A CHALLENGE FOR PSYCHIATRY.

With the exception of the first six paragraphs the following article was published in the Evening Echo on Tuesday March the first.

 

February 22nd marks the first anniversary of the death of psychiatrist Dr. Michael Corry.  A gentle and soft-spoken man, Dr. Corry found himself being ostracised by his psychiatric peers for questioning the orthodox thinking and practice of modern psychiatry which he did in his book ‘Depression- an Emotion not a Disease’, co-authored with Dr. Aine Tubridy.

 

In 2006 Dr. Corry wrote “There is an urgent need for change within psychiatry.  An ever-growing number of depressed individuals, their families and mental health professionals are deeply disturbed by the way depression is currently being treated.  Psychiatry is attracting much criticism and anger from those using the service.  Anti-psychiatry movements abound, yet none exist in other branches of medicine.  Why?  Because they are all accomplishing their primary task, that of delivering the best possible service.  Meanwhile, on a worldwide scale there is a growing constituency of individuals who feel they have been traumatised during their treatment, who have found their emotional needs sidelined, their treatment ineffective, their difficulties with the side effects of medication unresolved and their spirit and dignity undermined.  For the majority, little or no healing occurs during psychiatric treatment, merely containment by ‘medication’, fostering in sufferers a climate of hopelessness, despair, fear and a life lived under-utilised and expressed.”

 

In expressing these views, Dr.Corry was placing himself on the same side as two other dissenting psychiatrists – the late Dr. Leon Mosher and Dr. Peter Breggin.  Dr. Mosher had resigned from the American Psychiatric Association in 1998.  In his resignation letter he stated “At this point in history in my view, psychiatry has been almost completely bought out by the drug companies.  Psychiatric training reflects the pharmaceutical industry’s influence as well: the most important part of a resident’s curriculum is the art and quasi-science of dealing drugs, ie prescription writing.  No longer do we seek to understand whole persons in their social contexts, rather we are there to realign our patients’ neurotransmitters.  ‘Biologically based brain diseases’ are certainly convenient for families and practitioners alike.  We are all just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible.”  Declaring that he wanted “no part of a psychiatry of oppression and social control” he concluded by asking “Is psychiatry a hoax as practiced today?  Unfortunately, the answer is mostly yes”.

 

Harvard trained Dr. Peter Breggin has been a practising psychiatrist for over forty years.  He has been called ‘the conscience of psychiatry’ for his efforts to reform the mental health field and expressing his concern about the hazards of contempory biological psychiatry, the escalating overuse of psychiatric medications, the oppressive diagnosing and drugging of children, electroshock, lobotomy, involuntary treatment and fake biological theories.  He still works to bring professional and laypersons together to promote more caring and empathetic approaches to personal conflict and suffering.

 

With the exception of the ‘moral treatment’ asylums of the Quakers in the 19th century, psychiatry’s history is a shameful one of ill-treatment, brutal procedures and a regime founded on fear and force.  The pharmacological revolution of the 1950’s was presented as a ‘breakthrough’ akin to the discovery of penicillin and at long last, science had produced a ‘cure’ which would be to the benefit of all – patients, staff and government health departments.  But like the emperor’s new clothes, what was/is the reality?

 

As we are only too well aware, the reality is the continuing ‘revolving door’ syndrome of our psychiatric hospitals, an ever-increasing number of people on psychiatric drugs and an alarming rise in the incidence of suicide.

 

Take a typical scenario.  A person for some reason – and there will always be a reason – is feeling depressed.  He sees his GP who may prescribe some drugs himself or refer him to a psychiatrist who will also prescribe drugs.  If the situation is deemed serious, the person will be admitted to a psychiatric hospital where again, the main treatment will be pharmacological.  A diagnosis will be made and a label attached.  Compliance is expected and, under the Mental Health Act, the patient’s rights over-ruled if he is not.  Physical force will then be used to inject the patient, all in the name of being ‘for their own good’.  Politicians will announce ambitious plans in shiny brochures for a ‘Vision for Change’ and five years later, very little will have changed.

 

So it is not surprising that those who know most about all this, those who have been through the system are voting with their feet and saying ‘Enough!’  As recently seen in Egypt, there always comes a breaking point.

 

A revolution has started.  It began with organisations like The Patients’ Liberation Movement in New York in the early 70’s.  ‘Mental patients’ were second class citizens, an abused minority, discriminated against with their rights trodden upon.  Support Coalition International, later renamed MindFreedom, was another group who began to speak out.  It was difficult and dangerous.  ‘Speaking out’ invited the charge of ‘lacking mental insight’ and given your previous psychiatric history, you could quickly find yourself incarcerated again.  But the flame of protest continued to flicker boosted by evidence provided by the likes of Drs. Mosher and Breggin.

 

The 1990’s saw the establishment of the World Network of ex-Users and Survivors of Psychiatry.  Drawing strength from mutual support and the exchange of ideas and experiences, the movement grew. ‘Psychrights’ was established in Alaska, ‘’Psychout’ in Canada, the Hearing Voices Movement in Holland, the Patients’ Advocacy Movement in New Zealand and a European Network of ex-Users and Survivors was also set up. By the turn of the millennium and the advent of the internet, the revolution was spreading.  It was all about knowledge and education.  People had their own stories to tell, their own painful experiences of the ‘system’, their own suffering with not just the many adverse effects of drugs but also the trauma of insulin coma and electro-shock ‘treatment’.  Mainstream media like the BBC Panorama programme investigated Seroxat.

 

In Ireland, Dr. Terry Lynch published his book Beyond Prozac. Paddy McGowan, co-founder of the Irish Advocacy Network, addressed meetings all over Ireland, Joan Hamilton founded the Cork Advocacy Network and started her Sli Eile – Another Way project. MindFreedom Ireland was set up and held Ireland’s first ever electroshock protest in Cork in 2007.  John McCarthy founded Mad Pride Ireland. Dr. Harry Gijbels and Lydia Sapouna hosted a number of ‘change’ conferences in UCC.  Michael Corry invited Peter Breggin to speak to an audience of 600 in Dublin along with another progressive Irish psychiatrist, Dr. Pat Bracken from West Cork.  Brian Hartnett founded the Irish Hearing Voices Movement, Grainne Humphreys courageously campaigned on behalf of her partner John, Basil Millar and the Wellbeing Foundation along with Doug Ross of Renew established support groups in Dublin.

 

In November 2010, the Dr. Michael Corry Memorial Conference was held in UCC with the theme of ‘Critical positions on and beyond recovery’.  The conference was also the occasion for the launch of the Irish Network of Critical Voices in Mental Health which stated its intention to expand the debate on new ways to embrace mental health within the Irish community and to campaign for a system which is not based on the traditional bio-medical model but one which recognises and responds to human distress in a more creative, diverse and non-coercive manner.

 

In December 2010, the new Network extended an invitation to the acclaimed American journalist Robert Whitaker to visit Ireland.  Whitaker is the author of ‘Mad in America’ and the recently published ‘Anatomy of an Epidemic – Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America’.  In the book, he investigates a troubling question: do psychiatric drugs increase the likelihood that people taking them, far from being helped, are more likely to become chronically ill?

 

Whitaker’s visit is another step in the knowledge revolution.  The public needs to know, the government needs to know and psychiatry needs to know.  A new way is needed. New ways have already been established in Sweden, Finland, Germany, Switzerland and the US.  As Robert Whitaker says “Psychiatry needs to reinvent itself as a discipline. Medication needs to be just one tool in a larger tool bag – only used in a cautious and selective manner”.

 

Robert Whitaker is speaking at the following venues:

 

11am February 25th, Institute of Technology, Athlone

 

7.30pm February 26th, Edmund Burke Lecture Theatre, Trinity College, Dublin.

 

7.30pm February 28th, Carrigaline Court Hotel, Cork.

 

6.00pm March 1st, Boole 2 Lecture Theatre, University College Cork.

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7.30pm March 2nd, Ballsbridge Inn (formerly Jury’s), Dublin.

 

 

 

Jim Maddock,

MindFreedom Ireland.

www.mindfreedomireland.com

 

Physicians: Prescribing Less  May Improve Outcomes

 

Excessive Pills, Overtreatment, May Do More Harm Than Good  

OPINION by STEFAN P. KRUSZEWSKI, M.D.

Feb. 23, 2011

With a few exceptions, when physicians talk, they recommend. Take this. Try that. They satisfy

the expectation that automatically comes with a patient's visit or phone call. The physician is

compelled to make a recommendation -- a pill, a device or a procedure. Both the physician and

medical supplier financially benefit. But is your doctor's advice always in your best interest? Not always.

In a 2000 JAMA publication, Julie Magno Zito of the University of Maryland and her coauthors

stated that there had been an explosion in psychotropic prescriptions for pre-schoolers without

adequate safety and long-term studies and generally without FDA approvals.

Dr. Joseph Coyle of Harvard Medical School editorialized on this "troubling change in practice."

Likewise, in a 2001 JAMA article, Dr. Chunliu Zhan of the Agency for Healthcare Research and

Quality and his colleagues found that American elderly patients are often overly and

inappropriately medicated.

And, there are medical errors. Reports from the Institute of Medicine and HealthGrades indicate

that there have been 400,000 to 1.2 million error-induced deaths in the United States from 1996 to

2006. Excessive medications and procedures, adverse events and medical errors are endemic to

medicine. In the early 1990s, surgeons were encouraged to perform quadruple bypass surgery for

heart disease. Recent studies now suggest the surgery was, in many cases, a waste of time and

money, improving neither morbidity nor mortality. Surgeons are not the only medical professionals who misdiagnose and perform unnecessary

procedures. In fact, no one in the medical industry is a bigger offender when it comes to

mistreatment than those of us in psychiatry. With psychoactive diagnoses and medications, I'm currently seeing a trend among doctors

prescribing adolescents with stimulants for bogus reports of ADD. In the most common

occurrence, the doctor misses the diagnoses of daily marijuana abuse, alcohol abuse and

oxycodone abuse. Many doctors fail to perform a simple urine drug screen, treating instead the residual drug-related

symptoms of inattention, lack of motivation, poor academic performance and forgetfulness with

amphetamines, antidepressants or antipsychotics.

At worst, kids receive all three medications together, which is dangerous in immeasurable ways.

This also happens to adults.

When 'Medicine' Makes Things Worse

In the past, psychiatric physicians have diagnosed homosexuality, paraphrenia, paranoia,

narcissism, neuroses, combat fatigue and other entities, treating those "disorders" with a variety

of therapies, including pills.

More recently, psychiatrists diagnose bipolar disorder not otherwise specified (NOS), adult

attention deficit disorder and pre-psychotic conditions, for which they may prescribe pills. The

problem is that some of those earlier diagnoses like (homosexuality, neuroses, combat fatigue,

paranoia and paraphrenia) no longer exist as entities recognized by the DSM-IV-TR -- the most

current compendium of mental conditions and disorders. Virtually anyone at any given time can meet the criteria for bipolar disorder NOS or ADD.

Anyone. And the problem is everyone diagnosed with even one of these illnesses triggers the pill

dispenser. Taking stimulants, antidepressants, antipsychotics or off-label use of anti-convulsants often

obscures the real problem and instead adds a new layer of unintended adverse events that only

make conditions worse. My advice to doctors: It's OK not to prescribe anything. It's OK to listen, to do no harm, to offer

compassionate and helpful living advice. It can be therapeutic to recommend abstinence from

cigarettes, drugs and alcohol, to eat more nutritiously, to sustain a relationship, lose weight,

volunteer, meditate, pray, walk, laugh, sing, play music and

embrace kindness. It's also OK to offer the patient a metaphorical motivational kick and advise them to just do

something to help themselves. That may do more to improve outcomes and reduce adverse events

and unnecessary prescribing than an injudiciously prescribed pill or procedure.

Dr. Stefan Kruszewski is an Addiction Psychiatrist and CEO of Kruszewski & Associates, a

Harrisburg, Pennsylvania based firm specializing in illuminating healthcare and financial fraud.

Use of ECT without patient consent

Madam, – I would like to respond to Dr Muiris Houston’s article about electroconvulsive therapy (HEALTHplus, February 22nd). While the article is generally balanced and well argued, it fails to tackle the central concern in the ECT debate in Ireland at the moment. This concerns the use of ECT when a patient cannot, or will not, give consent for the procedure. At present, ECT can be given in such circumstances simply on the say of two consultant psychiatrists.

But psychiatrists differ greatly in their use of the treatment. The most recent Mental Health Commission figures (for 2009) show a continuing massive variation in the use of ECT across the country. It would appear that while most psychiatrists now use ECT very cautiously (perhaps only in the sort of scenario described by Dr Houston) some are “ECT enthusiasts” and have a much lower threshold. They will see an indication for ECT where other psychiatrists will look for alternative interventions.

The Irish mental health service is sectorised, which means that patients and their GPs have no control over which psychiatrist will be allocated to them. In these circumstances, I believe that it is simply wrong that the psychiatrist should be able to decide on the use of such a controversial treatment without the patient’s consent.

That they can do so without consultation with relatives and other professionals, or take into account an advance directive signed by the patient, is outrageous. As it now stands, the Mental Health Act 2001 provides protection for the psychiatrist, not the patient. The amendments being proposed by the Department of Health, as outlined in its recent response to the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, will not materially alter the situation. Our national policy on mental health, A Vision for Change, advocates a move to a less paternalistic, more “user-centred” philosophy of care. As it now stands, this is contradicted by our current Mental Health Act. – Yours, etc,

Dr PAT BRACKEN,

Clinical Director, Centre for Mental Health Care and Recovery,

Bantry General Hospital,

Co Cork.