1 Boring Old Man

This bogus theory need to die publicly and loudly.

Dr. Healy’s editorial makes a lot of sense.

HEALY STATES THE OBVIOUS
As a matter of clinical science, these debates about a simple serotonin deficiency in depression ended 45 years ago, when the proposed therapeutic utility of monoamine neurotransmitter precursors was disconfirmed. See PubMed # 4936139. There have been major missteps in the intervening years – for starters, the foolish focus on generic major depression in lieu of clinically differentiated types of depression; the displacement of disinterested clinical science by corporate experimercials; the corruption of key opinion leaders who promoted corporate marketing narratives; and the capture of research funding agencies and regulatory agencies by commercial forces. The discomfort that David Healy’s editorial in BMJ caused reflects a general embarrassment at the emptiness of current research in mood disorders. The yield has not been commensurate with the billions of dollars thrown at the problem – to the point where most corporations have exited the field out of a healthy self-interest. Little wonder, then, that the movers and shakers and wannabes are now throwing the book at Dr. Healy for stating the obvious.

I can list many, many published studies done in the last 15 years premised on some variation of serotonin deficiency causing depression. The principle of “chemical imbalance” was widely endorsed by psychiatry researchers and clinicians.

Doctors are still telling their patients antidepressants correct an underlying “chemical imbalance.” (It’s misinformation I have to deal with daily on my Web site. In fact, I’ve banned extensive discussion of it because it’s so tedious to debunk.) New people often arrive with the belief they’ve been treated for a “serotonin deficiency” or “chemical imbalance.”

Here’s an informational video on the Mayo Clinic site I just found http://www.mayoclinic.org/diseases-conditions/depression/multimedia/antidepressants/vid-20084764 saying, in part, “If you have depression, you may have a serotonin imbalance. Your overall level of serotonin may be low, and some of it may be reabsorbed too soon. As a result, communication between the brain cells is impaired.”

Here’s how WebMD waffles it http://www.webmd.com/depression/features/serotonin “There are many researchers who believe that an imbalance in serotonin levels may influence mood in a way that leads to depression. Possible problems include low brain cell production of serotonin….”

It is trivially easy to find such misinformation on the Web sites of even elite medical institutions, so common is the “chemical imbalance” theory among them. Having preached it for so many years, they simply cannot leave it behind.

That’s the thing about psychiatry…so much of it is subjective that these things can happen when you don’t have measurable parameters as you would in a field like cardiology…where nothing like this could ever happen….

Oh wait…it did happen in cardiology, In fact it happened because doctors were so eager to get measurements. (Mickey probably knows more about this than I because of his background, and Dr. Dawson has brought up this point before as a point of comparison, so hat tip.) Swan Ganz pulmonary catheters were a mainstay of intensive care in the 1970s and 1980s. For the laymen reading this, this is balloon catheter inserted though the right atrium and ventricle, making a sharp upward turn into the pulmonary artery and wedged into a branch and often connected to a thermometer. Obviously inserting one was a big deal and very risky. 40% of ICU patients, usually people with complications of MI or some form of cardiac failure. Learning how to “float a Swan” was a scary rite of passage for internal medicine and critical care residents.

Fortunately as an intern I never got to do one and I was thankful for that. Even when I was a third year medical student, I didn’t get why it was so popular based on risk/benefit. Of course I didn’t say anything to any of the profs, but with other students at lunch I would comment that knowing pressures didn’t really count for a whole hell of a lot if the device didn’t improve outcomes and save lives. The retort was always that data points were important even if you couldn’t explain if it improved outcomes. My response was that the dependent variables are morbidity and mortality not hemodynamic parameters. And that someone should really look at this and see if it makes a goddam bit of difference.

That first study was done in 1985 and repeatedly thereafter and confirmed by Spidey sense was correct. Now it is not used except in rare circumstances and essentially replaced by less invasive transesophageal echo.

The point is that psychiatry is not alone in falling prey to pseudoscientific fads, and that this can also occur in more “scientific” specialties.

http://www.csahq.org/pdf/bulletin/issue_2/orestes_pacath.pdf

P.S. The author is not related to me.

I agree with the need to publicly retire the simplistic “chemical imbalance” myth. As the reaction to David Healy’s editorial shows, it will not die an easy death despite its obvious mythological status. As Altostrata noted, it remains quite popular even in unexpected places. Here’s an interesting example from my own experience. Our 2008 meta-analysis of antidepressant efficacy in PLOS Medicine (http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045) had this quote in the Editor’s Summary: “Depression is a serious medical illness caused by imbalances in the brain chemicals that regulate mood.”

The sources that Altostrata just cited are to clinical science as nursery rhymes are to Shakespeare’s sonnets. They are corporate pabulum from Mayo Clinic on the one hand and from a commercial bottom feeder in medical journalism on the other hand.

As another clinical science nail in the serotonin deficiency coffin, Frederick Cassidy at Duke demonstrated almost 20 years ago that classically depressed patients who have recovered with ECT don’t relapse when they volunteer for a tryptophan depletion protocol that reduces serotonin production. As a matter of fact, they don’t relapse even when both serotonin and norepinephrine production are reduced simultaneously. Clinical research studies like these, combined with the long-ago failure of treatment trials with monoamine neurotransmitter precursors that I noted above, make the Mayo Clinic cartoon appear, well, cartoonish. There is really no need for the pseudonymous Altostrata to keep flogging this dead horse.

What sometimes befuddles me about this comment section is that when members of the profession write critically of our problems, it is considered serious discourse but when non-psychiatrists add information and join in, it is often considered anti-psychiatry or some sort of distraction.
I look forward to reading more from 1BOM but I think everyone here is saying the same thing – there is no support for the simplistic “chemical imbalance” and yet it lives on. That “corporate pablum” from Mayo clinic is targeted to their customers (aka patients). I understand why those who believed these messages and took the drugs, only to find out later that this information was more of a commercial than scientific evidence and that long term consequences were minimized or not even discussed (or worse yet, poorly understood), get angry and stay angry.
I fairly recently had the experience of sitting in my office with a patient, family member and his psychologist. For many reasons, I was less than eager to prescribe an SSRI. The psychologist brought in beautiful, colorful print outs from McGill University’s website that demonstrated the abnormal serotonin levels in the brains of people who were depressed to educate me on the serotonin hypothesis of depression. He wanted to make sure I knew about this important scientific knowledge. From McGill! How could a lowly community psychiatrist question that source of knowledge?

and yet, is it going to be debated that studies have shown there were low levels of serotonin in cerebrospinal fluid of successfully suicide patients?

it is not just about chemical imbalance, but, there is biology as well in mental disorders at times.

And to reply briefly to Dr steingard above, the problem with non clinician commenters here is that if you ask them to give a mission statement, most of them want the abolition of Psychiatry. So I guess you are supporting people who want to put you out of business?

Sounds a bit dicey to me…

Dr. Hassman,
I would agree that the strict definition of anti-psychiatry characterizes it as an abolitionist movement. However, there are many who consider themselves reformers (me among them) rather than abolitionists. So I think it is an error to lump all who are critical in with the abolitionists. As I have delved into this in recent years, I realize that there are many opinions and varied suggestions for reform. This is not unlike those of us in the profession who are critical but do not share entirely overlapping perspectives on either the exact nature of the problem or recommended suggestions for change.

the problem with non clinician commenters here is that if you ask them to give a mission statement, most of them want the abolition of Psychiatry.

JM, MD: I’m not a psychiatrist, and I have absolutely no interest in abolishing psychiatry. Please don’t paint with such a broad brush.

I don’t think that either Sandra or Allostrata were arguing that serious scientists were advancing the serotonin deficiency hypothethis of depression.

It’s well known, however, that it takes several years (around 10) for new research to trickle down to actual practice in community settings. Their point, I believe, is that despite its having been debunked, the marketing of the theory has been very successful.

Dr. Carroll criticizes those links as experimercials. I suspect that Allostrata would agree with him. There are probably still a lot of doctors on the ground promoting those explanations.

I know as a fact that more than one intelligent, caring psychiatrists that are very well respected and experienced in their field, explained the chemical imbalance theory to family members as an explanation for a mood disorder as late as a year ago.

As a consumer I had always assumed that statements from centers like the Mayo Clinic would have been informed by professionals in the field but it sounds like that is not the case?

In my profession misinformation is considered very upsetting and there are measures that our professional organization takes to try and correct myths and misunderstandings, but I have no doubt that the correct information takes a long time to filter down. Does anyone know if the professional organization of psychiatrists has taken active measures to dispel this myth via literature or public statements?

Let’s be careful to separate two issues. It is true that depression is not a disorder of serotonin deficiency. Neither are migraines. But serotonin agonists (triptans) do work for migraines. Pneumococcal pneumonia is not caused by a deficiency of penicillin and lupus is not caused by a deficiency in corticosteroids.

I bring this up because it would be easy for some lay readers to then jump to the facile conclusion that antidepressants don’t work.

I agree that Mayo Clinic beclowned themselves with that video.

My mistake, I should not have written “most” and not clarified it with a specific percentage. That said, a good portion of what I’ve read here and at other more populated mental health blog sites show that at least 50% of the commenters who are antipsychiatry friendly relate zero tolerance for Psychiatry in any form.

so, I regret using the word “most”, but I feel safe to say more often than not commenters here are not negotiable, they just want to find clever or insidious ways to chip away at the fabric of our profession until they can find ways to watch it fall down.

And, I challenge most readers, when have any of the anti Psychiatry commenters offer alternatives for care.? That to me speaks volumes about their agends and it is not about helping people, is just about a mission.

I feel the comment reflects the point of the post above, I defer to Mickey to decide whether or not to allow the comment to stay as presented,

Sincerely,
Joel Hassman MD

I think there are antipsychiatry commenters on this board (see Germanwings thread), but I do not think the identified MD/DOs on this board fit that category.

The medical editor of the Mental health articles of the Mayo Clinic site is Dr. Daniel Hall-Flavin http://www.mayoclinic.org/expert-biographies/daniel-k-hall-flavin-m-d/bio-20025098, active clinician and oft-time university faculty.

Over the years, I’ve written several times to Dr. Hall-Flavin and mayoclinic.org about “chemical imbalance” errors on the site. One on Aug. 14, 2011 contains 23 links with specific errors described and requests for correction. It’s not my fault psychiatry keeps embarrassing itself.

Perhaps if any of you know Dr. Hall-Flavin, you might let him know his psychiatry content needs a long-overdue overhaul.

Sally wrote, “As a consumer I had always assumed that statements from centers like the Mayo Clinic would have been informed by professionals in the field but it sounds like that is not the case?” Actually, I suspect it is the case. I doubt any mental health professional who has worked in the Mayo Clinic Department of Psychiatry and Psychology would be surprised to see the chemical imbalance explanation of depression featured on mayoclinic.org. The Mayo Clinic psychiatrists I worked with were fond of the chemical imbalance explanation and frequently used it with their patients. I witnessed one veteran psychiatrist explain to my patient, during a group meeting, that he was particularly skilled at choosing the antidepressant that best targets each patient’s unique chemical imbalance.

That the chemical imbalance explanation is a myth has been established for decades. Scientifically speaking, the mythical status of this explanation is old news. Ethically speaking, the idea that it is problematic to disseminate a known myth to patients and the public, especially one that is potentially harmful, is also old news. Yet the chemical imbalance story seems alive and well, and is still being promoted in high-profile places (like McGill University, courtesy of Sandra).

Arguably, the chemical imbalance story has always been a “dead horse” from a scientific perspective. But this horse has long thrived in the realm of clinical practice, drug marketing, and public education, and it continues to do so today it would seem. I think this is important and deserves lengthy and searching critical analysis. This analysis is likely to be particularly uncomfortable for well-informed psychiatrists for obvious reasons, and unfortunately I agree with Sandra’s observation that contributions of non-psychiatrists to this discussion are often too easily dismissed. I would add that psychiatrists often seem too quick in my view to sweep this discussion under the rug, Ronald Pies being the poster boy for this position. The result I fear will be another missed opportunity to learn from mistakes of the past lest they be repeated. In this case, we’re still working on acknowledgement of the mistake (at least in any kind of clear official pronouncement, for example, that would put this matter to rest), and the problem continues to be repeated.

2010 American Journal of Psychiatry paper on the political advantage to psychiatry of “neurobiological understandings of mental illness”:

http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2010.09121743
“A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence

“In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.”

The “neurobiological causes” improved the business of psychiatry but the stigma of a psychiatric diagnosis intensified. The paper notes specific responses to phrasing the cause as “chemical imbalance,” among others.

The paper is uncritical regarding “neurobiological causes”; rather, it is focused on relieving the unanticipated byproduct of increased stigma.

Brett Deacon is certainly correct about the disingenuous responses from the pearl-clutching Victorian company men of the APA. Their defense was that an APA position paper denied the trimonoamine hypothesis. As if any layman (or most psychiatrists) reads that or that this trumps the myriad of promotional sites like Mayo and McGill that kept the myth going. On this point I agree with Dr. Whitaker.

Next big mistake they will have to dial back: childhood bipolar disorder….

The Mayo thing is disappointing…but I remember when they got carried away with cytochromes too.

Most of the people who come to me with diagnoses of everything from major depression to bipolar II to anxiety to PTSD are suffering because something bad is happening to them. Their resources are not up to the demands on them. Eventually this wears them out and they develop symptoms. Kind of like someone who has overworked their back for years and now has all sorts of back pain. The sources of demand are legion, marital distress, struggling children, extended family members who are dysfunctional, obnoxious bosses, intractable EHR’s, financial instability due to lack of job security (through no fault of their own). I am using medications and therapy often to help them cope enough to keep going and meeting the demands on them because they don’t have another option. They can’t leave their job or family. I can’t give the abusive boss, hospital administrator, or spouse thorazine so I prescribe fluoxetine for my patient because at least that numbs their pain while I teach her how to develop internal and external resources to deal with the external stressors.

The chemical imbalance myth is just one version of the myth that the “problem” is within the patient and that myth ignores the socioeconomic contributors and causes of mental distress, which is very convenient for those who want to perpetuate the oppressive status quo.

THANK YOU DR ARPAIA! !!

Now wait for possible attack dogs to appear out of nowhere…

http://www.madinamerica.com/2015/05/when-the-hunger-for-real-knowledge-is-enough-change-will-come/
I recommend this article by Carina Håkansson as one of several constructive efforts by critics of mainstream psychiatry to truly, honestly help suffering people to greater understanding of who they are and how to live in this world.

1BOM and MIA are terrific sites for us who hunger for real knowledge. I only wish all commenters would rise to dr Nardo’s, Robert Whitaker’s and Carina Håkansson’s standard of discourse. Anger and sorrow are natural responses when we find out that our trust was betrayed, that not only willful ignorance, but fraud, lies and crimes are committed by uncaring, selfcentered guilds of professionals. Change will come. The hunger for real knowledge is growing and real knowledge is widely disseminated. The organized denial by the psychiatric guild is continuously being documented and exposed.

Altostrata has come back with erroneous and misleading opinions. Her last comment is remarkable for its narrow tendentiousness. Heaven forfend that John and Jill Q. Public should be more likely to seek treatment from physicians or psychiatrists when a neurobiologic perspective on major depression gains traction. No… that would be good for “the business of psychiatry.” And at the cost of increased stigma, yet!

This is demonizing of a positive and welcome trend through Altostrata’s garbled and unsound exposition of the data. There actually was no significant change in stigma involving depression from 1996 to 2006, while neurobiological attributions of depression and endorsement of antidepressant treatment by physicians and psychiatrists increased significantly (Table 1 of the article). Comparison of Figures 1 and 2 with Figure 3 shows much the same pattern. Notice how wide are the confidence intervals for major depression in Figure 3 – all spanning zero effect by a wide margin. The authors also acknowledged (page 1324) that there was no significant change in any aspect of stigma with respect to a neurobiological conception of major depression between 1996 and 2006 (Table 2). Only one aspect showed even a trend effect – that was the item perceived dangerousness toward self. It was included in the construct of stigma by the sociologist authors, but most physicians and psychiatrists would disagree with that decision. It makes sense that an increased neurobiological perspective on depression will be linked in most people’s minds to an increased perceived risk of suicidal behavior. Anyway, it was not a truly significant effect. For Altostrata to assert airily that “the stigma of a psychiatric diagnosis intensified” because of increasing acceptance of “neurobiological causes” is nothing short of mischievous.

As a retired RN. I can assure you the chemical Imbalance theory was taught to us to explain all mental disorders and is still prevalent today. As a former stressed out nurse I was once prescribed antidepressants. They are effective for short term use, long term use and increasing dosage is where I ran into trouble. I am not anti psychiatrist but I am very critical of the way these drugs are currently being used. I find the intolerance of the Doctor’s in Dr Mickey’s comments very off putting. Your patients know themselves listen to them. Sometimes they just may know more about themselves and how the meds make them feel than you do. Sorry for poor grammar, it is another thing that heavy dosage of antidepressants have taken from me. Thank you Don’t like I don’t care. Sorry Dr Mickey.

Thanks so much Brett Deacon, for adding such an informative and respectful perspective.

This important and knowledgeable and fact based blog is read widely by people all over the world.
It has grown in stature and is now recognised internationally as a good source of information.
I am sure many more people would comment if the Boys Zone desisted.
It is not a good idea to prevent people commenting.
I fear, once again, this comment section is now closed.
Thank you Dr. Mickey, from Scotland.
Thank you Altostrata, whilst I am here.
You have both done such a service for our benefit.

As a forced into retirement whistle blowing RN, I am witnessing the response of my profession (child/adolescent psychiatry) to the [now} widespread publicizing of the corruption that both Robert Whitaker and David Healy have referred to as child abuse,– though as witness to the effects of – juvenile bipolar disorder, to take just one example, from many examples of reification of diagnosis for profit, or market based medicine, I now tend towards stronger, more appropriate language to describe the apathy of psychiatry to this scourge.I will, however refrain from my usual rant here on this site.
Witnessing the effects on the thousands of children I met just during my last 5 years as a nurse in the pedi inpatient unit of a world acclaimed Harvard affiliated children’s hospital, I applaud Robert Whitaker for taking on psychiatry itself in his latest book. I do not think the expectation of significant reform from within the ranks of psychiatrists after 5 years is unreasonable– speaking for myself and my professional/personal experience these past 5 years. Whitaker has been gauging responses, too, over that same period of time. David Healy’s discourse has evolved as well, reflecting the questions I have regarding the integrity of a profession that does not reform itself when confronted with evidence of very compelling reasons to do do.
Child/adolescent psychiatry represents a subspecialty within a medical specialty, but children are the innocents most likely to be severely harmed. Is there still an excuse for this? Or is it time to look closely at the reasons , and even more closely at the profession that seems more concerned with its own survival.

Science Media Center published these reactions to David Healy’s BMJ piece. Reading them is like hold one’s face over a hornet’s nest. You can’t make out what’s going on, and you hope to Jesus they can’t get out.

You’ll see some sherds of serotoninism and chemical-imbalancism in the reactions of some of these experts.

Expert reaction to editorial on serotonin and depression

In an editorial published in The BMJ, the treatment of patients with depression has been discussed with regard to serotonin and pharmaceuticals which attempt to control its levels.

Prof. Sir Simon Wessely, President of the Royal College of Psychiatrists, said:

“That antidepressants are helpful in depression, together with psychological treatments, is established. How they do this is not. Most researchers have long since moved on from the old serotonin model.

“Most important of all, the newer drugs (the SSRIs) are safer if taken in overdose than the older tricyclics.

“People should not change their current medication on the basis of this editorial alone.”

Prof. David Taylor, Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King’s Health Partners, South London and Maudsley NHS Foundation Trust, said:

“Professor Healy makes a forceful but poorly supported argument against something which doesn’t and has never really existed: the idea that SSRIs ‘correct’ an ‘imbalance’ of serotonin in the brain.

“Researchers and psychiatrists alike know that SSRIs are effective in a number of disorders but no one is sure exactly how they work. Their readily demonstrable effect is on serotonin but they have many indirect secondary effects in the brain. Professor Healy also ignores very strong evidence that tryptophan depletion (which reduces serotonin production) reverses the beneficial effects of antidepressants with a variety of modes of action. He fails to mention that SSRIs supplanted earlier tricyclics largely because of their relative safety in overdose, not because of any conspiracy concerning a theory of serotonin’s involvement in depression.”

Dr Paul Keedwell, Consultant Psychiatrist and Specialist in Mood Disorders, said:

“Most psychiatrists are quite happy to admit to patients that they do not know precisely how antidepressants work. Their primary focus is on treating depression effectively and safely. They take into account evidence from trials but also recognise individual differences in response to different medications.

“In the real world of the clinic, SSRIs are undeniably effective in treating individuals with major depression. They have become the first line treatment of choice because they have fewer troublesome side-effects than their predecessors, and are safer in overdose. There is no evidence to suggest that they are less effective than the old tricyclics in general, although this could be true in individual cases.

“Exactly how SSRIs work could only be irrefutably proven by opening up someone’s brain. Even then, methods of observation would be likely to affect what we observe. Animal evidence and tests of blood, urine and spinal fluid of humans strongly suggests that serotonin function is affected in some way by these drugs. However, the profession is well aware of the fact that other systems are likely to be involved.

“Many individuals do not achieve complete remission with the first SSRI that is trialled, but this is also true of other types of antidepressant. We know from the large STAR-D trial that switching to a different type can bring about a successful outcome in many of these cases.

“There remain a significant number of people who are resistant to all existing forms of antidepressant, which is why more research is needed.

“The idea that a ‘serotonin myth’ is somehow restricting such research is simply not true. Ketamine, which is thought to work predominantly through glutamate receptors, had been shown in independent trials to bring about a rapid remission in at least a third of previously treatment-resistant individuals. Other drugs in development work on the interplay between noradrenaline and serotonin, or on novel manipulations of dopamine, melatonin, glutamate and the stress hormone cortisol. Psychiatrists have long known that therapeutic success likely involves a complex interplay between all of these brain chemicals.

“Hence, Healy’s assertion that disturbed serotonin function is not sufficient to completely explain depression is not news. However, his assertion that SSRIs may be less effective than older drugs is not supported by the evidence from clinical trials or the real world of the clinic.

“David Healy has previously claimed that SSRIs cause dependence or provoke suicide. In so doing he has risked deterred individuals with severe depression from getting the help they need and this latest article just adds to this problem. The risk of suicide from untreated depression is much greater than the risk of treating it with antidepressants, and yes, this includes SSRIs.

Dr Clare Stanford, Reader in Experimental Psychopharmacology, UCL, said:

“Prof David Healy’s article treads a path that is well-worn but out of date. He argues that selective serotonin re-uptake inhibitors (SSRI) antidepressants are used because of a pervasive myth that they boost serotonin levels, but this is something of a straw man. He makes the mistake of assuming that antidepressants reverse a functional abnormality in the brain that causes depression. Actually, the theory that low ‘levels’ of serotonin in the brain (whatever that means, functionally) causes depression died many years ago, in spite of the fact that a deficit in the synthesis of serotonin in the brain can trigger relapse of depression in some patients who are in remission: a fact which he also fails to mention.

“By contrast, the monoamine theory of ‘anti-depression’ is alive and kicking. There is plenty of evidence that SSRIs increase communication from neurones that release serotonin, as well as other monoamine transmitters, and that the ensuing downstream changes, such as creation of new neurons (neurogenesis) or modification of gene expression, can ameliorate depression.

“In short, SSRIs probably switch-on anti-depression, rather than switch-off depression (which could explain the rapid efficacy of ketamine).”

“I am sure that most clinicians and scientists will be dismayed that a flawed argument is used to underpin a suggestion that the use of older tricyclic antidepressants, which are so dangerous in overdose, is always preferable to the SSRIs.”

‘Serotonin and depression: The marketing of a myth’ by Healy published in The BMJ on Tuesday 21st April.

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/?s=SSRI&cat

Declared interests

Prof. Simon Wessely: None declared

Prof. David Taylor: I am employed by the NHS, King’s College London, Mental Health Research Network, Department for Transport and Driver and Vehicle Licensing Agency (DVLA). I am an Advisory Board member for Lundbeck, Servier and Sunovion. I receive research funding from Bristol-Myers Squibb, Janssen and Lundbeck. I have given lectures for Janssen, Otsuka, Servier and Lundbeck. Of these companies, Lundbeck market several SSRIs and Servier market an antidepressant with a different mode of action.

Dr Paul Keedwell: None to declare

Dr Clare Stanford: Fellow of the British Pharmacological Society and Past President of the British Association for Psychopharmacology

http://www.sciencemediacentre.org/expert-reaction-to-editorial-on-serotonin-and-depression/

Stigma is not the same as sleeping in the bed one makes. People will always judge behavior, sometimes wisely sometimes erroneously. I don’t think it’s really a good idea for society to cease stigma against a disorder such as sexual sadism . I do think it’s a good idea for society to stop stigmatizing depression and it pretty much has.

I find it interesting that the most vociferous anti-stigma advocates in the APA KOLCHO crowd and the antipsychiatry crowd are extremely PC, which is essentially all about stigmatizing people who have different opinions.

I’d just like to see some action– on the front lines, in clinical practice with youth – especially, that there is strong evidence to pause and rethink– re-evaluate, re-assess the diagnosing and drugging of innocents–. My anti-psychiatry position evolved from in-action in the context of status based intellectual posturing and more labeling, stigmatizing –. Enough was enough – long before I decided to view the profession of psychiatry as the one and only perpetrator of this particular child abuse– . Anyone familiar with how accountability and responsibility is determined and assigned in the charge of child neglect/abuse, will put the pieces together without input from mine– or anyone’s personal feelings. The more real and precise we get– based on factual, scientific evidence– the harder it is to construct obfuscating rhetorical arguments.

Sorry– my last sentence above is clumsy and vague, and incorrect. Frustration sets in. Actually, the label anti-psychiatry is, itself frustrating. I am protesting lack of professional accountability from a profession– and maybe that means that in the absence of that accountability, the profession should cease to be recognized? Again, to me– common sense based on 40 years believing in the integrity and duty of medical professionals-. The louder protests, I think, just reflect the degree to which harm continues for lack of acknowledgement of *common sense*.

You may note that Lieberman sings a song harmonizing with Pescosolido, 2010 (the paper I referred to above). He has never addressed disinformation resulting from the APA’s alliance with pharma, he maintains the neurobiological model is correct and the problem is reducing stigma.

Thank you, Dr. Arpaia for stating the reality. Unfortunately, it is difficult for patients to find psychiatrists with your perspective.

No need to apologize or walk it back. I think you were accurate in your first post about being antipsychiatry. Thank you for validating my observations. I prefer truth in labeling to obfuscation.

The previous Boyz Zone comment is uncalled for. There are obviously plenty of women here. Secondly, the implication is that a bunch of male doctors are being authoritarian and oppressive, and protecting the establishment. It goes without saying the Mickey is challenging it. Dr. Carroll has criticized the head of NIMH and Dr. Hassman and myself have taken on the KOLCHO lackeys of the APA over at Psychiatric Times far more aggressively than we have called out the posters here. But misstatements and fraudsters need to be called out, regardless of how people want to inject their own transference issues.

Last time I checked this was a critical psychiatry site, not a Tavistock group.

Just like what happened last week in Baltimore, so many contributed to the failures that resulted in destruction and mayhem that now pervades in mental health, and yet, the supposed leaders just want to deflect, deny, and minimize. It is apparent with psychiatry and with antipsychiatry.

Ironic the middle is left with either being overmedicated, or being denied medication. You have to love polarization of debate, it really is the domain of the characterologically impaired!

I chose to cater to truth, standards of care, and accountability. Oh, and common sense, but, even that last point easily gets twisted to partisan agendas so quickly.

Imagine almost half your patients now having to scramble to find a pharmacy reasonably close to their homes. That CVS that was torched and then sabotaged by the thugs who cut the hoses served many people where I work.

But, the alleged greater good being preached by those without common sense, that doesn’t seem to benefit the narrative when real lives are negatively impacted by the damage. Deeds, not words, folks, it really does define us at the end of the day…

I have an will continue to do my best as well, to assist the kids I meet who have been harmed; by psychiatric mistreatment and to prevent more from this fate. There are surely many more points on which we all can become allies ?

I am happy to se the action of leaders (Ms. Mosby and Ms. Rawling-Blake) in Baltimore– despite all the obstacles they [already knew] knew had to be hurdled- criminal charges were filed on an investigation that was initiated well ahead of
the status quo process the community knew well. This can serve as an example of what is possible– and indeed is necessary for leaders to consider– those who want to prevent harm, that is. Food for thought…

To quote Dennis Prager, I prefer clarity to agreement.

Since we’re into stating our positions clearly I wonder if you have any affiliation with CCHR?

What does the trimonoamine theory have to do with Baltimore?

Per Dr O’Brien’s last comment, I don’t recognize the CCHR term, but I mention what goes on in Baltimore to this thread because my concern, or clarity, is that if the debators here are so concerned with the well being of the public as patients, then do the polar opposites risk abandoning them by not providing the public the full access to standards of care?

I get that patients hopefully won’t riot or take to the streets in mass protests (or could they, that would be quite a response), but, we debate here how psychiatry has basically abandoned standards and adovcacy for the public, and then the rebuttals by dissenters seems to do the same, so what do readers who are seeking answers or directions turn to from here?

I would hazard to guess that someone in a moment of brutal candor might try to spin the burning of CVS as a benefit to the public. I hope that opinion is wrong, but, I would not be surprised if a dissenter of health care would risk such a moment of transparency.

To bring it back to the post, my instinct is that Dr Nardo writes about where psychiatry has gone astray and then introduces Whitaker narrative to help us seek the middle ground, or, something else? Only he, Dr N, can clarify that question. I believe it is foolish to just genuflect to the Big Pharma gods, as well as avoid embracing antithesis gospel that all of a profession is a failure.

Otherwise, could we end up with a proverbial riot at the thread, until the proverbial national guard shuts it down??? The beauty of perceived analogies…

I bring up Whitaker because he’s there.

I was directly my comment to her, CCHR is the Citizens Commission on Human Rights, part of the Church of Scientology. Some of her earlier statement sounds like their rhetoric.

I got your Baltimore point, but not hers.

I’m not going to go along with the noble lie argument. Lies always come back to haunt. Also, those who believe in the noble lie ethos tend to make a habit of lying way too often.

It would have all been simpler and more honest to just say that while the TMA hypothesis is incorrect, drugs that affect these systems can help people and leave it at that. The triptan KOLs by the way DID promote a low serotonin theory of migraine that has never really been proven. So psychiatry isn’t alone.

It was dumb to obsess down that path anyway. How many treatments in medicine involve taking the chemical your body isn’t producing anyway? Addison’s disease and a few others.

I had a few links but cut and paste doesn’t seem to be working today.

To Dr N:

Yeah, Whitaker is there in the debate, but, so is his blog that has quite a hostile, vindictive, and I think a sizeable number, even it if isn’t it 50% it sure ain’t a low 20% either, who talk of abolition that has an eerie Nazi/ISIS-type quality to ridding society of psychiatry. That should bother you as a psychiatrist, even if retired, that giving that type of narrative some validity alienates some of your colleagues I would think you want to ally with a bit. I believe strongly we are defined by who we associate and align ourselves with to a perceptible degree, and some of your posts are concerning to me.

Whitaker has some legitimacy in some of his narrative, but, his lack of discipline in holding his perceived faction accountable, or his frank ignoring of what goes on at his site is not excusable at the end of the day to people who pay attention to repetitive commentary.

I’ll end this comment,that will be my last here at the thread, simply with this: I have been at least somewhat harassed for being Jewish, then being a white male, and now for being a psychiatrist. People can argue back that anyone can be a target for bias and discrimination, but, the pervasiveness I have seen by my demographics makes me tired of it, when people pathetically rationalize or minimize my responses to being harassed and demeaned.

Look at it this way, if at my blog I had people writing on threads how wonderful psychiatry was in it’s current state and how disgusting all who had any antipsychiatry rhetoric were all the time, that would get backlash, and deservedly so. And I would not tolerate that, it would be challenged and eventually discarded. Yes, my blog, my choices at editing and censoring, but, I blog to voice an opinion, but hope it has some value and credibility. And threads impact on that value and credibility, the way I read blogs at least.

By the way, you should have either omitted Edward Dantes’ last comment at an earlier thread that was rude, or allow mine to follow and then close it, but, I take your censoring to be a bit of a slap in the face, my saying to Edward I don’t want to be lectured to is not a heinous reply.

I get it though, your blog.