to listen to…

Posted on Saturday 28 September 2013

You don’t get to have many really original thoughts in life [and invariably when you do, you find out many before you have already had the same thought]. One of mine had to do with authority. Like many, I have an ambivalent relationship with authority – not just with others but with myself. When I ended my first training as an Internist, I was placed in a situation where I was the authority, and I didn’t like it. At the same period of life, I was in the Air Force, a place where authority was defined by the insignia on your collar. I didn’t like that at all [in either direction]. I figured out that there were two kinds: the authority of knowledge or wisdom [earned]; and the authority of power [usually designated]. Like Einstein was an authority in physics versus "by the authority of invested in me by …." I decided that the first kind was preferable, except in desperate straights when somebody needs to take charge.

Personally, I preferred the collaboration of psychotherapy to the seeming asymmetric relationship in physical medicine. It wasn’t always that way, but more often than suited me. I liked earned authority better, and I liked listening. I had more time to think. That may sound odd considering how a lot of people see psychiatry these days, but it’s how I see it. All of this is my lead-up to the interchange between Allen Frances and Eleanor Longden, both of whom most of you know already. Allen Frances is the Emeritus Chair of Psychiatry at Duke, the former Chair of the DSM-IV Revision Task Force, and more recently an outspoken critic of the DSM-5, who has continued with a campaign against over-diagnosis and over-medication he calls "Saving Normal." Eleanor Longden is a mental health worker who suffered long with hearing voices and found recovery, not from hearing voices but from a broken life by treating her voices as what they are – part of her mental life. Now she is a part of the Hearing Voices Movement. Her Ted presentation was unique, powerful, moving:

After it was published, Dr. Frances wrote a piece about it at the request of Huffington Post, followed by a dialog between them. Here’s a catalog of their public dialog if you haven’t seen it:
Both were under a microscope engaging in a public dialog. They each could easily have been made into ink-blots, targets for people to project their own preconceived ideas onto. Lord knows, there are plenty enough stereotypes and stereotypists to go around these days. Likewise, while both are authorities, there was also a chance for either to become authoritarian from their differing perspectives. By my read, neither one of them did that. I put it here because I thought it was an important exchange for all of us to listen to…
    September 29, 2013 | 10:28 AM

    Nice post. I identify with this issue with how authority can easily lose sight of the basic principles that guided one to seek a position of leadership, only to degrade into an attitude of tyranny.

    In yesterday’s Baltimore Sun editorial page, a Towson professor, Richard Vatz, (who by the way I fairly much detest per his antipsychiatry rants he falsely presents as one of authority when in fact he is a political science professor) wrote a piece about how the Baltimore County board of education had a farce of a town hall meeting that led to the false arrest of a citizen trying to protest a new policy in the school system. Just google “Youtube & Robert Small & Baltimore County School board meeting Sept 2013” and enjoy dictatorship behaviors at their worst in this country. (here is the link to read the whole piece to understand the below reference:

    Anyway, Dr Vatz mentions an article by Thomas Cronin that was published in the Duke University law journal Law and Contemporary Problems decades ago, and I link it below, but beware, it is a 53 page read:

    My point to this comment? We are being inundated and falsely represented by people in positions of authority of late who have no clue to represent nor negotiate, politicians as best example this week alone, and the sheer arrogance and self serving nature is dangerous to let it go unchallenged, responsibly mind you.

    You may not win even if you do your best to responsibly challenge authority, but if you don’t at least question it publicly, leadership will run roughshod over those who foolishly trust and depend on such authority. Being silent does not make you a better person. Trust me, I know this personally, not because I have been a silent one (yeah, no surprise to readers), but I am continually astounded by how many think that saying nothing is better than being brusk and brutally honest. Frankly, with the way people think this culture is represented by FaceBook and Twitter, writing at sites like this is fairly polite and respectful at the end of the day.

    Good luck with just swimming around in that fishbowl we have created as a lifestyle. I have two kids I really want to have a better life than I have had. Our generations behind us who really are struggling deserve better than what people are offering now, what with zealot politics, over simplified care interventions, and even cultural expectations based on computer choices first and foremost.

    Frankly, I think the Boomer generation, which I am a member of by the way, is a major player to the basic mindset of this culture today. I think Dr Frances alludes in his Response to an Open Letter that this extremist debate between the antipsychiatrists and the fervent biological psychopharmacologists should be relegated to an empty field where the two zealot sides can finish their banter for their own enjoyment.

    Those of us who are moderate, independent, and attentive citizens aren’t interested in the “My way or NO WAY” discourse. Whether it is about PPACA or psychiatric medications, there is a middle ground. Stop letting the zealots set the tone of the discussion. Get out of the bowl!

    Sorry for the rant. Again, nice post.

    Nick Stuart
    September 29, 2013 | 12:44 PM

    Joel – you state ‘this extremist debate between the antipsychiatrists and the fervent biological psychopharmacologists should be relegated to an empty field where the two zealot sides can finish their banter for their own enjoyment.’

    I think one should be careful when using the term ‘anti-psychiatry’ since this has been used for years to denigrate those who have criticisms of biological psychiatry much like the term ‘mental illness denier’. Szasz himself, whom I see is misrepresented by Frances again in his first Huff Post response! is often accused of being anti-psychiatry when in fact he was not so and wrote the book ‘Anti-Psychiatry – Quackery Squared’. Richard Bentall is another whose views have been disparaged by the use of this insult.

    September 29, 2013 | 12:52 PM

    The argument that, done right, psychiatry can be helpful is a tautology that does nothing to shed light on the central problem: It is so infrequently “done right.”

    Patients have a very, very difficult time finding psychiatrists who do not base decisions on a narrow reductionist model and reflexively throw prescriptions at them. Good doctors in psychiatry are extremely scarce.

    The field is populated by mediocre practitioners who have little understanding of drug effects, beneficial and adverse, although writing prescriptions is what they do all day long.

    Theoretically, psychiatry “done right” can benefit humanity — who can argue with that tautology? — but the reality is quite different. The poor quality of clinicians is what needs to be addressed.

    Nick Stuart
    September 29, 2013 | 1:29 PM

    Altostrata, I am not sure it is the ‘poor quality of clinicians’ that is the problem here – many are trying their utmost to help using the best methods available to them. As Szasz stated, and as Eleanor Longden and the Intervoice group have discovered, if one treats the human condition and suffering AS IF it were a medical disease, just like measles or diabetes, then this myth dictates how the ‘cure’ is to be administered – i.e with ‘medical drugs’. Szasz was an existential psychotherapist, although he would not agree to that term, who correctly forecast the rise of the ‘therapeutic state’ in dealing with human and sociological problems replacing the former theocratic state. A man, in my view, too ahead of his time to be fully appreciated.

    September 29, 2013 | 2:22 PM

    Though this post is impressive, I truly question why Dr. Allen Frances maintains such a great reputation. Dr. Nardo, you mentioned on one post the fact that those who profited from the corrupt Texas Algorithm agenda like Dr. Frances were never really called to account.

    Due to the past history of Dr. Frances’ vile, ridiculous expansion of the horrific bipolar stigma begun with Spitzer in DSM III to be used by all for all to push every lethal drug available from Big Pharma with special emphasis on the poison neuroleptics for which Frances prostituted himself with J&J for greed, profit and status paving the way for Joseph Biederman with another J&J scandal, I don’t think those in the recovery movement should put much faith in Frances’ ongoing self serving, biased agenda to cover his tracks and justify a life of fraud and predation on his fellow humans in Community Mental Health Centers serving the poor no less with the bogus Texas Algorithm scheme above. Also, I think he like Biederman should have been sent to prison for their many crimes against humanity.

    I think it is obvious that rather than flaunting himself as the great savior of psychiatry and normal due to his malignant narcissism, Frances like Spitzer should slink away in shame with the contempt they deserve for their role in selling out psychiatry and the whole mental health profession to Big Pharma and corrupt government hacks. They should be grateful they aren’t in jail as they should be instead of flaunting their crimes with impunity.

    September 29, 2013 | 2:34 PM

    Where Can One Find An Honest, Forthcoming Psychiatrist? Response to Allen Frances’ communication to AHRP protesting being quoted as saying defining mental disorders is bullshit and other inconsistent claims when called to account:

    September 29, 2013 | 4:12 PM

    I have been writing at mental health care sites for over 3 years, and I think those who show respect there are a variety of treatment options and interventions by a variety of providers are not the issue in calling one “antipsychiatry”.

    Frankly, the people who take offense to the term are often the ones who are in fact offensive. Come on, how many times has a writer who has written something that is supportive of reasonable standards of care has been mercilessly attacked by the “anonymous”?! And it reflects exactly what is going on in DC with PPACA, you have these alleged “representatives” who think and act so rigidly and inflexibly, it only ruins responsible and appropriate discourse for those who are honestly looking for solutions.

    So, people like me who want progress and healthy function have to put up with people who just want it their way, or no way. And the people who read and comment here with regularity who embrace moderation and independence irregardless of a partisan ideology or personal gain know who is interested in seeing a system work and not just for a selective or personal benefit. But, then there are those who just want to grind that ax, and I think some would relish putting it in some skulls. That is my interpretation.

    I appreciate the blog author allowing me to write here and he can call me on it if I am outlandish or abusive. I don’t think that has legitimately been the case over 95% of the time I have commented. The rhetoric that has been printed here, I can’t imagine unbiased and objective readers can’t figure out who wants to rail away that anything to do with psychiatry is heinous. So, hence why it gets called antipsychiatry.

    Some of you, well, I don’t think the blog author could honestly say there is some flexibility and interest to debate a middle ground, in your defense. There are rogues, and there are saints in my field, I don’t think some of you can honestly see the difference. But, prove me wrong, I like to be happy when I am mistaken these days.

    September 29, 2013 | 4:34 PM

    Exactly, Nick Stuart. The small number of psychiatrists who treat the whole person transcend the medical model.

    Florence, it looks like Allen Frances is defensively emphasizing his underlying pro-psychiatry position. This conflicts with his role as a critic. His very human attempts to resolve the cognitive dissonance yields articles that sometimes lack logical coherence.

    September 29, 2013 | 5:32 PM


    Very good analysis of Allen Frances and his not so subtle invalidation of those in the Hearing Voice Movement as he repeats his pathetic mantra of the need for the degradation rituals of the DSM schizophrenia “sacred symbol” and lethal neuroleptics as the mainstay for the majority for which he prostituted himself for J&J to poison adults (above link) while paving the way for Joseph Biederman to prostitute himself for J&J to poison children.

    But, given the long, long, long list of very renowned experts on the open letter sent to him by and about the Hearing Voices movement, one has to admit the man has plenty of gall, chutzpah and audacity for sure given his sordid history. Dr. Mary Boyle is listed there as the famous author of Schizophrenia: A Scientific Delusion? and many other excellent works.

    To quote him from a post I cited above from ARHP, “My goal is to keep psychiatry doing what it does best and what only it can do really well- treating the clearly ill who definitely need help.” I would say that Frances needs help with his delusional disorder, paranoia, obsessive compulsiveness, malignant narcissism with more than a touch of psychopathy and many other DSM categories. We’d have to give him a bipolar stigma according to the originators of the DSM like Spitzer to “treat” him with his preferred algorithm since character disorders like his are not reimbursable by design so they and their cohorts in crime can get off scot free as “untreatable” and unchangeable or so they say. I think jail would be the best treatment for these hard core criminals with no conscience or remorse for their many crimes against humanity.

    September 29, 2013 | 6:26 PM

    Guidance for medication in bipolar depression published
    By Eleanor McDermid, Senior medwireNews Reporter
    18 September 2013
    Am J Psychiatry 2013; Advance online publication

    “…The panel of international experts, led by Eduard Vieta (University of Barcelona, Spain), found that it “is not currently possible to make firm clinical recommendations that are soundly evidence based.” As well as the evidence being very limited, “much of it is methodologically weak,” they say.

    Nevertheless, the group put together 12 consensus recommendations based on a systematic review of the literature and expert opinion (using the Delphi method); these are published in the American Journal of Psychiatry….”

    September 29, 2013 | 8:34 PM


    I feel cautiously encouraged by the last entry:
    Allen Frances: Psychiatry & Hearing Voices: A Dialogue With Eleanor Longden
    Huffington Post September 27, 2013

    Thank you for sharing this.

    September 29, 2013 | 10:59 PM

    Here is Dr. Frances’ fantasy and/or deceit of what comprises good psychiatry today in complete agreement with Eleanor and the Hearing Voices Movement:

    Thanks, Eleanor. We are in complete agreement on all the following points:
    •We both believe there is no one size fits all way to understand and deal with hearing voices.
    •We both agree that medication prescribed appropriately and collaboratively can be necessary and helpful for some people; and when prescribed inappropriately can be excessive and harmful for others.
    •We both agree that voices (just like dreams) are meaningful experiences that are informative about both internal psychological conflicts and external life stresses—and are not just a pathological symptom devoid of context.
    •We both believe in the value of individual resilience and fortitude in listening to, learning about, and coping with voices.
    •We both believe in hope, courage, and that no one is ‘too ill to benefit.’
    •We both believe that treatment relationships should be collaborative partnerships.
    •We both believe in the important role Intervoice has played in supporting those who are struggling with voices.
    •We both believe that psychiatry done poorly follows a narrow biomedical reductionism, while psychiatry done well benefits from an inclusive and humanitarian model that integrates biological, psychological, and social factors.
    •We both believe in active advocacy for those who are badly under-served, unsupported, and stigmatized in so many parts of the world.

    This is highly disingenuous because Dr. Frances of all people knows that the DSM III onward has been deliberately designed to refuse to acknowledge all social/environmental causes and context, life stressors, abuse, domestic/work/school and other violence, trauma, bullying, oppression, racism, misogyny and now even bereavement over the death of a loved one. Dr. Spitzer of the infamous DSM III said that if context or causes were considered the whole house of cards of the DSM would fall apart. But, he supposedly admits now that this was an unfortunate mistake along with his homosexuality debacle. Tell that to his many victims with their destroyed lives thanks to him and his cohorts like Frances.

    Anyone at all familiar with biopsychiatry’s biobiobio model created when the APA sold out to Big Pharma to once again appear medical while swimming in drug company money and corruption per Whitaker’s Mad in America and Breggin’s Toxic Psychiatry knows that the above list by Frances is an outrageous lie in terms of modern biopsychiatric treatment for the vast majority of cases.

    Here is an infamous NYT article exposing the truth about most of what passes for help in biopsychiatry:

    Given that most if not all of the drugs used in biopsychiatry have been exposed as no better than placebo for the most part with life threatening symptoms and withdrawal syndromes plus brain damage/shrinkage, vastly reduced life spans and other horrible effects, it is obvious this New York Times psychiatrist is grossly deceiving himself. The worst part is that per the article his son is following in his footsteps. Note, his high income is all that matters while even getting to know his patients is out of the question. Sounds like Dr. Daniel Carlatt in Psychiatry Unhinged; only Carlatt at least sounds like a human being despite his lying to his patients while admitting psychiatric stigmas and drugs given aren’t based on science but more on whim like which sales rep he saw most recently, etc. Nice to know we are all in such good hands thanks to you, Dr. Frances.

    September 30, 2013 | 12:48 AM

    Re psychiatry and Intervoice, I believe it is worth keeping in mind:
    “Intervoice likewise recognizes that many people find medication helpful and advocates for informed choice following honest, open discussions between patients and prescribers about the benefits and limitations of psychiatric drugs.”
    “Clearly, people have been helped as well as harmed by mental health treatment, and while we critique and question the practice of some psychiatrists, we have never located ourselves as an ‘anti-psychiatry’ movement.”

    I do very much wish that Frances had done a better job of acknowledging how little psychiatry has incorporated the very valuable work done by Intervoice and its allies. I am also not aware of whether or not he has publicly expressed any regret about his role in TMAP. I could see where it could be a additional concern if he has not done so.

    September 30, 2013 | 3:09 AM

    Seeing a mutual understanding and agreement between a leading voice in psychiatry and a recovery group is refreshing. Most such things are lost today.

    Most of the exchange was nothing new to me, old ideas, the same arguments. What was a little strange to me is that the exhange was about the philosophical nature of the illness and it’s implications.

    Allen frances still managed to offend me though.
    There is no doubt that schizophrenia is sometimes over-treated with medicine — but currently the much greater problem in the U.S. is its massive undertreatment caused by the radical slashing of state mental health budgets and the monopoly that allows Big Pharma to overprice the medicines.
    (From Allen Frances: Psychiatry and Recovery: Finding Common Ground And Joining Forces)

    He listed the cause of overtreatment.. to be a lack of access to prescription drugs. I’m sure all those muti-billion dollar felony convictions, as of late, for illgeal marketing and fraud, simply never happened.

    I’m not sure how his thought process works, but I’d love to hear him explain how drugs that are too expensive somehow causes overtreatment. I’d also like to know how a lack of access to mental health care somehow results in overtreating.

    I suppose he could try to explain the latter with the idea of overworked psychiatrits having too many patients who can’t go elsewhere, resulting in poor quaility care. However there’s a ‘shortage’ of psychiatrits in general (due to lack of recruitment and increasing patient count), so that argument would apply to the entire profession. That would the majority of care may be poor, or otherwise that it isn’t an important factor.

    Anyway, it’s a failure to address criminal activity (mostly by the industry), off-label prescriptions (which is what maintenance therapy is), or otherwise recognize what the problems actually are (criminal industry influence).

    In the meantime, it nice to see another alterative embraced publically, if not in any real functional way. It wa snice to see an empathetic understanding arrived at by a leading voice in psychiatry.

    September 30, 2013 | 3:29 AM

    I think I should have worded that the problem not addressed was:

    “Overwhelming, systemic curruption of medical knowlege, though rampent criminal Industry Influence. Felony illegal marketing and fraud, kickbacks, and bribes”

    Not that I expect anyone important in psychiatry could say those words without being excommunicated, but the persistent omission is frustrating none the less

    Nick Stuart
    September 30, 2013 | 9:12 AM

    Allen Frances wants to keep a foot in each side of the debate…. trouble is that it is now causing a pain in the groin.

    September 30, 2013 | 12:00 PM

    The “shortage” of psychiatrists is due to disease-mongering by the psychiatry industry. Disease-mongering drives many people who do not have severe psychiatric conditions but whose money (or insurance) is good to seek psychiatric care.

    Every time I see an ad for a psychiatric drug I shudder. These are messages for the mass market, not for the rare severe problem.

    Psychiatrists happily see and “treat” (by throwing prescriptions at) people who do not merit the DSM diagnoses applied to them, often quite cynically, by the doctor. If the diagnosis didn’t justify the treatment, the doctor wouldn’t get paid.

    Poor quality of treatment is a matter of personal choice by the clinician.

    September 30, 2013 | 12:57 PM


    “Psychiatry is a mess! A MESS!!! I am a practicing clinical psychiatrist. I’ve been seeing patients for 26 years. And while I enjoyed the work at first, and had respect for my chosen profession, I now find myself feeling ashamed to be a part of what I believe has turned into a money-hungry scam, foisted on an unsuspecting and vulnerable consumer public. Harsh words? Yes. Deserved? You bet.”

    Reviews of Psychiatryland

    Phillip Sinaikin, M.D., ‘Psychiatryland’ Author, Explains How Psychiatry is Broken

    Dr. Sinaikin exposes another dirty, evil trick here in that drug/alcohol addictions would no longer be covered by insurance if they didn’t have an additional Axis I stigma paving the way for zillions more bogus, life destroying degrading defamations of all the more suffering people by inflicting the fraudulent, but very lucrative bipolar farce on them for bipolar I to VI with this ever expanding “disease” thanks to the likes of Nassir Ghaemi and Fred Goodwin making a killing off this scam. Dr. Jill Littrell has also exposed this evil farce of falsely accusing those with alcohol and drug problems of being bipolar to continue to expand this despicable fraud exponentially to babies and toddlers no less resulting in the death of Rebecca Riley so well exposed in the media along with her indirect killer, Biederman.

    Though Dr. Sinaikin recommends alternatives like 12 step groups and many warnings to consumers to avoid this fraud, he admits he and other miserable psychiatrists sucked into this abyss must diagnose and prescribe or they won’t be able to work. So, as in a vast number of other cases in our modern world a growing number of people feel forced to earn their living by preying on others, robbing them and destroying their reputations, livelihoods and lives for their own perceived status and survival of the so called fittest in our increasingly cruel Darwinian world or jungle mentality.

    Again, Allen Frances and his cohorts like Robert Spitzer, the APA and corrupt government hacks in the NIH and NIMH, FDA, Congress and others contributed greatly to this horror show.

    It’s very sad now that computers and other machines are being recommended to replace psychiatrists/mental health, but if you check out the article about how the NYT biopsychiatry poster child in New York is maintaining his lucrative income by acting like an inhumane vending machine and treating his so called patients like robots with no feelings either by “playing the game” with stigmas he doles out in 45 minutes he admits, I can see how such so called “mental health” experts seem very dispensable in that other machines can dispense the same bogus stigmas and lethal drugs they do.

    It seems to be the majority of the mental health profession should be revolting greatly against this so called “standard of care” as some have been doing already with the junk science DSM and other betrayals and retire the likes of Allen Frances and Robert Spitzer who did enough harm to humanity to compete with Hitler and his Nazi Doctors with their predatory, bogus eugenics agenda.

    Since the biopsychiatry poison drug agenda has been forced on one and all backed by billions from Big Pharma and through the courts in gross violation of civil liberties, it is little wonder that the Hearing Voices Movement feels pressured to give this vile paradigm lip service while others have been brain washed that these toxic drugs help them when the truth is they damage their brain and other body organs and mostly make their original problems much, much worse and destroy their lives if they don’t catch on and escape in time.

    Since those trying to change the system by exposing the evil of the current biopsychiatry paradigm are against the assault on people’s rights in what Szasz rightly called “the therapeutic state,” those in the recovery movement don’t try to dictate to others as to whether they should take drugs or not. But, the truth and enlightening information can help such victims to save their lives before it’s too late. The truth can set you free and safe your life at the same time!

    September 30, 2013 | 3:29 PM

    There is Scientology and there are the well-justified critics of psychiatry. If you want to use the term “anti-psychiatry,” be specific — otherwise, it is a straw person.

    September 30, 2013 | 4:49 PM

    The Myth of the Antipsychotic or The Myth of the Chemical Cure

    September 30, 2013 | 5:03 PM

    Frankly, I don’t get why someone of this blog author’s experience and intent with the blog puts up with some of the rhetoric by the usual commenters who really do just vilify EVERYBODY who is associated with psychiatry and has positive comments about the profession. And then such opposition expresses this alleged outrage we who are slimed by the anonymous and entrenched dissenters have the audacity to use the term “antipsychiatry”.

    While Wikipedia is not the sole authority to definitions and reliable history, let’s link it and examine what is written:

    This near the end I think is a fair statement: “Many claims of anti-psychiatry are historical exaggerations based on events and primitive conditions from a century ago. However, although irritating and often unfair, Henry Nasrallah says “antipsychiatry helps keep us honest and rigorous about what we do, motivating us to relentlessly seek better diagnostic models and treatment paradigms. Psychiatry is far more scientific today than it was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past. The best antidote for antipsychiatry allegations is a combination of personal integrity, scientific progress, and sound evidence-based clinical care”.”

    But, to all who are unbiased and objective, read the entire link and also perhaps go to this one as well, well titled I would say:

    Not everyone who criticizes psychiatric interventions are antipsychiatry, and I would hope that not all psychiatrists are inappropriate and irresponsible.

    But, there are people here who think that honesty and candor is situational and convenient.

    Again, if every psychiatrist is bad based on the behaviors of a minority, then so is every cop. You can’t have it both ways in the way some write.

    It is what it is, when you look the other way when one who espouses views you agree with, but does it with vitriol and all encompassing of the target, and you say nothing to distance from it, well, silence is interpreted as condoning.

    And, I can only think of one person I have personally called antipsychiatrist in my writings here at least. So if you are reacting negatively to my general comment about antipsychiatry, hmm, what is that nerve innervating?

    Disagree, that is the spice of life. You as invested and concerned citizens and voters should be profoundly disappointed by the way you are NOT represented by our Congress this past week plus! And that is not a partisan comment, it is an indictment of the dysfunction by entrenched, incompetent, and uncaring incumbent politicians. They are as a collective, again not every single one of them, but most, are anti-public! How is that for a condemnation?! But, not the direct issue with this post.

    September 30, 2013 | 6:59 PM

    Joel Hassman,

    I think perhaps a lot of people don’t realize the effect Illegal Marketing campaigns actually have on prescribing practices.

    Although illegal marketing and fraud lawsuits make headlines when they are filed, they have little or no effect on rising prescriptions until after they are settled. So it’s tough to see physician activity that is borderline ‘illegal’ continuing seemily wifffully in mass, but in reality most practicing physicians aren’t aware the lawsuit is happening until it’s been sellted. Only then do they realize they were mislead (lied to) by the manufacturer of a given drug soley to increase sales.

    “False Claims Act prosecution did not deter off-label drug use in the case of neurontin.”

    Once medical knowlege is corrupted by illegal marketing, it’s hard to fix that. Although prescriptions sales do begin to lower on a conviction. The problem is part ignorace, and part a problem with regulation. Doctors really don’t have time to go though all this stuff, and the significance of the risk they take (both to themselves and their patient) by making off-label prescriptions usually goes over their head.

    For personal reference,
    “Ten Common Questions (and Their Answers) About Off-label Drug Use”

    When these huge unreleting illegal marketing campaigns ultimently wind millions of children on drugs, and thousand of involuntarily hosptalized patients on ‘forced’ off label ‘experiments’ (like maintenance therapy) it may become pretty difficult for many people to seperate cruel acts and abuse of power from corrupted medical knowlege.

    At least that was my shot in the dark at it.. I do admit i profess some ‘antipsychiatry’ views myself, but i think the word is dumb and I wouldn’t use it personally. A lot of people really are very sick, and we don’t know what’s wrong with them yet. We’re just arguing about the approach I guess. It’s sad how hostile that gets. Misdirected reaction to criminal activity on both sides seems to drive most of it, so compromise is rare :/

    September 30, 2013 | 7:32 PM

    The above is well appreciated, and fairly true. Thank you for a frank but reasonable rebuttal.

    It comes down to what I have said globally for years now. Take the “F-O-R” out of profit in health care, and watch the nefarious and inappropriate elements that work the system fleeing for more manipulative professions.

    September 30, 2013 | 9:51 PM
    October 1, 2013 | 3:29 PM

    So I am just curious, all this outrage how psychiatry is overtreating people, is there equal outrage with these statistics regarding somatic care?

    “About a quarter of Medicare’s $550 billion annual budget pays for medical treatment in the last year of life, and during that time, one third to one half of Medicare patients spend time in an intensive care unit, where 10 days of futile flailing can cost the US health care system an estimated $158 billion to $226 a year.”–from The Last Word column in THE WEEK magazine, an excerpt from Katy Butler’s book “Knocking on Heaven’s Door: The Path to a Better Way of Death”.

    Or, is the outrage simply about psychiatry? Maybe these are stats that aren’t being discussed openly during all this debate about PPACA because, well, people will get a crash course in dealing with death by our government?

    But just beware, if you let the Ronald Pies’s of the world have their way, all this grief from deaths that should be more natural will be labeled Depression instead. And then everyone can be medicated.

    Tied it in all very well, eh?

    October 1, 2013 | 3:59 PM

    That wikipedia article describes pretty well why “anti-psychiatry” is a straw person. The term is a misrepresentation. Some criticisms are unreasonable and some are right on; some are driven by ideology and some are driven by alarm at the true state of the profession.

    Lumping them all together under a perjorative distracts from the validity of a criticism, which is what a fallacious straw man argument is supposed to do.

    Having suffered from bad press (mostly associated with Scientology) “anti-psychiatry” is now what “feminism” was a few years back — a derision for dismissing critics. As such, it is meaningless, since it paints with a broad brush such a wide range of expertise and opinion.

    Every time “anti-psychiatry” is mentioned, the discussion devolves to an always pointless debate of what exactly it means. This is never resolved because it’s a rhetorical device. It has history but no true current meaning.

    October 1, 2013 | 9:14 PM

    So what do you call a collection of people who fervently reject a group or philosophy that is relatively accepted by the society such group or belief is active? Non believers, eh?

    I guess if one like me is fairly pro-psychiatry, then my opposites are con-psychiatry? Oh, what about that other link noted in my prior comment?

    October 1, 2013 | 10:29 PM

    Well, actually antipsychiatry has grown in strength and size as of lately. The movement is more diverse and at least slightly larger then it has ever been.

    I don’t know if you saw, but mind freedom redesigned somewhat their website to appeal to a larger audience. While not technically an antipsychiatry group, they are allied with many, and are the largest of all the groups.

    Antipsychiatry groups like the CCHR have been at least somewhat effective in getting some legislation changed, passed, or repealed.

    Other then that, antipsychiatry had little effect on psychiatry’s practices, industry influence, or conflict of interest.

    Although there are some legitimate reasons to profess the view that psychiatry be abolished as a medical specialty, it can’t be. There are too many very sick people who end up in asylums because they have an unknown illness. No medical field other then psychiatry would be associated with running mental asylums historically.

    Asylums will always be ‘needed’, as they always have been for hundreds of years before psychiatry existed. Without them, the sick wind up in jail or homeless and die from exposure early. Treatment of untreatable patients inside was always poor, and will remain a problem for any profession that tries to take them over. Neurology tried this in the 1880s, and promptly chickened out by fear of association with poor patient care.

    In the end, it’s extensive illegal activity that causes so much frustration. Psychiatry is racked in an atomosphere of conflict of interest in leadership, industry ghost writing, ‘medicare fraud’ convictions, illegal marketing campaigns, widespread kickbacks & bribes, and the controversal legal status of mental asylums (involuntary hosptialization and treatment). These problems have all been inreasing, and the profession has been vastly expanding, mostly outside hosptials.

    It’s questionable if psychiatry will change to reflect the domanent view of science outside the profession, or if it will simply collapse trying due the sheer degree of industry influence. The DSM5 was a warning sign. Either way, it’s the end of an era. Time may be running out to address this.

    However, antipsychiatry doesn’t work for a simple reason: If you wish to burn a bridge, you need to build a boat first.

    There must be a replacement medical field for the sick who are persistently psychotic or otherwise, and as of yet untreatable.

    Again, personal conjecture, but that’s how i saw it.

    October 2, 2013 | 12:36 AM

    An Interview with Pat Bracken, MD, Ph.D. on Post-Modern Psychiatry and the Social Context of Trauma
    David Van Nuys, Ph.D.

    Dr. Nardo published and praised this article along with Dr. Sandra Steingard:

    Dr. Pat Bracken et al, Psychiatry Beyond the Current Paradigm, British Journal of Psychiatry

    Critical Psychiatry Network

    If psychiatry is serious about protecting society, they should start focusing on the most dangerous people in society, psychopaths/sociopaths/malignant narcissists rather than scapegoating and destroying their many victims who have suffered much harm, trauma and loss at work, home, schools and the community at large:

    Web site of Dr. Robert Hare, Psychologist, and world authority on psychopaths:

    Aftermath: Surviving Psychopathy Foundation

    Dr. Robert Hare, Psychologist, creator of the PCL-R test for psychopathy used throughout the profession world wide recommends “Aftermath” above, a website with resources he helped create to help the many victims/survivors of psychopaths.

    Dr. Jeffrey Schwartz, Psychiatrist, famous author of Brain-Lock, You Are Not Your Brain and books on neuroplasticity of the brain showing we can change and rewire our own brains without drugs:

    Though I do not necessarily agree that OCD is a genetic disorder, I applaud this natural nondrug approach of rewiring one’s own brain to heal what is called OCD (an anxiety/trauma reaction for the most part like the Monk TV show) and addictions/bad habits.

    Interestingly, like Dr. Bracken, Dr. Schwartz also has a degree in philosophy.

    These are just some examples of what I think are some excellent approaches in the mental health profession instead of the current harmful biobiobio approach with Big Pharma calling the shots.

    Dr. Nardo has posted many items that could be called anti-psychiatry, but his point is that they represent bad psychiatry, corrupt psychiatry, harmful psychiatry and related critique about the vast changes that occurred when psychiatry sold out to Big Pharma in the 1980’s and threw the baby out with the bath water. Many other psychiatrists have also written many critical articles and books about biopsychiatry because they feel their profession has been greatly harmed and degraded by all the drug company and other corruption while harming many “patients/clients” as well.

    Thus, I think using such sweeping terms as “anti-psychiatry” or “scientology/conspiracy nuts” and other derogatory terms to silence critics with very helpful critiques to save the profession from itself including disgruntled survivors welcomed by Dr. Bracken is self defeating and harmful to all. It also guarantees “business as usual” that is truly not working for the most part as many within and outside the profession admit.

    October 2, 2013 | 1:35 AM

    I hope in the end things work themselves out somehow. I want to see what Allen Frances did happen with the rest of the leadership and their critics.

    There is nothing more powerful then compromise.

    October 2, 2013 | 7:17 AM

    “If psychiatry is serious about protecting society, they should start focusing on the most dangerous people in society, psychopaths/sociopaths/malignant narcissists rather than scapegoating and destroying their many victims who have suffered much harm, trauma and loss at work, home, schools and the community at large”

    Um, no, that is why we have prisons and graveyards. What next, you want ER docs to work in morgues? Antisocial personality disorder without interest in change is akin to treating a corpse.

    Nice try, though.

    October 2, 2013 | 1:25 PM

    Dr. Robert Hare explains the fallacy of confusing so called antisocial personality disorder with psychopathy (AKA sociopathy depending on one’s theory of cause of nature versus nurture). ASD only describes certain criminal behaviors that might be typical of very unsuccessful, low class psychopaths who end up in prison. ASD does not describe the successful ones who ply their trade with psychopathic character traits by destroying lives without having to directly harm their many victims via physical violence.

    It is sad and ironic that the bogus DSM has not recognized the work of Dr. Robert Hare, the world’s foremost authority on psychopaths, who based his own work on the classic work of Dr. Hervey Cleckley, The Mask of Sanity. Cleckley like many other experts warned long ago about the dangers psychopaths pose to society at large to no avail if one considers the recent fiascos like the Wall Street Meltdown, Enron and other social predations caused by the so called successful psychopaths that Hare calls sub-criminal or white collar psychopaths in his book, Without Conscience.

    As Dr. Hare and Dr. Babiak, both experts on so called white collar or sub-criminal psychopaths make clear, most psychopaths are not physically violent, but use their evil character traits of superficial charm, excess charisma, lack of conscience and remorse, superior ability to lie and manipulate with impunity and many others to betray and destroy people’s psychological and physical health, reputations, careers, families and many other areas of their lives while even driving them to suicide. Think Bernie Madoff and the many lives and organizations he destroyed. Dr. Hare and Dr. Babiak co-authored the book, Snakes in Suits: When Psychopaths Go to Work, about the mayhem these literal deadly snakes cause to those unfortunate enough to cross their path.

    Unlike the many who erroneously believe the psychopath is a serial killer like Hannibal Lector or Ted Bundy, Dr. Hare and Dr. Babiak expose this myth and fallacy by exposing that most psychopaths are not only not physically violent, but ply their trade as our coworkers, spouses, family, friends, doctors, lawyers, teachers, religious leaders and any other area where these chameleon like predators can hide in plain sight. This scary idea of which all too many remain unaware thanks to biopsychiatry with more than its share of the character disordered is made clear in Dr. Martha Stout’s great book, The Sociopath Next Door. These human intraspecies predators find it much easier to ply their trade as psychopathic and/or narcissistic traits are increasingly rewarded by what Christopher Lasch called The Narcissistic Culture. Of course, though not all malignant narcissists are psychopaths, all psychopaths are malignant narcissists because that is their main trait per Dr. Hare.

    Dr. M. Scott Peck, Psychiatrist, wrote the great book, The People of the Lie, to attempt to describe evil people and possible remedies for them and their many victims. He, too, describes evil people as all too common who freely mingle among us with their malignant narcissism perpetrated through psychological violence and their many other crimes while appearing to be the most upstanding people in their communities and churches.

    So, the point is not necessarily “treating psychopaths” or evil people unless some real “treatment” can be found when experience shows typical “treatment” makes them worse per Dr. Hare, but to at least protect their many victims they are able to traumatize and destroy with impunity thanks to biopsychiatry and its cohorts refusing to deal with them or expose them. Again, it is very hypocritical of biopsychiatry to claim to protect society from so called mentally ill dangerous people while aiding and abetting the millions of psychopaths and malignant narcissists among us by scapegoating and stigmatizing their many victims with bipolar and other bogus stigmas while denying their horrific reality. For this reason, those like Dr. Hare and Dr. Babiak are greatly admired for their great efforts to expose these predators and help their victims see through them as well. See web site, Love Fraud, approved by Dr. Hare as well. Dr. Babiak works in the corporate area to expose the psychopaths there and not in prisons or graveyards where the antisocial criminals abide.

    October 2, 2013 | 11:19 PM

    Authority without accountability is basically tyranny, perhaps other terms or perspectives, but to bring this thread back to the point of the post at the top, we are looking at the authority of a provider and the authority of the patient who has fully defined her strengths and weaknesses.

    Allen Frances is a guy, by the way I write his writings and perspectives, who is very accountable and realistic. There are comments above in this thread that have just tried to smear him as yet another psychiatrist who just does what he wants and risks the public good. That is wrong to write, sure, those commenters’ opinions, but not backed up by the facts and history with this doctor discussed in the post.

    So, this direction Florence is taking with the last few comments about alleging we should take on entrenched sociopaths and we are ignoring the victims is just inappropriate to take here. I think it is making a veiled reference that Frances is antisocial/sociopathic. And this is an issue I have been writing about at my blog for months, so I think I have some legitimate perspective to write this comment now.

    The issue is NOT black and white, which those who know me understand how I use this comment. And I am done here with this thread.

    I hope you, Dr N, have some interest in commenting about what is going on in Congress of late. I know it is not about clinical trials and historical experiences to relate to treatment now, but, it is about the direction of this society which does drag psychiatry into it, in my opinion.

    Nick Stuart
    October 3, 2013 | 9:32 AM

    Allen Frances/accountability is an oxymoron. I hesitate to post here now given what has happened in a later thread with comments closed. As much as I may disagree with some of what both Joel and Florence say, I do admire the passion of their beliefs. I think I am adult enough and can use the internet sufficiently to pass by those comments which I can choose not to read without recourse to censorship. I hope Dr. N. does not get too disheartened – without his excellent work.. there would be no debate. I thank him.

    October 3, 2013 | 5:52 PM

    I’m sure it’ll be fine, it comes and it goes.

    A lot of people have very strong and passionate opinions. I really don’t mind them, often they have good reasons to feel that way. Myself, I try to a be a realist and figure out why things are the way they are. Often times bad things, or things that never worked, won’t change because there wasn’t an alterative. In the case of psychiatry, part of it was industry sponsored experimenting and corruption of knowledge. People are just people.

    I just have some trouble seeing, so it’s difficult when the quantity or lengh of comments is too big, to be able to sort and read them. I don’t have that much a problem with the content of the posts.

    October 4, 2013 | 11:53 AM

    Obviously Allen Frances has a lot of internal conflicts, not the least his concern about his reputation within psychiatry, but right now he seems very earnestly to be trying to do the right thing.

    Under public scrutiny and with decades of writings, how many of us can show absolute consistency and moral commitment? Not many, I’m sure.

    Our heroes are all deeply flawed. They’re only human, after all.

    Nick Stuart
    October 5, 2013 | 1:43 AM

    Well TinCan.. in a world where kids get killed by chemical weapons (and I am not talking about speed here), it is hard for me to get too offended by those who maybe comment too much on what is, to be honest, a little (although extremely valid) blog. I happen to like a lot of Florence’s links although I believe Hare’s checklist to be pseudoscience – (yet used in UK prisons to determine who is worthy of parole!). I am an adult. I do not need to be protected from anyone. But hey.. ban who you want.

    Nick Stuart
    October 5, 2013 | 1:46 AM

    But anyways.. I do not have the answers. I am still working hard on the right questions.

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