has to stop…

Posted on Tuesday 18 June 2013

Dr. Charlie Nemeroff gave his lecture yesterday at the Institute of Psychiatry [IoP], Kings College, London at the inauguration of their new Affective Disorders Centre amid protests from both sides of the Atlantic [including mine coffee-house science…, two footnotes…, mystified in america…, still mystified in america…, character is pervasive…]. His topic was The Neurobiology of Childhood Abuse: Treatment Implications.

Dr. Bernard Carroll had weighed in with a comment at Pharmalot, but today he has a blog post of his own at Healthcare Renewal about the IoP lecture [PROFESSOR NEMEROFF GOES TO LONDON: THREE STRIKES AND …]. After summarizing Dr. Nemeroff’s well known history of ethical misadventures, he added a story about Dr. Nemeroff’s presentations on this particular topic that was news to me, and I thought it was worth running down. From Healthcare Renewal:
Professor Nemeroff’s sole publication of original data in this area appeared in 2003. It was a secondary analysis of a large clinical trial, first reported in 2000, that originally did not consider child abuse as a moderating variable in the response of chronically depressed patients to an antidepressant [nefazodone] or to cognitive behavior therapy [CBASP]. The 2003 report claimed that, in patients with a history of childhood trauma, response to CBASP was superior to response to nefazodone. At the same time there was no significant difference in response rates to drug or to CBASP between patients with or without childhood trauma histories. A portion of this report was later retracted because the data concerning reduction of Hamilton depression scores had been misrepresented.
Here’s the abstract from PubMed that mentions an Erratum:
Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma.
by Nemeroff CB, Heim CM, Thase ME, Klein DN, Rush AJ, Schatzberg AF, Ninan PT, McCullough JP Jr, Weiss PM, Dunner DL, Rothbaum BO, Kornstein S, Keitner G, Keller MB.
Proceedings of the National Academy of Science. 2003 100[24]:14293-14296.
[full text on-line]
Erratum [see below]

Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant [nefazodone], Cognitive Behavioral Analysis System of Psychotherapy [CBASP], or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.
  Here’s the text of the 2005 Erratum in PNAS describing the error:
Erratum in Proceedings of the National Academy of Science. 2005 102[45):16530.
[full text on-line]

MEDICAL SCIENCES. For the article "Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma," which appeared in the Proc. Natl. Acad. Sci. in November 13, 2003, the authors note the following. "Results of the analyses of variance comparing change in Hamilton Rating Scale for Depression scores as a function of treatment type and early life trauma histories as well as Fig. 1A reflect change relative to the first week of treatment instead of baseline. When change scores relative to baseline are used, the interaction effects between treatment type and childhood trauma histories are not statistically significant. This discrepancy is due to marked changes in depression scores during the first week of treatment. Note that all analyses comparing the more conservative outcome measure of remission as a function of treatment type and childhood trauma as well as Fig. 1B are correct. Thus, consideration of treatment response relative to baseline does not detect the effect of childhood trauma on final remission, whereas consideration of final response relative to first response does detect the effect."
This is reported as if it’s simply an error, but to my reading, it’s a fatal error. The whole point of the article is that in this depressed cohort, those with child abuse histories responded to Cognitive Psychotherapy but not to Antidepressants. That’s the title of the article! And it wasn’t significant after all! They had done their statistics using the week 1 data rather than the baseline! This error invalidates the whole study. I can find no evidence that the now invalidated article was retracted, just that the error was reported. Last week [character is pervasive…], I had said, "…having heard and read Dr. Nemeroff’s body of work for over twenty years, it has always felt like teflon science." This is the kind of thing I was talking about – slippery, always slippery. So I thought I’d follow the thread of this article backwards to its source. And that’s when I fell into the deepest of holes, and down I tumbled. I’ll spare you all the sites I saw along the way, and get straight to what was at the bottom of the hole – this article in the New England Journal of Medicine:
A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression
by Martin B. Keller, M.D., James P. McCullough, Ph.D., Daniel N. Klein, Ph.D., Bruce Arnow, Ph.D., David L. Dunner, M.D., Alan J. Gelenberg, M.D., John C. Markowitz, M.D., Charles B. Nemeroff, M.D., Ph.D., James M. Russell, M.D., Michael E. Thase, M.D., Madhukar H. Trivedi, M.D., Janice A. Blalock, Ph.D., Frances E. Borian, R.N., Darlene N. Jody, M.D., Charles DeBattista, D.M.H., M.D., Lorrin M. Koran, M.D., Alan F. Schatzberg, M.D., Jan Fawcett, M.D., Robert M.A. Hirschfeld, M.D., Gabor Keitner, M.D., Ivan Miller, Ph.D., James H. Kocsis, M.D., Susan G. Kornstein, M.D., Rachel Manber, Ph.D., Philip T. Ninan, M.D., Barbara Rothbaum, Ph.D., A. John Rush, M.D., Dina Vivian, Ph.D., and John Zajecka, M.D.
New England Journal of Medicine. 2000 342[20]:1462-1470.
[full text on-line]

Methods: We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone [maximal dose, 600 mg per day], the cognitive behavioral-analysis system of psychotherapy [16 to 20 sessions], or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression [indicating clinically significant depression]. Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients’ treatment assignments.
Results: Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response [both remission and satisfactory response] was 48 percent in both the nefazodone group and the psychotherapy group, as compared with 73 percent in the combined-treatment group [P<0.001 for both comparisons]. Among the 519 subjects who completed the study, the rates of response were 55 percent in the nefazodone group and 52 percent in the psychotherapy group, as compared with 85 percent in the combined-treatment group [P<0.001 for both comparisons]. The rates of withdrawal were similar in the three groups. Adverse events in the nefazodone group were consistent with the known side effects of the drug [e.g., headache, somnolence, dry mouth, nausea, and dizziness].
Conclusions: Although about half of patients with chronic forms of major depression have a response to short-term treatment with either nefazodone or a cognitive behavioral-analysis system of psychotherapy, the combination of the two is significantly more efficacious than either treatment alone.

[reformatted for clarity]

So it started life in 2000 as a Bristol-Myers Squibb funded, non-placebo controlled trial comparing Nefazodone to CBT to both with 29 authors. Of interest, in the same issue, then NEJM Editor Marcia Angell wrote an editorial focused on this specific article, the first of what would later become her book and campaign against conflicts of interest. It began:
Is Academic Medicine for Sale?
New England Journal of Medicine. 342[20]:1516-1518.
[full text on-line]

In 1984 the Journal became the first of the major medical journals to require authors of original research articles to disclose any financial ties with companies that make products discussed in papers submitted to us. We were aware that such ties were becoming fairly common, and we thought it reasonable to disclose them to readers. Although we came to this issue early, no one could have foreseen at the time just how ubiquitous and manifold such financial associations would become. The article by Keller et al. in this issue of the Journal provides a striking example. The authors’ ties with companies that make antidepressant drugs were so extensive that it would have used too much space to disclose them fully in the Journal. We decided merely to summarize them and to provide the details on our Web site.

Finding an editorialist to write about the article presented another problem. Our conflict-of-interest policy for editorialists, established in 1990, is stricter than that for authors of original research papers. Since editorialists do not provide data, but instead selectively review the literature and offer their judgments, we require that they have no important financial ties to companies that make products related to the issues they discuss. We do not believe disclosure is enough to deal with the problem of possible bias. This policy is analogous to the requirement that judges recuse themselves from hearing cases if they have financial ties to a litigant. Just as a judge’s disclosure would not be sufficiently reassuring to the other side in a court case, so we believe that a policy of caveat emptor is not enough for readers who depend on the opinion of editorialists……

There are a number of things to say about this little trip down memory lane:
  • Industry Funded Clinical Trial: The study in question was an industry funded clinical trial of Nefazodone against Cognitive Behavior Therapy or both. Since there’s no Placebo Group, the only conclusion is that the combination was better than either treatment but we can conclude nothing about the effect size.
  • Multiple Authors, Multiple Publications: It’s inconceivable that it took 29 authors to do this study. The author list looks like a KOL convention with many familiar mega-résumé names [and four authors who would end up on Senator Grassley’s COI investigation list 8 years later]. When I referred to the sites I saw along the way, I was talking about the number of articles published using this same data and some combination of these multiple authors. It was reminescent of John Rush’s STAR*D study where the same thing occurred – endless papers with multiple authors looking at different aspects of the data after the fact. I call it résumé-churning. It took me a while to work my way back to even find the original NEJM article in 2000.
  • Conflict of Interest: The Conflict of Interest list on the original article was so long that the NEJM didn’t even include it in the printed journal but posted it on their web site. It obviously caught the editor’s attention and she penned a damning editorial that later became a cause célèbre for her. Is Academic Medicine for Sale? is an eloquent early indictment of the pharmaceutical-academic alliance that we came to know all too well.
  • Nemeroff’s paper – the Erratum: In Nemeroff et al in 2003, much was made of a difference in response between the antidepressant and CBT only in patients with a childhood abuse history. This was hardly raised as an issue at the time of the study – an undeclared parameter. So this is what’s called HARK – hypothesis after the results are known. It’s ihe kind of thing you find if you run statistics on everything imaginable after the fact until you hit on something. So they reported his findings. Two years later, they published an Erratum that says the central thesis of the article wasn’t significant after all [with what I would call a very suspicious error]. Even though the error invalidated the results, the paper was not officially retracted.
  • Back where we started: So finally back to Dr. Carroll’s point. In spite of the fact that the 2003 Nemeroff et al study was invalidated in 2005, it’s still being presented as a positive study. In fact, it’s on the front burner of the Treatment Implications section of Dr. Nemeroff’s presentation. In his Grand Rounds presentation at NYU in 2012, there it is [@41:10]. The graph from the original 2003 paper is on the left and the one from 2012 is on the right,
    unchanged even though the reported error invalidates this specific slide:
      Results of the analyses of variance comparing change in Hamilton Rating Scale for Depression scores as a function of treatment type and early life trauma histories as well as Fig. 1A reflect change relative to the first week of treatment instead of baseline. When change scores relative to baseline are used, the interaction effects between treatment type and childhood trauma histories are not statistically significant.
Was that slide part of the IoP presentation yesterday in London? Did he mention that this data came from an industry funded study? I don’t know that. But it was sure there in 2012 at NYU.

To be honest, I can’t figure out how this study fits into his lecture about The Neurobiology of Child Abuse when everything that comes before is about genetic predisposition and neurogenesis changing the brain. I guess he needed something to say about Treatment Implications at the end. But using data that he knew was in error is inexcusable. It took the trained eagle eyes of Dr. Carroll to see it, and I expect that most of this kind of subtle sleight of hand goes right over most readers. But once it’s pointed out, it’s pretty appalling.

I included the origins of this story, the résumé-churning KOL authorship, Dr. Angell’s early comments about Conflicts of Interest with the sell-off of academia, and the details of Dr. Nemeroff’s article along with Dr. Carroll’s recent findings in his presentation because I thought it was a classic example of the widespread forms of corruption and deceit that have tainted all of us. It’s why we write these blogs, support ALLTRIALS and RIAT, insist on vetting the previous clinical trials, balk at the expansiveness of the DSM-5, etc. This kind of conduct has to see the light of day. And it just has to stop…

see also Big Pharma, Bad Medicine in the Boston Review
    Bernard Carroll
    June 18, 2013 | 2:32 AM

    We are waiting to see what response comes now from the Institute of Psychiatry in London where Dr. Nemeroff gave his lecture today. Meanwhile, your reference to Marcia Angell’s editorial in New England Journal of Medicine (Is Academic Medicine for Sale?) reminded of a zinger response that the Journal published: Is academic medicine for sale? No, the present owners are very happy with it!

    Steve Lucas
    June 18, 2013 | 7:59 AM

    This just lends further creditably to my concept that psychiatry is the business model pharma wishes to impose on all of medicine, where evidence is replaced by salesmanship and everyone can be bought.

    Steve Lucas

    June 18, 2013 | 9:51 AM


    i don’t recall that oneboringoldman has focused attention on care guidelines and clinical pathways

    Real Psychiatry
    Monday, June 17, 2013
    Collaborative Care Model – Even Worse Than I Imagined


    June 18, 2013 | 12:30 PM

    If the clinical trials are nonsensical; if the data is untrustworthy; if the research chairs are on the take; if the publications are ridiculous; if the drug companies are comprised of crooks….

    Why continue to write the prescriptions?

    The buck stops with the prescribers!


    June 18, 2013 | 12:31 PM

    It’s not rocket science!


    Steve Lucas
    June 18, 2013 | 12:37 PM

    From Roy Poses:

    Upton Sinclair famously said, “It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”

    Steve Lucas

    June 18, 2013 | 1:43 PM

    If these KOLs had consciously set out to protect predators, abusers, and parenting figures who neglect their children) while making children easier targets for them, they might not have done a better job of it.

    These poor children. Hasn’t the drugging of children in foster care demonstrated that this drugging is not being done on behalf of the children?

    June 18, 2013 | 2:03 PM

    That’s interesting, Jamzo. However, I find it hard to believe that the APA and psychiatrists in this country have been helpless to change it. If the response of the APA is to add more mental illnesses with few requirements to the DSM, then it’s hard to believe that specificity and nuance was what they were after.

    The DSM committee debated about whether or not to create “excessive bitterness” as a form of mental illness in the DSM-5 because after the largest financial collapse in the history of money, a lot of psychiatrists noted that a lot of their patients were very, very bitter. What fresh hell is this?

    It was psychiatrists who bought into the bio-bio-bio-psychiatry and the school of neuro-pharmacology that hasn’t even gelled yet, yet doctors like Nemeroff already consider themselves to be experts in.

    It was psychiatrists who accepted money and “medical studies” done by bigpharma as medicine. It was psychiatrists who thought that they could be effective psychiatrists while spending only 15 minutes with a patient while prescribing drugs that were still patented as if they really were more effective.

    Why wouldn’t they be considered redundant right now? Nurses and GPs can go through a little checklist and write a prescription, too. When psychiatry writ large decided that nothing in a person but their genes and a “disease” (that could be divined through a checklist) was relevant to the people suffering before them, they set the wheels in motion to put themselves out of a job.

    caveat emptor

    June 18, 2013 | 2:51 PM

    Brave New Technology:
    “Arcadian TelePsychiatry”

    June 18, 2013 | 3:55 PM

    From “The Gulag Archipelago V 1”
    Aleksandr L Solzhenitsyn

    “And this Archipelago crisscrossed and patterned that other
    country within which it was located, like a gigantic patchwork,
    cutting into its cities, hovering over its streets. Yet there were
    many who did not even guess at its presence and many, many
    others who had heard something vague. And only those who had
    been there knew the whole truth.

    But, as though stricken dumb on the islands of the Archipelago,
    they kept their silence.”

    June 18, 2013 | 5:02 PM

    If it’s not those nasty anti-psychiatry groups, it’s the APA…
    It’s always someone else’s fault.

    A bunch of whiners.


    June 18, 2013 | 5:05 PM

    There are a million excuses why kids have been drugged into oblivion.
    But not one good reason.

    Stop it.


    June 18, 2013 | 5:46 PM

    How do those two comments relate to the content of this post, or this blog?

    June 18, 2013 | 6:24 PM


    Fraudulent research results in harm – not only to the psychiatric profession, but more importantly, with public trust… grave harm to children – every day.

    Re: The last 2 comments

    Joel constantly blames the APA for the predicament of the field on this blog.
    Wiley made a comment on this post about children and the injury that is taking place.

    If you want me gone from your site, say the word.


    June 18, 2013 | 9:34 PM


    I don’t see a comment from Joel on this post. Recently, he said “I think Mickey does not want us to debate our polarized views, not that mine are so polarized, but threads seem to close when we banter, so, it is what it is.” I think that’s right, though it hadn’t occurred to me in that way. I’ve never censored comments. I have turned them off when the two of you start the snipes going back and forth and begin to simplify each other. Joel’s point is that he feels oppressed by the state of psychiatry from within. I think many psychiatrists feel that. I feel that myself. You focus on the damage of over prescribing and over medication. I feel that too.

    So comment on what you want to comment on. Joel the same. Express whatever you want to express an opinion about. Just lay off the sniping at each other. I said some time back that this is what I didn’t want:

        1: likely to cause disagreement or argument
    <a contentious issue>
        2: exhibiting an often perverse and wearisome tendency to quarrels and disputes
    <a man of a most contentious nature>

    That’s all..

    June 18, 2013 | 10:03 PM

    Fair enough.


    June 18, 2013 | 11:54 PM

    My apologies, I tend to drop link grenades sometimes.

    June 19, 2013 | 5:15 PM

    Though this may appear to be off topic, I believe my question is crucial regarding the credibility of many “experts” on this site including Dr. Nardo in my opinion. I was unable to ask this question on the applicable article due to my “shock” and closed comments. I was very disheartened to find that it appears there is a group of mental “health” experts on this web site including Dr. Nardo advocating for ECT directly and indirectly by practice, book recommendations, etc.

    I would especially like to know if Dr. Nardo recommends/promotes ECT for so called melancholia or other so called mental illnesses, please.

    The reason I ask is that Dr. David Healy also promoted on this web site was found to be a great promoter of ECT while deliberately ignoring the many studies exposing the enormous harm done with this STILL barbaric torture treatment including Harold Sackeim, Bentall & Read, Breggin and many others including several neurologists or real brain experts.

    Finding that David Healy was so thorough in exposing the harms of psychiatric drugs while denying and covering up the even worse harm and brain damage of ECT has increasingly harmed his credibility with me. The fact that he has written a book about ECT funded by the infamous ECT promoter Max Fink that is nothing more than an ECT commercial roundly condemned by many experts and ECT survivors certainly calls David Healy’s motives and/or expertise into question. Now, Healy is claiming that the brain damage attributed to ECT was really caused by the psych drugs used prior to ECT and other bogus claims like ECT has improved in safety when the opposite is true. Yes, psychiatric drugs are toxic and cause brain damage, but that doesn’t justify another equally or more brain damaging torture treatment forced on more victims now that many of the drugs are going off patent and are more exposed as useless and toxic. The fact that ECT practices can be quite lucrative also makes the recent great comeback highly suspicious. We can thank ECT for the suicides of Ernest Hemingway and Sylvia Plath who realized they could no longer create or write once robbed of their brains, memories and what made them human.

    Dr. Nardo has indirectly supported ECT by recommending the book, HIPPOCRATES CRIED. and the great comeback of melancholia as a proposed DSM stigma that supposedly responds best to ECT by the supposed neuroscientist author and Gary Greenburg in THE BOOK OF WOE. Dr. Noll, Dr. Carroll and others posting or recommended here seem to be promoting the barbaric brain damaging/disabling ECT big time recently on this site, which I find horribly dishonest and fraudulent given the many studies and exposes exposing the huge harm done with ECT. The book, DOCTORS OF DECEPTION, recommended by a neurologist is one of many good sources of the huge harm of ECT written by a former ECT victim. Dr. Peter Breggin has condemned this brain damaging treatment as an electrical lobotomy similar to psychiatry’s chemical and surgical lobotomies to destroy/disable the brains of so called mental “health” patients to lower them to a more animal type existence.

    Anyway, I would appreciate it if Dr. Nardo would let us know if he has practiced and advocated ECT while working in the mental “health” profession in the past and if he promotes ECT now. I must confess that Dr. Nardo’ s credibility when exposing the junk science and fraud of psychiatric drugs is highly questionable if he is an ECT advocate as is the case with Dr. David Healy. Before I get accused of making false accusations, due to my respect for Dr. Nardo’s work, based on his recommendation, I sought out the book, HIPPOCRATES CRIED, and felt shocked and betrayed to find the author was a big ECT promoter and far less than credible based on my vast amount of research. That combined with several people in the profession coincidentally promoting ECT on this web site has raised red flags to me recently when reading this web site.

    June 19, 2013 | 5:25 PM

    Another effort to polarize an issue. ECT works for some, and not for others.

    Gray is a color, please deal with it!

    June 19, 2013 | 5:32 PM

    I believe you are the one polarizing the issue when I simply asked a question based on legitimate FACTS. Yes, ECT “works” when one considers that psychiatry “works” by disabling the brain by causing brain damage. Thank you for your “informed, unbiased opinion” Do you use ECT in your practice? I’ll stick to those like Dr. Peter Breggin and others who have proven themselves over many years along with all the many neurologists and even former ECT promoters admitting/exposing the huge harm of ECT like Harold Sackeim.

    I also find your comment very rude and offensive.

    June 19, 2013 | 6:13 PM

    Here is an expert review of Dr, David Healy’s infomercial book on ECT with Edward Shorter that also reviews the sordid history of brain damaging, memory destroying ECT in general.


    June 19, 2013 | 6:33 PM

    No I don’t use ECT in my practice, and rarely refer for it either. But aren’t you being rude and offensive in your slighting comments of the blog author for supporting the TREATMENT intervention?!

    God, the projection and frank denial by some is just incredible to read. If the procedure was so heinous and profoundly disruptive and impairing as the dissenters write so passionately, why haven’t medical monitoring authorities removed it from consideration by now?

    Oh, that damn color gray again.

    June 19, 2013 | 6:47 PM

    I am aware of Dr. Breggin’s work and am particularly grateful for his focus on the withdrawal syndromes from antidepressants and other psychiatric drugs. If you’ve read this blog much, you know that I practiced as a psychotherapist and after leaving academia only saw referred patients, so Melancholia is something I saw as a resident, as an attending faculty member from afar, and in a few friends. I came into Psychiatry with a contract that said I never had to do ECT, feeling back then much as you do. However, as a resident, I had a retired school teacher with a profound agitated depression unresponsive to medications. The attending recommended ECT and discussed it with she and her husband. Her husband asked me to do it. I agreed and was supervised by the attending. She had four treatments and was literally cured by the second. Several years later, we had a young woman with Catatonia, again unresponsive to anything who had stopped eating. I conducted the ECT and it was again a remarkable result. Today, she would be treated with Valium, but we didn’t know about that back then. That’s the extent of my experience.

    I don’t like the idea of ETC. It was discovered by accident. It was abused in the Asylum days. Nobody has any idea why it works that I know of. But I came to see it as no more dangerous that Grand Mal Epilepsy, and I believe that to be true. I’ve never recommended it, but when I’ve seen Melancholic patients I’ve always referred the patients to a center where ECT was available.

    So I’m not opposed to ECT. I do use medications in my volunteer work in a clinic. It’s not my cup of tea, but I do it because the other doctors there do it so badly with heavy hands. I do treat ADHD adults with stimulants, but only those with a lifelong and obvious history. I only use antipsychotics in psychotic patients. The only atypical antipsychotic I’ve ever used is Risperdal in patients who can’t tolerate Haldol. That’s only a few patients in five+ years of volunteering.

    If my wife developed Melancholia that was unresponsive to TCA Antidepressants, I would agree to ECT if that’s what was recommended and what she wanted. But I might just fly us to Wales and ask Dr. Healy to treat her because I respect his carefulness about biological interventions.

    I’m not skirting your question about whether am I an ETC advocate or anti-ECT because I’m obviously neither. There are lots of things in medicine like that – things that don’t fit with my own sensibilities but are helpful.

    I didn’t start writing this blog to become an expert on any of these things. If I’m an expert on anything, its the Object Relations Theories of the British Middle School and the history and psychotherapy of Traumatic Mental Illness, hardly blog topics. I started writing because I realized that academic psychiatry and the pharmaceutical industry had entered into a corrupt alliance. I didn’t know that, but I should have. That’s what I’ve spent my time learning about and writing about and will likely continue to write about. I advocate returning Melancholia to a distinct category because I personally think it is an actual disease with a cause and I’d like to see it defined as such so someone might figure out what causes it.

    That’s all I can think of to say in response to your question. You decide…

    June 19, 2013 | 6:52 PM

    Your question about corrupt authorities not removing toxic drugs and ECT is appalling, insulting and abusive again. The whole point of this web site is to expose the massive corruption of psychiatry in bed with BIG PHARMA and corrupt government hacks in Congress, NIMH, etc. I fail to see why the equally and more deadly ECT surrounded by massive lies and corruption should get a free pass.

    Here is Dr. Friedberg, Neurologist, on the deadly effects of ECT. You are being very disingenuous with your false claims of gray regarding ECT known to cause great brain damage, memory loss, death, suicide and other life destroying effects. Please do your homework before attacking me or others.


    I have asked the question of Dr. Nardo who is obviously competent to speak for himself. My, you seem awfully threatened by my comments. Me thinks Joel Hassman protests too much!

    Here’s a great review of the latest electroshock megalomania by the Alliance For Human Research Protection exposing the lies and fraud of ECT’s usual promoters:


    Your abuse and bullying may work with your unfortunate patients, but not with me since I have done my homework unlike you (or you are unwilling to admit the truth while I do not have your conflicts of interest). Please let Dr. Nardo speak for himself. I do not need to hear any more of your repetitious apologetics for psychiatric fraud and brain damaging torture treatments.

    It appears that you have been bullying other people here while making them appear the villains of the piece. Also, your ad hominem attacks in lieu of any evidence of your false claims is all too typical of biopsychiatry and its ideology.

    I asked Dr. Nardo this question because I did not wish to make false assumptions about somebody I have so greatly admired. I did not ask you! Please refrain from any more of your abusive comments to me and others.

    June 19, 2013 | 7:10 PM

    Thank you, Florence.


    June 19, 2013 | 7:12 PM
    June 19, 2013 | 7:25 PM

    Re: ECT

    “ECT (electroconvulsive therapy) involves the application of two electrodes to the head to pass electricity through the brain with the goal of causing an intense seizure or convulsion. The process always damages the brain, resulting each time in a temporary coma and often a flatlining of the brain waves, which is a sign of impending brain death. After one, two or three ECTs, the trauma causes typical symptoms of severe head trauma or injury including headache, nausea, memory loss, disorientation, confusion, impaired judgment, loss of personality, and emotional instability. These harmful effects worsen and some become permanent as routine treatment progresses.” – Psychiatrist, Peter Breggin, M.D.

    ECT Resources Center –

    IMO, Florence was respectful and asked some good questions.


    June 19, 2013 | 7:29 PM


    My comments had nothing to do with the post or the blog.
    The thread took a direction…

    I’ll do my best to respect your request.
    I hope Joel will do the same.
    If not, I’m leaving this site, without being asked.


    June 19, 2013 | 7:30 PM

    All of the treatments should only be carried out with genuinely informed consent. Should something as apparently drastic and vilified as ECT be considered as a last option, then, I think the patient is entitled to that choice. There are indeed people who suffer from such mental anguish that intervention is warranted and welcomed. Some drugs that are, if honestly evaluated, unnecessary and/or contraindicated for most people can be a godsend to others.

    Countering abuses of authority and bad science doesn’t require every possible kind of intervention be damned. That many people who have been mislabeled as being “mentally ill” and medicated to the gills with brain-damaging drugs, and that many people who do indeed suffer from what can rightfully be called mental illness can benefit profoundly from medical intervention can both be true. The primary difference, I think, is in the numbers.

    It’s a particular tendency, I think, in the U.S., to throw babies out with the bathwater. I know I speak loosely on these issues sometimes, but that’s because there are so few places in which the hegemony of bio-psychiatry can be challenged without the challenger being labeled as a “scientologist” or “anti-science.”

    Being a person who, I think, was caught up in a dragnet of psychiatric over-reach and routine over-medication who also suffers some psychiatric afflictions that I claim as my own, Dr. Nardo’s measured critiques are very important to me as a moderating and edifying voice in my own decisions about what is and is not a mental health problem for me and how I choose to deal with it.

    June 19, 2013 | 8:49 PM

    Dear Dr. Nardo,

    Though I may not agree with all that you said, I do appreciate your thoughtful response, which shows that my high opinion of you was not in vain. I know others have a high opinion of you too. I have only recently found out about your blog, so I am not familiar with all of your posts. However, I have checked out your background and some information about you that seemed quite positive. I am very pleased to see that you are not an avid ECT or psychiatric stigma/drug promoter like some of the great advocates I cited here. Rather, per your claims, you use such treatments sparingly and judiciously when you believe they are absolutely necessary as a last resort and/or to avoid further harm by those not so inclined.

    Given Dr. Nemeroff’s recent use of the so called bogus genetic and other vulnerability of trauma survivors for more psychiatric drug promotion, I think your knowledge and background of trauma would be very useful and enlightening since trauma has become a great focus among psychiatric survivors, SAMSHA, etc.

    The problem with Dr. Healy is that though he is credible with his work on drugs, he is not credible about ECT if you read his book and the many very negative reviews about it. Taking over for Max Fink as the latest greatest ECT promoter does damage Dr. Healy’s credibility in my opinion and many others. According to one review, the sendoff of Dr. Healy’s new ECT book was a ploy to advocate the use of this brain damaging treatment on all types of so called mental disorders in children, which I find appalling. This brings up the horrors of Joseph Biederman. I am also appalled at the recent great comeback of this barbaric treatment for so called depression and many other “disorders” mainly perpetrated against women and the elderly.

    I am not greatly familiar with melancholia, but could it be that somebody could be so bullied and abused to the point of what Seligman found to be learned helplessness in his experimental dogs in that the victims become so powerless with no means of escaping their oppression, abuse, bullying and/or mobbing, they just give up in despair? Trauma informed treatment and validation would be more helpful in aiding such victims to regain their power and self-efficacy to escape their abusers rather than being subjected to brain disabling treatments, which impede any escape from one’s oppressors per Dr. Warshaw and many domestic violence experts including Dr. Lenore Walker. Even Seligman’s dogs could be retrained and rescued from the learned helplessness that often defeats abuse trauma victims. Stigmatizing the victims as mentally ill also aids and abets the abusers and destroys victims in the courts, their careers, custody and in general. Again, I would have to do more research on melancholia, but I am quite familiar with trauma and its effects which are rampantly misdiagnosed by psychiatry per trauma and other experts like Dr. Judith Herman, Dr. Carole Warshaw, Dr. Frank Ochberg and many others. As Dr. Warshaw exposes in PSYCHIATRIC TIMES, psychiatry fails to see domestic abuse in women and children with their sole focus on outer symptoms and failure to acknowledge toxic environmental stressors like abuse, mobbing and bullying by definition in the DSM. Dr. Heinz Leymann coined the term mobbing that is explained on his web site and in the book, MOBBING, by Dr. Noah Davenport whereby a group teams up against one person at work or school and subjects the person to psychological terror, ostracism and other extreme abuse often leading to severe complex PTSD and often suicide. Both Dr. Warshaw and Dr. Leymann expose that psychiatry routinely misdiagnoses such abuse as bipolar, delusions, paranoia, ADHD and other DSM stigmas causing grave harm to the victims.

    Dr. Hans Selye, known as the father of stress theory and author of such books as STRESS WITHOUT DISTRESS has pointed out that anyone can have a stress breakdown after being subjected to enough negative stress, which can easily happen with any type of abuse, bullying, mobbing, domestic/work/community and other violence, etc. Therefore, it worries me that the increased cortisol and other effects of such toxic stressors are being used as a ploy to falsely claim these to be proof of various victim blaming DSM labels or even melancholia. You say you have certain beliefs about melancholia, ECT and other topics, but as you know beliefs need to be confirmed by evidence. Perhaps more listening to the victims or patients would be the most beneficial, but I get the impression you are more inclined to do this than others in psychiatry given the limits of the DSM and biopsychiatry. Another problem is that the claim of “treatment resistant depression” did not take into consideration Dr. Irving Kirsch’s work on the lack of efficacy of SSRI’s in his book, THE EMPEROR’S NEW DRUGS and much similar work, which also blamed the victims rather than the mostly useless drugs.

    Also, actual physical illnesses, vitamin deficiencies and other medical caused could cause such symptoms as well, which usually go unchecked by psychiatry.

    Since so many psychiatric survivors have suffered trauma and the topic is making quite a comeback for good and bad per your latest article on Nemeroff, I believe your views and knowledge about trauma in addition to your work on psychiatric drugs would be most welcome here. I would be most interested in such comments by you for sure.

    Again, I thank you for your thoughtful, heart felt response. You didn’t disappoint me and that is why I wanted to hear from you personally/directly rather than making unfair assumptions based only on implications rather than the whole truth that only you could provide.

    June 20, 2013 | 3:00 AM

    Dear Florence,

    I’m going to respectfully disagree with you especially as to your lack of understanding of Doc Hassman remark “Gray is a color…” in my opinion.

    I personally find your choice of words all telling and one-sided in my opinion as it relates to ECT:

    “the enormous harm done…barbaric torture treatment…brain damage…real brain experts…bogus claims like ECT has improved in safety when the opposite is true…another equally or more brain damaging torture treatment forced on more victims…We can thank ECT for the suicides of Ernest Hemingway and Sylvia Plath who realized they could no longer create or write once robbed of their brains, memories and what made them human…barbaric brain damaging/disabling ECT…I find horribly dishonest and fraudulent given the many studies and exposes exposing the huge harm done with ECT…the huge harm of ECT written by a former ECT victim…brain damaging treatment as an electrical lobotomy…shocked and betrayed…Yes, ECT “works” when one considers that psychiatry “works” by disabling the brain by causing brain damage…even former ECT promoters admitting/exposing the huge harm of ECT like Harold Sackeim…the sordid history of brain damaging, memory destroying ECT in general…Your question about corrupt authorities not removing toxic drugs and ECT is appalling, insulting and abusive again…the deadly effects of ECT…You are being very disingenuous with your false claims of gray regarding ECT known to cause great brain damage, memory loss, death, suicide and other life destroying effects…or you are unwilling to admit the truth while I do not have your conflicts of interest…The problem with Dr. Healy is that though he is credible with his work on drugs, he is not credible about ECT if you read his book and the many very negative reviews about it.”

    I think the above is enough to clarify your impartiality and ability to be open and reasoning.

    First, I don’t think any physician should promote and/or endorse any therapy but rather to rightfully inform and reasonably educate the patient and his/her support person(s) to make un-coerced medical decisions as to the available treatment options, their potential benefits and potential downside as well as the potential for side-effects and especially the potential for serious side-effects.

    Unlike you I also realize the potential life threatening side-effects of aspirin and the potential side-effect of death from excess consumption of water. Maybe under your system of thinking we should ban all drugs including aspirin because there is the potential for death and even brain damage?

    Are you aware Vladimir Horowitz continued his career after having ECT and so did Kitty Dukakis, Thomas Eagleton, Carrie Fisher, Judy Garland, Vivien Leigh, and Yves Saint-Laurent but to name a few?

    You omit a very important word in your writings; potential. Not every patient who undergoes ECT, as you would allude, experiences the potential serious side-effects of memory loss and cognitive deficits. This is not to deny that there are patients who have suffered these serious side-effects but then again I can attest to many patients from my years as a facilitator who would testify that the very treatment you vilify had saved their lives.

    This particular discussion brings back memories from years ago when I was booted from Ms. Juli Lawrence’s forums while also not ingratiating myself with Linda Andre because I opposed some of the very thinking and statement I am reading in your writings. One piece of logic I recall from one of their cadre of participants was, “Don’t you know electricity can kill”? That was one I could never forget. My response was not taken very well and broke the camel’s back so to speak. I stated don’t you know electricity lights and warms your home, cooks your food, runs your computers, washer and dryer and starts your automobiles, enables the use of X-ray, MRI and just imagine it also shocks one’s heart back into rhythm in a life-threatening emergency.

    Oh and least I forget I’ve also opposed Mr. David Oaks and his Mind Freedom group calling for the banning ECT which I know benefitted my spouse and others. Additionally in my opposition of Juli Lawrence and her group was when I more clearly explained to Ms. Katherine Bryson, Utah Congresswoman the use and importance of ECT that she modified HB 109.

    The point being at this time and place ECT in my opinion is still a viable treatment option for the reasonably informed and knowledgeable patient to consider with his/her physician although there are newer neuro-modulation therapies I would consider first that is unless my charge was imminently acting upon his/her suicidal ideations.

    Oh yes, the brain damage issue. I find it strange that my spouse having undergone series of ECT treatments in the past and subsequent CT and MRI scans and X-rays according to her neurologist showed no brain damage. The doctor’s findings were normal for a woman of her age.

    How is that possible according to your statements?

    How in good conscience would you or anyone consider denying a desperately ill individual an informed choice of treatment option that might just save his/her life?

    Back to the color gray; there really are shades of gray.


    June 20, 2013 | 3:40 AM


    I have not stated MY views on ECT and other brain damaging treatments perpetrated by biopsychiatry, but rather, the many experts who have seen and exposed the harm first hand including neurologists, psychiatrists, psychologists and many others. I only cited a few of the many, many experts who have exposed the huge harm of ECT. The vast majority of people receiving ECT were/are outraged by being subjected to such horrific atrocities and do all in their power to expose this barbaric treatment destroying their lives, memories and capabilities. Dr. Peter Breggin recently won a large lawsuit for a nurse who lost her memory and career due to ECT.

    I find it appalling that you would try to get laws passed to maintain this barbaric practice. I also find it typical that males frequently falsely accuse their wives of being crazy and needing psychiatry’s toxic brain damaging treatments to make their victims more easily controlled and perhaps more accepting of abuse, bullying and/or male domination. This is all too typical in psychiatry’s sordid history with women and children their most frequent victims since the white old boy network rules biopsychiatry.

    So, I stand by what I said in that ECT is a barbaric, brain damaging practice based on the massive EVIDENCE of many, many experts who have done careful studies. Many of the people you cite as ECT successes were either destroyed or willing to live in a grossly reduced vegetarian state like Kitty Dukakis. I believe that women like her and those like Carrie Fisher have been grossly brainwashed by psychiatry and have done immense harm to other women with their irresponsible behavior. I guess you are not familiar with the destruction of Vivien Leigh. Judy Garland and Francis Farmer by psychiatry and its nasty ECT.

    Therefore, there are no shades of gray. If a situation involves a real life or death situation like ones Dr. Nardo cited, I might reluctantly agree that such a drastic measure may be tried. Unfortunately, such toxic treatments for life threatening situations become every day treatment/business as usual for the latest fraud fad epidemics like depression and bipolar. However, there are better alternatives and if abused, bullied women and children were validated and helped from the start, they might not reach such desperate states.

    The fact that you are controlling your wife’s medical care says it all to me in that you are most likely controlling just about everything else in her life, so I pity this poor woman like so many who find themselves in such horrific, oppressive situations even though they may not be able to realize it due to subtle undermining by such “helpful” husbands. I am all too familiar with this scenario having read a great deal about controlling, abusive husbands who constantly accuse their wives of being crazy!

    Finally, I hope you will reconsider your oppressive actions whereby you are trying to force such barbaric, brain damaging/disabling treatments on others for the purpose of social control and robbing others of their human, civil and democratic rights that you would never tolerate for yourself obviously.

    Please spare me any more ECT advocacy because you are wasting your time since I’ll trust the real experts on this one like the ones I cited above including Dr. Peter Breggin.

    June 20, 2013 | 3:54 AM


    I checked out your very depressing blog and found you are heavily involved in the BIG PHARMA front group, DBSA, which also greatly lowers your credibility in my opinion. As I’ve stated many times, abused, traumatized women and children are frequently misdiagnosed with bipolar and other bogus stigmas with immense “help” from their abusive, control freak husbands. So, you picked the wrong person to try to convince of your supposed support for your most unfortunate wife. I feel very sorry for this poor person and can only advise you to reconsider your approach to her and others who you are trying to bully into submission to your narrow, dangerous, self serving, unproven views.

    By the way, you claim your wife did not suffer brain damage, but one neurologist claimed that though such damage may be hard to see in typical MRI’s or brain scams, such brain damage from ECT is inevitable. Also, if you read the promotional material passed off as science by ECT promoters, they routinely lie and deny the brain damage, memory loss, death and other huge harm and risks of ECT like Max Fink as exposed in some of the links I cited above.

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