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Wednesday 30 December 2015

Timberrr! Psychiatry’s Evidence Base For Antipsychotics Comes Crashing to the Ground - by Robert Whitaker Courtesy of the MadinAmerica Website.

Timberrr! Psychiatry’s Evidence Base For Antipsychotics Comes Crashing to the Ground

HYPERLINK : http://www.madinamerica.com/2015/12/timberrr-psychiatrys-evidence-base-for-antipsychotics-comes-crashing-to-the-ground/

When I wrote Anatomy of an Epidemic, one of my foremost hopes was that it would prompt mainstream researchers to revisit the scientific literature. Was there evidence that any class of psychiatric medications—antipsychotics, antidepressants, stimulants, benzodiazepines, and so forth—provided a long-term benefit? Now epidemiologists at Columbia University and City College of New York have reported that they have done such an investigation about antipsychotics, and their bottom-line finding can be summed up in this way: Psychiatry’s “evidence base” for long-term use of these drugs does not exist.
This is a finding, published in the American Journal of Orthopsychiatry, that profoundly undercuts the societal narrative that has been driving psychiatric care in our society for the past sixty years.
In the conventional narrative of psychiatry’s history, Thorazine, which is remembered today as the first “antipsychotic,” is said to have kicked off a “psychopharmacological revolution” when it arrived in asylum medicine in 1954. Thorazine, wrote Edward Shorter, in his book A History of Psychiatry, “initiated a revolution in psychiatry, comparable to the introduction of penicillin in general medicine.” Soon psychiatry was touting that it had discovered “antidepressants” and “anti-anxiety” agents, and that narrative—of a medical specialty that had developed chemical antidotes to mental disorders—became fixed in the public mind, and drives psychiatric care today.
I once believed that narrative, but by the time I had finished researching Mad in America, which was published in 2002, I was convinced that it was out of sync with the scientific literature. It was, I wrote in one chapter, the “story we told ourselves.” Then, in 2004, I wrote a paper titled “The Case Against Psychiatric Drugs: A 50-year record of doing more harm than good,” which was published in Medical Hypotheses. In Anatomy of an Epidemic, which was published in 2010, I expanded on this argument, as I believe there isa long line of research, stretching across more than five decades, that reveals that antipsychotics worsen outcomes over the long term.
By writing that journal article and that book, I was challenging the conventional narrative, and the evidence for that “counter-narrative” is of many types: retrospective studies, a few randomized studies, cross-cultural studies, long-term naturalistic studies (such as Martin Harrow’s), MRI studies, and animal research into why antipsychotics “fail” over the long-term. It is that collective body of evidence that I find convincing, and in 2015, I updated that argument once more in for a new edition of Anatomy of an Epidemic. The case against antipsychotics grows stronger and stronger.
The paper published in the American Journal of Orthopsychiatry is titled “Weighing the Evidence for Harm from Long-term Treatment with Antipsychotic Medications: A Systematic Review. “ Nancy Sohler, from City College of New York, and a team of five epidemiologists from Columbia University, note that their study was occasioned by my writings on this topic. They wrote:
“Recently, Robert Whitaker advanced a troubling interpretation of the evidence base for long-term use of antipsychotic medication. He reviewed a number of epidemiological and clinical studies and concluded that antipsychotic medications are an iatrogenic cause of chronicity in schizophrenia, and that these medications may lead to the deterioration of patients’ health and well-being over time. His explanation rested on the notion that antipsychotic medication may induce a hypersensitivity to dopamine. We were concerned by Whitaker’s findings and wondered whether a systematic appraisal of published literature would produce the same results.”
So this was the very inquiry that I hoped Anatomy of an Epidemic would provoke. Let mainstream researchers take a trip through the scientific literature, and see what they would conclude.
In their “systematic appraisal of published literature,” Sholer and colleagues searched for studies that met two criteria: they had to be at least two-years in length and they needed to “permit a comparison of patients who were exposed to antipsychotic medications with patients who were not exposed to medications over the 2-year follow-up period.” They identified 18 studies that met this criteria, and then they assessed--in a yes, maybe, or no fashion--whether the reported results supported the hypothesis that antipsychotics worsen long-term outcomes.
Now, in my opinion, the researchers were reluctant to conclude that a study showed harm, even when the researchers themselves drew such a conclusion. For instance, in their assessment of Martin Harrow’s long-term study of psychotic patients, they concluded that his findings were “mixed” in terms of whether they showed long-term harm from drug usage. But in Harrow’s report on their 20-year outcomes, he noted that in every subgroup of patients, outcomes were worse for the medicated group, and when he compared those patients who took antipsychotics throughout this lengthy period, versus those who got off by year two and never took them again, it was the medication-compliant patients who, by far, had worse outcomes, and on every domain of functioning. As Harrow stated in 2008, at the American Psychiatric Association’s annual conference, “I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics.” But these researchers did not find such results a “yes” in terms of their supporting a hypothesis that antipsychotics worsen long-term outcomes.
I also think the “evidence” that can be reviewed in regard to this question is much broader than the studies that Sholer and colleagues selected. Cross-cultural studies, MRI studies, animal models of psychosis, and reviews of serious adverse effects, such as tardive dyskinesia, are also relevant to this question of whether the drugs do more harm than good over the long-term.
But that is not important here. The important result from this study was this: “We found the published data to be inadequate to test this hypothesis.”
This is a stunning admission. Even though psychiatrists have been prescribing these drugs for 60 years and have been telling their patients that they should stay on these medications indefinitely, the profession never spent the necessary effort to assess whether this drug treatment actually benefits patients over the long-term. This conclusion also reveals that psychiatry, when it boasts of its treatments being “evidence-based,” is making a rather hollow boast.
It is important to understand too that in the realm of evidence-based medicine, it is the obligation of the medical specialty to find evidence that its treatments are helpful, and not vice versa. In other words, it is not the responsibility of critics to find evidence showing harm done; the responsibility rests with the profession to show evidence of a treatment benefit.
In sum, this study shoots one more arrow into the conventional narrative that drives societal thinking today. In that narrative, the antipsychotics occupy a central role. These are the drugs that kicked off the psychopharmacological revolution and made it possible to empty the mental hospitals. These are the drugs that are presented to the public as an absolute necessity for psychotic patients. Read Jeffrey Lieberman’s book Shrinks, and you see this conventional narrative on display. But this study reveals that it’s a narrative woven from a profession’s own desire to tell a narrative of progress, to itself and to the public, rather than a narrative grounded in science.
As for a referendum on Anatomy of an Epidemic, I think this review helps advance the discussion. The researchers didn’t find, in their review of studies that met a certain criteria, evidence that allowed any conclusion to be drawn about the long-term merits of antipsychotics. What is needed now is to broaden the evidence reviewed, so that it includes the MRI research (showing drug-induced brain shrinkage), the cross-cultural evidence, the animal evidence, and a chalking up of all the adverse events from antipsychotics. At that point, researchers might conclude that the pieces of the evidence puzzle all fit together, and they paint a consistent picture of harm done.
Robert Whitaker
In the News: A journalist’s review of reports in medical journals and the media on psychiatric disorders and treatments.

Tuesday 8 December 2015

The Modern Day Witch-hunt - MadinAmerica Website - “Mental illness” is the scapegoat dependably relied upon by politicians and fearful citizens to blame for senseless violence and chaos.

The Modern Day Witch-hunt

Fear is a funny thing. When people are afraid, they need to feel a sense of control. Often, control may be perceived when blame is cast and scapegoats are named. If there is someone to blame, then there is something we can do. Fear can lead to irrational postulations of immense proportions; depending on one’s hierarchical position in the world, such postulations may be considered delusional or innovative.
The centuries-long persecution of witches was a powerful example of society and governments acting to combat social problems through the scapegoating of (mostly) innocent prey. Areas that had the greatest social and political turmoil were those that also persecuted the greatest number of witches. Most witch hunts were commanded by government authorities in response to chaos and death. Investigations frequently involved obtaining ‘testimony’ from subjective informants, including children, and confessions through torture.  Execution was generally the official punishment. In fact, well before the infamous Salem witch trials, Connecticut held witchcraft as one of 12 capital crimes punishable by death.
Similarly, “mental illness” is the scapegoat dependably relied upon by politicians and fearful citizens to blame for senseless violence and chaos. According to Arthur Colman, “The basis of the scapegoat myth is this: the group is not to blame for its problems, its bad feelings, its pain, its defeats. These are the responsibility of a particular individual or subgroup – the scapegoat – who is perceived as being fundamentally different from the rest of the group and must be excluded or sacrificed in order for the group to survive and remain whole”. Unlike other scapegoats, such as Jews, Muslims or African Americans, mental illness is more akin to witchery due to its illusive, subjective, and culturally defined nature.
Scapegoating the “mentally ill” every time violence or chaos breaks out allows us to absolve society of any blame. It allows us to ignore the problems that give rise to anger, distress, and violence (i.e., poverty, rejection, discrimination, oppression, injustice, abuse, etc) and instead focus on the one thing that can never be proven or defined and yet so easily can be identified in another. It provides relief without any reflection on how our society and way of life, and the inevitability of death, may be contributing to the terror that overwhelms us.
In the same way that the “mentally ill” are defined by highly educated, elite, usually white professionals, so too were witches. Identifying, classifying, and interrogating witches was a highly sophisticated endeavor, so much so that an official publication, commissioned by the pope, was printed and reprinted over 13 times and held persuasion for over 200 years. The Malleus Maleficarum was used by judges and prosecutors — among others — in the effort to officially condemn those marginalized offenders of witchcraft. Further, once defined as such, defendants would often admit to unfathomable behaviors, such as flying on poles and causing violent storms, and behaved in deranged and frightening ways in tandem with expectations. In much the same way, the DSM acts as a manual with the fa├žade of sophistication, that allows the elite class to identify and classify those that are different, abnormal, or deviant from the social norms.
Methods for testing the validity of accusations of witchcraft likewise had a veneer of superiority and complexity that allowed professional witch hunters to feel justified in their authority, as is also the case with psychological testing. For instance, witches might be bound and thrown in the water to see if they would sink, or would be examined for a “witches’ teat,” which was an extra nipple through which to nourish the witch’s helper animals. If one wanted to discover signs of a person being a witch, he or she was sure to find something. While fortunately we have moved past the era of phrenology, which was much more closely akin to witch tests, mental health professionals continue to evaluate for mental illness with tautological questionnaires based on politically-driven diagnostic categories examining deviations from cultural norms that subjectively can be found anywhere one may choose to look.  And, as with the hysteria of centuries before, the more chaos and violence within society, the more governments and frightened citizens will continue to look for something and someone to blame.
Interestingly, many scholars have suggested that many of the people deemed witches were, in fact, traumatized citizens who were suffering the ills of rape, child abuse, poverty,gender oppression, and other psychologically damaging events.  Not coincidentally, these also tend to be the most common factors predicting a mental illness diagnosis. Trauma survivors and those with developmental disruptions tend to make perfect scapegoats; they spent their childhood learning how to be just that.
Are you upset and struggling with this thing called life? Mentally ill. Are you violent? Mentally ill. Are you passive and avoid conflict? Mentally ill. Are you angry? Mentally ill. Are you energetic and happy all the time? Mentally ill. Are you numb and repressing emotions? Mentally ill. Are you anti-authoritarian? Mentally ill. What an easy solution. If every person who acts ‘crazy’ and does bad things is, by definition, crazy, then I guess the witch-hunters, er, mental health professionals are right. All the bad things that happen are because of mental illness.
The Helping Families in Mental Health Crisis Act (H.R. 2646) is a prime example of hysteria reaching the Federal government, in much the same way fear of witches did 600 years ago. In the same vein as burning the witches in Salem, Murphy and others are suggesting that we essentially “round ‘em up, drug ‘em, and lock ‘em away” in an effort to ameliorate society’s fear of death and violence. Yes, there are likely many other political and financial reasons for this, but people are afraid and Murphy has provided a scapegoat and a method to give the illusion of action and control. People seem to believe that persecuting, excluding, and taking away the rights of people already in distress will somehow result in American society becoming whole and safe. Witch hunts did nothing to increase security or safety; they bred fear and hatred. Perhaps by understanding the uncanny and disturbing similarities between the hysteria of the 16th and 17th centuries and our current culture, we might be able to heed warning and save the lives of thousands of vulnerable and powerless individuals before it’s too late.
Noel Hunter
Madness and Meaning in the Human Experience: A clinical psychology doctoral student, Noel explores the link between trauma and various anomalous states and the need for recognition of states of extreme distress as meaningful responses to overwhelming life experiences.