{"id":64184,"date":"2016-03-25T15:06:48","date_gmt":"2016-03-25T19:06:48","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=64184"},"modified":"2016-03-26T17:53:30","modified_gmt":"2016-03-26T21:53:30","slug":"the-agenda","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/03\/25\/the-agenda\/","title":{"rendered":"the agenda&#8230;"},"content":{"rendered":"<div align=\"justify\" class=\"small\"><img decoding=\"async\" width=\"143\" vspace=\"3\" border=\"0\" hspace=\"4\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/shipping-news.jpg\" \/>In Annie Proulx&#8217;s novel, <em><font color=\"#200020\">The Shipping News<\/font><\/em>, emotionally broken protagonist Quoyle and his young daughter move to his ancestral home in Newfoundland to reclaim his life. He goes to work for the local paper, The Gammy Bird, where reporter Billy tries to show him the ropes:<\/div>\n<ul><span class=\"small\">  <\/p>\n<div align=\"justify\"><strong><font color=\"#200020\">Billy:<\/font><\/strong> It&#8217;s finding the center of your story, the beating heart of it, that&#8217;s  what makes a reporter. You have to start by making up some headlines.  You know: short, punchy, dramatic headlines. Now, have a look, what do  you see? [Points at dark clouds at the horizon]<\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Billy:<\/font><\/strong> Tell me the headline.<\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Quoyle:<\/font><\/strong> Horizon Fills With Dark Clouds?<\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Billy:<\/font><\/strong> Imminent Storm Threatens Village.<\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Quoyle:<\/font><\/strong> But what if no storm comes?<\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Billy:<\/font><\/strong> Village Spared From Deadly Storm.<\/div>\n<p><\/span><\/ul>\n<hr width=\"84%\" size=\"1\" \/>\n<p align=\"justify\" class=\"small\">Those are my favorite lines from a favorite book [and movie]. They come to mind whenever I watch the news in the evening. It&#8217;s a habit I&#8217;ve developed to remind me not to get too caught up in the dramatic rhetoric of journalism. And they came to mind reading this article in Mad in America:<\/p>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2016\/03\/dr-pies-and-dr-frances-make-a-compelling-case-that-their-profession-is-doing-great-harm\/\">Dr. Pies and Dr. Frances Make a Compelling Case that Their Profession is Doing Great Harm<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Mad In America<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Robert Whitaker<\/div>\n<div align=\"center\" class=\"small\">March 17, 2016<\/div>\n<\/blockquote>\n<div class=\"small\">Some lead-in references&#8230;<\/div>\n<ul><sup>              <\/p>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.madinamerica.com\/2015\/05\/psychiatry-through-the-lens-of-institutional-corruption\/\" target=\"_blank\">Psychiatry Through the Lens of Institutional Corruption<\/a> [Whitaker]<\/div>\n<div align=\"justify\">May 7, 2015<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.madinamerica.com\/2015\/12\/timberrr-psychiatrys-evidence-base-for-antipsychotics-comes-crashing-to-the-ground\/\" target=\"_blank\">Timberrr! Psychiatry&rsquo;s Evidence Base For Antipsychotics Comes Crashing to the Ground<\/a> [Whitaker]<\/div>\n<div align=\"justify\">December 29, 2015<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.madinamerica.com\/2016\/01\/me-allen-frances-and-climbing-out-of-a-pigeonhole\/\" target=\"_blank\">Me, Allen Frances, and Climbing Out of a Pigeonhole<\/a> [Whitaker]<\/div>\n<div align=\"justify\">January 27, 2016<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.huffingtonpost.com\/allen-frances\/do-antipsychotics-help-or_b_9131376.html\" target=\"_blank\">Do Antipsychotics Help or Harm Psychotic Symptoms?<\/a> [Frances]<\/div>\n<div align=\"justify\">February 1, 2016<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.huffingtonpost.com\/allen-frances\/setting-the-record-straig_23_b_9243828.html\" target=\"_blank\">Setting the Record Straight on Antipsychotics<\/a> [Frances]<\/div>\n<div align=\"justify\" class=\"small\">February 16, 2016<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.psychiatrictimes.com\/blogs\/couch-crisis\/long-term-antipsychotic-treatment-effective-and-often-necessary-caveats\" target=\"_blank\">Long-term Antipsychotic Treatment: Effective and Often Necessary, with Caveats<\/a> [Pies]<\/div>\n<div align=\"justify\" class=\"small\">February 22, 2016<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.huffingtonpost.com\/allen-frances\/psychiatry-and-antipsychi_b_9243944.html\" target=\"_blank\">Psychiatry And Anti-Psychiatry<\/a> [Frances]<\/div>\n<div align=\"justify\" class=\"small\">February 24, 2016<\/div>\n<\/li>\n<p>    <\/sup><\/ul>\n<div align=\"justify\" class=\"small\">Drs. Pies and Frances had both gone out of their way to clarify areas of agreement in the dialog that lead up to this piece before talking about areas of disagreement. As I&#8217;ve read their comments, their concern is that Robert Whitaker and others at Mad in America are encouraging psychotic patients on medications to discontinue them and in doing so put themselves in harms way from relapse &#8211; promoting something like a&nbsp; morality that being on medications is bad &#8211; being off medications is good. Yet in that headline, we read something quite different &#8211; that Drs. Pies and Frances are themselves [unwittingly] indicting the profession of psychiatry.<\/div>\n<p align=\"justify\" class=\"small\">Robert Whitaker does the same thing most of the bloggers on his site do &#8211; he anthropomorphizes <em><font color=\"#200020\">psychiatry<\/font><\/em> as a unitary entity that is of a single mind. Psychiatry says&#8230; &quot;<em><font color=\"#200020\">one size fits all.<\/font><\/em>&quot; Psychiatry says&#8230; &quot;<em><font color=\"#200020\">medications for life.<\/font><\/em>&quot; Parenthetically, that notion of psychiatric one-mindedness has made my own discussions with people who are MIA followers quite difficult. And that problem continues here. When Drs. Pies and Frances clarify their positions, and they turn out to be fairly close to Whitaker&#8217;s, he sees them as going against this singular <em><font color=\"#200020\">psychiatry<\/font><\/em> he apparently thinks of as making universal recommendations.<\/p>\n<div align=\"justify\" class=\"small\">On the other hand, it&#8217;s not hard to see why he might think that. From Harrow [<a href=\"http:\/\/schizophreniabulletin.oxfordjournals.org\/content\/early\/2013\/03\/19\/schbul.sbt034.full#ref-3\" target=\"_blank\">Does Long-Term Treatment of Schizophrenia With Antipsychotic Medications Facilitate Recovery?<\/a> 2013]:<\/div>\n<blockquote>\n<div align=\"justify\">As a consequence of positive results from numerous  short-term [1&ndash;2 years] studies, prolonged use of antipsychotic  medications                      over a long period has become the current standard  of care in the field. Thus, antipsychotic medications are viewed as the                      cornerstone of treatment, in both the short-term  and the long-term treatments of patients with schizophrenia.<\/div>\n<p align=\"justify\"><strong><font color=\"#990000\">American Psychiatric Association [APA] guidelines  suggest clinicians to consider antipsychotic discontinuation for  schizophrenia patients who have been symptom free for a                      year or more.<\/font><\/strong> Nevertheless, many clinicians keep  schizophrenia patients on antipsychotics indefinitely assuming that the  medication                      is essential for continued stability.<\/p>\n<div align=\"justify\">Antipsychotics are also  viewed by some as leading, over a prolonged period, to eventual recovery  for some patients with schizophrenia.                      A comprehensive review from the World Psychiatric  Association section on Pharmacopsychiatry notes &ldquo;Antipsychotic treatment                      has a significant impact on the long-term course of  schizophrenic illness and can significantly facilitate recovery&#8230;&rdquo;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">The <a target=\"_blank\" href=\"http:\/\/www.psychiatry.org\/File%20Library\/Psychiatrists\/Practice\/Clinical%20Practice%20Guidelines\/schizophrenia.pdf\"><strong><font color=\"#990000\">American Psychiatric Association [APA] guidelines<\/font><\/strong><\/a> do indeed make that recommendation, but it&#8217;s embedded in 100+ pages, a lot of which are about how to encourage &quot;medication compliance.&quot; Like most in private practice, my post-training experience with Schizophrenic patients was limited, and they were &quot;good prognosis&quot; patients. I was inclined towards using medications only for psychotic episodes, but most ended up on some version of maintenance medication by their own request because of disruptive relapses. I think much of my leaning towards no medications, except when required, had to do with fear of tardive dyskinesia. I was not aware of the APA guidelines which are, by the way, listed as outdated, and seven years beyond the update date [and I wouldn&#8217;t personally see the American Psychiatric Association as representing the Institution of Psychiatry for any number of reasons].  <\/div>\n<blockquote>\n<div align=\"justify\"><em>Originally published in February 2004. This guideline is more than 5 years old and has not yet been updated to ensure that it reflects current knowledge and practice. In accordance with national standards, including those of the Agency for Healthcare Research and Quality&rsquo;s National Guideline Clearinghouse, this guideline can no longer be assumed to be current.<\/em><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">But I&#8217;m not writing to enter this specific debate. I&#8217;m writing because of Whitaker&#8217;s final paragraphs:<\/div>\n<blockquote>\n<div align=\"justify\">But, as was seen above, psychiatry&rsquo;s evidence base for  antipsychotics, which states that the drugs are effective over the short  term for curbing psychosis and effective for reducing the risk of  relapse, does not promote such selective-use prescribing, and, indeed,  any survey of 100 people diagnosed with a psychotic disorder in the past  25 years would find&nbsp;that most had been told they needed to take the  drugs for life. Frances and Pies, in their blogs, were seeking to defend  psychiatry&rsquo;s prescribing practices and the long-term effectiveness of  antipsychotics, but the caveat they expressed &mdash; that the drugs are  effective for a certain subset of psychotic patients &mdash; naturally focuses  attention on the drugs&rsquo; effects on those who don&rsquo;t need them long-term,  and that leads to a finding of great harm done.<\/div>\n<p align=\"justify\">And that finding, in turn, supports a demand, based on Frances and  Pies own writings, for a radical rethinking of psychiatry&#8217;s use of  antipsychotics.<\/p>\n<div align=\"justify\"><strong><font color=\"#200020\">In a follow-up blog, I will respond to their review of the &ldquo;evidence&rdquo;  for the long-term effects of antipsychotics. That provides another an  opportunity to watch their minds at work as they sift through the  evidence. What studies do they dismiss? What studies do they embrace?  This is a review that ultimately leads to this question: Do we see, in  their assessment of the scientific literature, evidence of the critical  thinking that we want to see present in a medical specialty that has  such a large impact on our lives? And if not, what shall we do?<\/font><\/strong><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">I&#8217;m writing this because here at the end, even though he sees Dr. Pies and Frances essentially agreeing with him, he&#8217;s questioning their capacity for critical thinking almost implying that they have devious minds. And why is there such a theme of &quot;<font color=\"#200020\">all psychiatrists think &#8230;<\/font>&quot; instead of &quot;<font color=\"#200020\">this psychiatrist thinks &#8230;<\/font>&quot; versus &quot;<font color=\"#200020\">that psychiatrist thinks &#8230;<\/font>&quot;? Why isn&#8217;t the title of the article above, &quot;<font color=\"#200020\">Deep down, Drs. Pies and Frances agree with me after all<\/font>&quot;? It&#8217;s because there&#8217;s a much larger agenda on the table &#8211; clarified in this next blog post, but made much more explicit in his most recent book, <strong><font color=\"#200020\">Psychiatry Under the Influence<\/font><\/strong>. <\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/www.madinamerica.com\/2015\/05\/psychiatry-through-the-lens-of-institutional-corruption\/\" target=\"_blank\">Psychiatry Through the Lens of Institutional Corruption<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Mad in America<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">By Robert Whitaker<\/div>\n<div align=\"center\" class=\"small\">May 7, 2015<\/div>\n<p> <\/p>\n<div align=\"justify\">When you write a book, you usually do so in response to a prompt of  some type, and in the process of researching and writing the book, you  will come to see your subject in a new way. <a href=\"http:\/\/www.madinamerica.com\/product\/psychiatry-under-the-influence\/\" target=\"_blank\">Psychiatry Under the Influence<\/a>,  a book I co-wrote with Lisa Cosgrove, provided that learning  experience, and this is what I now know, with a much greater certainty  than before: Our citizenry must develop a clear and cogent response to a  medical specialty that, over the past 35 years, has displayed an  &ldquo;institutional corruption&rdquo; that has done great injury to our society. In  fact, I think this is one of the great political challenges of our  times&#8230;<\/div>\n<p align=\"justify\">As I noted in the beginning of this post, co-writing this book led me to &ldquo;see&rdquo; this subject of psychiatry and its influence on our society in a new way. It puts the focus on society as the injured party, and it is easy to see that the social injury arising from this corruption is vast and profound.<\/p>\n<div align=\"justify\">The institution of psychiatry, with its disease model, has dramatically changed our society over the past 35 years. It has given us a new philosophy of being, and altered how we view children and teenagers, and their struggles. It has touched every corner of our society, and this societal change has arisen because of a story told to the public that has been shaped by guild and pharmaceutical influences, as opposed to a record of good science. That is the nature of the harm done: our society has organized itself around a &ldquo;corrupt&rdquo; narrative&#8230;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">The Pies\/Frances article seems a mighty indirect way to approach this agenda. And I just wanted to clarify what all of this seems to be about&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In Annie Proulx&#8217;s novel, The Shipping News, emotionally broken protagonist Quoyle and his young daughter move to his ancestral home in Newfoundland to reclaim his life. He goes to work for the local paper, The Gammy Bird, where reporter Billy tries to show him the ropes: Billy: It&#8217;s finding the center of your story, the [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-64184","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=64184"}],"version-history":[{"count":42,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64184\/revisions"}],"predecessor-version":[{"id":64247,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64184\/revisions\/64247"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=64184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=64184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=64184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}