been proven.

Sure, you can argue that your medication makes you feel better, but wouldn’t other psychoactive drugs make you feel better too?

Dr. Moncrieff isn’t suggesting that people take cheaper illegal drugs, since they may have similar effects, but instead wants people to really get real about their anti-depression or anti-anxiety medications– what are they really doing to themselves when they rise each morning and pop the same pill, occasionally having to up their dosage because their body has developed a tolerance.

And with the number of Americans on antidepressant medication estimated to be 1 in 10, perhaps a critical look at this drug trade is warranted.

'Shy' children at risk of being diagnosed with mental disorder

(Good fucking grief! The psychiatric industry has gone nuts itself. They are out of their minds turning every little childhood issue or dilemma into a psychiatric disorder. OK, see, when people think I go off on rants too much, this is one of the reasons why. This is insane!--jef)

++++

Children who are merely shy or sad are at risk of being diagnosed with mental disorders and given powerful drugs, experts warn.

By Martin Beckford, Health Correspondent

14 Sep 2011

Psychologists say that new guidelines being developed in America will lead more young people seeing their common problems regarded as illnesses that must be treated, rather than just being given support.

They fear that pupils who are quiet at school could be diagnosed with “social anxiety disorder” while those who become withdrawn after suffering a bereavement are classified as having a “depressive disorder”.

Children who just talk back to adults or lose their temper regularly could be diagnosed with “oppositional defiant disorder”.

As a result, those found to have these increasingly broad mental disorders could be prescribed powerful medication such as Prozac or Ritalin to control or alter their behaviour.

Now the pressure is increasing for a national review of the use of such drugs on schoolchildren as well as more research into their long-term effects, following a vote at the TUC Congress on Wednesday.

Kate Fallon, general secretary of the Association of Educational Psychologists, told delegates: “Behaviours develop over a long period of time, often with a range of complex causes; we can’t ‘cure’ the behaviours we don’t like with a quick fix of medicine. They usually require careful management by all the adults around the child.

“In 2013 we’re expecting new criteria for the definition of mental illness to be adopted here in the UK. These criteria will lead to many more children being diagnosed as mentally ill, based on reports of their behaviours.

“A shy child could be diagnosed with social anxiety; a sad or temporarily withdrawn child could be diagnosed with depression.

“These are conditions which are also likely to be treated with medication – and under these circumstances, Congress, we will be putting potent drugs into children with little or no understanding of what it will lead to.

“In a society that wants quick results using drugs to improve behaviour is very tempting. But there can be other ways of improving children’s behaviour which typically involve time and energy from people.”

Research has found that children under the age of six are being prescribed the drug Ritalin for attention deficit hyperactivity disorder, prompting calls for the Department of Health to investigate the scale of the problem and the potential long-term damage it may be causing.
Recent figures show 650,000 children aged between eight and 13 are on the pscyhotropic drug, up from just 9,000 two decades ago, while others are taking Prozac for depression or anxiety.

Fears are growing that the number of children diagnosed with mental disorders and prescribed drugs will increase still further after 2013, when a new “bible” of the psychiatric profession is published.

Known as DSM-5, the book widens the diagnostic criteria for many supposed conditions including social anxiety disorder, better known as shyness, and will likely be adopted by the health authorities in Britain after appearing first in the US.

The proposed new definition for social anxiety disorder states that it is marked by “fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech)”.

In children this fear could be expressed by “crying, tantrums, freezing, clinging, shrinking or refusal to speak in social situations”.

Young people will be deemed as having oppositional defiant disorder if they display symptoms including losing their temper, arguing with adults, deliberately annoying people or being “spiteful or vindictive at least twice within the past six months” to people other than their brothers or sisters.

The British Psychological Society has also raised concerns about the proposed revisions to the DSM.

It does not dispute that some children have emotional and behavioural problems but says that patients and the public are “negatively affected” by the continued “medicalisation” of natural and normal responses to their experiences, and that classifying such problems as “illnesses” ignores their wider causes.

Prof Peter Kinderman, chairman of the society’s Division of Clinical Psychology, said: “We’re not certain that a diagnosis and a medical response is the best way to help these kids.
“Absolutely understand and help, not necessarily diagnose and treat.”

How Big Pharma Hooked Americans on Drugs

Saturday, July 16, 2011 by Al-Jazeera-English
Mass Psychosis in the US:
by James Ridgeway

 

Has America become a nation of psychotics? You would certainly think so, based on the explosion in the use of antipsychotic medications. In 2008, with over $14 billion in sales, antipsychotics became the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.

Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses - primarily schizophrenia and bipolar disorder - to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis.

It is anything but a coincidence that the explosion in antipsychotic use coincides with the pharmaceutical industry's development of a new class of medications known as "atypical antipsychotics." Beginning with Zyprexa, Risperdal, and Seroquel in the 1990s, followed by Abilify in the early 2000s, these drugs were touted as being more effective than older antipsychotics like Haldol and Thorazine. More importantly, they lacked the most noxious side effects of the older drugs - in particular, the tremors and other motor control problems.

The atypical anti-psychotics were the bright new stars in the pharmaceutical industry's roster of psychotropic drugs - costly, patented medications that made people feel and behave better without any shaking or drooling. Sales grew steadily, until by 2009 Seroquel and Abilify numbered fifth and sixth in annual drug sales, and prescriptions written for the top three atypical antipsychotics totaled more than 20 million.  Suddenly, antipsychotics weren't just for psychotics any more.

Not just for psychotics anymoreBy now, just about everyone knows how the drug industry works to influence the minds of American doctors, plying them with gifts, junkets, ego-tripping awards, and research funding in exchange for endorsing or prescribing the latest and most lucrative drugs. "Psychiatrists are particularly targeted by Big Pharma because psychiatric diagnoses are very subjective," says Dr. Adriane Fugh-Berman, whose PharmedOut project tracks the industry's influence on American medicine, and who last month hosted a conference on the subject at Georgetown. A shrink can't give you a blood test or an MRI to figure out precisely what's wrong with you. So it's often a case of diagnosis by prescription. (If you feel better after you take an anti-depressant, it's assumed that you were depressed.) As the researchers in one study of the drug industry's influence put it, "the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence." For this reason, they argue, it's particularly important that the guidelines for diagnosing and treating mental illness be compiled "on the basis of an objective review of the scientific evidence" - and not on whether the doctors writing them got a big grant from Merck or own stock in AstraZeneca.

Marcia Angell, former editor of the New England Journal of Medicine and a leading critic of the Big Pharma, puts it more bluntly: "Psychiatrists are in the pocket of industry." Angell has pointed out that most of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental health clinicians, have ties to the drug industry. Likewise, a 2009 study showed that 18 out of 20 of the shrinks who wrote the American Psychiatric Association's most recent clinical guidelines for treating depression, bipolar disorders, and schizophrenia had financial ties to drug companies.

In a recent article in The New York Review of Books, Angell deconstructs what she calls an apparent "raging epidemic of mental illness" among Americans. The use of psychoactive drugs—including both antidepressants and antipsychotics—has exploded, and if the new drugs are so effective, Angell points out, we should "expect the prevalence of mental illness to be declining, not rising." Instead, "the tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 - from one in 184 Americans to one in seventy-six. For children, the rise is even more startling - a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children." Under the tutelage of Big Pharma, we are "simply expanding the criteria for mental illness so that nearly everyone has one." Fugh-Berman agrees: In the age of aggressive drug marketing, she says, "Psychiatric diagnoses have expanded to include many perfectly normal people."

Cost benefit analysisWhat's especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old - vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.

Carl Elliott reports in Mother Jones magazine: "Once bipolar disorder could be treated with atypicals, rates of diagnoses rose dramatically, especially in children. According to a recent Columbia University study, the number of children and adolescents treated for bipolar disorder rose 40-fold between 1994 and 2003." And according to another study, "one in five children who visited a psychiatrist came away with a prescription for an antipsychotic drug."

A remarkable series published in the Palm Beach Post in May true revealed that the state of  Florida's juvenile justice department has literally been pouring these drugs into juvenile facilities, "routinely" doling them out "for reasons that never were approved by federal regulators." The numbers are staggering: "In 2007, for example, the Department of Juvenile Justice bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children…That's enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day." Further, the paper discovered that "One in three of the psychiatrists who have contracted with the state Department of Juvenile Justice in the past five years has taken speaker fees or gifts from companies that make antipsychotic medications."

In addition to expanding the diagnoses of serious mental illness, drug companies have encouraged doctors to prescribe atypical anti-psychotics for a host of off-label uses. In one particularly notorious episode, the drugmaker Eli Lilly pushed Zyprexa on the caregivers of old people with Alzheimer's and other forms of dementia, as well as agitation, anxiety, and insomnia. In selling to nursing home doctors, sales reps reportedly used the slogan "five at five"—meaning that five milligrams of Zyprexa at 5 pm would sedate their more difficult charges. The practice persisted even after FDA had warned Lilly that the drug was not approved for such uses, and that it could lead to obesity and even diabetes in elderly patients.

In a video interview conducted in 2006, Sharham Ahari, who sold Zyprexa for two years at the beginning of the decade, described to me how the sales people would wangle the doctors into prescribing it. At the time, he recalled, his doctor clients were giving him a lot of grief over patients who were "flipping out" over the weight gain associated with the drug, along with the diabetes. "We were instructed to downplay side effects and focus on the efficacy of drug…to recommend the patient drink a glass a water before taking a pill before the  meal and then after the meal in hopes the stomach would expand" and provide an easy way out of this obstacle to increased sales. When docs complained, he recalled, "I told them, ‘Our drug is state of the art. What's more important? You want them to get better or do you want them to stay the same--a thin psychotic patient or a fat stable patient.'"

For the drug companies, Shahrman says, the decision to continue pushing the drug despite side effects is matter of cost benefit analysis: Whether you will make more money by continuing to market the drug for off-label use, and perhaps defending against lawsuits, than you would otherwise. In the case of Zyprexa, in January 2009, Lilly settled a lawsuit brought by with the US Justice Department, agreeing to pay $1.4 billion, including "a criminal fine of $515 million, the largest ever in a health care case, and the largest criminal fine for an individual corporation ever imposed in a United States criminal prosecution of any kind,''the Department of Justice said in announcing the settlement." But Lilly's sale of Zyprexa in that year alone were over $1.8 billion.

Making patients worse As it turns out, the atypical antipsychotics may not even be the best choice for people with genuine, undisputed psychosis.

A growing number of health professionals have come to think these drugs are not really as effective as older, less expensive medicines which they have replaced, that they themselves produce side effects that cause other sorts of diseases such as diabetes and plunge the patient deeper into the gloomy world of serious mental disorder. Along with stories of success comes reports of people turned into virtual zombies.

Elliott reports in Mother Jones: "After another large analysis in The Lancet found that most atypicals actually performed worse than older drugs, two senior British psychiatrists penned a damning editorial that ran in the same issue. Dr. Peter Tyrer, the editor of the British Journal of Psychiatry, and Dr. Tim Kendall of the Royal College of Psychiatrists wrote: "The spurious invention of the atypicals can now be regarded as invention only, cleverly manipulated by the drug industry for marketing purposes and only now being exposed."

Bottom line: Stop Big Pharma and the parasitic shrink community from wantonly pushing these pills across the population.

Ask Not for Whom the Drug Tolls

Wendy McElroy - January 25, 2011
The Freeman

“Fifty years ago, it made sense to assert that mental illnesses are not diseases, but it makes no sense to say so today. Debate about what counts as mental illness has been replaced by legislation about the medicalization and demedicalization of behavior. Old diseases such as homosexuality and hysteria disappear. New diseases such as gambling and smoking appear.” So writes the iconoclastic psychiatrist Thomas Szasz.

Almost 50 years ago Szasz published The Myth of Mental Illness. It changed the political framework in which mental illness was addressed by laying the foundation for a concept Szasz developed through a series of books, including The Manufacture of Madness (1970). That concept was “the Therapeutic State”—a collaboration between psychiatry and the State through which “undesirable” actions, thoughts, and behavior patterns were suppressed. Thus Szasz not only disputed the moral and scientific basis of psychiatry but also argued that modern medicine was an engine of social control, with pharmaceuticals as primary tools.

A new slate of drugs now addresses a wide range of so-called disorders, or dysfunctions, that former generations considered environmental problems or lifestyle choices: from obesity to attention deficit, from erectile dysfunction to social anxiety (shyness), from menopause to alcoholism. Indeed, laziness is now being discussed as “a neuro-developmental dysfunction” for which drugs are being developed. The current Therapeutic State may be best analyzed as a collaboration between modern medicine, the pharmaceutical industry, and the State.

The debate stirred by Szasz has muted. The medical establishment and mainstream media are now advocates of the Therapeutic State. Similar advocates dominate universities, studies, prestigious committees, FDA hearings, and governmental bodies. Since writing The Myth, Szasz himself has noted that “the formerly sharp distinctions between medical hospitals and mental hospitals, voluntary and involuntary mental patients, and private and public psychiatry have blurred into nonexistence. Virtually all medical and mental health care is now the responsibility of and is regulated by the federal government, and its cost paid, in full or in part, by the federal government.” Problems of everyday life have been medicalized, and people are viewed as having little or no ability to “cure” conditions such as alcoholism or drug abuse through willpower or change of habit. The focus Szasz tried to foster on the individual’s responsibility for his or her own dysfunctions has eroded.

Happily, a backlash against the medicalization of everyday life is occurring. Alas, it is being fought on the wrong ground.

In this regard, a fascinating book has just been published. Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction by Ray Moynihan and Barbara Mintzes is a work of investigative journalism that explores the close financial relationship between the medical experts who define and develop the “science” behind new dysfunctions and the $500-plus billion pharmaceutical industry that profits from treating them. For example, Moynihan examines the makeup of experts on committees that define dysfunctions for the extremely influential Diagnostic and Statistical Manual of Mental Disorders (DSM); it is from the DSM that “social anxiety disorder” derives. (Revealingly, homosexuality was only delisted as a disorder in 1970.) Moynihan observes, “The DSM has been criticised for the closeness between the expert committees who write the definition of diseases and the pharmaceutical companies that sell the drugs prescribed to treat them. One study that looked closely at the affiliations of the men and women on those committees found that more than half of them had ties to drug companies. On the committees revising mood disorders, including depression, the figure was closer to 100 per cent.”

In short, he constructs a strong case for endemic bias within the medical establishment in favor of drug companies and the creation of disease.

Another sign of backlash is the emergence of grassroots rebellions against specific “diseases,” such as the currently emerging “female sexual dysfunction,” and against the use of drugs, such as Ritalin, to “cure” attention deficit disorder in children.

A reopening of debate on medicalizing everyday life is to be applauded. But, unlike Szasz, the new critics, such as Moynihan, do not take aim at the Therapeutic State; instead they focus on the therapeutic industry—that is, the flow of money between the medical establishment and the pharmaceutical companies. The culpability of the government in the creation of disease is either marginalized or denied.

Other pharmaceutical dissidents tend to view the State as the solution, not part of the problem. For example, feminist activist Leonore Tiefer works through the World Health Organization to impose new legislation that promotes such “rights” (or entitlements) as “the right to comprehensive sexuality education” and “the right to sexual health care, which should be available for prevention and treatment of all sexual concerns, problems, and disorders.”

It is possible that critics like Moynihan and Tiefer will accomplish some good. Perhaps they will be able to reduce the widespread prescription of the powerful Ritalin to grade-school children. But without understanding the essential role played by the State in the medicalization of everyday life, critics can never strike at the root of the problem. Indeed, they may well worsen matters by shifting blame and giving more authority to the very agency most responsible for the creation of disease.

The Need for a New Focus

The focus of the reemerging debate needs to shift onto Szaszian grounds, onto an analysis of the Therapeutic State, in at least four ways.

First, it must be clear that government defines the framework for all medical practices within North America. Second, the protection offered to pharmaceutical companies should be analyzed as legal privilege. Third, the relatively new and influential “private-public partnerships”—a marriage between the corporate sector and government institutions—should be examined and exposed. And, fourth, the role government plays in “marketing” drugs through institutions like the public school system and social services must be examined.

Government framework. There is no genuine competition allowed in the practice of medicine or the administration of drugs. Both of these vital functions of society are monopolies that the government assigns to those who meet State requirements and abide by State rules. Thus the American Medical Association (AMA) is able to exert monopoly control of medical care, such as hospitalization, and has a long history of persecuting competitors such as midwives.

But licensing is only the most obvious way in which the State and AMA define medical care. There are many other labyrinthine ways in which the medical establishment partners with authority. In reporting on the AMA’s support of Obamacare, for example, the Wall Street Journal explained last year, “The organization wants to protect a monopoly that the federal government has created for it—a medical coding system administered by the AMA that every health-care professional and hospital must use if they wish to get paid for the services they provide. This monopoly generates income of $70 million to $100 million annually for the AMA. That makes the AMA less an association looking out for doctors and more a special-interest group beholden to Congress and the White House.”

FDA Approved

Legal privilege. All prescription drugs must be approved by the FDA; but, again, the monopoly privilege of being the sole legal drug dealers in society is only the most obvious one granted the pharmaceutical industry and hardly captures the extent of partnership. Moynihan chronicles a less obvious privilege in writing about “one of the biggest healthcare frauds in U.S. history. Pfizer was accused of illegally promoting an anti-arthritis drug for unapproved uses and, so, creating a health risk to users. Pfizer admitted to limited guilt and paid a criminal fine of $1.2 Billion and civil penalties of $1B.” Despite the hefty financial hit, not one executive was held personally responsible; no retribution was sought. The sentencing judge, federal District Court Judge Douglas Woodlock (Massachusetts) commented in his concluding remarks, “This is a case in which no human being, apparently, is going to be held responsible for substantial criminal activity by a corporation.” He notes that Pfizer absorbed the financial hit as a “cost of doing business” and still returned record profits.


Private-public partnerships (PPP). A PPP is a collaboration between government and the private sector in which a venture is funded (in part or in full) by tax dollars and operated through the private sector, or else the private sector raises capital under contract with the government to provide services. Although PPPs are most often associated with infrastructure projects, such as the repair of roads or building of bridges, this sort of ersatz capitalism is rampant within medical research and drug promotion. According to a 2001 study, “hundreds of millions of dollars” have been invested in the United States to promote partnerships around health issues, creating “thousands of alliances, coalitions, consortia and other health partnerships.” That trend has only increased in the ensuing years. Tax-funded research is commonly funneled through nominally private organizations or researchers. Conferences, studies, reports, and such are conducted at taxpayer expense. Arguably, such funding constitutes the greatest barrier to alternative, independent research.

Uncle Sam the Pusherman

Government peddling of pharmaceuticals. It is not merely that private for-profit organizations have used tax dollars to climb aboard the public health bandwagon. The government uses its agencies to create a market base. Just one example is the role of the public schools as a “pusher” of Ritalin—a form of speed more potent than cocaine—to millions of school-age children. Overwhelmingly, it is prescribed to boys who are “unruly” in class. A 2001 report stated, “If Huckleberry Finn and Tom Sawyer were in a school in Massachusetts today, they’d be drugged with Ritalin, according to many psychiatrists and other experts.” As a recent September Huffington Post headline asked, “Do 2.5 Million Children Really Need Ritalin?” Dr. Sanford Newmark continued, “What is going on here? Have millions of our children become so hyperactive and unable to focus that they are incapable of succeeding at school or dealing with the demands of normal life? Or are we creating an illness where there is none, calling normal variations in temperament and personality a ‘disease’ that requires the intervention of long term, and extremely profitable, pharmaceutical medication?”

Monopoly, legal privileges, the rise of PPPs, the use of tax dollars to create disease and eliminate competition, the peddling of pharmaceuticals through government agencies—these issues must be prominent in any productive discussion of the medicalization of everyday life. If the discussion focuses on corporate greed, then the Therapeutic State will have merely entered a new phase.

Choosing healthy foods now called a mental disorder

by Mike Adams -- NaturalNews

In its never-ending attempt to fabricate "mental disorders" out of every human activity, the psychiatric industry is now pushing the most ridiculous disease they've invented yet: Healthy eating disorder.

This is no joke: If you focus on eating healthy foods, you're "mentally diseased" and probably need some sort of chemical treatment involving powerful psychotropic drugs. The Guardian newspaper reports, "Fixation with healthy eating can be sign of serious psychological disorder" and goes on to claim this "disease" is called orthorexia nervosa -- which is basically just Latin for "nervous about correct eating."

But they can't just called it "nervous healthy eating disorder" because that doesn't sound like they know what they're talking about. So they translate it into Latin where it sounds smart (even though it isn't). That's where most disease names come from: Doctors just describe the symptoms they see with a name like osteoporosis (which means "bones with holes in them").

Getting back to this fabricated "orthorexia" disease, the Guardian goes on to report, "Orthorexics commonly have rigid rules around eating. Refusing to touch sugar, salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn and dairy foods is just the start of their diet restrictions. Any foods that have come into contact with pesticides, herbicides or contain artificial additives are also out."

Wait a second. So attempting to avoid chemicals, dairy, soy and sugar now makes you a mental health patient? Yep. According to these experts. If you actually take special care to avoid pesticides, herbicides and genetically modified ingredients like soy and sugar, there's something wrong with you.

But did you notice that eating junk food is assumed to be "normal?" If you eat processed junk foods laced with synthetic chemicals, that's okay with them. The mental patients are the ones who choose organic, natural foods, apparently.

What is "normal" when it comes to foods?

I told you this was coming. Years ago, I warned NaturalNews readers that an attempt might soon be under way to outlaw broccoli because of its anti-cancer phytonutrients. This mental health assault on health-conscious consumers is part of that agenda. It's an effort to marginalize healthy eaters by declaring them to be mentally unstable and therefore justify carting them off to mental institutions where they will be injected with psychiatric drugs and fed institutional food that's all processed, dead and full of toxic chemicals.

The Guardian even goes to the ridiculous extreme of saying, "The obsession about which foods are "good" and which are "bad" means orthorexics can end up malnourished."

Follow the non-logic on this, if you can: Eating "good" foods will cause malnutrition! Eating bad foods, I suppose, is assumed to provide all the nutrients you need. That's about as crazy a statement on nutrition as I've ever read. No wonder people are so diseased today: The mainstream media is telling them that eating health food is a mental disorder that will cause malnutrition!

Shut up and swallow your Soylent Green

It's just like I reported years ago: You're not supposed to question your food, folks. Sit down, shut up, dig in and chow down. Stop thinking about what you're eating and just do what you're told by the mainstream media and its processed food advertisers. Questioning the health properties of your junk food is a mental disorder, didn't you know? And if you "obsess" over foods (by doing such things as reading the ingredients labels, for example), then you're weird. Maybe even sick.

That's the message they're broadcasting now. Junk food eaters are "normal" and "sane" and "nourished." But health food eaters are diseased, abnormal and malnourished.

But why, you ask, would they attack healthy eaters? People like Dr. Gabriel Cousens can tell you why: Because increased mental and spiritual awareness is only possible while on a diet of living, natural foods.

Eating junk foods keeps you dumbed down and easy to control, you see. It literally messes with your mind, numbing your senses with MSG, aspartame and yeast extract. People who subsist on junk foods are docile and quickly lose the ability to think for themselves. They go along with whatever they're told by the TV or those in apparent positions of authority, never questioning their actions or what's really happening in the world around them.

In contrast to that, people who eat health-enhancing natural foods -- with all the medicinal nutrients still intact -- begin to awaken their minds and spirits. Over time, they begin to question the reality around them and they pursue more enlightened explorations of topics like community, nature, ethics, philosophy and the big picture of things that are happening in the world. They become "aware" and can start to see the very fabric of the Matrix, so to speak.

This, of course, is a huge danger to those who run our consumption-based society because consumption depends on ignorance combined with suggestibility. For people to keep blindly buying foods, medicines, health insurance and consumer goods, they need to have their higher brain functions switched off. Processed junk foods laced with toxic chemicals just happens to achieve that rather nicely. Why do you think dead, processed foods remain the default meals in public schools, hospitals and prisons? It's because dead foods turn off higher levels of awareness and keep people focused on whatever distractions you can feed their brains: Television, violence, fear, sports, sex and so on.

But living as a zombie is, in one way quite "normal" in society today because so many people are doing it. But that doesn't make it normal in my book: The real "normal" is an empowered, healthy, awakened person nourished with living foods and operating as a sovereign citizen in a free world. Eating living foods is like taking the red pill because over time it opens up a whole new perspective on the fabric of reality. It sets you free to think for yourself.

But eating processed junk foods is like taking the blue pill because it keeps you trapped in a fabricated reality where your life experiences are fabricated by consumer product companies who hijack your senses with designer chemicals (like MSG) that fool your brain into thinking you're eating real food.

If you want to be alive, aware and in control of your own life, eat more healthy living foods. But don't expect to be popular with mainstream mental health "experts" or dieticians -- they're all being programmed to consider you to be "crazy" because you don't follow their mainstream diets of dead foods laced with synthetic chemicals.

But you and I know the truth here: We are the normal ones. The junk food eaters are the real mental patients, and the only way to wake them up to the real world is to start feeding them living foods.

Some people are ready to take the red pill, and others aren't. All you can do is show them the door. They must open it themselves.

In the mean time, try to avoid the mental health agents who are trying to label you as having a mental disorder just because you pay attention to what you put in your body. There's nothing wrong with avoiding sugar, soy, MSG, aspartame, HFCS and other toxic chemicals in the food supply.

Pharma Influence Felt at Psychiatric Meeting

No Free Pens But Pharma Influence Still Felt at Psychiatric Meeting
Posted By Martha Rosenberg
June 2, 2010

New Orleans

It was 95 degrees with 99 percent humidity. The Gulf had the biggest oil spill in US history. And attendees to this week’s American Psychiatric Convention (APA) annual meeting in New Orleans had to brave 200 protestors chanting “no drugging kids for money” and “no conflicts of interest” to get into the convention hall.

Since 2008 when Congress investigated some APA psychiatrists for alleged pharma conflicts of interest, more light has shone between the two groups, historically almost indistinguishable.

Participants at this year’s meeting, estimated at 14,000, saw conflict of interest slides before presentations and in their 240-page program book, fewer pharma funded classes and entertainment and no gifts or free meals at the 5-day event.

“They used to wine us and dine us,” said one participant, a veteran of decades of annual meetings, ruefully.

“An SSRI maker flew my entire group to a Caribbean island,” remembered a doctor from the East coast who did not want to be identified. Anymore.

But polarizing figures were still present. Sitting next to outgoing APA president Alan F. Schatzberg, MD, even as protestors chanted outside, was Charles Nemeroff, MD, former psychiatry chairman at Emory University who was investigated by Congress for unreported GlaxoSmithKline income and left his post in disgrace. Nemeroff was signing the Textbook of Psychopharmacology which he co-edited with Schatzberg, also investigated by Congress. Schatzberg, psychiatry chairman at Stanford, consults to seven drug companies, owns stock and patents with others and is on Sanofi-Aventis’ Speakers Bureau according to the meeting’s Daily Bulletin.

Heading a symposium about schizophrenia was S. Charles Schulz, MD, psychiatry chairman at the University of Minnesota who was investigated for financial links to AstraZeneca believed to alter his scientific conclusions.

Presenting a poster about the benefits of long acting risperidone was Wayne MacFadden, MD, AstraZeneca’s US medical director for Seroquel until questions about his alleged sexual affairs with women doing research on the drug arose.

And a paper presented about attention deficit hyperactivity disorder (ADHD) was co-written by Harvard’s Joseph Biederman, MD, also investigated by Congress for pharma financial links and considered the father of the pediatric bipolar disorder craze.

Despite the pharma thaw, exhibition displays were still pretty gee-whiz with Cymbalta, Seroquel XR, Abilify, Lunesta and Pristiq the most prominent. (A rep struggled to explain to a group from Columbia that Pristiq was not, repeat not, just a more expensive Effexor.) ADHD was also big. “Let’s be as brave as the people we serve” said Shire’s display, showing a patient’s giant, valiant face; another of its displays used an entire children’s bedroom to sell INTUNIV.

But where take-one signs once existed, signs now warned health care providers they may be governed by no gift policies. And whereas glad-handing reps were still eager to answer questions –once they scanned badges for marketing data – pharmacodynamic and patient care questions were referred to an information booth with a line to, well, see the doctor.

Nor was there a star of the show. The Next Big Thing was not a new drug at all but adjunctive therapy also known as adding existing drugs to existing drugs because they don’t work right. Throwing good drugs after bad, popularized with the antipsychotic Abilify, has only been enhanced by a study in the January JAMA that found antidepressants don’t work for mild depression at all. Antipsychotics are also being “enhanced” by adding drugs to offset weight gain and lethargic side effects.

No wonder panelists at a forum called “Is a Game Changing Psychotropic Too Much to Expect?” assailed pharma for issuing “me too” drugs and “seat of the pants” drug combinations, calling the industry nothing but a “marketing organization.”

No wonder a Canadian physician castigated the FDA’s Jing Zhang for approving drugs for “competitive reasons” not patient health in a symposium about comparative drug effectiveness. “In a recent transcript on your web site, Dr. Laughren [FDA director of psychiatry products] clutches at studies to try to approve a new drug on behalf of industry,” he charged. “FDA’s non-inferiority studies in which a drug can be less effective that an existing one and only beat placebo, present the ‘patient risk’ of a drug not working,” he said.

But elsewhere drugs were given a better spin.

Ann Childress, MD, gave a veritable commercial for the ADHD drug Vyvanse, manufactured by Shire on whose Speaker’s Bureau she serves. And the Wyeth funded C. Neill Epperson, MD, appearing with Wyeth Speakers Bureau member Claudio Soares, MD, actually told a clinician not to trust a pharmacist for a hormone preparation but to use pharma’s drugs in a symposium called “Mood, Memory and Myths: What Really Happens at Menopause.” Biodentical hormones, compounded by pharmacists, have been a revenue threat for Wyeth’s menopause drugs. (The seminar’s pro hormone therapy message crumbled when breast cancer patients in the audience discussed their “chemo” and “tamoxifen brain.”)

If there were a take home message at the APA meeting about the blizzard of ADHD, bipolar and personality disorders threatening adults and children, it was don’t wait. These dangerous conditions, no different from cancer or diabetes, won’t go away.

Thanks to genetic advancements, psychiatric disease risks can now be detected and treated before symptoms surface, said presenters, fostering early treatment paradigms that are pretty Brave New World: People being told they have a disease they can’t feel that needs immediate and lifelong treatment at hundreds of dollars a month or their health will suffer. Run that past me again? The National Institute on Drug Abuse is even working on vaccines to treat the specific genetic risks in opioid addicts. Good luck with that.

Not everyone agreed about early treatment. The very fact that bipolar disorder is a lifelong disease is reason to wait until you are sure said Mark Zimmerman, MD director of outpatient psychiatry at Rhode Island Hospital whose research, published in the June Journal of Nervous and Mental Disease, finds a link between unconfirmed, overdiagnosed cases of bipolar disorder and… the receipt of disability payments.

Not everyone agreed about multidrug combinations commonly called polypharmacy either. In between industry “research” in poster sessions extolling Seroquel, Vyvanse, Saphris, Geodon, Risperdal and Zyprexa was a study at Maimonides Medical Center in Brooklyn “Evaluating Antipsychotic Polypharmacy Regimens for Patients with Chronic Mental Illness.”

When 24 patients on polypharmacy combinations of Seroquel, Zyprexa and other antipsychotics were reduced to only one drug – monotherapy – there was no worsening of symptoms or increased hospitalizations in 23. Not only did patients not deteriorate, their waist circumferences and triglycerides improved, say the researchers as drug interactions, side effects and cost of treatment declined.

“These are interesting data,” said a young female psychiatrist viewing the poster. “Normally clinicians are afraid to take such patients off polypharmacy.”

So is pharma.

The Astonishing Rise of "Mental Illness" in America

A Conversation with Robert Whitaker
By BRUCE E. LEVINE

In 1987, prior to Prozac hitting the market and the current ubiquitous use of antidepressants and other psychiatric drugs, the U.S. mental illness disability rate was 1 in every 184 Americans, but by 2007 the mental illness disability rate had more than doubled to 1 in every 76 Americans. Robert Whitaker was curious as to what was causing this dramatic increase in mental illness disability. The answers are in his new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown Publishers, April 2010).

Whitaker’s findings will create a problem for both Big Pharma and establishment psychiatry, but his credentials and his craftsmanship will make it difficult to marginalize him.

Whitaker is the author of four books including Mad in America, about the mistreatment of the mentally ill; and as a reporter for the Boston Globe, he won a George Polk Award for medical writing, a National Association of Science Writers Award for best magazine article, and was a finalist for a Pulitzer Prize. In the tradition of Michael Pollan, Eric Schlosser, and other investigative reporters who get taken seriously, Whitaker is scrupulous, fair, and describes complex phenomena in a way that is easy to understand.

Levine: So mental illness disability rates have doubled since 1987 and increased six-fold since 1955. And at the same time, psychiatric drug use greatly increased in the 1950s and 1960s, then skyrocketed after 1988 when Prozac hit the market, so now antidepressant and antipsychotic drugs alone gross more than $25 billion annually in the U.S. But as you know, correlation isn’t causation. What makes you feel that the increase in psychiatric drug use is a big part of the reason for the increase in mental illness?

Whitaker: The rise in the disability rate due to mental illness is simply the starting point for the book. The disability numbers don’t prove anything, but, given that this astonishing increase has occurred in lockstep with our society’s increased use of psychiatric medications, the numbers do raise an obvious question. Could our drug-based paradigm of care, for some unforeseen reason, be fueling the increase in disability rates? And in order to investigate that question, you need to look at two things. First, do psychiatric medications alter the long-term course of mental disorders for the better, or for the worse? Do they increase the likelihood that a person will be able to function well over the long-term, or do they increase the likelihood that a person will end up on disability? Second, is it possible that a person with a mild disorder may have a bad reaction to an initial drug, and that puts the person onto a path that can lead to long-term disability. For instance, a person with a mild bout of depression may have a manic reaction to an antidepressant, and then is diagnosed with bipolar disorder and put on a cocktail of medications. Does that happen with any frequency? Could that be an iatrogenic [physician-caused illness] pathway that is helping to fuel the increase in the disability rates?

So that’s the starting point for the book. What I then did was look at what the scientific literature -- a literature that now extends over 50 years -- has to say about those questions. And the literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness. In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug-- say have a manic episode after taking an antidepressant -- and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic pathway that is helping to fuel the increase in the disability numbers.

Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature -- and this really is a tragic story -- clearly shows that our drug-based paradigm of care is a primary cause.

Levine: I have a clinical practice and I have seen several examples of what you are talking about, and I had previously read several of the scientific studies that you detail in Anatomy of an Epidemic, so I am not exactly a naïve reader. However, in reading your book and seeing the enormity of the problem and just how much overwhelming evidence there is for a horrible crisis, I started getting a little sick to my stomach. I wonder, as you got into the research, did you start drawing comparisons to Rachel Carson and Silent Spring? Specifically, this is such a huge unnecessary tragedy, affecting several million people including children, yet there is virtually no discussion of it in the mass media.

Whitaker: A journalist friend of mine, who was a long-time reporter at the Washington Post and Newsday, said that he too was reminded of Silent Spring when he read Anatomy of an Epidemic. And, in fact, I was stunned by much of what I found when I was researching the book, and I did at times become overwhelmed by the magnitude of the tragedy. Let me give a specific example. When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children. But once psychiatrists started putting “hyperactive” children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants. Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature. And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up “rapid cyclers,” which means they have severe “bipolar” symptoms, and that they can now be expected to be chronically ill throughout their lives. We also know that the atypical antipsychotics [such as Risperdal and Zyprexa] prescribed to bipolar children cause a host of physical problems, and there is pretty good evidence that they cause cognitive decline over the long term. When you add up all this information, you end up documenting a story of how the lives of hundreds of thousands of children in the United States have been destroyed in this way. In fact, I think that the number of children and teenagers that have ended up “bipolar” after being treated with a stimulant or an antidepressant is now well over one million. This is a story of harm done on an unimaginable scale.

So why hasn’t the media reported on this? The answer is that the media, when it covers medicine, basically repeats the narrative fashioned by the academic doctors who are leaders in the particular discipline, and in this case, academic psychiatrists have told a story of new illnesses -- like juvenile bipolar illness -- being “discovered,” and of drugs for those treatments that are safe, effective and necessary. They tell this story to the public even as their own studies find that their juvenile bipolar patients -- who when they first came to a psychiatrist might simply have been “hyperactive” or struggling with a momentary bout of depression -- are ending up with severe bipolar symptoms and can now expect to be chronically ill for life. The problem is that our society trusts academic doctors to tell an honest story, and in this corner of medicine, it's quite easy to document -- and I did document this in Anatomy of an Epidemic -- that academic psychiatry has belied that trust.

Levine: Let’s get to the issue of psychiatric medications fixing “chemical imbalances.” This idea was absolutely crucial in making Prozac and other antidepressants attractive to depressed patients. However, these days even much of the psychiatry establishment has backed off the idea that depressed people have too little serotonin between their synapses and that antidepressants fix this chemical imbalance. Maybe it’s just me, but I can’t help but see the comparison between Big Pharma and the Bush Administration, which told Americans that the U.S. needed to invade Iraq because Saddam Hussein had weapons of mass destruction and he was connected to Al Qaeda. Of course, the Saddam Hussein-Al Qaeda connection was simply a lie, and the WMD rationale proved to be false. Do you believe that Big Pharma and establishment psychiatry were lying about this chemical imbalance theory at the time Prozac hit the market in 1988, or do you believe that they had hoped this theory was true because it sold drugs -- and it just turned out to be wrong?

Whitaker: The low-serotonin theory of depression was first investigated in the 1970s and early 1980s, and those studies did not find that people diagnosed with depression had “low serotonin.” As the NIMH [National Institute of Mental Health] noted in 1984 at the conclusion of such investigations: “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” So why was the public told differently?

The answer is a bit complicated. In the late 1970s, the market for psychiatric drugs declined and psychiatry suddenly saw itself as a profession under “siege,” having now to compete with a burgeoning number of psychologists and other non-physician therapists for patients. In response, the profession -- at its highest levels -- decided to sell the public on a biomedical model of mental disorders, as that model would naturally emphasize the importance of taking “medications” for a disease and it was only psychiatrists who could prescribe those drugs. This story-telling began with the publication of DSM-III in 1980, which the American Psychiatric Association (APA) heralded as a grand “scientific achievement,” and then soon the APA was announcing that great discoveries were being made about the biology of mental disorders. And once psychiatry began to tell a story that wasn’t science based, but rather was best described as a marketing campaign, I think it began to believe its own marketing slogans. I don’t know this for a fact, but I am willing to bet that Bush, Rumsfeld, Cheney and others began to believe their own public pronouncements about weapons of mass destruction and a Saddam Hussein-Al Qaeda connection, and I think something similar to that happened in American psychiatry when Prozac came to market. The field stopped looking at the science that showed that the low-serotonin theory of depression had basically already flamed out, and instead began to believe its own propaganda.

Moreover, the chemical-imbalance story did more than just spur sales of drugs. It provided psychiatrists with a desirable public image. They were now like doctors in infectious medicine and other respected specialties, their medications “like insulin for diabetes.” The chemical-imbalance story told of medical progress, of a discipline that was unlocking the mysteries of the brain. Indeed, when Prozac came to market, there were newspaper stories about how psychiatry now had a new reason to “feel proud,” and how its public image had improved. So in the late 1980s and early 1990s, the chemical imbalance story is not one that tells of how lying moved into the heart of the field, but rather how professional delusion did.

At some later point, however, as the chemical imbalance story repeatedly fell apart, psychiatrists in the research community understood that they were telling a “fib.” I can still remember -- this was the summer of 1998 -- when I questioned a prominent academic psychiatrist about whether the chemical imbalance story was really “true” and he replied by stating that it was a “useful metaphor” that “helped patients understand why they needed to take their medication.” This really is the tragedy of modern psychiatry -- it became a medical discipline devoted to telling a public story that made its drugs look good, as opposed to telling a story rooted in honest science.

Levine: Big Pharma and their partners in establishment psychiatry would like the general public to believe that the only critics of psychiatry are Scientologists. In reality, most scientists who are critics of psychiatry are also critics of the pseudoscience of Scientology. It is my experience that serious critics of psychiatry are not anti-drug zealots. For example, I know that you have talked with “psychiatric survivors” -- ex-patients who want to reform mental health treatment. David Oaks, one of the leading activists in the psychiatric survivor movement, often repeats that some members of his MindFreedom organization continue to take their psychiatric drugs while many choose not to, and what MindFreedom and other psychiatric survivors are fighting for is truly informed choice and a wider range of treatment options. Do you think that David Oaks’s fight is the right one?

Whitaker: Big Pharma and their partners in establishment psychiatry have smartly used Scientology to defuse criticism of their medications. I honestly believe that if Scientology weren't around, then our society could have a much more rational discussion about our drug-based paradigm of care. As for the position taken by MindFreedom and other psychiatric survivors, I basically do think that is the right one to take, with two caveats. In order to make a “truly informed choice,” a person needs to know the long-term effects of a treatment. It’s not enough for people to be fully informed about the immediate “side effects” of a drug. People need to be presented with information about whether such treatment has been shown to better the long-term course of the disorder, or worsen it. They need to be told about long-term physical and cognitive problems that often arise with every day use of psychiatric drugs. So providing people with a “truly informed choice” is a tall order.

My second caveat is this: As a society, we expect the medical community to develop the best possible form of care. We do not expect a medical community to offer a therapy that regularly leads to a bad end. And so, if we were to draw up a blueprint for reforming the current paradigm of care, it would be nice if the psychiatric community would try to develop therapeutic approaches that involved using psychiatric medications in a selective, cautious way that best promoted good long-term outcomes. In other words, I think psychiatry does have a responsibility to develop a true evidence-based model for using its drugs, a model that incorporates the long-term outcomes data. In the solution section of Anatomy of an Epidemic, I write of how doctors and psychologists in northern Finland use antipsychotics in a selective, cautious manner when treating first-episode psychotic patients, and their long-term outcomes are, by far, the best in the Western World. So if you believe in evidence-based medicine, then American psychiatry should look to the Finnish program as a model for reform. Doctors have a responsibility to lead, but I think that you see in David Oaks’ position a belief that establishment psychiatry in America cannot be trusted to provide such leadership. He’s right to believe that, of course, and that's what is so tragic about modern American psychiatry.

The Psychiatric Drugging of Infants and Toddlers

An American Phenomenon
By EVELYN PRINGLE

The United States has become the psychiatric drugging capital of the world for kids with children being medicated at a younger and younger age. Medicaid records in some states show infants less than a year old on drugs for mental disorders.

The use of powerful antipsychotics with privately insured children, aged 2 through 5 in the US, doubled between 1999 and 2007, according to a study of data on more than one million children with private health insurance in the January, 2010, "Journal of the American Academy of Child & Adolescent Psychiatry."

The number of children in this age group diagnosed with bipolar disorder also doubled over the last decade, Reuters reported.

Of antipsychotic-treated children in the 2007 study sample, the most common diagnoses were pervasive developmental disorder or mental retardation (28.2%), ADHD (23.7%), and disruptive behavior disorder (12.9%).

The study reported that fewer than half of drug treated children received a mental health assessment (40.8%), a psychotherapy visit (41.4%), or a visit with a psychiatrist (42.6%) during the year of antipsychotic use.

"Antipsychotics, which are being widely and irresponsibly prescribed for American children--mostly as chemical restraints--are shown to be causing irreparable harm," warned Vera Hassner Sharav, president of the Alliance for Human Research Protection, in a February 26, 2010 InfoMail.

"These drugs have measurable severe hazardous effects on vital biological systems, including: cardiovascular adverse effects that result in shortening lives; metabolic adverse effects that induce diabetes and the metabolic syndrome," she wrote. "Long-term use of antipsychotics has been shown to result in metabolic syndrome in 40% to 50% of patients."

The lead researcher on the study above, Columbia University psychiatry professor Mark Olfson, told Reuters that about 1.5% of all privately insured children between the ages of 2 and 5, or one in 70, received some type of psychiatric drug in 2007, be it an antipsychotic, a mood stabilizer, a stimulant or an antidepressant.

Psychiatric drugs bathe the brains of growing children with agents that threaten the normal development of the brain, according to Dr Peter Breggin, founder of the International Center for the Study of Psychiatry and Psychology (ICSPP), and author of about 20 books, including "Medication Madness."

The drugs themselves are causing severe disorders in millions of children in the US, he warns. "Substances like antidepressants, stimulants, mood stabilizers, and antipsychotic drugs cause severe, and potentially permanent, biochemical imbalances."

American Phenomenon

A number of presentations at the annual meeting of the American Psychiatric Association in May 2009, addressed the diagnosis of bipolar disorder, including one titled, "Pediatric Bipolar Disorder: A Critical Look at an American Phenomenon," at which Dr Peter Parry, a consultant child & adolescent psychiatrist, and senior lecturer at Flinders University in Australia, presented a survey on, "Australian and New Zealand's Child and Adolescent Psychiatrists' Views on Bipolar Disorder Prevalence and on Rates of Pediatric Bipolar Disorder in the USA."

Dr Parry and his colleagues conducted a survey of child and adolescent psychiatrists in Australia and New Zealand. Of the 199 psychiatrists who responded to the survey, 90.5% thought pediatric bipolar disorder was overdiagnosed in the US.

In an October 1, 2009 article titled, "Medicating Our Children," Dr Parry reports that since "the mid-1990s in the USA, some researchers have claimed that Paediatric Bipolar Disorder (PBD) frequently starts prior to puberty."

One of PBD's main proponents, Harvard University's Professor Joseph Biederman, stating onset "is squarely in the preschooler age group," he notes.

Parry explains that "PBD has been created by moving the diagnostic goalposts away from traditional concepts of bipolar disorder."

"In children," he says, "episodes were redefined to last hours instead of days or weeks and, instead of manic elation, severe anger in children sufficed as mania."

"Unlike diagnoses like ADHD or depression, or simply accepting a child has serious emotional and behavioural problems in reaction to various stressors, PBD implies a lifelong severe mental illness requiring of strong psychiatric medication," Parry warns.

"In the USA," he says, "the public is furthermore exposed to direct pharmaceutical advertising that can feed the natural desire parents of distressed and aggressive children have for a quick solution by suggesting a simple medication fix."

"The medicating of America's children has become intensely controversial, highlighted by the tragic case of Rebecca Riley, a four-year-old Boston girl diagnosed at 28 months old with ADHD and PBD," he points out.

On April 7, 2009, the author of the book, "Shyness: How Normal Behavior Became a Sickness," Christopher Lane, featured an interview on his Psychology Today blog, "Side Effects," with journalist, Philip Dawdy, the creator of the popular website, Furious Seasons, and discussed the rising number of children being diagnosed with bipolar disorder.

"As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world," Dawdy told Lane. "The bipolar child is a purely American phenomenon."

"The pharma companies and the Harvard crew worked hand-in-hand to bring America a generation of ADHD kids and bipolar children, and their profound influence can be seen in the millions of children and teens who now carry lifetime diagnoses and take gobs of psychotropic drugs each day, often to their detriment," he advised.

Lane asked for Dawdy's opinion on a recent report in the St Petersburg Times that found 23 infants less than one-year-old had been prescribed antipsychotics in Florida in 2007, as well as the drug overdose death of 4-year-old Rebecca Riley in Massachusetts. "How is it possible for psychiatrists to continue prescribing to infants in such numbers without more oversight?" Lane asked.

"What's gone on with antipsychotics prescribed to infants and toddlers is simply inexplicable to me," Dawdy said. "The drugs are known to cause huge problems in adults, so why the heck would a doctor give them to little kids, especially infants? It boggles my small mind."

"I'm no fan of bans or restrictions," he told Lane, "but this does strike me as a situation where there needs to be a serious rethinking of what we are doing—and maybe there should be a ban on the use of these drugs in kids under, say, 6 years of age."

An October 2007 report by the University of South Florida found the most common diagnosis for antipsychotic use with children in Florida’s Medicaid program, between July and December 2005, was ADHD. Roughly 54%, or 1,372 cases, involved prescriptions for children five and under and the total number of antipsychotic users in this young age group was 2,549, with all disorders combined, according to the report.

Increased Prescribing to Poor Children

Federally funded research published online in December, 2009, revealed that children covered by Medicaid were prescribed antipsychotics at a rate four time higher than children with private insurance. The data showed that more than 4% of children in Medicaid fee-for-service programs received antipsychotics, compared to less than 1% of privately insured youth. The study found Medicaid kids were more likely to receive antipsychotics for unapproved uses such as ADHD and conduct disorders than privately insured children.

The researchers examined records for children in seven states for the years 2001 and 2004, chosen as representative of the US Medicaid population. But more recent data through 2007 indicates that the disparity has remained, said Stephen Crystal, a Rutgers professor who led the study, according to the December 11, 2009, New York Times.

Antipsychotics were the top selling class of drugs in both 2008 and 2009. With sales of $14.6 billion in 2009, they brought in more than the $13.6 billion earned by both heart burn and cholesterol medications. Antidepressants ranked fourth with sales of $9.9 billion, according to data by IMS Health. In 2008, the drug makers took in $11.3 billion from antiseizure drugs and $4.8 billion from ADHD drugs.

In a new book titled, "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America," Robert Whitaker reports that the number of children on government disability rolls due to severe mental illness has increased more than 35-fold since 1987.

The book explores the question of whether the epidemic rise in people disabled by mental illness, among all age groups in the US over the past 20 years, could have been fueled by a drug-based paradigm of care.

It also explores what is happening to children over the long-term who are placed on psychiatric drugs. "Once again, science tells a very clear story, and, as you might imagine, it is one that — when you think of the millions of children so affected — makes you want to weep," Whitaker stated in a March 26, 2010, notice for the book's release on the Beyond Meds Website.