[Cslist] [Fwd: Fw: Lancet essay questions psychiatric industry myths]

Thu Feb 26 11:05:13 CET 2009

-------------------------- Messaggio originale ---------------------------
Oggetto: Fw: Lancet essay questions psychiatric industry myths
Da:      "hanna genova" <hannagenova85 at yahoo.com>
Data:    Mer, 25 Febbraio 2009, 7:09 pm
A:       telviola at ecn.org
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--- On Sun, 2/22/09, News and alerts from www.MindFreedom.org
<mindfreedom-news at intenex.net> wrote:

From: News and alerts from www.MindFreedom.org <mindfreedom-news at intenex.net>
Subject: Lancet essay questions psychiatric industry myths
To: "News: Human Rights in Mental Health" <MindFreedom-News at intenex.net>
Date: Sunday, February 22, 2009, 9:06 PM

The Lancet, a widely-respected international medical journal, 
published an essay this weekend BELOW sharply critical of the 
psychiatric industry.

The piece by Athar Yawar reviews two books: "The Myth of the Chemical 
Cure: A Critique of Psychiatric Drug Treatment" by Joanna Moncrieff 
and "Side Effects: a Prosecutor, a Whistleblower, and a Bestselling 
Antidepressant on Trial" by Alison Bass.

http://tinyurl.com/lancet-yawar   or
http://www.mindfreedom.org/kb/psychiatric-drugs/lancet-yawar

~~~~~~~~~~

The Lancet

February 21, 2009 - http://www.thelancet.com - pages 621 to 622 - Vol 
373

Perspectives

Book Review

~~~~~~~~~~

The fool on the hill

The spinning chair. Bloodletting (copious). Removal of possibly 
infected viscera. Extraction of teeth. Electric shock. Forcible 
restraint, for days or weeks. Wrapping in cold blankets. Brain 
damage. Repeated coma. Back-breaking convulsions. Slicing through the 
brain with an ice pick. Sterilisation. Female genital mutilation.

Since the Enlightenment, all the above have been used to treat the 
"mad". Even the most grotesque treatments have often been introduced 
as humane alternatives to existing options. In the 1950s, the 
chemical lobotomy, or "hibernation therapy" was introduced. Patients 
were given a drug that rendered them immobile and semiconscious for 
days, on the assumption that they would emerge improved. The drug was 
called a "neuroleptic", or brain restrainer. Its name? 
Chlorpromazine. Since marketed as an antipsychotic, it is used, at 
lower doses, today. So too are a host of related drugs. Many doctors, 
and some patients, swear by them (other patients swear at them).

Antipsychotics are, at times, cruel drugs. Some cause shaking, 
salivation, restlessness, infertility, stiff ness, agitation, and 
frail bones; others cause obesity, somnolence, and increase the risk 
of heart attack, diabetes, and stroke. Antidepressants also have side-
effects, although theirs are typically less dramatic: sickness, 
sexual dysfunction, a feeling of being numbed, or losing one's 
personality, and acutely increased risk of suicide. But side-effects, 
when they occur, seem justified, since mental illness is extremely 
unpleasant; and evidence indicates that the drugs work.

What if they didn't? In "The Myth of the Chemical Cure: A Critique of 
Psychiatric Drug Treatment," psychiatrist Joanna Moncrieff has 
amassed copious evidence that perhaps the drugs don't work. What have 
we missed, all these years? Selective and misleading outcome 
measures; inadequate follow-up; selective attention to evidence; 
publication bias; and our ability to define questions whose answers 
are predictable, but partial. Robert Whitaker's "Mad in 
America" (2001) provided a breathtaking overview; Moncrieff, by 
contrast, examines many studies in detail. "The Myth of the Chemical 
Cure" is not always easy reading, but I do not think that serious 
psychiatrists can afford to ignore Moncrieff's book. It is a mine of 
information; a provocation to think creatively and compassionately 
about patients; and a momento mori, the equivalent of a mediaeval 
scholar's skull staring back from his desk: our works are mortal, and 
our paradigms always limited.

Psychiatrists are widely regarded (and not just by other 
psychiatrists) as insightful and intelligent people. How can 
systematic research errors influence practice? In "Side Effects: a 
Prosecutor, a Whistleblower, and a Bestselling Antidepressant on 
Trial," Alison Bass illustrates the method. The book lacks a little 
in intensity; it could be shorter than it is. However, it manages to 
illustrate that drug companies fund and design research; academic 
advancement depends on procuring research grants; and, especially 
with materialist approaches to the mind requiring expensive tools, 
ambitious doctors often have little choice about the paymaster. Bass 
indicates, as William Broad and Nicholas Wade did many years ago, 
that research fraud is not merely anomalous, but the result of 
pressures placed on academics, some of them self-generated. Even in 
the absence of research fraud, the mechanisms of research would often 
not be conducive to original or patient-centred thinking. Moreover, 
acceptance of (in retrospect) bizarre and cruel remedies predates the 
growth of the pharmaceutical industry.

This occurs although psychiatry, of all disciplines, ought to be 
based on the art of listening. A patient's story is a symphony of 
suffering, longing, meaning, understanding, hope, fear, loss, wit, 
and wisdom. Not to accompany the person afflicted on his journey is 
inhumane. People will always need psychiatrists. But do people always 
need psychiatry? Instead of the art of expert companionship, 
psychiatry has become the discipline of brain mechanics. Experiences 
are matched to labels of descriptive poverty. "Depression" implies a 
low level of something, presumably mood, rather than the rich and 
complex turmoil felt by the patient. "Schizophrenia" means several 
contradictory things, but does not reflect the search for meaning 
that is at the heart of the disorder.

Is it a disorder at all? Madness is to sincerely hold beliefs that 
society regards as insupportable. But no society's knowledge is 
complete. Our ancestors would regard us as mad, or, charitably, as 
ill-informed; we observe with relief that we do not share all their 
beliefs. Healthy societies have often regarded at least some madness 
as serendipitous. If reason follows from incomplete assumptions, 
madness, by outflanking reason, can complete the human picture. The 
notion was enshrined in the King's Fool: a measurelessly eccentric, 
often holy, man who told the state, embodied in the king, what it 
otherwise could not hear (the tradition died out in Britain after 
Charles I was deposed, not long after his fool was expelled from 
court, at the behest of a jealous archbishop). Our assumption that 
madness is necessarily a disorder assumes that we are necessarily 
sane. I would hate to make that an article of faith.

In focusing on, and stigmatising, people with mental illness, we tend 
to ignore the context. In our fervour to understand mental illness, 
we have applied grossly oversimplified biochemical models to the 
brain, with usually unhelpful results. The search for a 
"schizophrenia gene" has been heroic and, so far, labyrinthine; but 
to be black, isolated, and urban in the UK increases the risk 
manifold. Society, and circumstances, can drive people mad; the 
epidemic of depression and anxiety is otherwise inexplicable. To 
focus research on the person who has become ill can be a little like 
concentrating on a damaged house after a tsunami has hit a village. 
The cause may be elsewhere.

Some would argue that even if drugs work, they do not work. The 
margin over placebo is not large; the number needed to treat is not 
vanishingly small; prognosis may be worse than with the "moral 
treatment" (rest, respect, good food, work, prayer) of 200 years ago; 
patients' adherence, especially to antipsychotic drugs, is patchy; 
drug treatment attends to the symptoms, but not to the human being 
who has the symptoms. We would, as a society, achieve a great deal by 
listening to patients' demands for good food, companionship, respect, 
practical support, and gainful activity. As doctors, being with the 
patient is one of the most powerful healing tools we have. It can 
sound trite; but the phrase describes receiving the patient's 
humanity, and allowing it to come through crisis intact and enriched, 
without the loss of dignity and self almost inherent in labelling. We 
rarely have the time, or encouragement, to treat patients according 
to their story, rather than our diagnosis; outcome measures are too 
coarse to consider whether the patient has been allowed to preserve 
and fulfill his or her humanity. The work of Moncrieff and Bass is a 
warning that the doctor must be intellectually and morally free.

Athar Yawar

The Lancet, London NW1 7BY, UK

~~~~~~~~~~

Books reviewed:

"The Myth of the Chemical Cure: A Critique of Psychiatric Drug 
Treatment" by Joanna Moncrieff (Palgrave Macmillan) 2008. 296 pages. 
ISBN 0-230-57431-9.

"Side Effects: a Prosecutor, a Whistleblower, and a Bestselling 
Antidepressant on Trial" by Alison Bass (Algonquin Books) 2008. 260 
pages. ISBN 1-565-12553-3.

~~~~~~~~~~

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