He got lost and fell asleep in the woods. Now he has the head of an ass and the queen of the fairies wants to marry him. The last thing he needs is more complications. Do you dream of an uncomplicated antidepressant? Chances are you're dreaming of Cipramil. It's effective, well tolerated and associated with a low risk of drug interactions. In other words, Cipramil helps to make treating depression or panic disorder less of a performance. CIPRAMIL citalopram Antidepression not antipatient Lundbeck
I don't think it takes any special kind of expertise to acknowledge that the FDA is failing to do it's duty to regulate the pharmaceutical industry; worse it's failing to protect people from dangerous drugs it approves on shoddy evidence. The facts are plain, the failure permeates all of medicine.
The excuses offered by psychiatrists for the real world outcomes of psychiatric patients sound like the ill-conceived justifications offered by misbehaving juvenile delinquents. To realistically assert one's professional integrity, requires a record for demonstrating ethical behavior. Ethical integrity is not an affectation. Professional opinions and treatment recommendations need to be based on more than a professional's subjective experiences; without empirical support, a subjective opinion is still the weakest, most fallible type of scientific "evidence." For this reason, subjective observation is used only to support empirical data in ethical scientific research. Diagnoses are not consistently reliable among psychiatric professionals; therefore they are not verifiable or replicable. Psychiatric treatment recommendations are not supported by empirical data, but are more reliant upon consensus. A consensus of well-educated opinions is evidence of agreement; it is not evidence of diagnostic validity or treatment safety and effectiveness. Pretending that a consensus is a valid or sufficient substitute for evidence serves to add insult to the iatrogenic injuries caused by consensus-based psychiatric medicine.
The excuses offered by psychiatrists for the real world outcomes of psychiatric patients sound like the ill-conceived justifications offered by misbehaving juvenile delinquents. To realistically assert one's professional integrity, requires a record for demonstrating ethical behavior. Ethical integrity is not an affectation. Professional opinions and treatment recommendations need to be based on more than a professional's subjective experiences; without empirical support, a subjective opinion is still the weakest, most fallible type of scientific "evidence." For this reason, subjective observation is used only to support empirical data in ethical scientific research. Diagnoses are not consistently reliable among psychiatric professionals; therefore they are not verifiable or replicable. Psychiatric treatment recommendations are not supported by empirical data, but are more reliant upon consensus. A consensus of well-educated opinions is evidence of agreement; it is not evidence of diagnostic validity or treatment safety and effectiveness. Pretending that a consensus is a valid or sufficient substitute for evidence serves to add insult to the iatrogenic injuries caused by consensus-based psychiatric medicine.
to paraphrase William Shakespeare: The doctor doth protest too much...
via Psychiatric Times: Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”
By Ronald Pies, MD | July 11, 2011 an excerpt:
"In short, we cannot afford to view our patients’ afflictions in the balkanized terms of “mental” vs. “physical”, “mind” vs. “body”, “psyche” vs. “soma”. Neither can we afford the luxury of supposing that only one type of treatment—medication or psychotherapy—will be effective for the illnesses we treat." here
More on the So-called Chemical Imbalance Theory
an excerpt:
"My usual practice is to ignore crackpot bloggers who misrepresent psychiatric writing in general, or my own writing, in particular. However, when an academician with some influence over public opinion radically misreads-and misrepresents-my views, I find myself with no alternative but to rebut the errors." (emphasis mine)
Nine months later, Pies wants to clarify exactly who he did not characterize as being "crackpots" and "predictably irresponsible bloggers." Incredibly, it's not Jonathan Leo, even though it is Leo, Pies complains of in his comment enumerating the instances Pies believes that Leo, "misreads-and misrepresents-my views." Apparently, Pies' lengthy enumeration of perceived slights he complained of, were unrelated to do the "crackpot bloggers who misrepresent psychiatric writing in general, or my own writing, in particular" comment which preceded the list of slights. Pies makes it as clear as mud by stating, "With respect to my comments dated Sept 1, 2011, I would like to clarify one statement. My allusion to "crackpot bloggers" was not intended to apply to anyone in particular. Rather, I wanted to contrast such predictably irresponsible bloggers with established academic writers, such as Prof. Jonathan Leo. I regret any confusion or misunderstanding arising from my wording.
"And, to reiterate a point I have made on numerous--bordering on "innumerable"! --occasions: I do not advocate, and never have advocated, the use of antidepressant medication for ordinary, "adaptive" grief or sadness, as typically encountered with uncomplicated bereavement. For further review of the bereavement exclusion controversy, please see the recent publications by Zisook at al, in :
Depress Anxiety. 2012 May;29(5):425-43; and Lancet. 2012 Apr 28;379(9826):1590 Best regards, Ronald Pies, MD" June 08, 2012 8:52 PM EDT
Reading the second comment, particularly the second to last sentence
almost broke my trusty bullshit meter:
via The New York Times:
Redefining Depression as Mere Sadness
an excerpt:
"Third, and perhaps most troubling, is the implication that a recent major loss makes it more likely that the person’s depressive symptoms will follow a benign and limited course, and therefore do not need medical treatment. This has never been demonstrated, to my knowledge, in any well-designed studies. And what has been demonstrated, in a study by Dr. Sidney Zisook, is that antidepressants may help patients with major depressive symptoms occurring just after the death of a loved one.
"Yes, most psychiatrists would concede that in the space of a brief “managed care” appointment, it’s very hard to understand much about the context of the patient’s depressive complaints. And yes, under such conditions, some doctors are tempted to write that prescription for Prozac or Zoloft and move on to the next patient.
But the vexing issue of when bereavement or sadness becomes a disorder, and how it should be treated, requires much more study. Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of “normal sadness.” Until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just “normally sad” — and I will provide him with whatever psychiatric treatment he needs to feel better."
via Psych Central:
Why Psychiatry Needs to Scrap the DSM System:
An Immodest Proposal By
brief excerpts about schizophrenia and bipolar on PsychCentral:
"Since schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of their ability to reduce the symptoms of schizophrenia and to lessen the chances that symptoms will return." here
"The cause of bipolar disorder is not entirely known. Genetic, neurochemical and environmental factors probably interact at many levels to play a role in the onset and progression of bipolar disorder. The current thinking is that this is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain). As a biological disorder, it may lie dormant and be activated spontaneously or it may be triggered by stressors in life. Although, no one is quite sure about the exact causes of bipolar disorder." here
via Mad in America:
Psychiatry’s Grand Confession Posted on January 23, 2012 by Jonathan Leo, Ph.D. / Jeffrey Lacasse, Ph.D. an few excerpts: "Given the enormous marketing programs that pushed this theory combined with the media’s lack of skepticism, we were sympathetic to the general public who could hardly be faulted for thinking that theory had some foundation in fact. Following the publication of our piece a reporter contacted us and suggested that we were attacking a well accepted theory. We pointed out to the reporter that we weren’t attacking a sacred cow but that instead we were pointing out the mainstream psychiatry didn’t even accept this theory. We urged the reporter to contact the FDA, NIMH, APA, etc and ask them about the science behind the advertisements. He did, and as expected, an expert from the FDA explained that the theory was really just a metaphor. The problem is that patients who heard their physician explain the serotonin theory thought they were hearing real science. They weren’t told it was a metaphor and hence thought it was a fact." read here
via: TELOSscope
Is Talk Therapy Dead? by Nicole Burgoyne
It is my impression that Ronald Pies called Jonathan Leo a "crack pot blogger" and my perception is that Pies seemed to feel justified in calling him that since Pies believed that Leo had misrepresented what Pies had written. Although Pies states he usually ignores bloggers who according to him, "misrepresent psychiatric writing in general, or my own writing, in particular." It seems obvious to this crackpot blogger that Dr. Pies, is disrespectful and less than honest. It's a fine example of how academic debate is actively discouraged.
an excerpt:
"Leo takes a closer look at the idea that mental illnesses are just like other diseases, chemical imbalances that should be rectified by introducing ameliorating substances.
"Aside from pointing out that nearly all scientific studies that establish a direct relationship between behavioral problems and chemical treatment have later been called into question, or found unsatisfactory in terms of replication, Leo also hits on a more insidious aspect of the trend toward biological psychiatry, the problem of successful corporate marketing:
"In their marketing efforts to promote the biological explanations of mental illness, pharmaceutical companies have stretched their fingers into patient advocacy groups, consensus panels, continuing education for psychiatrists, and even major medical journals. Most problematic is the way funding drives research. Because they hold the purse strings, the pharmaceutical companies dictate what gets studied, resulting in little investigation into the role of psychosocial factors in the etiology of mental illness. Worse yet, doctors in search of information about a drug are much more likely to read a pharmaceutical company brochure than scientific journals." read here
It is my impression that Ronald Pies called Jonathan Leo a "crack pot blogger" and my perception is that Pies seemed to feel justified in calling him that since Pies believed that Leo had misrepresented what Pies had written. Although Pies states he usually ignores bloggers who according to him, "misrepresent psychiatric writing in general, or my own writing, in particular." It seems obvious to this crackpot blogger that Dr. Pies, is disrespectful and less than honest. It's a fine example of how academic debate is actively discouraged.
What is most troubling to me however, is the lack of personal responsibility of psychiatists in general. In particular, responsibility for the adoption of a bio-disease paradigm; without any definitive evidence to support the decision, or the skeptical claim that mental illnesses are caused by biological diseases and genetic defects. In the absence of evidence for the disease hypothesis, absence of evidence supporting the prolific use of teratogenic drugs that psychiatrists claim actually "treat" cognitive and emotional reactions of human beings to distress. Without evidence, psychiatrists claims are simply a means of perpetrating fraud. Psychiatrists have mis-treated millions; and encouraged other medical professionals to use unethical standards of care not empirically validated but standardized by agreement among psychiatrists. Psychiatry appears to lack an understanding of scientific principles, and do not seem to value medical ethics enough to exercise ethical medical judgement in the best interests of their patients enough to find out what the patient's interests are...
Psychiatry disseminated it's pseudo-medical, pseudo-scientific specialty through professional Journal articles, practice parameters, clinical guidelines and treatment algorithims. The general public and other medical professionals, including psychiatrists who practiced psychoanalysis, assumed that these articles, parameters and algorithims were based on empirical data ethically collected and ethically reported. It is now known that this is an erroneous assumption. All of the diagnoses and all of the psychopharmacological treatment standards are ratified in committee; then validated by a vote of the membership of the American Psychiatric Association. Psychiatry is a medical profession in name only; the methods relied upon developing both the diagnostic criteria and the treatment standards are political; ergo, not scientific.
The academic psychiatrists who allowed their names to be put on educational materials disseminated to other professionals, are not unwitting victims; but are in fact willing participants in fraud. The manner in which mainstream bio-psychiatry developed is not simply due to the undue influences of "BigPharma," and "managed care;" it is ludicrous and insulting for psychiatric professionals to claim they are merely victims or pawns in this charade. While the aforementioned entities indeed contributed to and influenced the wholesale adoption of the bio-disease model, it was only made possible by working collaboratively with academic psychiatrists who are willing collaborators; not unwitting victims. Pharmaceutical company executives, the HMO executives and insurance companies may have an undue influence, but it is psychiatrists who write the prescriptions and the treatment guidelines.
The fact is the proliferation of the bio-disease model requires the willing and active complicity of psychiatrists who are members of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. Dr. Pies is not exceptional in his abdicating any personal responsibility, or unique in blaming BigPharma and managed care for the damage done because of the seriously flawed bio-disease paradigm of care. It is common for psychiatric "experts" to abdicate responsibility for the harm caused psychiatric patients who defend their professional status and their right, i.e. priveledge to continue to use seriously flawed diagnostic criteria and unethical clinical standards of care; with the excuse, "It's what we have, as if this is the case by accident. I would be willing to bet that not a single drug company executive, sales person, or managed care executive wrote those prescriptions...
While much of mainstream psychiatry's information and advocacy literature states that a combination of psychosocial, cognitive behavioral therapies, educational support, and prescription drugs are necessary for effective treatment; the fact remains that in real world practice, there is a bias favoring pharmacological treatment, and more often than not, it's all that is available. Many psychiatrists claim that psychiatry had nothing to do with the current clinical lanscape and it's bias for using drugs first and recommending drugs for life...
As if the bias favoring biological treatment has nothing to do with the APA and AACAP selling the bio-disease pardigm! It is simply unbelievable; this claim adds insult to injury. In effect, this claim is predicated on the notion that psychiatrists are unwitting victims, not active and passive participants who are complicit. Defending a bio-disease bias without scientific support is exacerbating the damage caused from an abject failure to be accountable individually and collectively as a profession. It is a definitive abdication of a physician's primary ethical duty: to serve the best interests of the patient, according to the patient's morals and values repecting and supporting the patient's self-determined goals.
It took the active willing participation of practicing academic psychiatrists to manipulate the scientific data, and clinical psychiatrists to coerce and manipulate patients and families in order to gain treatment compliance; to maintain psychiatric authority. It took active participation to formulate public policies and lobby for the legislation that gave psychiatry Police Powers to detain and forcibly treat unwilling patients. It was only psychiatrists cast votes for the validation of diagnoses and treatments. It was only psychiatrists who voted to adopt coercive, manipulative social control strategies as tools used in this "medical" specialty.
What matters now for any psychiatrist to regain any lost respect and trust is defending the patients who are being harmed, attending to instead of denigrating and invalidating survivors. A psychiatrist who endeavors to regain lost trust and respect by defending himself or herself, defending pseudo-scientific methodology, defending social control strategies disguised as treatment protocols, will only further erode psychiatry's diminished integrity.
The reason I state this is that while psychiatrists are busy defending their professional integrity (it seems more of a defense of their own EGOs) they are abdicating responsibility to the people who are being grievously harmed. The harm is real and it is inevitable as long as psychiatrists believe that therapeutic treatment is something that can be forced on human beings without Informed Consent. As long as psychiatrists reclassify the traumatic iatrogenic injuries as "tolerable side effects" and iatroginic drug-induced death as "natural death" due to the inability or the unwillingness to actually believe every patient is humanity suffering.
None of this would in fact be possible without stigma being part and parcel an intrinsic aspect of a psychiatric diagnosis. The biological defect/disease HYPOTHESIS is the source; it is used to propogate fear and perpetrate medical fraud. It is used to deprive patients of their basic Human Rights, among other crimes... All of this required the willing and ongoing participation of psychiatrists. A physician's professional integrity requires having respect and empathy for all patients, it requires being honest with patients and their family members; it requires ethical integrity. The ethical principles of science and medicine are necessities that are indispensable. Medicine is both science and art; it requires a great deal of humility to be a 'good' doctor. A physician's primary duty is to serve the patient; it is not to serve his colleagues, her profession, the general public or to feed his ego or her wallet...
Psychiatrists who are in the APA and/or the AACAP, but who are failing to take personal responsibility, and who are not encouraging collective responsibility of APA and AACAP members active and passive participation in the selling of the bio-disease paradigm of care lack fortitude and humility. Bio-psychiatry is reliant upon deceit, coercion, emotional manipulation and abuse of power, these are methods of maintaining political control, not any way to provide ethical medical treatment. The biological treatments were standardized and implemented as clinical care standards without being supported by any definitive empirical evidence, most still don't have empirical support years and decades later.
The APA, the NIMH and the AACAP and the FDA have worked collaboratively with the pharmceutical industry. The direct to consumer and professional marketing of FDA approved drugs is supposed to be regulated by the FDA---The FDA is utterly and completely failing it's supposed mission to protect the public. In approving drugs based on sub-standard and outright fraudulent data and abdicating it's ethical duty to warn about known risks of FDA approved drugs, the FDA protects BigPharma. The have a lot of help...
Obviously this has been forgotten by more than a few psychopharmacologists:
"We have to remember that we are not treating diseases with this drug.
We are using a neuropharmacologic agent to produce a specific effect."
~ Dr. E. H. Parsons, 1955
We are using a neuropharmacologic agent to produce a specific effect."
~ Dr. E. H. Parsons, 1955
on clorpromazine
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