1 Boring Old Man

Thank you both.

Duane

It sounds all so nice and tidy; almost like a fairytale story….psychiatry becomes self aware & owns the of the errors of their ways; leading us to a renewal of the therapeutic arts, carefully rooted in the greater good of our humanity….

The problem unfortunately is that this conjecture is nothing more than a dream like fantasy…for today nothing has substantially changed or does it seem a remote possibility in the near future….

it’s the same pharmaceutical powers that be, pushing and succeeding at marketing a very profitable colossal failure….the same KOL’s sitting atop ivory towers built upon the suffering & carnage of the afflicted; always creating new myths to propagate old crimes…

What I’m not seeing, is the smallest glimmer of light shining through upon this blackness, or a spotlight shimmering reflection to guide us toward a long over do reckoning of truth, accountability, and ultimately reconciliation …

There are a very few fleeting & whispering voices of truth crying out from a carefully contained obscurity, which are muffled out swiftly under the incessant weight of the corporate overseers and governing politically corrupted elite…they undoubtedly still control the orchestra, the drum beat message, and the vast preponderance of messengers….

I have watched, listened, been a voice, and even thrown down a gauntlet or two while being part a movement to help confront this monstrosity driven tragedy on so many levels over the years…Yet little has really changed…the lies, the human toll taken, and the wide spread carnage continues unabated…

This story has no happily ever after endings and/or heroes that ride off into the sunset…anyone that believes otherwise; is being played a court jester fool yet once again…

Kudo’s to all those who speak out & fight on….but let’s never fool ourselves into a false sense of conquest or boast of some glorious transformation…because quite frankly; that is just not the cold hard factual living reality of our time…

“now they need to either face the truth [which would be devastating to the ego] or continue hiding from it [which would be devastating to the soul]”

I see an unending ocean of ego’s in medicine no doubt….(besides a few speaking out on the internet, including some boring old man)…I can’t recall ever seeing a doctor personally that was the least bit concerned with their soul…who do think is going to win out…

Reader’s might like to read the Will Spirit blog for more on the topic from his perspective:

http://willspirit.com/

Mickey, you’re heating up with every new post! It’s fascinating to get a window into your loss of professional innocence with each new post!

Anyway, a response to WillSpirit’s quote that you included in your post, which I find the most fascinating thing of all. It’s longish, but I hope you find the time reading it time will spent:

“”I feel sorry for psychiatrists of my generation. They got duped…”

BINGO. Psychiatrists are still coming to grips with this. In this respect, psychiatrists are behind the curve; patients have already learned long ago that they were duped when they had horrific reactions to these “safe” meds or suffered awful withdrawal syndromes that doctors were clueless about.

And psychiatrists are obviously resisting this revelation more than patients because they have more to lose. After all, psychiatrists’ pride and entire professional outlook is at stake when they realize this. I’ve always said that the Pharma companies (and the KOLs and the elite APA and NIMH clubs) were magnificent bastards, because they, like all genius rulers, gave the masses (here psychiatrists) the ILLUSION that they had power. It’s tyrannical rule 101. Just as the American masses accepted the systemic hollowing out of our economy by a ruling Wall Street and Government elite because they mistook a succession of volatile bubbles as a booming economy, psychiatry accepted the hollowing out of its profession because it mistook the “medical model revolution” as a booming rebirth of its profession.

In both cases, it took an amazingly cynical — and ingenious — understanding of the worst characteristics of human nature to pull this off. In the case of the economy, the powers that be (TPBP from here on) knew that the average human couldn’t say no to free money, so loans and cheap credit increased so as to paper over any gaps in Americans’ dwindling income, as well as serving as an amazingly seductive way of allowing Americans to buy any and every little consumerist goodie they wanted (Ipads! Ipods!) RIGHT NOW, whether they could afford it or not. This was nothing more than mere bread and circus and a way of buying votes, but Americans were as vulnerable to this political theater as any Roman citizen. Meanwhile, sociopathic a**holes on Wall Street made trillions buying and selling Americans’ debt, which is basically what makes up the bulk of this diseased economy. Nothing ever changes; human nature and history isn’t about linear progress. It’s cyclical.

In the case of psychiatry, TPBP (in this case, the pharma companies) probably got wise to the inherent weakness of psychiatry in the early ‘80s. After all, psychiatry was near collapse then, considering the cultural and media fallout of the CUCKOO’S NEST late-‘70s backlash. Psychiatry was desperate for a reason to believe in itself again, to be a LEGITIMATE medical specialty. And who comes along right at that time? Pharma. I constantly play out this hypothetical dialogue between a few Pharma guys, circa 1987, in my head concerning the turning point where psychiatry became indivisible from pharma:

-Bill (Eli Lilly board member): Lar, you won’t believe who I just got off the phone with.
-Larry (Eli Lilly CEO): Who?
-Bill: The President of the APA!
-Larry: What the f*ck is the APA?
-Bill: The American Psychiatric Association.
-Larry: So what?
-Bill: Get this: he says psychiatry is in some crisis right now and it needs to go in a bold new direction and that it needs to be seen as a medical profession.
-Larry: No sh*t! What’s that got to do with us?
-Bill: You know that new drug we’re developing?
-Larry: Prozac? Yeah, what about it?
-Bill: THAT will be our golden ticket. We’re gonna ride these APA guys for all they’re worth. They NEED US, and we’ve got the cure, baby.
-Larry: Damn, you’re right! OK Bill, let’s get marketing in on this. Tell the R&D team to work overtime on this to roll out the Prozac ASAP. By this time next year, I want this stuff in every man, child, and woman’s bloodstream. This is gonna make us billions! The investors are gonna have boners all day over this! You remember that coke you were saving, that sh*t directly from Columbia that all the hardcore dealers hoard and never give to loser street junkies? Well break it out buddy! Let’s hit the town and get us some hookers, we’re gonna make a KILLING off this!

–The scary thing is I don’t think this is too far from the truth. Remember, for business types (and KOLs), patients’ well-being doesn’t even enter into the equation. Never has. Patients are just binary abstractions of 1s and 0s on a balance sheet in a quarterly statement. It was all about grabbing big gobs of cash as fast as possible, and Pharma knew they had a willing ally in the elite psychiatric clubs because elite psychiatry would do ANYTHING to keep the field alive and respectable. It was truly a match made in hell. The patients and the well-meaning psychiatrists like you and others weren’t ever part of their mental calculus. Mickey, you just got lucky because you professionally came of age in the eye of the storm and could thrive professionally largely before the vampire squid of pharma completely wrapped its oily-black tentacles around the profession.

And to this day, elite psychiatry continues to court Pharma with papers on personalized medicine, biomarkers, etc. all in a cynical ploy to woo Pharma back with new possibilities for revenue streams. And psychiatrists like Stephen Stahl are too stupid to see the big picture that Pharma was always in control all along.

Let me explain: the recent conference Stahl held in England (I believe it was England — I can’t remember all the minutia of this stuff!) to discuss the “crisis” psychiatry now faced (re the drying up of the drug pipeline as pharma leaves psychiatry) was never, in my opinion, about the interests of patients. I think it was more about finding a way to win pharma back into the good graces of psychiatry, because what is psychiatry without pharma? Stahl and other psychiatrists don’t realize that their profession has been HOLLOWED OUT by pharma. Think about it: the bedazzling allure of psychopharmacology and the limitless progress promised by it hoodwinked an entire profession into forgetting about the patient and not pursuing a wide variety of therapeutic modalities, including things like Open Dialogue Therapy or Soteria House (the latter of which showed promising early results until the funding was shut down by the NIMH) and instead just believing slavishly in pills. So because of this, we now have psychiatrists who flatly refuse to believe that some patients can recover without meds from extreme mental states like psychosis because these psychiatrists came of age in a medical program that was bought out and EXTRACTED by pharma and KOL pimps. Thusly, patients’ health and chances at recovery are being EXTRACTED to pharma and the KOLs’ pockets just as average hard-working Americans’ real income is being extracted to the top 1%.

And this is key: we’ve allowed it to happen. We’ve done it to ourselves. We very much get the leaders (whether they be political or medical) we deserve.

I really don’t see how psychiatry’s inability to see how they are enslaved by pharma is any different from people who don’t realize they are slaves to a welfare state and think they are smart to suckle off the teat of the state and not have to work. If they knew how much better it feels to be truly self-sufficient and not reliant on anyone but themselves, they’d instantly be disgusted in themselves for allowing themselves to be enslaved by rhetoric and handouts.

-To conclude, I’ll modify a statement I found on one of my favorite economic news sites that spoke about how hopeless the euro was to reflect the situation in psychiatry:
“Removing all the corrupt literature and pharmaceutical drugs, and all the magical thinking of the KOLs and the PR psy-ops of the APA and NIMH, one is forced to realize that the entire profession has been nearly entirely intellectually bankrupt for three decades.”

Your post, and this http://www.psychologytoday.com/blog/mad-in-america/201111/rorschach-test-psych-meds made me think of all the people who’ve been demonised as non-compliant for not following doctor’s orders on their medication regime. Who were ignored when they said that the side effects weren’t worth the benefits – or that there were no benefits at all.

In Australia we’ve had a formal apology to indigenous people for taking away their children – and that’s been followed by apologies to child migrants and children raised in care. (Seehttp://www.theage.com.au/articles/2008/02/12/1202760291188.html and http://forgottenaustralianshistory.gov.au/ )
This has been really important for those affected, and although it’s small in some ways, has had a huge healing impact, and has changed community attitudes. Maybe it’s an Australian thing….we don’t have quite the same litigant culture as the US.
Just wondering what kind of apology could be warranted in the future to people whose lives have been blighted by the kinds of practices you describe. And grateful that while there are lots of people who have been affected in Oz, I don’t think it’s as rampant as the US, and hopefully the work of people like Senator Grassley mean it won’t ever be the same here.
Please keep blogging – what you are doing is really important.

Quick shout out to Stan: YES to everything you said. We must never underestimate how hard and ingeniously the status quo will fight to keep this psychiatric Ponzi going. I myself was just thinking of likening the tricks big psychiatry and big pharma have up their sleeves as an “unending ocean” too. Considering the vastness of the scientific field and the limitless ways one can tweak statistics and studies (and the media!), this could go on forever…

First of all, Mickey, outstanding post and thank you very much. Not that this is completely related, but here goes…I walk my dog in a “historic” cemetery, a peaceful, beautiful place and I often spend time gazing at the grave markers and reading the dates and imagining the human lives represented. I have been drawn for months to six graves….two the “grandparents”, two the “parents” and two the “children”. I was aware one child died at age 14. The second died in her late 20s. She had an additional name so she had married. She passed away in 2004. When I recently walked there, I discovered that dates had been added for both parents. The same date. Ominous. One parent was 85, the other 75. They lost BOTH children, about 15 years apart. Given the wonders of the Internet, I researched it and discovered (no surprise) it was a murder/suicide. The father had called the local police to report two “mercy killings”. When I accessed the comments based on a newspaper article about the tragedy (which failed to mention they had buried two children), one commented mentioned that it was so sad because it was obviously “clinical depression” and they could have benefited from “treatment”. What kind of crock is that? Clinical depression? Treatment? You’ve got to be kidding me. They were done. They had suffered enough. And were only left with a shotgun option. My God, I treat my dogs better.

Outstanding post! As I have been reading your posts on this, I have tout again and again about a book that came out in 2000 – Of Two Minds: The Growing Disorder in American Psychiatry by T.M. Luhrmann. She followed residents as they proceeded through residency and described the divide between mind and brain that they encountered, that most came inclined to mind and left inclined to brain.

Re: Mind versus Brain

IMO (from learning/listening to others), the key to overcoming a serious mental health diagnosis is often possible when a few things take place:

1) Rejection of a psychiatric label (not “denial,” but outright “rejection”). This includes rejection biological psychiatry
2) Individualized search for things that work (whatever those things are for each person).
3) Developing better relationships and healthier lifestyles

I’m not sure that psychotherapy is always the answer either.
Sometimes, it’s finding ways to get centered, to move beyond, to overcome.
This seems to especially be the case for people who have been diagnosed with “bipolar disorder” and “schizophrenia” (whatever those things are… who knows?)

Finding recovery and increased sense of wellness are often more spiritual, calling on the “inner spirit.” Support from one good friend can often go a long, long way….. and IMO, may go further than all the “professions” a person cares to talk with, and all the doctors they care to see.

My two-cents,

Duane

I feel called to remark on Stan’s statement: “I can’t recall ever seeing a doctor personally that was the least bit concerned with their soul.” This sounds either tragic or a bit closed-minded. As I indicated in my initial offering on this site, the atmosphere within psychiatry during the eighties was charged with optimism. It seemed like the drugs would solve, at last, the great psychiatric dilemma. I personally witnessed what looked like dramatic improvements when wildly psychotic patients were started on drugs. Of course, as a medical student I wasn’t able to follow these people over the longterm, so I didn’t see the gradual accumulation of awful side effects. But there was honest excitement about the possibility of returning severely mentally disturbed patients to normal life. Yes, some of the doctors became cynical and ceased caring. But it is simply not the case that none of them felt concern for their patients or cared for their own souls. That’s why I feel sorry for my peers who became psychiatrists back then. Most started out with the best of intentions. Sure, some were complicit in the evils that we now recognize, but many more were just trying to do right by their patients. The fact that psychiatrists of my generation ended up injuring so many people can only eat at the conscience of a great many doctors who were taken in by the drug industry’s deceitful marketing blitz. If they had all been heartless jerks right from the beginning, I’d feel no pity at all.

please forgive the sloppy grammar and typos (above)

duane

With regard to Duane’s comment, I think the rejection of the psychiatric “disease” label is a key to wellness. This doesn’t mean refusing to see that there might be challenges, but it does mean refusing to describe our brains as diseased (see my essay, The Death of Mental Illness. Once we believe our nervous systems to be damaged, we lose faith in our ability to choose right action. We become vulnerable to those who would undermine our sense of autonomy. We get sucked in by a system all-too-ready to profit from our capitulation. It is important for every single person on earth to recognize areas of weakness and delusion. But it is also vital to maintain faith in our conscience and our ability to choose what’s best.

Reading what WillSpirit wrote resonated in me. I went into psychiatry in the early 1990’s for several reasons, two being I wanted to spend time talking with patients and being able to access as many treatment options as able as a mental health care provider, being able to prescribe one option but not the only one. When I learned what was the agenda of managed care by the mid 1990’s, I was incensed not by what insurers wanted, but that so many of my colleagues basically laid down and allowed themselves to be figuratively buried up to their necks. Check out the basic premise of the 1995 APA president election between Harold Eist and Steve Sharfstein, and you’ll see how the writing on the walls were handled then.

Every profession has it’s whores and cowards, but I cannot fathom the pervasiveness to what I have directly witnessed in my travels these past 15 years. For me though, I was not duped, I was sold out by the profession as a whole.

So, what can you do after learning a select expertise that is now so dumbed down that people without an MD degree can do the same thing? Watch Rome burn, just from a distance and save those who want to save themselves.

By the way, I still get looks of confusion/astonishment when I ask eval patients to see a therapist if starting out with a psychiatrist after having a PCP/Fam Doc/other provider than psychiatrist be medicating first. “What, you talkin’ to me, you talkin’ to me?!” If it was simply a biochemical imbalance, why haven’t we cured the ills of the majority of people seeking care? Let’s see any KOL who isn’t shoved into the back pocket of big pharma answer that one!

Dr. Hassman wrote:

“If it was simply a biochemical imbalance, why haven’t we cured the ills of the majority of people seeking care? Let’s see any KOL who isn’t shoved into the back pocket of big pharma answer that one!”

Yes, exacty.

As I always say, if the meds worked the psych wards and institutions would be empty and everyone would be well….

We all know the facts, that antipsychotics may knock out psychosis short term or bring someone down a bit, but there is no long term medication based answer that does not have more risk than benefit in my opinion, which is based on watching this in my own loved one and countless others the last decade.

Dr. Hassman: Just want to give credit where it is due. Your comment was one of the best things I’ve heard from a psychiatrist yet. Scalding and full of hard-won wisdom and self knowledge, and yet at the same time refusing to plunge headfirst into nihilism that such jaundiced wisdom and awareness tempts us to. In these times, often all we have left is our professionalism and integrity.

I honestly think your line quoted below is applicable to a larger and larger swath of Americans of ALL professions. It’s not just psychiatry that’s become mindless. We’ve all lost our minds and forgot about quality, nuance, patience, and the sheer joy of intellectual adventure and integrity in ALL sectors of American life. Sad — and tragic.

“So, what can you do after learning a select expertise that is now so dumbed down that people without an MD degree can do the same thing? Watch Rome burn, just from a distance and save those who want to save themselves”
————-
I’ll end this comment with a quote I read from an excellent article on the Penn State debacle. I think it’s highly appropriate here:

“It is not a failure of our institutions so much as it is a window into what they have become — soulless, profit-driven monsters, Darwinian predators with precious little humanity left in them. Penn State is only the most recent example. Too much of this country is too big to fail.”

I have often thought when the generation of psychiatrists now in their 40s and 50s retires, if they’re honest, they will look back on their careers with tremendous sorrow and regret. But most probably will still employ the same defenses they’re employing now, chiefly denial and grandiosity, amounting to anosognosia.

As for the withdrawal difficulties, they’re actually far worse than indicated above — and I thank you, Dr. Mickey, for focusing on this.

Psychotropic withdrawal syndrome can last for years. It is, of course, consistently misdiagnosed as relapse or emergence of a virulent new mental disorder somewhere in bipolar territory and aggressively medicated with whatever is at hand. Every adverse reaction will be interpreted as needing new medication, as Will Meecham experienced.

This is much to the detriment of the patients, of course, as they deteriorate under the onslaught of drugs. Psychiatry is much too sanguine about the elasticity of the human nervous system, and withdrawal symptoms already indicate injury.

There are many stories like this on my site, http;//survivingantidepressants.org, and I invite all doctors reading this to view them at http://tinyurl.com/3o4k3j5

(I myself have had withdrawal syndrome for 7 years. My withdrawal from Paxil in 2004 was botched by UCSF psychiatry — not a podunk outfit. The FDA warning about withdrawal was added to Paxil inserts in December 2001.)

That medicine is ignorant about the difficulties of withdrawal is not an accident. If the truth were acknowledged, it would have significantly reduced the enormous pharma profits of the last 20 years.

Over and over, psychiatry has categorically defined withdrawal syndrome as mild and lasting a couple of weeks “in all but a small minority,” without ever explaining what happens to the small minority, and just how large that minority is. That information is unpublished.

Shelton et al 2006 http://tinyurl.com/3hngcy7 (et al includes Mauricio Fava, Alan Schatzberg, and Peter Haddad) stated flatly that withdrawal lasts 2 weeks and any symptoms after that were “something else,” although the authors knew then (and millions of patients know now) this is not true. At the time his 2006 paper went to press, Richard Shelton sent me this correspondence: http://tinyurl.com/3rgyfhw

Shelton et al 2006 was a J Clin Psychiatry supplement sponsored by Wyeth, manufacturer of Effexor, one of the prime offenders for severe and prolonged antidepressant withdrawal syndrome (Paxil is the other; it looks like Cymbalta is a comer).

Coincidentally, in the mid-2000s pharma put a lot of money into emphasizing “maintenance”despite patient objections or failure of the medication to work, as Bronwen Elliott mentioned above. The expectation of perpetual medication muffled any further discussion of withdrawal. “Maintenance” was, and continues to be, hugely profitable for the manufacturers of psychiatric drugs.

All of this has bred complacency in medicine about the difficulties of withdrawing from antidepressants and near-complete ignorance about post-acute withdrawal syndrome. The bad news is nowhere near over. There will be more shame for psychiatry to come out about this. I feel sorry, I do, for anyone with a conscience who has gone into psychiatry.

(Excuse me if I have posted some of this before.)

Regarding “I think the rejection of the psychiatric “disease” label is a key to wellness.”
You do realize, you do know that psychiatric patients (serious mental illness) are behaviorally conditioned (AKA brainwashed) in a hospital (not a jail) for a time of about three months.
Only when the “patient” wants/needs to stay in the hospital (that isn’t a jail), is it time for the patient to leave.