<table cellspacing="0" cellpadding="0" border="0" ><tr><td valign="top" style="font: inherit;"><BR><BR>--- On <B>Sun, 2/22/09, News and alerts from www.MindFreedom.org <I><mindfreedom-news@intenex.net></I></B> wrote:<BR>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: rgb(16,16,255) 2px solid"><BR>From: News and alerts from www.MindFreedom.org <mindfreedom-news@intenex.net><BR>Subject: Lancet essay questions psychiatric industry myths<BR>To: "News: Human Rights in Mental Health" <MindFreedom-News@intenex.net><BR>Date: Sunday, February 22, 2009, 9:06 PM<BR><BR>
<DIV class=plainMail><BR>The Lancet, a widely-respected international medical journal, <BR>published an essay this weekend BELOW sharply critical of the <BR>psychiatric industry.<BR><BR>The piece by Athar Yawar reviews two books: "The Myth of the Chemical <BR>Cure: A Critique of Psychiatric Drug Treatment" by Joanna Moncrieff <BR>and "Side Effects: a Prosecutor, a Whistleblower, and a Bestselling <BR>Antidepressant on Trial" by Alison Bass.<BR><BR><A href="http://tinyurl.com/lancet-yawar" target=_blank>http://tinyurl.com/lancet-yawar</A> or<BR><A href="http://www.mindfreedom.org/kb/psychiatric-drugs/lancet-yawar" target=_blank>http://www.mindfreedom.org/kb/psychiatric-drugs/lancet-yawar</A><BR><BR>~~~~~~~~~~<BR><BR>The Lancet<BR><BR>February 21, 2009 - <A href="http://www.thelancet.com/" target=_blank>http://www.thelancet.com</A> - pages 621 to 622 - Vol <BR>373<BR><BR>Perspectives<BR><BR>Book
Review<BR><BR>~~~~~~~~~~<BR><BR>The fool on the hill<BR><BR>The spinning chair. Bloodletting (copious). Removal of possibly <BR>infected viscera. Extraction of teeth. Electric shock. Forcible <BR>restraint, for days or weeks. Wrapping in cold blankets. Brain <BR>damage. Repeated coma. Back-breaking convulsions. Slicing through the <BR>brain with an ice pick. Sterilisation. Female genital mutilation.<BR><BR>Since the Enlightenment, all the above have been used to treat the <BR>"mad". Even the most grotesque treatments have often been introduced <BR>as humane alternatives to existing options. In the 1950s, the <BR>chemical lobotomy, or "hibernation therapy" was introduced. Patients <BR>were given a drug that rendered them immobile and semiconscious for <BR>days, on the assumption that they would emerge improved. The drug was <BR>called a "neuroleptic", or brain restrainer. Its name?
<BR>Chlorpromazine. Since marketed as an antipsychotic, it is used, at <BR>lower doses, today. So too are a host of related drugs. Many doctors, <BR>and some patients, swear by them (other patients swear at them).<BR><BR>Antipsychotics are, at times, cruel drugs. Some cause shaking, <BR>salivation, restlessness, infertility, stiff ness, agitation, and <BR>frail bones; others cause obesity, somnolence, and increase the risk <BR>of heart attack, diabetes, and stroke. Antidepressants also have side- <BR>effects, although theirs are typically less dramatic: sickness, <BR>sexual dysfunction, a feeling of being numbed, or losing one's <BR>personality, and acutely increased risk of suicide. But side-effects, <BR>when they occur, seem justified, since mental illness is extremely <BR>unpleasant; and evidence indicates that the drugs work.<BR><BR>What if they didn't? In "The Myth of the Chemical Cure: A
Critique of <BR>Psychiatric Drug Treatment," psychiatrist Joanna Moncrieff has <BR>amassed copious evidence that perhaps the drugs don't work. What have <BR>we missed, all these years? Selective and misleading outcome <BR>measures; inadequate follow-up; selective attention to evidence; <BR>publication bias; and our ability to define questions whose answers <BR>are predictable, but partial. Robert Whitaker's "Mad in <BR>America" (2001) provided a breathtaking overview; Moncrieff, by <BR>contrast, examines many studies in detail. "The Myth of the Chemical <BR>Cure" is not always easy reading, but I do not think that serious <BR>psychiatrists can afford to ignore Moncrieff's book. It is a mine of <BR>information; a provocation to think creatively and compassionately <BR>about patients; and a momento mori, the equivalent of a mediaeval <BR>scholar's skull staring back from his
desk: our works are mortal, and <BR>our paradigms always limited.<BR><BR>Psychiatrists are widely regarded (and not just by other <BR>psychiatrists) as insightful and intelligent people. How can <BR>systematic research errors influence practice? In "Side Effects: a <BR>Prosecutor, a Whistleblower, and a Bestselling Antidepressant on <BR>Trial," Alison Bass illustrates the method. The book lacks a little <BR>in intensity; it could be shorter than it is. However, it manages to <BR>illustrate that drug companies fund and design research; academic <BR>advancement depends on procuring research grants; and, especially <BR>with materialist approaches to the mind requiring expensive tools, <BR>ambitious doctors often have little choice about the paymaster. Bass <BR>indicates, as William Broad and Nicholas Wade did many years ago, <BR>that research fraud is not merely anomalous, but the
result of <BR>pressures placed on academics, some of them self-generated. Even in <BR>the absence of research fraud, the mechanisms of research would often <BR>not be conducive to original or patient-centred thinking. Moreover, <BR>acceptance of (in retrospect) bizarre and cruel remedies predates the <BR>growth of the pharmaceutical industry.<BR><BR>This occurs although psychiatry, of all disciplines, ought to be <BR>based on the art of listening. A patient's story is a symphony of <BR>suffering, longing, meaning, understanding, hope, fear, loss, wit, <BR>and wisdom. Not to accompany the person afflicted on his journey is <BR>inhumane. People will always need psychiatrists. But do people always <BR>need psychiatry? Instead of the art of expert companionship, <BR>psychiatry has become the discipline of brain mechanics. Experiences <BR>are matched to labels of descriptive poverty.
"Depression" implies a <BR>low level of something, presumably mood, rather than the rich and <BR>complex turmoil felt by the patient. "Schizophrenia" means several <BR>contradictory things, but does not reflect the search for meaning <BR>that is at the heart of the disorder.<BR><BR>Is it a disorder at all? Madness is to sincerely hold beliefs that <BR>society regards as insupportable. But no society's knowledge is <BR>complete. Our ancestors would regard us as mad, or, charitably, as <BR>ill-informed; we observe with relief that we do not share all their <BR>beliefs. Healthy societies have often regarded at least some madness <BR>as serendipitous. If reason follows from incomplete assumptions, <BR>madness, by outflanking reason, can complete the human picture. The <BR>notion was enshrined in the King's Fool: a measurelessly eccentric, <BR>often holy, man who told the state, embodied
in the king, what it <BR>otherwise could not hear (the tradition died out in Britain after <BR>Charles I was deposed, not long after his fool was expelled from <BR>court, at the behest of a jealous archbishop). Our assumption that <BR>madness is necessarily a disorder assumes that we are necessarily <BR>sane. I would hate to make that an article of faith.<BR><BR>In focusing on, and stigmatising, people with mental illness, we tend <BR>to ignore the context. In our fervour to understand mental illness, <BR>we have applied grossly oversimplified biochemical models to the <BR>brain, with usually unhelpful results. The search for a <BR>"schizophrenia gene" has been heroic and, so far, labyrinthine; but <BR>to be black, isolated, and urban in the UK increases the risk <BR>manifold. Society, and circumstances, can drive people mad; the <BR>epidemic of depression and anxiety is otherwise
inexplicable. To <BR>focus research on the person who has become ill can be a little like <BR>concentrating on a damaged house after a tsunami has hit a village. <BR>The cause may be elsewhere.<BR><BR>Some would argue that even if drugs work, they do not work. The <BR>margin over placebo is not large; the number needed to treat is not <BR>vanishingly small; prognosis may be worse than with the "moral <BR>treatment" (rest, respect, good food, work, prayer) of 200 years ago; <BR>patients' adherence, especially to antipsychotic drugs, is patchy; <BR>drug treatment attends to the symptoms, but not to the human being <BR>who has the symptoms. We would, as a society, achieve a great deal by <BR>listening to patients' demands for good food, companionship, respect, <BR>practical support, and gainful activity. As doctors, being with the <BR>patient is one of the most powerful healing tools
we have. It can <BR>sound trite; but the phrase describes receiving the patient's <BR>humanity, and allowing it to come through crisis intact and enriched, <BR>without the loss of dignity and self almost inherent in labelling. We <BR>rarely have the time, or encouragement, to treat patients according <BR>to their story, rather than our diagnosis; outcome measures are too <BR>coarse to consider whether the patient has been allowed to preserve <BR>and fulfill his or her humanity. The work of Moncrieff and Bass is a <BR>warning that the doctor must be intellectually and morally free.<BR><BR>Athar Yawar<BR><BR>The Lancet, London NW1 7BY, UK<BR><BR>~~~~~~~~~~<BR><BR>Books reviewed:<BR><BR>"The Myth of the Chemical Cure: A Critique of Psychiatric Drug <BR>Treatment" by Joanna Moncrieff (Palgrave Macmillan) 2008. 296 pages. <BR>ISBN 0-230-57431-9.<BR><BR>"Side Effects: a Prosecutor, a Whistleblower,
and a Bestselling <BR>Antidepressant on Trial" by Alison Bass (Algonquin Books) 2008. 260 <BR>pages. ISBN 1-565-12553-3.<BR><BR>~~~~~~~~~~<BR><BR> * * * ACTION * * * ACTION * * * ACTION * * *<BR><BR>Please forward to all interested people on and off Internet.<BR><BR>~~~~~~~~~~<BR><BR> URGENT CALL FOR SUPPORT FOR MINDFREEDOM INTERNATIONAL<BR><BR> <A href="http://www.mindfreedom.org/join-donate" target=_blank>http://www.mindfreedom.org/join-donate</A><BR><BR>Especially because of world economic problems, it's important for <BR>*everyone* to support MindFreedom International today.<BR><BR>MindFreedom International has, for 23 years, been 100 percent <BR>independently funded by members, supporters and a few foundations, <BR>with zero funding from corporations and the mental health system.<BR><BR>Everyone: Join, donate or renew early to MindFreedom International
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