Welcome to the Mad in America podcast, a new weekly discussion that searches for the truth about psychiatric prescription drugs and mental health care worldwide.
This podcast is part of Mad in America’s mission to serve as a catalyst for rethinking psychiatric care. We believe that the current drug-based paradigm of care has failed our society and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.
On the podcast over the coming weeks, we will have interviews with experts and those with lived experience of the psychiatric system. Thank you for joining us as we discuss the many issues around rethinking psychiatric care around the world.
For more information visit madinamerica.com To contact us email email@example.com
David Cohen - Mad Science, Psychiatric Coercion and the Therapeutic State
On MIA Radio this week, MIA’s Peter Simons interviewed David Cohen, PhD, a social worker, professor of social welfare, and Associate Dean for Research at the Luskin School of Public Affairs of the University of California, Los Angeles. He discussed his path to becoming a researcher focused on mental health, coercive practices, and discontinuation from psychiatric drugs. He studies the social construction of psychoactive drug effects, the union of law and psychiatry within a criminalization/medicalization system and envisions alternatives to the current mental health industrial complex and the medicalization of everyday life. He has also taught in Canada and France, and for over 20 years held a private practice to help people withdraw from psychiatric drugs. He is the author of over 100 book chapters and articles. His first book, published in 1990, was Challenging the Therapeutic State: Critical Perspectives on Psychiatry and the Mental Health System. His latest book, published in 2013, with colleagues, Stuart Kirk, and Tomi Gomory is Mad Science: Psychiatric Coercion, Diagnosis and Drugs.
On MIA Radio this week, MIA’s Akansha Vaswani interviewed Dr. John Read, a clinical psychologist at the University of East London, about the influences on his work and research on mental health over the years. John worked for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, in 1994, where he worked until 2013. He has published over 140 papers in research journals, primarily on the relationship between adverse life events (e.g. child abuse/neglect, poverty, etc.) and psychosis. He also researches the negative effects of biogenetic causal explanations on prejudice, the opinions, and experiences of recipients of antipsychotic and antidepressant medication, and the role of the pharmaceutical industry in mental health research and practice. John is on the Boards of the Hearing Voices Network – England, the International Institute for Psychiatric Drug Withdrawal and the UK branch of the International Society for Psychological and Social Approaches to Psychosis (www.isps.org). He is the Editor of the ISPS scientific journal ‘Psychosis.’
Lee Coleman – The Insanity Defence, Storytelling on the Witness Stand
This week on MIA Radio, we present our second chat with Doctor Lee Coleman. In the first interview in this series, we discussed Lee’s career, his views as a critical psychiatrist and his 1984 book Reign of Error. For this second interview, we focus on psychiatry in the courtroom and why the psychiatric expert witness role may be failing both the individual on trial and society at large. We also focus on Chapter 3 of Reign of Error: The Insanity Defence, Storytelling on the Witness Stand. In this episode we discuss: What led Lee to his involvement in the courtroom as a psychiatrist testifying as to the reliability of psychiatric testimony itself. How both psychiatrists and psychologists have been given a role by society to judge both the current mental state of an individual on trial and also the potential future behaviour of that individual. How important it is to address the three dimensions of past, present and future when looking at psychological testimony. The role of psychiatry in the trial of Patty Hearst, when required to provide evidence that she has been brainwashed and therefore was incompetent to stand trial. How Lee and a colleague, George Alexander, came to arrange a press conference to address the issue of the reliability of psychiatric or psychological testimony. How speaking out in this way ultimately led to many years of opposition not only by psychiatry but also by attorneys on both sides of the debate. The legal definition of the term ‘insanity’ and the context in which it is used. How if someone is found legally insane, the punishment may be far worse and the incarceration far longer than if that person were found guilty. The details surrounding the trial of Dr. Geza De Kaplany, who committed a gruesome murder but came to be represented at trial as having multiple personalities and being mentally disordered. The inconsistency often found in both the defense and prosecution in the courtroom when it comes to subjective assessments of the mental state of an individual. That it is crucial that people band together to share information and to actively demonstrate and have conferences and influence legislators because we can’t rely on media channels and we can’t rely on professional bodies. Relevant Links: Doctor Lee Coleman The Reign of Error YouTube - Competent to Stand Trial?- A Psychiatric Farce YouTube - Society Doesn't Need Protection from the "mentally ill" The Trial of Patty Hearst Geza De Kaplany To get in touch, email us at firstname.lastname@example.org
Mark Horowitz - Peer-Support Groups Were Right, Guidelines Were Wrong - Tapering Off Antidepressants
Interview by Peter Simons. Dr. Mark Horowitz is a training psychiatrist and researcher and recently co-authored, with Dr. David Taylor, a review of antidepressant withdrawal that was published in Lancet Psychiatry, which we've written about here at Mad in America (see here). Their article suggests that tapering off antidepressants over months or even years is more successful at preventing withdrawal symptoms than a quick discontinuation of two to four weeks. Dr. Horowitz is currently completing his psychiatry training in Sydney, Australia, and has completed a PhD in the neurobiology of antidepressants at the Institute of Psychiatry at King's College, London. He is a clinical research fellow on the RADAR study run by University College, London. His research work focuses on pharmacologically informed ways of tapering patients off of medication. He plans to conduct studies examining the best methods for tapering medications in order to develop evidence based guidelines to assist patients and doctors.
Gail Hornstein - First-Person Accounts of Madness and Global Mental Health
This week, MIA Radio presents the fifth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team. We interview Dr. Gail Hornstein, a Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts. She is the author of To Redeem One Person is to Redeem the World: The Life of Frieda Fromm-Reichmann and, most recently, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. In her work, she chronicles both the personal narratives of people with lived experience of being treated as “mad,” and also the growing movement of survivor and service-user activism. Her Bibliography of First-Person Narratives of Madness in English (now in its 5th edition) lists more than 1,000 books by people who have written about madness from their own experience; it is used by researchers, clinicians, educators, and peer groups around the world. She is now director of a major research and training project investigating how hearing voices peer-support groups work, supported by a grant from the Foundation for Excellence in Mental Health Care. This project is training dozens of new hearing voices group facilitators across the US and sponsors research to identify the key mechanisms by which this approach works.
This week on MIA Radio, we turn our attention to Open Dialogue and we chat with psychotherapist and Open Dialogue trainer Alita Taylor. Alita is a licensed Marriage & Family Therapist, trainer and facilitator based in Tacoma, Washington USA. Her passion is working from a community-based, non-expert, need-adapted Open Dialogue perspective, which utilizes social networks, family, and co-facilitation with other professionals. In this recent blog, Alita shares why Open Dialogue ‘cannot be taught, but needs a teacher‘. Love Is In the Air… I am in love. I’m in love with this way of working. And I won’t stop. Open Dialogue Washington began in 2018 upon my graduation/commencement from Jaakko Seikkula’s dialogic approaches to couple and family therapy trainer/supervisor training, in collaboration with Dialogic Partners and the University of Jyväskylä. In 2016, I embarked to partake in the best training course I had ever experienced as a family therapist. The embodiment I experienced working with my Open Dialogue colleagues felt like the missing key in psychiatry and psychotherapy. Something intangible, yet what I knew all along. Something ineffable, yet also a shared language. Something deeply and autonomically human, yet unrepeatable and fleeting. It led me onto a moment-by-moment path where everything I learned in my 27-year long career about systemic family therapy and emergency psychiatric protocols ebbed, and the present moment of love flowed, neither the ebbing knowledge nor the cresting wisdom having any lesser value than the other. The complete work we do in mental health care is this ocean of love. We are in constant change when we are in crisis. Timelessness sets in. Growth is happening. We don’t exactly know what we need. That is what mental health work is, sitting with this human happening. In the in-between space, something happens, and we don’t know what will. This is the paradox. We are navigating the ebb and flow of incoming knowledge we have from research and the ebb and flow in each patient and family’s difficulties (the meanings they make of them). “It cannot be taught, but it needs a teacher.” After getting trained to facilitate and supervise Open Dialogue, I found that this is the crux of the work, holding more than one truth. As human beings, as a society, as mental health practitioners, we must be able to ask what is helpful, and we must be willing to co-provide this “help” creatively, without barriers, between the digitized rows and columns of tick-boxes and presumptive diagnostic menus. Remember the analog world of dials and infinite decimals? Agency lies within ourselves to expand the possibilities, to be willing to open to solutions that have not yet been tried. Michael Pohl wrote about dialogical leadership and culture in which he referenced Karl-Martin Dietz and Thomas Kracht of the Hardenberg Institute for Cultural Studies in Heidelberg, Germany. Michael remembered a discussion on whether dialogism can be taught or experienced. It was argued that the dialogic attitude cannot be learned and that any thought of teaching it is unnecessary. Michael disagreed. He writes, “It cannot be taught, but it needs a teacher.”— Medium.com, March 2018. In Helsinki and Tornio while learning the Open Dialogue approach, I had many teachers: Jorma Ahonen, Pekka Borchers, Birgitta Alakare, Aino Maija Rautkallio, Kari Valtanen, Tom Erik Arnkil, Jaakko Seikkula, Tapio Salo, Tanja Pihlaja, Eija-Liisa Rautiainen, Pekka Holm. How did they do it? To quote Birgitta Alakare when she was asked about the beginnings of the development of Open Dialogue in the 1980’s, “It was not only me, it was all of us, everyone.” When we include all the stakeholders, all the voices, polyphonically, something extraordinary is given space to emerge. This is challenging to enact when there are systems of health care based on bed occupancy, lengths of stay, productivity, staff ratios, definitions of “emergency” or “inpatient” levels of care. Well, Open Dialogue Washington is bringing to the fore the question, “What is our role as helpers??” To quote Mia Kurtti, Open Dialogue trainer of Tornio, Finland, “What are we really doing here?” Caring for our mental health, however defined (crises, hard times, depression, psychosis), is a human need that varies from moment to moment. I learn from every client and family I sit with. In Open Dialogue, multiple perspectives are allowed, in fact invited. Unusual experiences are uncategorized mystery, and understanding between client and family/social network is continuously underway. The course of schizophrenia was reversed in Western Lapland, and their inhabitants trust their mental health system. Hmmm… if we want to save State and Federal dollars and our own livelihoods, perhaps we should allow ourselves to practice psychotherapy and psychiatry with more questions than answers. Perhaps the ones in crisis will teach us what we didn’t know. Love is somewhere, here, in the air. Relevant links: Open Dialogue Washington Open Dialogue Training, April 2019 Open Dialogue UK
This week on MIA Radio, we interview Dr. Sandy Steingard. Dr. Steingard is Medical Director at Howard Center, a community mental health center where she has worked for the past 21 years. She is also Clinical Associate Professor of Psychiatry at the College of Medicine of the University of Vermont. For more than 25 years, her clinical practice has primarily included patients who have experienced psychotic states. Dr. Steingard serves as Board Chair of the Foundation for Excellence in Mental Health Care. She was named to Best Doctors in America in 2003 and writes regularly for Mad in America. She is editor of the book Critical Psychiatry, Controversies and Clinical Implications due in 2019. In this episode we discuss: What led Sandy to her career in psychiatry and her particular interest in the critical aspects of psychiatry and psychology. That Sandy’s initial interest was in biomedical explanations of psychotic experiences. How, in the late 80s, the advent of new antipsychotic drugs caused an initial excitement because of the promises made about safety and efficacy, but that Sandy came to realise the problems with the drugs. How she witnessed the over-promotion of the drugs and that the promotion was markedly different to the results of studies and her observations of patients that were taking them. How a series of disappointments and recognition of some inherent flaws in psychiatry led Sandy to her interest in alternatives. That the book, The Truth About the Drug Companies by Marcia Angel MD, had a big impact on Sandy’s view of the drugs during the 2000s. Other influential books were The Daily Meds by Melody Petersen and Side Effects by Alison Bass. That reading Anatomy of an Epidemic and particularly the problematic aspects of the long-term use of antipsychotic drugs caused Sandy to question how she was practising. That she found colleagues were sometimes angry at the conclusion that antipsychotic drugs might not be safe or lead to better outcomes for patients. That this led to the investigation of alternatives such as Open Dialog, training with Mary Olsen at the Institute of Dialogic Practice and discovering the Critical Psychiatry Network and the work of Dr. Joanna Moncreiff. How Sandy approaches practising from a critical perspective, particularly when expectations are in line with the dominant biomedical narrative. Her book, Critical Psychiatry, due in 2019 which aims to help clinicians apply transformational strategies in their clinical practices. That psychiatrists would be well served by welcoming lived experience input to their daily practice. Why informed consent should be viewed as an ongoing process rather than a one-time agreement. The problems that arise in clinical studies where experience is translated into a numerical form. Relevant links: Critical Psychiatry, Controversies and Clinical Implications (due 2019) How Well Do Neuroleptics Work? What We Are Talking About When We Talk About Community Mental Health The Truth About The Drug Companies by Marcia Angel MD (video) The Daily Meds by Melody Petersen (review) Side Effects by Alison Bass Open Dialog The Institute for Dialogic Practice Critical Psychiatry Network
Derek Summerfield - Moving Global Mental Health "Outside Our Heads"
This week, MIA Radio presents the fourth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team. Over the past three weeks, we have published interviews with many of the leading voices in this debate. Immediately following the release of the report and the beginning of the Summit, on World Mental Health Day, psychiatric epidemiologist, Dr. Melissa Raven, was on the MIA podcast. She questioned the evidence base of the movement, pointing to statistical issues in the prevalence rates of mental disorders internationally, and called for a focus on addressing barriers to health rather than on individualized treatment. Mental health service-user activists, Jhilmil Breckinridge, of the Bhor Foundation in India, and Dr. Bhargavi Davar, of Transforming Communities for Inclusion (TCI) Asia Pacific were also on the podcast. Each discussed the lack of involvement of service-user and disability rights groups in the UK Summit and Lancet report and laid out alternative frameworks for addressing distress in ways that are sensitive to culture and social context. Next, Dr. China Mills, a critical psychologist and author of Decolonizing Global Mental Health, spoke to my colleague, Zenobia Morrill, about her experience attending the UK summit and the lack of attention that has been given to the ways in which austerity policies in Britain have contributed to the increased demand for mental health interventions. You can find these earlier interviews at the links below: 10/10/18 - Interview with Dr. Melissa Raven, psychiatric epidemiologist - The Global ‘Mental Health’ Movement – Cause For Concern 10/20/18 – Interviews with mental health service-user/psychosocial disability rights activists Jhilmil Breckenridge and Dr. Bhargavi Davar - Global Mental Health: An Old System Wearing New Clothes 10/24/18 – Interview by MIA research news editor Zenobia Morrill with Dr. China Mills, a critical psychologist and prominent critic of the global mental health movement – Coloniality, Austerity, and Global Mental Health Today I am very pleased to announce that we are joined by Dr. Derek Summerfield. Dr. Summerfield is an honorary senior lecturer at the Institute of Psychiatry in London and former Research Associate at the Refugee Studies Centre at the University of Oxford and consultant and Oxfam. He was born in South Africa and trained in medicine and psychiatry at St. Mary’s Hospital Medical School in London. Dr. Summerfield has published hundreds of articles in medicine and social science and has contributed widely to understanding the impact of war-related trauma and torture on people around the world. He has been an outspoken critic of the global mental health movement for several years, criticizing the medicalization of trauma through PTSD, the exaggerated prevalence rates in the epidemiological data, and the lack of awareness of the different cultural experiences and understandings of distress.
China Mills - Global Mental Health - Coloniality, Technology and Medicalization
Today, we bring you the third in our series of podcasts on the topic of the global mental health movement. Part one of the series featured Dr Melissa Raven and part two featured Jhilmil Breckenridge and Dr Bhargavi Davar. These interviews are led by our Mad in America research news team. In this episode, we interview Dr China Mills. China participated in organizing the open letter in response to The Lancet Commission on Global Mental Health and Sustainable Development. In this interview, China shares her concerns and reactions to the Lancet’s proposal, elaborating on deeper issues related to the framing of global mental health as a “burden” and the underlying implications of coloniality, technology, and medicalization. In addition, China tells us about her insider perspectives after attending the Global Mental Health Ministerial Summit hosted by the UK government. In her recent piece for Mad in Asia about the summit, she writes: “It was ironic to listen to a range of UK Government minsters talk about the importance of mental health whilst sat in a room just over the river from Westminster, where governmental decisions to cut welfare, and sanction and impoverish disabled welfare claimants has so detrimentally impacted people’s mental health and led to suicide. It felt like arrogance on the part of the UK Government to position themselves as world leaders in mental health when in 2016, the UN found that the Government’s austerity policies had enacted ‘grave’ and ‘systematic violations of the rights of persons with disabilities’ . It was equally jarring, given the cuts to social security under austerity, to be transported by boat about 2 minutes away, to an evening drinks reception at the Tate gallery.” China Mills is a Lecturer in the School of Education, University of Sheffield, UK. Her research develops the framework of psychopolitics to examine the way mental health gets framed as a global health priority. In 2014, she published the book ‘Decolonizing Global Mental Health’ and has since published widely on a range of topics including: the inclusion of mental health in the sustainable development goals; the quantification of mental health and its construction as a technological problem; welfare-reform, austerity and suicide; and the intersections of psychology, security and curriculum. She is Principal Investigator on two British Academy funded projects researching the social life of algorithmic diagnosis and psy-technologies. China is a member of the editorial collective for Asylum magazine and for the journal, Critical Social Policy; and she is a Fellow of the Sheffield Institute for International Development (SIID).
Jhilmil Breckenridge and Bhargavi Davar - Global Mental Health - An Old System Wearing New Clothes
Today, we bring you the second in our series of podcasts on the topic of the global mental health movement. These interviews are led by our Mad in America research news team. On October 9th and 10th, 2018, World Mental Health Day, the UK government hosted a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement mental health policies globally. In the same week, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal for “scaling up” mental health care globally. In response, a coalition of mental health activists and service-users have organized an open letter detailing their concerns with the summit and report. The response has attracted the support of policy-makers, psychologists, psychiatrists, and researchers. In our last episode, we were joined by Dr Melissa Raven, a critical psychologist and epidemiologist, who discussed problems with the scientific evidence base used by the global mental health movement. She also emphasized the need to consider responses to the distress and suffering of people globally that address the social determinants of mental health, including poverty, education, and healthcare. Today we turn our focus to the concerns raised by mental health activists in response to the UK summit and the Lancet report. To discuss these issues, we are joined first by Jhilmil Breckenridge, a poet, writer and mental health activist and later by social science researcher Dr Bhargavi Davar. Jhilmil is the Founder of Bhor Foundation, an Indian charity, which is active in mental health advocacy, the trauma-informed approach, and enabling other choices to heal apart from the biomedical model. Jhilmil also heads a team leading Mad in Asia Pacific; this is an online webzine working for better rights, justice and inclusion for people with psychosocial disability in the Asia Pacific region. She is currently working on a PhD in Creative Writing in the UK and, for the last three years, she has also been leading an online poetry as therapy group for women recovering from domestic violence. She is working on a few initiatives, both in the UK and India, taking this approach into prisons and asylums. Her debut poetry collection, Reclamation Song, was published in May 2018. For our second interview, we are joined by Dr Bhargavi Davar. She identifies as a childhood survivor of psychiatric institutions in India. She went on to train as a philosopher and social science researcher at the Indian Institute of Technology in Bombay and has published and co-edited several books, including Psychoanalysis as a Human Science, Mental Health of Indian Women, and Gendering Mental Health, while also producing collections of poems and short stories. Dr Davar is an international trainer in the Convention on the Rights of Persons with Disabilities (CRPD) and the founder of the Bapu Trust for Research on Mind and Discourse in Pune, India. This organization aims to give visibility to user/survivor-centred mental health advocacy and studies traditional healing systems in India.
Melissa Raven - The Global Mental Health Movement - Cause for Concern
This week, we present the first in a series of interviews on the topic of the global ‘mental health’ movement. These interviews will be led by our Mad in America research news team and today’s interview is hosted by our lead research news editor, Justin Karter. In this episode, Justin interviews Dr Melissa Raven, who is a psychiatric epidemiologist, policy analyst and postdoctoral research fellow in the Critical and Ethical Mental Health research group at the University of Adelaide, South Australia. Originally qualified as a clinical psychologist, she then worked as a lecturer and researcher in public health and primary health care. Her current mental health research and advocacy is informed by a strong social determinants perspective and a strong critical orientation, which she applies to a range of topics, including suicide prevention, workplace mental health, (over)diagnosis, (inappropriate) prescribing, and conflicts of interest in mental health and the broader health/welfare arena. On October 10th, 2018, World Mental Health Day, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal to “scale up” mental health care globally. At the same time, the UK government is hosting a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement these mental health policies globally. In response, a coalition of mental health activists and service-users have organized an open letter detailing their concerns with the summit and report. The response has attracted the support of critical professionals, psychologists, psychiatrists, and researchers.
Sharna Olfman Ph.D interviews Zach Bush MD One of the few triple board-certified physicians in the country, with expertise in Internal Medicine, Endocrinology and Metabolism, and Hospice/Palliative care, Dr. Zach Bush abandoned his prestigious academic career in cancer research, and his conventional medical practice a decade ago, after coming to terms with the fact that not only were his pharmaceutically based research and treatment protocols ineffectual; they were making his patients sicker. He then opened a clinic in the middle of a food desert in rural Virginia, where he swapped out pharmaceutical interventions for the medicinal properties of plants. Now based in Charlottesville, Dr. Bush has assembled an outstanding group of scientists and clinicians who are at the forefront of research on the microbiome and epigenetics. He has developed an impactful approach to healthcare which directly challenges ‘big farming, ‘big pharma’ and conventional medicine. https://www.madinamerica.com/2018/10/healthy-planethealthy-mind-zach-bush-md/
John Read and Sue Cunliffe - The 57th Maudsley Debate - This House Believes that ECT has no Place in Modern Medicine
This week on MIA Radio we turn our attention to Electroconvulsive Therapy (ECT) or Electroshock as it’s known in the US. On Wednesday, September 19th, this emotive and controversial intervention was discussed at the 57th Maudsley debate, held at Kings College London. The motion proposed was: “This house believes that ECT has no place in modern medicine”. Supporting the motion were Professor John Read who has undertaken several scientific reviews of the literature supporting the use of ECT and Dr Sue Cunliffe. Dr Cunliffe was a paediatrician until she herself underwent ECT, after which she became cognitively impaired and found herself unable to continue working. She now campaigns for the risks of ECT to be made more explicit and to directly address the professional denial of the damage that ECT can cause. Speaking against the motion were Professor Declan McLoughlin and Dr Sameer Jauhar. Both John and Sue took time out to talk about the debate and the wider issues surrounding ECT. Professor Read kindly shared his debate notes, which are provided below. Thank you to the Institute for bringing us all together. Let us first remind ourselves tha thistory is littered with procedures which people believed in- just as strongly as some psychiatrists believe, today, in electrocuting people’s brains to cause seizures - but which turned out to be ineffective or damaging. The list includes spinning chairs, surprise baths, standing people next to cannons, and, more recently, lobotomies. It was 80 years ago, in 1938, that Ugo Cerletti administered the first ECT, to a homeless man in Rome. After the first shock the man called out ‘Not another – it will kill me’. The theory back then was that people with epilepsy didn’t have schizophrenia so the cure for schizophrenia was to cause epilepsy. So Cerletti was driven by the genuine belief that causing convulsions by shocking the brain really might help people, by the genuine hope that we might finally have come up with an effective treatment. The story of ECT illustrates, yet again, however, what happens when our beliefs and good intentions are not tempered with good science. ECT quickly spread from Rome across Europe and America. Finally, an effective treatment! People who received it were discharged earlier….… by the doctors who gave it. But there were no studies for 13 years, by which time everyone just knew it worked, and their belief may have been very helpful to some patients. The first study on depression (which became the main target for ECT), in 1951, found that those who had ECT fared worse than those who had not had it. It made no difference. I have co-authored four reviews of the ECT research, most recently last year. There are only ten depression studies comparing ECT and placebo; placebo meaning the general anaesthetic is given but the electric shock is withheld. Five of those 10 found no difference between the two groups. The other five found, compared to placebo, a temporary lift in mood during the treatment period, among about a third of the patients. One of these five found that this temporary improvement was perceived only by the psychiatrists, but not by the nurses or the patients. Most reviews and meta-analyses assert, on the basis of these temporary gains in a minority of patients, that ‘ECT IS EFFECTIVE’ But none of them have ever identified a single study that found any difference between ECT and placebo after the end of the treatment period. There is just no evidence to support the belief that ECT has lasting benefits, after 80 years of looking for it. Similarly, there are no placebo studies to support another genuinely held belief: that ECT prevents suicide. There is nothing wrong with treatments working because of hopes and expectations. But passing 150 volts through brain cells designed for a tiny fraction of one volt causes brain damage. Indeed, autopsies quickly led to a new theory about how ECT works. In a 1941 article entitled ‘Brain damaging therapeutics’, the man who introduced ECT to the USA, wrote ‘Maybe mentally ill patients can think more clearly with less brain in actual operation’. In 1974 the head of Neuropsychology at Stanford wrote: ‘I’d rather have a small lobotomy than a series of ECT….I know what the brain looks like after a series of shock’. All ECT recipients experience some difficulties laying down new memories and in recalling past events. What is disputed is how many have long-lasting or permanent memory dysfunction, which might reasonably be called brain damage. Findings range from one in eight to just over half. A review of studies that actually asked the patients, conducted here at the Institute, found ‘persistent or permanent memory loss’ in 29 to 55%. Yet another belief is that ECT used to cause brain damage, in the bad old days, but not any more. But a recent study found one in eight with ‘marked and persistent’ memory loss, ….. and also found much higher rates among the two groups who receive it most often, women and older people. The same study also found that the memory loss was not related to severity of depression. This is important because another belief about ECT is that the memory loss is caused by the depression, not the electricity. Psychiatric bodies in the UK and USA recite the belief that only ‘one in 10,000’ will die from having ECT, without producing a single study to support that belief. Our reviews document large-scale studies with mortality rates between one in 1400 and one in 700, several times higher than the official claims, typically – unsurprisingly - involving cardiovascular failure. ECT in England has declined, from 50,000 a year in the 1970s to about 2,500. The number of psychiatrists who still believe, despite all the evidence, is dwindling fast. It may have been understandable for the psychiatrists of the 1940s to believe that ECT worked and was safe. They didn’t know any better. But if psychiatry wants to be an evidence-based discipline, to be part of modern medicine, it must acknowledge that, despite all its honourable intentions, it has got this one, like lobotomies, woefully wrong. Thank you. Links and Further Information To watch the debate on YouTube, click here. To read a report on the first ever Maudsley Debate, held in January 2000, which also discussed ECT, click here. ECT Accreditation Service (ECTAS) MECTA The effectiveness of electroconvulsive therapy: A literature review, John Read and Richard Bentall Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009
Julia Rucklidge - Nutrition, Mental Health and TED
This week on MIA Radio we interview Dr Julia Rucklidge. Dr Rucklidge is professor of clinical psychology at the University of Canterbury in New Zealand and she leads the Mental Health and Nutrition Research Group. Originally from Toronto, Canada, Julia completed her PhD at the University of Calgary followed by a post-doctoral fellowship at the Hospital for Sick Children in Toronto. In the last decade, she and her lab have been running clinical trials investigating the role of broad-spectrum micronutrients in the expression of mental illness, specifically ADHD, mood disorders, anxiety and stress. Julia has over 100 peer-reviewed publications and book chapters, has been frequently featured in the media and has given invited talks all over the world on her work on nutrition and mental health. We discuss: What led Julia to her interest in nutrition and how it may have a role in responding to mental disorders, particularly Attention Deficit Hyperactivity Disorder (ADHD). Why using the Recommended Dietary Allowance (RDA) of vitamins and minerals may not be the best approach when responding to psychological difficulties. How Julia went about setting up a Randomised Controlled Trial to investigate the effect of micronutrients and minerals on behavioral problems. That the most consistent finding of the study is that the individuals taking micronutrients improved more in their general functioning and impairment when compared to those just taking a placebo. That it’s hard to move away from the conception of mental illness as a chemical imbalance in the brain, partly because of the vested interest in keeping it alive. That there is no opportunity to patent nutrient therapies, so there is little incentive for research and limited commercial interests. Why a single nutrient response might not be the best approach for someone who wanted to use nutrition to improve their mental health and wellbeing. How a dietary deficiency of Niacin during the 1930s led to a condition called Pellagra which often manifested as psychotic symptoms. What led to the flagging of a 2014 TEDx talk Julia gave entitled “The surprisingly dramatic role of nutrition in mental health”. How Julia felt about her talk being flagged by TED. How many historical medical advances, now accepted as the standard of care, at the time flew in the face of conventional scientific thinking. How difficult it has been to communicate with TED about the flagging of the talk. How Julia hears from many people who get in touch to share that they are struggling with psychiatric medications and instead want to look to nutritional solutions. That the best advice is often simple, eat more fruits and vegetables and reduce the amount of processed food. Relevant Links: Mental Health and Nutrition Research Group Vitamin-mineral treatment of ADHD in adults: A one year follow up of a randomized controlled trial. Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients A double-blind randomised, placebo-controlled trial of a probiotic formulation for the symptoms of depression TEDx Christchurch: The Surprisingly Dramatic Role of Nutrition in Mental Health TED Betrays Its Own Brand By Flagging Nutrition Talk Contact the Mental Health and Nutrition Research Group Mad Diet by Suzanne Lockhart
World Benzodiazepine Awareness Day 2018 - Part 2 - Robert Whitaker
This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 2 of the podcast, we interview Mad in America founder, Robert Whitaker. For many of us, Robert needs no introduction as he is well known for his award-winning book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, which was released in 2010. Robert has been a medical writer at the Albany Times Union newspaper, A journalism fellow at the Massachusetts Institute of Technology and Director of publications at the Harvard Medical School. Besides many papers, journals and articles, Robert has written five books which include Mad In America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001, Anatomy of an Epidemic in 2010 and Psychiatry Under The Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform published in 2015. We discuss: What took Bob from writing as an industry insider covering clinical trials to founding Mad in America. How writing a story about the botched introduction of laparoscopic surgery led to an interest in how commerce was corrupting healthcare. How Freedom of Information requests led to an understanding of the corruption in the clinical trials of antipsychotic drugs. What led to writing the book Mad in America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001. That, when you look at the science, you see an enduring theme in psychiatry of treatments that are full of promise, but ultimately can lead to harm. That Bob came to these issues as a journalist who felt a sense of public duty to be an honest reporter of the facts and the science. The extraordinary history behind the revival of the market for benzodiazepines. How Valium became the western world’s most prescribed psychiatric drug during the late 1960s. How, in the 1970s, it became apparent that people were struggling to get off the drugs. That women’s magazines started to write about the experiences of women addicted to Valium, and it was recognised as a bigger issue than heroin addiction. That the reaction by the pharmaceutical manufacturers was to reconceptualize anxiety-related distress as depressive distress and move patients on to SSRIs. How in 1980, in the third version of the Diagnostic and Statistical Manual, a new disorder is named: Panic Disorder, leading the maker of Alprazolam, Upjohn, to get it approved specifically for the treatment of panic disorder. How the study published showed that the reduction in panic attacks in the medicated group over four weeks was greater than the unmedicated group, but the study actually ran for eight weeks, by which time there was no difference between the medicated and unmedicated groups. That in the six-week withdrawal phase of the study, 44% were not able to stop the drugs. How newspapers reported that Xanax (Alprazolam) was an efficacious, safe and non-addictive treatment for panic disorder. That what you see in the heart of the Xanax story is a betrayal of the public. The reasons why doctors often don’t review the papers that would lead them to conclude that benzodiazepines are highly problematic drugs. A paper from a new International Task Force on Benzodiazepines which seems to be a statement of intent to increase benzodiazepine prescribing. That people should keep on telling their stories of withdrawal and iatrogenic harm. The attempt in Massachusetts to pass a bill requiring informed consent. The problems inherent in using the language of withdrawal when the symptoms are protracted and that it would be more appropriate to describe this as a neurological injury. That the benzodiazepine community is doing an incredible service by alerting the public to what should be seen as a public health crisis. Relevant links: Revival of the market for Benzodiazepines Malcolm Lader: It is more difficult to withdraw people from benzodiazepines than it is from heroin International Task Force on Benzodiazepines
World Benzodiazepine Awareness Day 2018 - Part 1 - Nicole Lamberson, Josef Witt-Doerring, Chris Paige
This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 1, we chat with W-BAD Lead Operations Volunteer and Virginia Representative Nicole Lamberson who talks about the events being held for W-BAD. We hear from psychiatrist Dr Josef Witt-Doerring, who talks about a recent paper he co-authored entitled “Online Communities for Drug Withdrawal: What Can We Learn?”. We also hear from therapist and campaigner Chris Paige who discusses his own experiences taking and withdrawing from benzodiazepines. Finally, in part 2 of the interview, we get to chat with Robert Whitaker, science journalist and author of the books Mad in America and Anatomy of an Epidemic. First, I am very fortunate to have had the chance to talk with Nicole Lamberson. Nicole is Lead Operations Volunteer and Virginia Representative for W-BAD and she has kindly taken time out of her busy preparations to talk about how she became involved with W-BAD, some of the events and campaigns being held around the world and how people can get involved. Nicole has an immense passion for benzodiazepine awareness and its victims and hopes that her efforts ultimately spare many others from taking this painful, senseless, and totally preventable iatrogenic “journey”. We discuss: How Nicole first became involved with W-BAD. How discovering personal testimonies encouraged her to reach out to find out more about an awareness day held on the birthday of Dr Heather Ashton - July 11. What it feels like to be part of the benzodiazepine community. How there is is still no medical consensus about the effects of both taking and withdrawing from benzodiazepines. The W-BAD T-shirt campaign, which was organised in partnership with the Benzodiazepine Information Coalition and As Prescribed, an in-production documentary by Holly Hardman. Pamphlet distributions happening in Auckland, Paris, Boston and Torrington. That Wayne Douglas, W-BAD founder is on the Dr Peter Breggin hour on July 11 at 4pm New York time. That people can visit W-BAD events to find out more. That on social media, people can follow events using @WorldBenzoDay and the hashtag #WorldBenzoDay. That people can participate in many ways and that one of the most important ways to participate is to submit reports of adverse effects and withdrawal reactions to the appropriate regulator, links to which can be found on the W-BAD website. How important it is to share stories and personal experiences. That W-BAD is for anybody, not just those who are damaged by the drugs but also for families and friends and those recovered too. Relevant links: W-BAD [IN]VISIBLE T-shirt campaign How to participate in W-BAD Benzodiazepine Information Coalition As Prescribed by Holly Hardman (documentary film in production) International Task Force on Benzodiazepines Dr Heather Ashton The 2017 W-BAD podcast featuring Professor Malcolm Lader, Jocelyn Pedersen and Barry Haslam. Next, we chat with psychiatrist Dr Josef Witt-Doerring. Josef trained in Queensland, Australia before becoming a psychiatric resident at Baylor College of Medicine, Houston, Texas. He co-authored a paper published in Psychiatric Times entitled “Online Communities for Drug Withdrawal: What Can We Learn?” which received praise for openly addressing the issues of dependence and withdrawal and identifying the support activity that goes on in forums like Benzo Buddies and Surviving Antidepressants. We discuss: What led Dr Witt-Doerring to become a psychiatric trainee after attending medical school in Queensland, Australia. How reading Anatomy of an Epidemic led to an awareness of some of the consequences of psychiatric drug use from a critical perspective. What led to his research into online support forums for those who are seeking support for psychiatric drug withdrawal. That Josef was surprised at the amount of support activity in online forums like Benzo Buddies and Surviving Antidepressants. How the paper that Josef co-authored on learning from online communities found a great deal of support both amongst colleagues and patient advocacy organisations. How he feels that there is a general lack of awareness of dependence and withdrawal issues because the messages can be drowned out by more strident communications in marketing or promotional material. That the idea of ‘treatment resistant’ conditions is probably much more on a general doctors mind than adverse reactions or protracted withdrawal experiences. How Josef’s experiences have influenced his approach to prescribing central nervous system drugs. That he would like to think that if a doctor and patient can talk frankly and openly about the pros and cons of treatment, then that is likely to lead to a better relationship and a better outcome. That there is a dearth of support services for people struggling with the drugs, particularly at the end of treatment. How academic detailing programmes could help raise awareness and disseminate information that would lead to doctors being more confident about de-prescribing. How the language of addiction and dependence can sometimes be a barrier to recognition of drug withdrawal issues. That it may be better to look through a neurological injury lens rather than an addiction lens both in terms of understanding experiences but also to enable better treatment and support options. That the community of those affected should continue to share their stories and to raise petitions with professional organisations, such as the boards that licence psychiatrists and OBGYN’s. How, because of the huge variation in patient experience, it would be very difficult to mandate short-term prescribing. Relevant links: Online Communities for Drug Withdrawal: What Can We Learn? Benzo Buddies Benzodiazepine Information Coalition Surviving Antidepressants Malcolm Lader: Anxiety or depression during withdrawal of hypnotic treatments Our next guest is Chris Paige. Chris has a bit of an 'inside' perspective to add to the conversation for World Benzodiazepine Awareness Day in that he is a licensed therapist of over 20 years who was iatrogenically injured by a prescribed benzodiazepine. Chris has practised in a variety of settings including hospitals, schools, and foster homes and has taught at the undergraduate and graduate level. He has presented papers at national and international conferences, appeared on Dateline NBC for his work with children of divorce and had his own national magazine column called 'On The Couch with Chris Paige'. Chris is on the board the Benzodiazepine Information Coalition, a non-profit organization that advocates for greater understanding of the potentially devastating effects of commonly prescribed benzodiazepines as well as prevention of patient injury through medical recognition, informed consent, and education. Chris currently resides and practices in Florida. We discuss: How Chris first came to be prescribed a benzodiazepine in 2000. His recollections of being prescribed Klonopin (Clonazepam) for anxiety, taking between 1 and 2 milligrams per day. How, after three years use, he started to notice tremors and memory loss. That a neurologist explained that his symptoms may be medication related and advised a taper but gave no specific instructions. How Chris came off the Klonopin fairly rapidly but didn’t find it too difficult at the time. How, some years later, he was given an antibiotic for a prostate infection but rapidly developed psychiatric symptoms including anxiety, agitation and insomnia. That this led Chris to consult a doctor for some Klonopin tablets to manage this and that he took a total of 16 milligrams over the next 10 weeks. That he understands now that the antibiotic and the Klonopin compete at the same receptor in the brain, leading immediately to a tolerance to the drug. That because of this tolerance he became more sleepless, more agitated and more anxious and working was becoming increasingly difficult. How he came to be in a five-day detox programme in Vermont, where they took him off one and a quarter milligrams of Klonopin in just five days. How Chris realised that the detox approach was not right and wanted to leave. How the detox programme decided to replace the Klonopin with four different psychiatric drugs, two of which he has now ceased with two still to taper. That he felt that his brain and nervous system were severely shocked by making such rapid medication changes. How this led to Chris being admitted to psychiatric hospital which he describes as “possibly one of the most humiliating experiences he has ever endured.” How Chris felt when experiencing akathisia which was a relentless compulsion to move and gave him a feeling as if his whole body was being electrocuted and that he had been lit on fire. That he initially felt supported by friends and family but that quickly eroded when he didn't get better or accept harmful and dangerous treatment advice. That this led to the misunderstanding of his injury and it being mislabeled as an addiction problem. That ultimately the only places he found validation and support were online support forums. The losses that Chris endured during his struggles including his health, his psychotherapy practice and even his reputation. That Chris’s message is that there is hope for the future and the importance of reconnecting with the simple things in life. The lack of acknowledgement of the impact of trauma on a person’s life. Relevant links: Benzodiazepine Information Coalition Chris's profile at BIC In part 2 of this podcast, we will hear from science journalist and author Robert Whitaker.
Laura Delano - Connecting people through the Inner Compass Initiative and Withdrawal Project
This week, we interview Laura Delano. Laura is Co-Founder and Executive Director of the Inner Compass Initiative and The Withdrawal Project, which aim to create safe spaces for people to connect and the opportunity to learn about and be guided through the process of getting beyond the mental health system and off psychiatric drugs. The passion she feels for the mission and vision of ICI arises from the fourteen years she spent lost in the mental health system and the journey that she’s been on since 2010, when she chose to leave behind a “mentally ill” identity and the various treatments that came with it, and gradually began to rediscover and reconnect with who she really was and what it means to suffer, struggle, and be human in this world. Since becoming an “ex-patient”, Laura has been writing and speaking about her personal experiences and about the broader social and political issues sitting at the heart of “mental illness” and “mental health”. Since 2011, she has worked both within and beyond the mental health system. In the Boston area, she worked for nearly two years for a large community mental health organization, providing support to and advocating for the rights of individuals in emergency rooms, psychiatric hospitals, and institutional “group home” settings. After leaving the “inside” of the mental health system, she began consulting with individuals and families seeking help during the psychiatric drug withdrawal process. Laura has also given talks and workshops in Europe and across North America, facilitated mutual-aid groups for people in withdrawal, and organized various conferences and public events such as the Mad in America International Film Festival. In this interview, we got time to talk about Laura’s personal experiences of the mental health system and what led her to co-found the Inner Compass Initiative and The Withdrawal Project. In this episode we discuss: Laura’s experiences as a patient in the mental health system, starting treatment aged thirteen and leaving the system behind aged 27. How she spent much of that time as a compliant patient, taking the medications and following the advice of her doctors. That, by 2010, she was on 5 medications (Lithium, Abilify, Lamictal, Effexor and Ativan) and had spent the last decade becoming worse and unable to properly engage with life. How she came to read Anatomy of an Epidemic by Robert Whitaker and that it was a profound moment of realisation. That Laura decided to take control of her life and became determined to get off the drugs as quickly as possible. How traumatic it was to come to the realisation that almost everything she had been told during treatment was overly simplistic or incorrect. That Laura did experience feelings of being a victim of psychiatry, but realised that this increased her emotional dependency on psychiatry and that it was necessary to move beyond that to feel free. That these experiences made Laura passionate about her own process of healing and rediscovering herself and helping others to find their way back to themselves after being psychiatrized. That as she healed she moved into a space of acceptance and gratitude and felt that the period around three years off the drugs was when she came to feel really alive and motivated again. That Laura feels that if we are going to move beyond the mental health system, it is about helping people to realise they don't need the mainstream system and point them to alternatives at a local level and creating physical spaces where people can come together. How Laura came to co-found The Inner Compass Initiative and The Withdrawal Project which aim to create safe spaces for people to connect and the opportunity to learn about and be guided through the process of getting beyond the mental health system and off psychiatric drugs. That The Withdrawal Project was highlighted in a recent New York Times article discussing antidepressant withdrawal. How ICI and TWP present information on many aspects of psychiatric drugs and withdrawal to help guide and inform people who do want to start the journey off their psychiatric drugs and away from the mental health system. That TWP connect is a free peer to peer networking platform that allows people to connect one on one with others who have similar experiences. How a similar peer to peer system is available on ICI to enable conversations about moving beyond the mental health system. That Laura wants to encourage people not to give up because we do heal from psychiatric drugs and that we need to spread that message far and wide. The need to both learn and unlearn when approaching how we take back our power and control of our lives after psychiatric treatment. How important it is to properly prepare before starting to taper from psychiatric drugs and how the Withdrawal Project can enable that preparation. The ‘speed paradox’ when coming off psychiatric drugs. How people can find out more about The Inner Compass Initiative and The Withdrawal Project. That Laura is keen to support local community initiatives to get underway. Relevant links: The Inner Compass Initiative The Withdrawal Project TWP Connect Learn about psychiatric drug withdrawal Inner Compass Initiative’s The Withdrawal Project Gets Mention in The New York Times—Is the Tide Finally Turning? The New York Times - Many People Taking Antidepressants Discover They Cannot Quit Read more about Laura’s journey into and out of the mental health system Laura’s presentation in Alaska, 2015 Anatomy of an epidemic by Robert Whitaker
John Read - UK Royal College of Psychiatry Refuses to Retract Misleading Statement about Antidepressant Withdrawal and Dismisses Complaint
Today on MIA Radio we have a special episode which is devoted to recent developments in the UK involving a formal complaint lodged with the UK Royal College of Psychiatrists. Professor John Read from the University of East London took time out to bring us up to date on the response to the complaint which was lodged on behalf of a group of thirty academics, psychiatrists and people with lived experience. Relevant links: Read the full reply letter on Mad in America Hear the Royal Society of Medicine’s podcast interview with Professor Wessely and Dr Clare Gerada The New York Times - Many People Taking Antidepressants Discover They Cannot Quit
This week, we interview Dr Russell Razzaque. Dr Razzaque currently works as a consultant psychiatrist and associate medical director in east London and, together with colleagues, he is leading a pioneering multi-centre Open Dialogue pilot in the UK National Health Service. In 2014 he released his book ‘Breaking Down Is Waking Up’ in which he explores alternative views of mental distress, their relationship to consciousness and comparisons to forms of spiritual awakening. In this interview, we discuss the relationships between mindfulness, Acceptance and Commitment Therapy and Open Dialogue and how the UK NHS is approaching the worlds first randomised controlled trial of Open Dialogue interventions for people struggling with emotional or psychological distress. In this episode we discuss: What led Dr. Razzaque to his interest in psychiatry and in particular some of the more unconventional aspects of the profession. How beginning to practice mindfulness nearly 20 years ago led to Russell starting to feel an incongruence between the dominant philosophy in psychiatry and what he was learning from his own mindfulness practices. That the dominant philosophy is one of trying to help people remove their pain and remove them from difficult and uncomfortable experiences, but in his own personal development, he was learning to sit with the pain and finding that valuable. How this led to an interest in novel therapeutic approaches like Acceptance and Commitment Therapy, originally pioneered by professor Stephen Hayes. That Russell felt disillusioned with the way that UK mental health services and systems were organised and realised that creating better outcomes for people would require system-wide change. How Russell came to be one of the leading figures in the worlds first multi-centre, fully randomised Open Dialogue Trial which seeks to establish the evidence base for Open Dialogue. That the trial involves eight NHS Trusts across the UK and that several hundred practitioners have already been trained in Open Dialogue therapy. That during the trial there will be randomly selected postcodes receiving Open Dialogue interventions compared with randomly selected postcodes receiving treatment as usual and that the results will be compared after three years. That this trial will allow us to answer questions about the efficacy of Open Dialogue because we will have built a strong evidence base. How colleagues have reacted to the Open Dialogue trial and why some might be threatened by the need to change. That Open Dialogue is a need adapted approach, so it is not fundamentally against any of the conventional interventions, but it encourages people to make their own choices, so medication use tends to significantly reduce. That it is necessary to change the power dynamic in current systems and approaches because the current methods lead to dependency, whereas Open Dialogue is about empowering and liberating the individual. That Russell is encouraged to find that many psychiatrists are willing to open up to new ways of thinking about mental and emotional distress. How spirituality and psychiatry can work hand-in-hand and how accepting spiritual explanations can sometimes lead to better understanding of personal experiences. That, in future, the system needs to change such that interpersonal relationships are put first and are seen as the key to successful outcomes. That we also need to adapt so that clinicians are trained to be present with distress and not just try to remove it. How people can hear Russell speak at the upcoming Compassionate Mental Heath event in South Wales, being held on April 25th and 26th 2018. Relevant links: Russell Razzaque Breaking Down is Waking Up Open Dialogue trial Developing Open Dialogue Compassionate Mental Health
This week on MIA Radio we interview Dr. Duncan Double. Duncan is a Consultant Psychiatrist at the Norfolk and Suffolk NHS Foundation Trust. He is founder of the Critical Psychiatry Network and also runs a critical psychiatry blog. He edited the book Critical psychiatry: The limits of madness published in 2006 and has written a number of journal articles and book chapters. We talk about Duncan’s experiences as a critical psychiatrist working within a bio-medically oriented profession. In this interview we discuss: How reading Freud as a teenager led Duncan to his interest in psychiatry. That, early in his training, he found it difficult to take to the overly physicalist aspects of what he was expected to learn. How he became interested in the work of RD Laing and Thomas Szsaz. How he left his studies for a time, working with drug users in London, studying for a psychology degree and working in banking. The formation of the Critical Psychiatry Network in January 1999. How critical psychiatrists take a different perspective from mainstream psychiatrists who tend to believe that mental illness is a brain disease. That critical psychiatrists are not so interested in arriving at a single word diagnosis, instead the focus is on understanding the person and why they have presented with the problems they have in the context of their life situation. That critical psychiatrists aim to minimise the use of coercion and have been against the introduction of community treatment orders. That the emphasis in treatment is on helping people improve their social situation and to be as independent as they want to be. How Duncan felt about a period of suspension which arose partly because of his different practices, being less concerned about formal diagnosis and using less medication than other psychiatrists. That critical psychiatry is still looking for more acceptance from the mainstream. That Duncan welcomes the more recent emphasis on recovery in mental health services. That Duncan does use medication but is very aware that the evidence for psychiatric treatment is biased for methodological reasons, for example, the difficulties having properly blinded placebo-controlled trials. That good science is often being sceptical about the evidence. That people can form attachments to their medication, so it is not surprising that people may become dependent on it and therefore may have discontinuation problems. Duncan’s critical psychiatry blog which he would like to invite readers to visit and that he would like to develop an Institute of Critical Psychiatry. Relevant Links: Critical Psychiatry Blog Critical Psychiatry Website The Critical Psychiatry Network Critical Psychiatry: The limits of madness (2006) My tutor said to me, this talk is dangerous What is Critical Psychiatry?
Tina Minkowitz - The Abolition of Forced Psychiatric Interventions
This week on MIA Radio, we interview Tina Minkowitz. Tina is an attorney and survivor of psychiatry who represented the World Network for Users and Survivors of Psychiatry in the drafting and negotiation of the United Nations’ Convention on the Rights of Persons with Disabilities. Tina is a strong proponent for the abolition of all forced psychiatric interventions and played a major role in attaining a shift in international law in favor of such a ban. In this interview, we talk about how the United Nations came to support the abolition of forced psychiatric treatment and why Tina believes that abolition of forced treatment, not reform, is necessary. In this episode we discuss: How Tina came to be interested in the intersection of international human rights law, disability rights law, and the issue of forced psychiatric treatment Why Tina believes in the abolition, not reform, of forced psychiatric treatment That the threat of forced treatment against some psychiatric survivors can be traumatic to the entire survivor community The barriers to the abolition of forced treatment, including public perceptions of people labeled mentally ill and lack of awareness of non-coercive alternatives That advocacy is needed to eliminate the 72-hour hold, not just ECT, forced drugging, or outpatient commitment Why forced treatment constitutes physical violence That we don’t need to put in place alternatives to the current mental health system in order to demand an immediate stop to forced treatment How mental health policy should center what we now consider alternative practices, such as peer-run services, hearing voices groups, and in-home supports How the issue of forced treatment fits within the disability rights framework Tina’s current activities with the Center for the Human Rights of Users and Survivors of Psychiatry Relevant Links: The Center for the Human Rights of Users and Survivors of Psychiatry Campaign to Support CRPD Absolute Prohibition of Commitment and Forced Treatment CRPD Course Committee on the Rights of Persons with Disabilities Convention on the Rights of Persons with Disabilities
John Read - The UK Royal College of Psychiatrists and Antidepressant Withdrawal
Today on MIA Radio we have a special episode which is devoted to recent developments in the UK involving the Royal College of Psychiatrists. These events relate to the media coverage of a widely reported antidepressant meta-analysis in the Lancet, information on antidepressant withdrawal effects and a letter to The Times newspaper by the President of the Royal College Professor Wendy Burn and the Chair of the Royal College’s Psychopharmacology Committee, Professor David Baldwin. Professor John Read from the University of East London took time out to explain recent events and to talk about a formal complaint which has been lodged with the Royal College on behalf of a group of eminent psychiatrists and psychologists. Relevant links: Read the letter on Mad in America Press Release by the Council for Evidence-Based Psychiatry The Times: More People Should Get Pills to Beat Depression The Royal College’s leaflet on Antidepressant Withdrawal
Joanna Moncrieff - Challenging the New Hype About Antidepressants
This week, we interview Dr Joanna Moncrieff. Dr Moncrieff is a psychiatrist, academic and author. She has an interest in the history, philosophy and politics of psychiatry, and particularly in the use, misuse and misrepresentation of psychiatric drugs. As an author, Dr Moncrieff has written extensively on psychiatric drugs and her books include The Myth of the Chemical Cure, A Straight Talking Introduction to Psychiatric Drugs and The Bitterest Pills: the troubling story of antipsychotic drugs. She is one of the founding members of the Critical Psychiatry Network which consists of psychiatrists from around the world who are sceptical of the idea that mental disorders are simply brain diseases and of the dominance of the pharmaceutical industry. We talk about the recent meta-analysis of the efficacy and tolerability of 21 antidepressant drugs, widely reported in the UK news media on February 22nd. In the episode we discuss: The approach taken in the largest ever meta-analysis of efficacy and tolerability of 21 common antidepressant drugs. The problems inherent in comparing antidepressants with each other, as opposed to trials that compare the active drug to a placebo. That the main conclusion reached was that all the antidepressants studied were better than placebo at reducing depressive symptoms. The limitations of the study, particularly how response rate was selected as the primary outcome measure. That ‘response’ is mostly defined as a reduction in the Hamilton Depression Rating Scale (or other scale) rating of 50% or more during the study. That the response rate can artificially inflate the difference between drug and placebo. The problems with blinding in the supporting trials and the effects of including people who are already receiving antidepressant treatment. That the study did not include adverse effects or withdrawal difficulties, only dropout rates which are not representative of the whole picture of taking the drugs. The short-term nature of the supporting trials, mainly 8 weeks, with a range of 4 to 12 weeks, which cannot be easily compared with the real world experience of people taking the drugs for much longer periods. That, when the primary data is analysed (the depression rating scale scores) the differences between placebo and antidepressants are very small and probably clinically insignificant. The uncritical and sensational nature of the media reporting of the study and the link to the Science Media Centre. The concerns about the reporting that depression is under-treated in the UK which is not supported by the results of the study. That people should carefully consider the balance of benefit versus risk, taking into account the potential for adverse effects or difficulties stopping the drugs. Relevant links: Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis Challenging the New Hype About Antidepressants The Hamilton Depression Scale Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences Efficacy of antidepressants in adults The Science Media Centre
Will Hall - A Harm Reduction Approach to Mental Health and Wellbeing
This week, we have an interview with Will Hall. Will is a mental health advocate, counsellor, writer, and teacher. Will advocates the recovery approach to mental illness and is recognised internationally as an innovator in the treatment and social response to psychosis. In 2001, he co-founded the Freedom Center and from 2004-2009 was a co-coordinator for The Icarus Project. He has consulted for Mental Disability Rights International, the Family Outreach and Response Program, and the Office on Violence Against Women, and in 2012 presented to the American Psychiatric Association‘s Institute on Psychiatric Services. As an author, Will has written extensively on mental health, social justice, and environmental issues, he is well known for the excellent Harm Reduction Guide to Coming Off Psychiatric Medications which is one of the first places that listeners should look to for help and support when considering taking or withdrawing from psychiatric medications. Will’s latest book is Outside Mental Health: Voices and Visions of Madness, released in 2016 it presents interviews with more than 60 psychiatric patients, scientists, journalists, doctors, activists, and artists to create a vital new conversation about empowering the human spirit. Outside Mental Health invites us to rethink what we know about bipolar, psychosis, schizophrenia, depression, medications, and mental illness in society. Will also hosts Madness Radio which broadcasts on FM and is also available as a podcast. For listeners, I recommend that you listen in and subscribe to the Madness radio podcast, particularly as the Harm reduction guide to coming off psychiatric medications can be heard in full here. In this episode, we discuss: ▪How Will became involved with the psychiatric system while living in the San Francisco Bay area ▪His experiences of being treated with a wide range of psychiatric drugs ▪How he came to meet with other psychiatric survivors and take control of his own recovery ▪The setting up of the Freedom Centre in Western Massachusetts ▪The creation of the ‘Harm reduction guide to coming off psychiatric drugs’ ▪How this led to Will’s work in counselling, training and education around psychiatric drugs ▪How Will approached collaborating with a wide range of contributors to develop the Harm reduction guide ▪That Will wanted to adopt a careful, non judgemental approach to his work to support people with their medications ▪How Will feels he reached more people because they knew that they weren’t going to be judged ▪That the research and evidence does not support the idea that psychiatric drugs are treating some brain disease or correcting an underlying brain chemical imbalance ▪The fear that exists around these kind of mental health difficulties ▪The dangers of psychiatric drugs ▪That people with lived experience of psychiatric medications need to share their experiences, particularly where withdrawal is concerned ▪That sometimes passivity can contribute to reliance on medications but people need to take their health into their own hands ▪That we should really be looking to a community based approach to supporting people with emotional distress or trauma ▪That we need to create healthy communities that support each other ▪That if people are considering stopping their psychiatric drugs they should make use of the Harm reduction guide because there is no single answer ▪That people should also make sure that they have a support network in place because stopping the drugs can become an isolating experience ▪That drug withdrawal is a life change process not just a chemical change in your brain ▪That psychiatry can make not claim to have answered the mind/body question ▪That fear is a big factor when considering not relying on medication ▪That where withdrawal is concerned, time tends to be on your side if you can get through the discomfort and difficulty To listen on Mad in America: https://goo.gl/tyyLmt Podcast show notes: https://goo.gl/18cg4L To get in touch with us email: email@example.com