The “Institutional Corruption” of Psychiatry: A Conversation with Authors of Psychiatry Under the Influence

We present at this link an interview with the authors of Psychiatry Under the Influence

Here's a snippet

Bruce Levine: Psychiatry Under the Influence attempts to understand psychiatry’s denial and refusal to accept blame for its failures. So, for example, Ronald Pies, editor-in-chief of Psychiatric Times, refuses to blame psychiatry for the dissemination of the disproven chemical imbalance theory of mental illness (which fueled the dramatic rise of antidepressant use). Pies claims that the chemical imbalance theory “was always a kind of urban legend—never seriously propounded by well-informed psychiatrists,” and he blames Americans’ widespread belief in it on drug companies. You attribute much of psychiatry’s denial and evasion of responsibility to “cognitive dissonance theory”—can you speak about this?

Robert Whitaker: Again, this is part of the “institutional corruption” lens we were using to study the institution of psychiatry and its behavior. The assumption is that individuals within the institution can’t see that their behavior has been corrupted by “economies of influence.” And so, when those outside the institution begin pointing out the corruption in it, those within it may construct a narrative that protects their self-image. In this case, psychiatrists need to protect their image as honest researchers and as physicians who put the interests of their patients first. Cognitive dissonance theory reveals that there are a myriad of ways that people protect themselves in this manner.

We can see that cognitive dissonance quite clearly in Ronald Pies’ claim that the “chemical imbalance” theory was always a kind of urban legend. The fact that psychiatrists, for a long period of time, regularly told patients that the drugs fix chemical imbalances in the brain represented a fundamental betrayal of those patients. So once the chemical imbalance story fell apart publicly, what does Pies do? Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story. Pies makes this argument even though it is easy to document that the leaders of the APA often told this chemical imbalance story to the public, and that, even today, many prominent psychiatrists serve on advisory boards of patient advocacy groups that continue to tell it to the public.

Lisa Cosgrove: One of my favorite quotes is by Carol Tavris: “Mistakes were made, but not by me.” None of us are immune to cognitive dissonance. It is part of the human condition to have implicit biases and remain blissfully ignorant of them.

Worth the read

Active Shooters and Psychotropic Drugs

Taken from the much larger article which is a book review of "Active Shooters and Psychotropic Drugs SSRI’s" by Chris Grollnek and Chris Magee. Without quoting the full review, all we really need to is to cite this list of deaths and "the coincidence" of all these shooting associated with psychiatric drugs.

• Eric Harris age 17 (first on Zoloft then Luvox) and Dylan Klebold aged 18 (Columbine school shooting in Littleton, Colorado), killed 12 students and 1 teacher, and wounded 23 others, before killing themselves. Klebold’s medical records have never been made available to the public.
• Jeff Weise, age 16, had been prescribed 60 mg/day of Prozac (three times the average starting dose for adults!) when he shot his grandfather, his grandfather’s girlfriend and many fellow students at Red Lake, Minnesota. He then shot himself. 10 dead, 12 wounded.
• Cory Baadsgaard, age 16, Wahluke (Washington state) High School, was on Paxil (which caused him to have hallucinations) when he took a rifle to his high school and held 23 classmates hostage. He has no memory of the event.
• Chris Fetters, age 13, killed his favorite aunt while taking Prozac.
• Christopher Pittman, age 12, murdered both his grandparents while taking Zoloft.
• Mathew Miller, age 13, hung himself in his bedroom closet after taking Zoloft for 6 days.
• Kip Kinkel, age 15, (on Prozac and Ritalin) shot his parents while they slept then went to school and opened fire killing 2 classmates and injuring 22 shortly after beginning Prozac treatment.
• Luke Woodham, age 16 (Prozac) killed his mother and then killed two students, wounding six others.
• A boy in Pocatello, ID (Zoloft) in 1998 had a Zoloft-induced seizure that caused an armed stand off at his school.
• Michael Carneal (Ritalin), age 14, opened fire on students at a high school prayer meeting in West Paducah, Kentucky. Three teenagers were killed, five others were wounded..
• A young man in Huntsville, Alabama (Ritalin) went psychotic chopping up his parents with an ax and also killing one sibling and almost murdering another.
• Andrew Golden, age 11, (Ritalin) and Mitchell Johnson, aged 14, (Ritalin) shot 15 people, killing four students, one teacher, and wounding 10 others.
• TJ Solomon, age 15, (Ritalin) high school student in Conyers, Georgia opened fire on and wounded six of his class mates.
• Rod Mathews, age 14, (Ritalin) beat a classmate to death with a bat.
• James Wilson, age 19, (various psychiatric drugs) from Breenwood, South Carolina, took a .22 caliber revolver into an elementary school killing two young girls, and wounding seven other children and two teachers.
• Elizabeth Bush, age 13, (Paxil) was responsible for a school shooting in Pennsylvania
• Jason Hoffman (Effexor and Celexa) – school shooting in El Cajon, California
• Jarred Viktor, age 15, (Paxil), after five days on Paxil he stabbed his grandmother 61 times.
• Chris Shanahan, age 15 (Paxil) in Rigby, ID who out of the blue killed a woman.
• Jeff Franklin (Prozac and Ritalin), Huntsville, AL, killed his parents as they came home from work using a sledge hammer, hatchet, butcher knife and mechanic’s file, then attacked his younger brothers and sister.
• Neal Furrow (Prozac) in LA Jewish school shooting reported to have been court-ordered to be on Prozac along with several other medications.
• Kevin Rider, age 14, was withdrawing from Prozac when he died from a gunshot wound to his head. Initially it was ruled a suicide, but two years later, the investigation into his death was opened as a possible homicide. The prime suspect, also age 14, had been taking Zoloft and other SSRI antidepressants.
• Alex Kim, age 13, hung himself shortly after his Lexapro prescription had been doubled.
• Diane Routhier was prescribed Welbutrin for gallstone problems. Six days later, after suffering many adverse effects of the drug, she shot herself.
• Billy Willkomm, an accomplished wrestler and a University of Florida student, was prescribed Prozac at the age of 17. His family found him dead of suicide – hanging from a tall ladder at the family’s Gulf Shore Boulevard home in July 2002.
• Kara Jaye Anne Fuller-Otter, age 12, was on Paxil when she hung herself from a hook in her closet. Kara’s parents said “…. the damn doctor wouldn’t take her off it and I asked him to when we went in on the second visit. I told him I thought she was having some sort of reaction to Paxil…”)
• Gareth Christian, Vancouver, age 18, was on Paxil when he committed suicide in 2002, (Gareth’s father could not accept his son’s death and killed himself.)
• Julie Woodward, age 17, was on Zoloft when she hung herself in her family’s detached garage.
• Matthew Miller was 13 when he saw a psychiatrist because he was having difficulty at school. The psychiatrist gave him samples of Zoloft. Seven days later his mother found him dead, hanging by a belt from a laundry hook in his closet.
• Kurt Danysh, age 18, and on Prozac, killed his father with a shotgun. He is now behind prison bars, and writes letters, trying to warn the world that SSRI drugs can kill.
• Woody __, age 37, committed suicide while in his 5th week of taking Zoloft. Shortly before his death his physician suggested doubling the dose of the drug. He had seen his physician only for insomnia. He had never been depressed, nor did he have any history of any mental illness symptoms.
• A boy from Houston, age 10, shot and killed his father after his Prozac dosage was increased.
• Hammad Memon, age 15, shot and killed a fellow middle school student. He had been diagnosed with ADHD and depression and was taking Zoloft and “other drugs for the conditions.”
• Matti Saari, a 22-year-old culinary student, shot and killed 9 students and a teacher, and wounded another student, before killing himself. Saari was taking an SSRI and a benzodiazapine.
• Steven Kazmierczak, age 27, shot and killed five people and wounded 21 others before killing himself in a Northern Illinois University auditorium. According to his girlfriend, he had recently been taking Prozac, Xanax and Ambien. Toxicology results showed that he still had trace amounts of Xanax in his system.
• Finnish gunman Pekka-Eric Auvinen, age 18, had been taking antidepressants before he killed eight people and wounded a dozen more at Jokela High School – then he committed suicide.
• Asa Coon from Cleveland, age 14, shot and wounded four before taking his own life. Court records show Coon was on Trazodone.
• Jon Romano, age 16, on medication for depression, fired a shotgun at a teacher in his New York high school.

Psychiatrists Do Not Know What Normal Sex Is.

Psychiatrists are trying to define what normal sex is for the next edition of the DSM, but will probably wind up making everything a for-profit treatable condition that be be treated with a pill.

As Seen on MSNBC

This month the American Psychiatric Association announced the names of “working group” members who will guide the development of the new Diagnostic and Statistical Manual of Mental Disorders, or DSM, the codex of American psychiatry.

Not surprisingly, given the DSM’s colorful history, particularly when it comes to sex, controversy erupted within days of the announcement, especially over membership of the Sexual and Gender Identity Disorders working group, which will wrestle with questions such as:

• Are sadomasochism or pedophilia mental disorders?
• Are dysfunctions like female hypoactive sexual desire disorder (low sex drive) psychiatric issues, or hormonal issues?

Perhaps the most important question is whether, when it comes to many sexual interests and issues, it’s even possible or desirable to create diagnostic criteria.

At least one petition, spearheaded by transgender activists, is being circulated to oppose the appointment of some members to the Sexual and Gender Identity Disorders work group and its chair, Kenneth Zucker, head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto, Canada. The petition accuses Zucker of having engaged in “junk science” and promoting “hurtful theories” during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy.

Zucker rejects the junk-science charge, saying that there “has to be an empirical basis to modify anything” in the DSM. As for hurting people, “in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.”

That sex is controversial comes as no surprise to Dr. Darrel Regier, the vice-chair of the APA’s DSM-V Task Force, based in Arlington, Va.

Sex, he says, in an understatement, “is an area that obviously has lots of emotion attached to it.” But the APA, he says, is doing its best to put science and evidence first, both in who it appoints to working groups and in the process it will use to create the DSM-V (so called because it is the fifth complete version). Each working group will accept input from many experts with varying views, reach a consensus on DSM content, and then put that work group’s product before the board of trustees of the APA and the APA assembly.

All that may be true, but Regier does not expect such reassurances to quell the forces already swirling around the DSM-V as it moves toward a 2012 publication date. Currently, the DSM-IV includes sex-related activities as varied as paraphilias like voyeurism, klismaphilia (erotic use of enemas) and sadism, and functional disorders like dyspareunia (pain with intercourse), erectile disorders and premature ejaculation.

'A set of scientific hypotheses'

The first DSM was issued in 1952. The idea was to create a more standardized way of talking about psychiatric disorders. As psychiatrist Dr. Gail Saltz, a TODAY Show contributor who also practices in New York, explains, the DSM is best viewed as “a language we have chosen to speak, a talking point we mental health professionals have created to communicate as well as we can with each other and with other professions.”

It is not a final arbiter of who’s crazy and who’s not. Saltz, who says she thinks the DSM can be limiting in clinical practice, prefers to take a holistic approach and look at each patient’s collection of symptoms and concerns without being restricted by the DSM’s various criteria.

Regier agrees that’s how doctors should use it, arguing that the DSM “really needs to be seen as a set of scientific hypotheses.” It is, he believes, “a living document” changeable with new research.

But if the DSM is a book of “hypotheses,” why the fuss? Does the DSM matter?

Yes. A lot.

The first reason why is prosaic. If you want your insurance to reimburse your visit to a mental health professional, you are probably going to need a DSM code signifying a diagnosis.

But the more profound reason is that it shapes how doctors, even the rest of rest of society, view sexuality.

“A psychiatric diagnosis is more than shorthand to facilitate communication among professionals or to standardize research parameters,” wrote Dr. Charles Moser and Peggy Kleinplatz in a 2005 paper published in the Journal of Psychology and Human Sexuality.

“Psychiatric diagnoses affect child custody decisions, self-esteem, whether individuals are hired or fired, receive security clearances, or have other rights and privileges curtailed. Criminals may find that their sentences are either mitigated or enhanced as a direct result of their diagnoses.

The equating of unusual sexual interests with psychiatric diagnoses has been used to justify the oppression of sexual minorities and to serve political agendas. A review of this area is not only a scientific issue, but also a human rights issue.”

A problem for whom?

There is no shortage of opinion on what ought to be changed, deleted or included in the new DSM-V. Sandra Leiblum, formerly a professor at New Jersey’s Robert Wood Johnson Medical School and an expert in female sexual health who is now in private practice in Bridgewater, N.J., says she wants to see a revision of diagnoses of female hypoactive sexual desire disorder, other female arousal disorders and sexual pain like dyspareunia. For example, she wants language that would separate arousal disorders into genital (more biological in origin) and subjective subtypes.

Carol Queen, a sexologist, sexual rights activist and co-founder of San Francisco’s Center for Sex and Culture, believes the new DSM should stress that sexual variances are only a problem “if they are problems in the life of the person showing up” in a psychiatrist’s office “so that when somebody is eroticizing something, or doing something in a consensual way, that’s not a problem” even if it may seem odd to most of us.

She also proposes an addition, a diagnosis of “absexual” (“ab” meaning “away from”). This would include those who appear to be “turned on by fulminating against it.” Examples could include state governors who crusade against prostitution even while paying hookers for sex, and religious leaders who wind up trying to explain engaging in the sex acts they preach against.

Moser, who is affiliated with the Institute for Advanced Study of Human Sexuality in San Francisco, and Kleinplatz, from the University of Ottawa, argue that all paraphilias, like sexual sadism, sexual masochism, transvestism, should be removed from the DSM, insisting that “the DSM criteria for diagnosis of unusual sexual interests as pathological rests on a series of unproven and more importantly, untested assumptions.”

This does not mean, as opponents of this idea have suggested, that they somehow approve of sex between adults and children. “We would argue that the removal of pedophilia from the DSM would focus attention on the criminal aspect of these acts, and not allow the perpetrators to claim mental illness as a defense or use it to mitigate responsibility for their crimes," they wrote. "Individuals convicted of these crimes should be punished as provided by the laws in the jurisdiction in which the crime occurred.”

Most of these suggestions are inherently political, as much as the APA and most psychiatrists would wish to avoid politics. Sex exists as part of the culture, and it cannot be separated from it.

The DSM has reflected cultural shifts through its revisions and new editions. The most famous example is homosexuality. When the first DSM was created in 1952, homosexuality was declared a mental illness. By 1973, and after much heated debate and over objections from religious conservatives, the DSM-II excluded homosexuality as a disorder with the exception of one variant, and that was soon dropped in an interim revision.

Once deviant, now desirable

“Definitely a change in culture affects diagnoses,” Leiblum says. “We used to think oral-genital sex was deviant and we have embraced that. Masturbation was evidence of out-of-control behavior, now we see it as not only normative but to be encouraged.”

So if enough people start to do it, or are more public about doing it, does that mean it is no longer a disorder? “I think it probably affects the degree to which people are willing to look at scientific evidence,” Regier says.

This fuzziness is why, starting in the 1980s, the field moved toward adding the notion of “distress” to the DSM.

“We do not consider something a disorder unless there is a clearly defined description of this entity and there is clearly some significant dysfunction and distress associated with it,” explains Regier. “I would say also if there is no victim involved … this behavior is not imposing a person’s will on another person, that is a critical component when one looks at conditions in this area.”

If you aren’t distressed, and everyone is a consenting grown-up, then there probably isn’t a disorder. But things won’t be that simple for the creators of the new DSM.

“How do you make a criteria that does not pathologize low desire?” Leiblum asks rhetorically. You add the need to be distressed about it. “But then whose distress should be looked at?” she asks, referring to a sexual partner. “You can have hypertension and not feel any distress because there is objective criteria for what is high blood pressure. But there is none of that for sexual diagnoses, even premature ejaculation. What constitutes premature?”

(At a press conference Monday, the International Society of Sexual Medicine made a stab at a definition, saying premature ejaculation is "a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.”)

This problematic lack of clarity, Leiblum argues, is especially acute for the paraphilias. Does the criteria amount to “If it’s mine it’s OK, but if it’s yours it’s kinky? These issues need to be grappled with.”

Madhouse: A Tragic Tale of Megalomania and Modern Medicine

An excellent review of the book "Madhouse: A Tragic Tale of Megalomania and Modern Medicine" (Yale University Press, $30). Here's a snippet:

Lobotomy

Psychiatric patients were unusually vulnerable to medical experimentation. (Remember Jack Nicholson in "One Flew Over the Cuckoo's Nest"?)

The lobotomy started in Portugal in 1935 and was revamped in the United States by Drs. Walter Freeman and James Watts. They began the surgery in 1936, drilling holes in the skull and inserting a knife-like object, severing the frontal portions of the brain. This was supposed to dramatically relieve symptoms of mental illness, although the brain damage it caused was permanent. Some patients lost spontaneity or became a bit slaphappy.

To find out when to end the operation, Freeman would put patients under local anesthesia and talk them through the operation, asking simple questions to make sure they were still in touch. He asked one patient, "What's going through your mind?" The reply: "A knife." The doctors later refined their procedure, using an instrument similar to an ice pick, inserting it in tear ducts. Freeman and Watts claimed that 52 percent of their first 623 surgeries were "good," but they did not define what they considered good.

Mental hospital

Scull's book, "Madhouse," recounts the story of Dr. Henry Cotton, a psychiatrist who was in charge of the state mental hospital in Trenton, N.J., from 1907 to 1930. Cotton assumed mental illness was the product of overlooked infections that fed toxins to the brain. His solution was to search for sources of infection and remove them.

Because teeth are close to the brain, Cotton had his patients' teeth pulled. Some of them recovered, a powerful placebo effect. Many did not, so Cotton looked elsewhere for infection. (Or did he wait too long to pull teeth?) He started removing tonsils. Again, no remedy.

Next, he removed colons and other organs, often on unwilling patients, ratcheting up his mortality rate. He had critics, but many followers, too. Cotton was investigated to determine whether his claims of an 85 percent cure rate were true. A report concluded that he was killing his patients, but the report was suppressed. His practices continued until a heart attack killed him in 1933. Long before he died, he had his two sons' teeth removed. They grew up and killed themselves.

The Dark Side of Antidepressants

As seen in this report on WVLT 8 TV in Knoxville, Tennessee

Internal documents of Eli Lilly and Co., some dating to the mid-1980s, as well as government applications and patents, indicate that the pharmaceutical giant has known for years that its best-selling drug could cause suicidal reactions in a small but significant number of patients. The reports could become critical as Lilly seeks government approval for its new Prozac.

Among the findings:

--Internal documents show that in 1990, Lilly scientists were pressured by corporate executives to alter records on physician experiences with Prozac, changing mentions of suicide attempt to ``overdose'' and suicidal thoughts to ``depression.''

--Three years before Prozac received approval by the US Food and Drug Administration in late 1987, the German BGA, that country's FDA equivalent, had such serious reservations about Prozac's safety that it refused to approve the antidepressant based on Lilly's studies showing that previously nonsuicidal patients who took the drug had a fivefold higher rate of suicides and suicide attempts than those on older antidepressants, and a threefold higher rate than those taking placebos.

--Lilly's own figures, in reports made available to the Globe, indicate that 1 in 100 previously nonsuicidal patients who took the drug in early clinical trials developed a severe form of anxiety and agitation called akathisia, causing them to attempt or commit suicide during the studies.

--A McLean Hospital researcher and associate professor at Harvard Medical School, Dr. Martin Teicher, whose early 1990s studies linked Prozac to akathisia and suicide, is a co-inventor of the new Prozac, which Lilly plans to market, along with Timothy J. Barberich, the CEO of Sepracor Inc., a Marlborough, Mass. drug company, and James W. Young.

--A just-published book, ``Prozac Backlash,'' by a Cambridge psychiatrist, Dr. Joseph Glenmullen, has drawn Lilly's ire for discussing Prozac's link to suicide, tics, withdrawal symptoms, and other side effects of Prozac and similar antidepressants.

Extensive details and documents quoted at the link.