1 Boring Old Man

“Some say” is weasel wording added by the Brown Daily Herald editors so they can claim to be fair when faculty friends of Martin Keller complain about this article.

Here’s an example of how conflict of interest causes harm to patients — children, in this case, which is why it gets continual attention:
“The study is continually cited in other papers as evidence of Paxil’s effectiveness, Jureidini said. That a fraudulent paper is still cited “really has to be addressed,” he added.”

It’s not just that this paper is a foundation of sludge for other papers; clinicians become informed by the massive pyramid of truthiness and prescribe accordingly. Hence, the infocrap filters down to actual patients, some have severe adverse reactions and suffer long-term iatrogenic damage and some will succeed in killing themselves under the influence of the drug.

Is this obvious to everyone or are we still talking about an isolated problem of a few rotten apples in psychiatry?

The sheer number of studies so many KOLs have put their name on should have sounded the klaxon that something was very, very wrong in the land of psychiatric drug studies. To ignore physical impossibilities is to play dumb or have a clinically significant difficulty with reality. Why are so many bigwigs in psychiatry and the FDA playing dumb?

wiley, you’re still operating under an antiquated understanding of “integrity.”

Actually, Altostrata, I’m looking for broader interpretations that apply to more than just one field or one issue within it. Psychiatry is a subset of academia and the sciences with which it is so eager to align itself. The lack of funding for the humanities and subsequent deterioration is a broader phenomenon, such that psychiatry isn’t alone in treating the difficult to quantify and more deeply meaningful aspects of humanity as if it were irrelevant.

Money has everything to do with psychiatry and any other academic endeavor and/or profession. Our society does not value scientific and social research that doesn’t have a purpose that makes it amenable to private enterprise. Here’s a quote that I think captures this and phenomenon like this Prozac study not being retracted:

The capitalization of universities and the de facto libertarian model of their development, imposed from above by the state bureaucracy, is something so grotesque that great liberals, above all, the liberal economists and political thinkers— never dreamt of it. It is academic capitalism without freedom and progress. At the same time it is a technocratice simulacrum of the free market, in which competition is fabricated from criteria chosen so tendentiously that certain favoured institutions are guaranteed to win.

~ Leonidas Donskis

difficulty of quantifying and addressing more deeply meaningful aspects of humanity as if they were relevant.

I have a serious noun/verb agreement issue. I kind of wish I were here as “felonious grammar”.

Actually, there are thousands of caring, committed, competent, critical psychiatrists out there. It bothers me when airy, sweeping, unsubstantiated charges are voiced against them.

Dr. Carroll, I would be happy to refer people to caring, committed, competent, critical psychiatrists if I could find them. They seem to be scarce, meanwhile I’ve got evidence in my face every day of something very wrong in clinical psychiatry.

If you know of psychiatrists who can recognize an adverse drug reaction when they see one and who know what “tapering” means, please send me their contact information at survivingads at comcast dot net

In the meantime, see http://survivingantidepressants.org/index.php?/topic/5956-jshect-major-issues-with-wellbutrindeplin-and-klonopin-addiction/ Here’s a guy who’s on 6 psychiatric drugs plus Deplin. None of the 5 psychiatrists he says he’s seen recognized the drug-drug conflicts, they all just added more drugs.

True, that’s a sample of only one patient — but it’s also a survey of 5 psychiatrists.

Dr. Carroll, as a patient who has cycled through numerous psychiatrists for almost 20 years dealing with depression/anxiety issues I wish I would come across one of the doctors you refer to. If I ever get more than 5 minutes, some WebMD level feedback, and a new three month prescription for Prozac then maybe I’ll have a more positive view of these M.D.s.

As it is I rely on the works

Bernard, if you go back and re-read my comments, you’ll see that I often take great care to delineate between the “it” of psychiatry that Dr. Nardo is addressing and individual psychiatrists who are critical and who take their patients, their narratives, and their agency seriously; which Mickey clearly does.

Your reaction makes sense in the context of exceptional individual psychiatrists, while ignoring the experiences of all of the psychiatric patients who are being told that they have an endogenous brain disease that requires psycho-active medication for life and for whom any protest or assertion of contrary experience is labeled as “anosognosia.” The assumption that effects of discontinuing these drugs are a resurgence of “mental illness” and symptoms caused by the drugs have “unmasked” other “co-morbid” diseases such that polypharmacy is required is routine among clinicians. The damage being done by these drugs in undeniable. It’s only by stressing the risks of suicide to the degree that most mental health professionals are neurotic about it that the drive for pre-emptive medication is justified even as it does it’s level best to hide the relationships between suicide and psychoactive drugs. Now the fear of violence among those labeled “mentally ill” is being used to force treatment on a general population that is far from homogenous and in which most are more likely to be the victims of violence than to be violent themselves.

Whenever feeling defensive about people’s criticism of the field of psychiatry, you might want to consider someone who has lost years of their lives to drugs that were more debilitating to them than the condition they sought help for.. Many of us here can honestly say that even taking traumatic experinces into consideration, that psychiatric labels and drugging are the worst things that have happened to us, and exctricating ourselves from those definitions, bleak prognoses, and treatments— though a long and hard slug of swimming upstream— has returned us to ourselves whole. What have you got to lose by listening? A little pride?

Wiley, I am listening all right, and I have little pride in the psychiatric establishment left to lose. With Robert Rubin, I called out the corruption in the KOL class long before it was generally recognized. We forced major changes in disclosure policy for the Nature journals and more generally. Fortunately, my present state of retirement gave me the independence to do that, and I am still doing it – witness my recent exposé of the Gibbons gang of five. I call myself an Equal Opportunity Critic.

At the same time I push back against demonizing of the field. I do know a great many caring, committed, competent, critical psychiatrists who are seriously angry because the corrupt KOLs have tarred everybody. It’s not an issue of personal pride for me… I have been hors de combat clinically speaking for a long time. It is rather an issue of fairness for the silent majority of psychiatrists who lack a platform to counter the damage done by the KOLs and by the spineless leaders of the major psychiatric organizations. In a human enterprise like clinical medicine there will always be bad outcomes, and I am sad that you experienced that. But we don’t demonize all of surgery because some operations predictably are botched or even because mindless fashion and deference to authority trump evidence for a while – as in the former rigid adherence to radical mastectomy, for instance. Just so, we don’t need to demonize all of psychiatry because predictably some patients were mismanaged or their doctors were under the sway of venal KOLs. We need, rather to learn from those incidents.

I appreciate your thoughts and insights, and I wish you well.

I’ve been pretty specific, Bernard, and I think the term”demonization” is silly in this context. Everyone here clearly respects Dr. Nardo and doesn’t demonize him or any other mental health professional that comments here. The field as it is is doing a lot of harm, drugging a lot of people to excess, and over-diagnosing. The people who are being harmed have no reason to consider the feelings of exceptional, individual, critical psychiatrists whenever talking about the reigning paradigm and the harm it’s done to them.

Of course there are exceptions, and many are working to make meaningful changes in the field, but your position is too privileged for you to treat criticism of psychiatry as a personal insult when people who have been hurt by your field are expressing their righteous anger with it and challenging its mythology. This is the same defensiveness that keeps this field’s worst practices intact.

Wiley and Alto, I couldn’t agree more as one who feels that several years of being on psych meds has destroyed my life. Thank you for precisely echoing my feelings.

Dr. Carroll, what meaningful changes is psychiatry making to recognize withdrawal symptoms that currently, in my opinion, they are mostly clueless about. And no, I am not asking the question to demonize a profession but because I think this is a very serious issue.

This discussion is not really about psychiatry, but about medicine in general. Today’s doctors report to an office administrator that may or may not have any medical training. They are burdened with student debt that is often not paid off until after 50 and until that time they are no different than an assembly line worker answering to an uncaring boss.

A comment on another blog highlighted how doctors at a nationally ranked cancer center had to make up time spent at conferences and had yearly increasing revenue goals.

A friend who practices general medicine cannot wait to retire in 18 months so as to do missionary and volunteer work. This will result in a reduction of hours.

Our medical system is broken at all levels. Evidence is pushed aside for revenue generation. Doctors have been maneuvered into health care providers, becoming in effect widgets in their own system.

I and my friends have all had medical encounters that have or would have resulted in serious medical repercussions had we not refused. Fen-phen all around and unwanted PSA test that are only two of the serious problems we have faced. A doctor blocking the door claiming we “owe” the system 90 day visits due to our insurance and disposable income so as to support the practice is common.

Psychiatry is only different in that as a subspecialty it offers pharma and business entities the perfect testing ground for a commercially based medical system where patients are simply there to feed the machine.

Steve Lucas

I want to go on record as a practicing psychiatrist for over 20 years now, I don’t see this percentage Dr Carroll alludes to of thousands of caring and committed psychiatrists that should be at least, what, 50% of us? Having done several locum assignments in the past 4 years, most of the colleagues I have either followed or worked with at these sites that can’t find a permanent doctor to work at reflects not only the dysfunction of these various programs, but, my “colleagues” practice shitty care.

Case in point for the past 2 assignments I have done: doctors writing for controlled substances en masse, giving very select and limiting diagnoses on day 1 of interaction, not promoting psychotherapy as a crucial adjunct if not primary intervention, and practicing polypharmacy as a standard from day 1 as well of treatment.

This does not reflect all those “c” qualities he claims are out there in psychiatrists. It reveals to me sloppy, inattentive, quick acting, and overgeneralizing practice, that leads to ineffective, dismissive, and shallow problem solving that only frustrates or minimizes what patients need and hope for improvement.

Yes, there are good and competent psychiatrists out there, I hope I am seen as one of them, but, I think I am one of the few these days. It only gives ammunition and justification to the antipsychiatry folks who seem to have some legitimacy to their comments at sites like these of late when the garbage is revealed by the authors like Dr Nardo what our moronic and self serving leaders and influence peddlers are doing in selling “drugs for all” mentality.

Maybe Dr Carroll is fortunate and his circle is filled with those competent and caring peers. I don’t see ’em much these days, maybe I am just screwed and stuck in the abyss of hell psychiatry practice where I live.

But, I would hope my interactions in finding colleagues I respect and admire would be larger than random chance! 1 out of 20 won’t add up to thousands of doctors, sorry to say!

I do not see how one can decry the extremely shameful conflict of interest issues in psychiatry and observe in minute detail the widespread poor quality of core psychiatric research (as this blog does) and not conclude this would have a corroding influence on the quality of patient care.

Thus, injury to patients by perhaps well-meaning but poorly informed clinicians. Should we turn a blind eye to poor quality of care because clinicians have been duped? Can’t they see what’s happening to the patients that show up face to face in their offices?

This may be a trend in all of medicine, but poorly informed care is more than a trend in psychiatry: it characterizes clinical practice. Contemporary psychiatry has been almost completely hollowed out by 20 years of corruption. If there was one good doctor among 10 psychiatrists, I would be surprised.

Nobody regrets this more than I do! And I sympathize with those conscientious physicians who cannot bear to see what’s happened to their chosen profession. It must be very difficult. But a good psychiatrist is very, very hard to find, and that’s the truth.

Dr. Hassman, the estimates I have seen place the number of psychiatrists in the US at 25,000 – 30,000. A conservative estimate would be that 20% of them are caring, committed, competent and critical. And that’s a really conservative estimate. Actually, I think the silent majority fit this description. But of course, you cannot nail it down and neither can I. What’s important is that we can agree there is room for improvement.

Alto,
“I do not see how one can decry the extremely shameful conflict of interest issues in psychiatry and observe in minute detail the widespread poor quality of core psychiatric research (as this blog does) and not conclude this would have a corroding influence on the quality of patient care. ”
“Is this obvious to everyone or are we still talking about an isolated problem of a few rotten apples in psychiatry?”

Are these things a response to something I’ve said or written in this blog? If your opinion is that I’m a psychiatry apologist, please say so directly.

Wiley, yes you were demonizing alright, and I called you on it. Your small exception clause for present company doesn’t change your dismissive tone. You also engaged in more than a little kitchen sinking in your recent comments. These tactics do not serve you or your cause well. I suggest also that you would do well to refrain from ad hominem comments like those about my imagined pride and privilege. We can agree that there is room for improvement, as I said to Dr. Hassman, without resorting to overstatement or to incendiary provocations.

What in the world makes you think you know what serves me or “my cause”, Bernard? My cause here, is to address just exactly what Dr. Nardo is addressing. Have you missed that somehow?

Please, copy and paste my “incendiary provocations” and we’ll address those together. As for your privilege, it’s obvious that you’re a psychiatrist and that you’re reacting as if you’re being personally hurt by criticism of your field. Do you actually think that accusing people who have been hurt by the treatment that results from the biological paradigm and its marriage to pharmaceutical companies of attacking you is anything other than your issue, that you should deal with? Most clinicians that most of too many people see care little about them as individuals— they’re diseases to be treated with polypharmacy. You having not had this experience and being unaware of it in your circles, does not change the big picture and what most people in the system have to deal with, especially low income people.

The “how dare you speak to me that way” response is a symptom of your privilege. You treated criticism of your field as if it were senseless “demonization” then defended yourself and other psychiatrists you think to be immune from criticism. If it were all about you, Bernard, it wouldn’t be Dr. Nardo’s blog, would it?

Every psychiatrist defending psychiatry as it is or being defensive about the psychiatrist they and their colleagues think they are is resisting the change that is needed in for psychiatry to stop doing the enormous harm it’s doing. If you don’t think it’s doing harm, then you have a lot of arguing to do here with the host, not the people who comment here.

If you’re so sensitive to criticism— and I don’t see Dr. Nardo making any less criticism of the “it” of psychiatry than other people who comment here (tones vary by personality and experience), when it comes to the specific problems with this field— then why are you here, at a site dedicated to analyzing what is harmful and corrupt about psychiatry? Which, by the way, for me, who has been through the wringer of being diagnosed with a brain disorder (for what was initially an iron deficiency), then given drugs to a treat a reaction to the first drug, then given rotating cocktails which left me truly debilitated for the first time in my life, then given less debilitating cocktails for years for a brain disease I still didn’t have; the truths that Dr. Nardo addresses are the most effective therapy I’ve gotten from a psychiatrist since the late eighties. I appreciate it very much and feel no reason to mince words when addressing the problems of the day in psychiatry. Surprisingly, I found myself defending psychiatry after Dr. Steingard suggested that the field be replaced with neurologists and teams composed of social workers, psychologists, and whatever other professionals could help a person get their footing again so that they could function well enough and not be a danger.

Clearly, a lot of psychiatrists are critical of the field and challenging it in meaningful ways on behalf of their field, the people who need help from it; and the people who need help, but not the diagnoses and drugs being offered to them or being required for them to take. I have the greatest respect for them— they’re up against a great deal of well financed resistance.

Dr Carroll, watch out with Wiley, she dreams of pistol whipping Freud to start her day. Yeah, I’ll never let you live that down, ma’am!

It may be time for everyone to step back and take a breath. These comments reflect the passions of all those involved. Doctors fighting a system that is geared towards minimizing their importance and patients injured by that system share a common ground.

Steve Lucas

I rest my case.

Just another data point: I rarely post here but my reputation as a psychotherapy-first, prescribe-second psychiatrist is well established. Unfortunately, in the past couple weeks two patients of mine with bipolar histories and apparent rock-solid stability have crumbled to the point of acute psychosis and inability to care for themselves outside a hospital. Why? In one case because I carefully tapered and discontinued lithium and replaced it with another mood stabilizer on the chance the lithium MAY have contributed to an unusual side-effect. My patient spent 10 days in the hospital, initially involuntarily, and is now back on lithium but still not well. In the other case I discontinued a small dose of olanzapine many months ago, as the patient hadn’t been psychotic (or manic) in years. Well, she is now — she stopped her mood-stabilizer, isn’t eating, and is likely headed to the hospital tomorrow. My first involuntary hold(s) in well over a decade, maybe two decades. Feels awful for them, their families, and for me.

I relate this to offer some balance. We psychiatrists can err in either direction, and patients suffer either way. Yes, many more err on the side of quick prescribing and polypharmacy, and this surely deserves criticism. But the patients described above remind me not to get too smug or ideological about my own position. Dr. Carroll is right about the thousands of good, caring psychiatrists who balance risks and benefits to patients the best we can, and who don’t deserve roundhouse condemnation whichever side we err on.

I also want to underscore Steve Lucas’ cogent comment that many of psychiatry’s ills are shared by the rest of our broken medical system. Shocking conversations in the blogosphere right now decry the growing inability of primary care doctors to practice competently and ethically in anything other than direct-pay or concierge practices for the wealthy. Other venues have devolved into a demoralizing thankless bureaucratic mess where it’s literally hard to make a living. Fewer and fewer med students choose primary care each year, and patients who aren’t wealthy have an awful time finding a doctor. As in psychiatry, the caring, committed, etc are faced with the dilemma of working within a broken system, or turning their backs on most of the patients who need them. Something’s got to give.

Yeah, something has to give, and it starts with a mass exodus of all those caring compassionate and concerned psychiatrists you all tell us are out there who yet belong to this corrupt and conniving organization of the APA that has sold out the profession, in numerous ways outside psychotropic use alone. CPT coding, the use of the MOC by the Board, as examples up front??

It is about deeds, not words that define people, and a lot of people do a lot of talking and writing at threads, blogs, and in social passing at conferences and other collegial events, but when the day is over, it is status quo for the vast majority of psychiatrists.

I don’t belong to the APA, I refuse to be bullied or harassed by organizations or clinics that sell a drugs only intervention plan, thus why I do Locum work now, and I certainly have no interest to renew my certification come due in 4 years if this is what the profession has deteriorated into as the MO for care.

Think about it for just one minute, if the APA lost 50% more of its members in the next year, what the hell will they do!?

Yes, after been asked by a psychiatrist if I was “in love with my stepfather” who sexually abused me, I had a fantasy of pistol whipping Freud. Context matters.

Joel, there are many kinds of violence far more harmful than violent fantasies and they are not called out as violence— victim blaming, for instance. You may be taking a victory lap with your “ha,” but your simple-mindedness is on display.

Nice try there, Wiley, I have no interest in victory laps, but, Dr Carroll picked up on your harsh, pervasive rhetoric directed to most supporters of mental health care, and I just wanted him to be aware of your over the top attitude that is just blantantly hostile in the pistol whipping comment.

I don’t begrudge you any anger or dissatisfaction with a provider who is ignorant, clueless, or inappropriate, but, keep the image to that provider, without the risk of being seen as homicidal or threatening to said provider. But, more important, when you write something of such a vivid and profoundly violent image, it will risk becoming your association with readers who know what such an idea portrays. Frankly, the real mistake with your comment wasn’t that you made it, but that Dr Nardo did not call you on it at the moment and then request something that parallels some type of retraction or clarification.

Also quite frankly I think you project a lot of your inappropriateness on us clinicians. Simplemindedness is, in my opinion, in fact contemplating a violent assault on a figure outside the direct conflict you were experiencing to think that would gain resolution. Sorry you got burned by a lame provider, but, not every single one of us are evil and unkind, nor the opposite of needing to provide absolute skewing every single moment of psychiatric cluelessness, some of it actually is just honest ignorance and inattentiveness.

You could surprise me and actually consider your pistol whipping comment was intense to some readers. But, that hasn’t happened to now, so would it be sincere to say so now? Frankly, I don’t care what you say or do, I have absolutely no relationship with you apart from being a commenter at this thread from time to time, and make sure I avoid your comments as much as humanely possible. But, this post hit home with me, I made my observation to Dr Carroll, and now also offer my observation to what I consider your agenda when other clinicians/providers comment here.

By the way, trivial, inconsequential, or not, I find it interesting you refer to us by first name, not that you can’t, but, there is an implied attitude by calling a physician by first name in my travels. Perhaps I am antiquated in that opinion, but, I think there is a dig in calling us Bernard and Joel.

Hey, you can refer to me as Joel, I don’t care these days.

But, I do offer to readers to go to the link regarding the post I did after the pistol whipping comment back in late October and watch the video of the scene from “Goodfellas”, you might find it evokes a reaction…

http://cantmedicatelife.com/tag/pistol-whipping-is-not-a-benign-thought/