Thursday, May 16, 2013

Will skeptics approach biopsychiatry skeptically?


I’ve been writing critically about biopsychiatry for a few years now. In that time, I’ve encountered a total of one prominent skeptic who was willing to do the same (as far as I know, following a backlash he hasn’t posted on the subject for two years). In that time, my posts on the subject on atheist-skeptic sites, regardless of context or tone, have been greeted by a barrage of ad hominems (directed at the authors I’m citing or at me) and anecdotes, factually unsupported assertions, and a resolute refusal to investigate the matter further.

I continue to be perplexed by this. This month, the head of the National Institute of Mental Health and the chair of the APA’s DSM-5 task force have publicly stated that psychiatric diagnoses lack scientific validity (I’m sure they now wish they could have given it a better spin, but it’s out there for all to see). The extant scientific evidence of the past several decades does not support the specific “diagnoses” or the genetic-biological model of psychiatry, as has now been recognized in a position statement by UK clinical psychologists. Belief in the validity of the diagnoses and model doesn’t stem from scientific knowledge, but from a gargantuan, wildly effective, and well documented marketing campaign that has lasted several decades.

If this were just about standing against pseudoscience or manipulation or about being right, or even about more abstract humanistic concerns, I wouldn’t have persistently written about it for the past few years in the face of the onslaught. But it isn’t. The acceptance of this false model has given psychiatry and drug companies unprecedented political power, and people – adults and children – are being coercively and forcibly drugged on a massive scale. In addition to the billions being funneled to pharmaceutical corporations, there have been catastrophic effects on people’s lives. It’s a political nightmare and a human rights disaster.

I’m disappointed that my efforts related to this for the past three years seem to have been almost entirely unsuccessful. The fact that the responses look the same as they did back in 2010 gives me some hope, though. The problem seems at root to be that skeptics aren’t, for some reason, investigating the matter. So all I’ll do right now is provide another list of sources, and urge people in the most heartfelt terms to read and engage with them fairly:

• The new article by Brett Deacon - “The Biomedical Model of Mental Disorder: A Critical Analysis of its Tenets, Consequences, and Effects on Psychotherapy Research”- whose full text is available via my link here (especially the conclusion, Tables 1 and 2, and the references).

The books listed here.

Joanna Moncrieff’s book, or at least her talk about it.

• The articles by Marcia Angell in the New York Review of Books linked to at the post above, but I’ll provide the links once again:
"The Epidemic of Mental Illness: Why?"

"The Illusions of Psychiatry"

• and this exchange.
If you’re unwilling to read these materials – especially if you continue to post in defense of biopsychiatry - you should turn in your skeptic’s badge. If you read them and don’t come away convinced that what I’ve been saying is true, well, I’ll be surprised, but at least then we could have a real discussion amongst skeptics.

17 comments:

  1. Billy Clyde TuggleJune 14, 2013 at 12:56 PM

    When you brought this topic up on Freethought blogs recently (in response to a post by Kate Donovan). I responded with what I believed to by a very thoughtful and non-confrontational reply, but I heard nothing back from you.

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  2. Thanks for your comment.

    I don't know if I read your comment there before I left the thread or what it said.

    A thoughtful reply, in my view, would be to read (critically, of course, but fairly and broadly) and engage with the materials I've listed here, and following that to respond thoughtfully to the arguments and evidence they present. (I've summarized and expanded on them in many posts here - you can find them under the "health" tag - but I'm not asking you to read those, unless you want to understand a little better where I'm coming from.)

    This is making me a bit cross. As people who value critical thinking and truth, we're obliged to engage actively with the evidence. We're obliged to combat falsehoods, and to speak out when others are spreading false and harmful claims, as Donovan was in her post. Millions of people (all of us, really) have been harmed by the misinformation spread by the pharmaceutical companies and the APA, and it's urgent that it stop. The only way it's going to stop is if people become aware of the evidence of what's been happening. I'm frustrated that the refusal to engage with that evidence is believed in this of all communities to be caring and ethical. It isn't.

    If your post was a thoughtful response to these materials, then I'll be happy to discuss it here. If you read them and want to discuss or debate them in the future, I'll be happy to do that, too. I won't be returning to her thread.

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  3. Billy Clyde TuggleJune 14, 2013 at 9:27 PM

    I think the reason you received such a strong reaction in the FTB thread is that a lot of people (myself included) have been relieved of tremendous suffering thanks to psychopharmacology.

    When you seem to be telling people that this thing that relieves their suffering is false or invalid, it comes across as the equivalent to telling a type I diabetic that dialysis is false or invalid. That sort of posture is bound to generate a backlash. Whether it is deserved or not remains to be seen.

    By the way, I do agree that psychiatric diagnoses for the most part "lack scientific validity". They are really just descriptions of symptoms (i.e. suffering). The problem is that with an organ as complex as the human brain, you are bound to have different root causes mapping into similar clusters of symptoms.

    This article kind of touches on that:
    http://www.theatlantic.com/health/archive/2013/06/who-should-take-antidepressants/276815/

    BCT

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  4. I didn't expect the backlash in this community. Or, I suppose, I didn't expect its persistence. I didn't expect people who claim to prize critical thinking as a tool for social justice and human well-being to so persistently refuse to engage with the already overwhelming and still growing evidence provided by the critics of biopsychiatry. I didn't expect to have to endlessly request/insist that people read and engage with it.

    I don't want you to agree or disagree with me on the basis of your current knowledge. I want you to read the materials I've listed. Could you, at the very least, read the articles by Marcia Angell and Brett Deacon, and maybe watch the video of Joanna Moncrieff? (Oh, OK - I want you to read all of it. :))

    You wouldn't have the same defensive reaction toward the critics of homeopathy or other "treatments" you recognize as quackery. What I'm saying is that biopsychiatry is quackery with political and economic power. I know you don't believe it's quackery, but might the recent admissions from Insel and Kupfer concerning scientific invalidity lead you to take a short step back and try to be more open to ideas and evidence that challenge your beliefs?

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  5. Billy Clyde TuggleJune 15, 2013 at 4:57 PM

    I just watched the video of Joanna Moncrieff (well most of it...I skipped some of the Q&A). I thought her commentary was very thoughtful and I suspect she is probably correct to a significant degree. I have suspected for a long time (based on my own experience with them) that these drugs are crude tools and that the brain is (to borrow an engineering term) a black box. We know that if we put drugs into the black box, we can get a certain response out of it (relief from suffering), but we have little if any understanding of what is really going on inside the black box. I find her notion of the "drug centered" modeled to be a much more accurate description of the reality of bio-psychiatry compared with the disease centered model. On that much I think we agree.

    Thank you for twisting my arm to watch the video. I can't promise to read all the other material, but I will at least put it on my to read list.

    BCT

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  6. "I just watched the video of Joanna Moncrieff (well most of it...I skipped some of the Q&A). I thought her commentary was very thoughtful and I suspect she is probably correct to a significant degree."

    I'm so glad you've started engaging!

    The talk (the Q&A for that one is actually pretty good) lightly summarizes her book, which I talk about here:

    http://saltycurrent.blogspot.com/2012/07/joanna-moncrieff-myth-of-chemical-cure.html

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  7. "I have suspected for a long time (based on my own experience with them) that these drugs are crude tools and that the brain is (to borrow an engineering term) a black box. We know that if we put drugs into the black box, we can get a certain response out of it (relief from suffering), but we have little if any understanding of what is really going on inside the black box."

    This is wrong. You'll better understand how it's wrong if you read the article by Brett Deacon linked here

    http://www.madinamerica.com/2013/05/a-critical-analysis-of-the-validity-utility-and-effects-of-the-biomedical-model/

    and the two pieces by Marcia Angell linked above. (All three together would probably take less than 45 minutes, even less if you skip the interesting but tangential section in the Deacon article about RCTs and psychotherapy.)

    We don't know that the drugs provide relief from suffering, other than in some cases as a placebo. The research has shown them to be ineffective (and often quite dangerous) in both the short and long term. The reason effective drugs haven't been forthcoming, despite decades of advances in neuroscience, isn't the complexity of the brain but that psychological distress isn't a brain disease or disorder.

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  8. A really good discussion about the effectiveness of "antidepressants" specifically is Irving Kirsch's The Emperor's New Drugs, which is included in my list.

    Here's a video of a story on 60 Minutes from last year featuring him:

    http://saltycurrent.blogspot.com/2012/02/60-minutes-on-antidepressants.html

    (Just to note again: in recommending these materials, I don't mean to imply 100% agreement with every argument their authors make - which would be impossible anyway since they don't agree on every point - or to suggest that any one alone makes the complete case. Together, though, they make a case against biopsychiatry and the drug model that is absolutely devastating.)

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  9. Billy Clyde TuggleJune 16, 2013 at 10:44 PM

    "We don't know that the drugs provide relief from suffering, other than in some cases as a placebo. The research has shown them to be ineffective (and often quite dangerous) in both the short and long term. The reason effective drugs haven't been forthcoming, despite decades of advances in neuroscience, isn't the complexity of the brain but that psychological distress isn't a brain disease or disorder."

    You lost me on that one, dude. I remember reading Peter Breggin a number of years ago and thinking here is some high achiever whose head works pretty good (got him through Harvard medical school) lecturing others on "legitimate" suffering as if others are supposed to suffer so he can enjoy good poetry and art and keep his religious notions intact (ghost in the machine).

    I could be wrong of course. I'll try to look at some more of the material as my time allows.

    Cheers

    BCT

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  10. "You lost me on that one, dude. I remember reading Peter Breggin a number of years ago and thinking here is some high achiever whose head works pretty good (got him through Harvard medical school) lecturing others on "legitimate" suffering as if others are supposed to suffer so he can enjoy good poetry and art and keep his religious notions intact (ghost in the machine).

    I could be wrong of course. I'll try to look at some more of the material as my time allows."

    I'm not sure how that anecdote is supposed to be relevant. My claim had nothing to do with "legitimate" or "illegitimate" suffering. It was a claim of fact that you'll see, if you take a little time to engage with the materials (at the very least, those three articles to which I've given links), is entirely supported by the scientific evidence.

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  11. Billy Clyde TuggleJune 19, 2013 at 2:24 AM

    My rant on Peter Breggin was triggered by this comment that you made:

    "The reason effective drugs haven't been forthcoming, despite decades of advances in neuroscience, isn't the complexity of the brain but that psychological distress isn't a brain disease or disorder."

    Breggin seemed to be advocating that in life there is some inevitable suffering (aka legitimate suffering) which is essential to the human experience and that overuse of psychotropic medication robs people of that experience. Alas, where would all the great poetry and art come from if all the otherwise tortured souls were high on happy pills.

    His position struck me as selfish and arrogant. If I confused your position on this issue with his, I apologize.

    BCT

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  12. Billy Clyde TuggleJune 19, 2013 at 2:53 AM

    By the way what exactly do you mean by this:

    "The reason effective drugs haven't been forthcoming, despite decades of advances in neuroscience, isn't the complexity of the brain but that psychological distress isn't a brain disease or disorder."

    "Psychological distress" is just a symptom. "I am sad because my dog died" - that is psychological distress, but it is considered a normal part of the grief response. If I am sad all the time and I cannot connect a reason to it, then one has to wonder if there isn't some system in the brain that is malfunctioning (e.g. a normal grief response that is stuck in an endless loop).

    Another important question is whether or not a malfunctioning brain can get that way for no good reason? In other words if someone is suffering with prolonged sadness, does there automatically have to be some sort of psychological trauma at the root of it?

    BCT



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  13. I am totally perplexed by this. In the time it took you to compose those two comments, you could have read a good portion of one of the articles I suggested (by Brett Deacon and Marcia Angell). Why are you so reluctant to engage with these arguments and evidence?

    I'm just going to keep saying what I've been saying: READ THE MATERIALS. I see no point in continuing with this unless you can make that minimal effort.

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  14. Billy Clyde TuggleJune 19, 2013 at 5:05 PM

    I am a very slow reader and I have a day job.

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  15. I hope you do find the time to read at least some of them. And if/when you do, I hope you find me on FTB or here and let me know your responses.

    Wish you the best.

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  16. Billy Clyde TuggleJune 22, 2013 at 9:47 AM

    I had a little time available this morning to finish the Brett Deacon article. I thought it was really well written and that he made a very good case for "biopsychocial" model. The only thing I found in the article to which I took strong exception was the following:

    "The National Alliance on Mental Illness (NAMI), a powerful patient advocacy group dedicated to reducing mental health stigma by blaming mental disorder on brain disease instead of poor parenting, forged close ties with the APA, NIMH, and the drug industry."

    In particular I reacted viscerally to the part about "instead of poor parenting". The implication of that statement is that rejection of the brain disease model means acceptance of the "bad parenting" model - the notion that parents of schizophrenics are responsible for their children's condition. Or perhaps I am just reading it wrong and Deacon was not disagreeing with them about the "poor parenting" part (esp for the severe thought disorders like schizophrenia), but rather pointing out NAMI's promotion of the disease model with its emphasis on psycho-pharmacology.

    BCT

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  17. My apologies for taking so long to post and respond to your last comment - I had a busy weekend, at the end of which I sprained my ankle (don't text while descending stairs).

    "In particular I reacted viscerally to the part about "instead of poor parenting". The implication of that statement is that rejection of the brain disease model means acceptance of the "bad parenting" model - the notion that parents of schizophrenics are responsible for their children's condition."

    I'm so glad you read it. No, I don't think that's what he meant at all! I believe he was referring in simplified form to the battles within psychiatry surrounding the DSM-III, which were generally between the pretty hard-core Freudians and the biopsych advocates (this history is discussed in more detail in Shyness). The reductive poor-parenting model was extremely harmful as well,* but it's important to keep in mind that it wasn't then and certainly isn't generally the only alternative.

    *Not that parents don't play an important role in how we develop.

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