Wednesday, April 2, 2014

The quackery exception

[*** I want to make one thing absolutely clear at the start: I resent the implication that anyone who contests biopsychiatry and tries to speak for a science-based approach (rather than a myth-based approach using the trappings of science) is trying to give unsolicited, amateur medical advice. I’m not giving personal medical advice any more than Greta Christina or others are when they make implicit or explicit claims about the reality of “mental illness” and its treatment with drugs. In stating that this approach is based on falsehoods and providing links to and suggestions for reading, I’m not telling anyone that they or anyone else should abruptly stop taking psychiatric drugs. You should never do this – it’s very dangerous. (It’s also dangerous to take medical advice from people on the internet in general.) If you do decide to discontinue taking any psychiatric drug, you should only do it under the supervision of a physician. None of the books or articles I’ve suggested advise this, or any course of action for a particular person. This isn’t to say that I’m not hoping to influence people to have a healthy skepticism regarding psychiatric drugs and to engage with the evidence and make decisions on that basis. Of course I am. I’m hoping that people will read these books and articles and turn away from biopsychiatry, and I accept that responsibility. I’m not going to feel guilty about recommending these books or articles presenting empirical evidence - gasp! - any more than I would for recommending books and articles about the MMR vaccine to anti-vaccinationists and hoping they'd change their minds.]

So… Greta Christina has published yet another post about how people should and should not respond to posts about “mental illness” written by the sufferers of these alleged illnesses. There’s a key paragraph in this one, and I think calling attention to it might help to clarify something important. She allows:
So unless someone tells you that their health care provider is prescribing actual quackery (like homeopathy or something), or unless you have some crucial piece of information that you’re pretty sure the person you’re talking with isn’t familiar with (and “Psych meds are all horrible and nobody should take any of them/ the entire mental health care profession is borked and is not to be trusted” doesn’t count — believe me, we’ve heard that before), or unless you have some more substantial evidence for your position than “I know that the established standard of care is (X), but this one guy disagrees and wrote a book about it,” it is seriously fucked-up to undermine people’s relationships with their health care providers. [my emphasis]
Since the quackery exception was noted, I’m going to be very clear about what I’m saying: A health care provider who is telling someone they have a chronic mental illness, depression, which should or must be treated indefinitely with “antidepressants” is prescribing actual quackery. Because biopsychiatry is based on pseudoscience. No one has a chronic illness called depression, because no such entity exists.* These diagnoses have no scientific validity.

No one has to listen to me to find the evidence for this proposition,** or read any of the books or articles I’ve recommended or linked to numerous times (some of which GC could have read in the time it took to write this series of hectoring posts and draw up elaborate flowcharts). You can read the statements of the Task Force Chairs of DSMs III, IV, and 5 and the current and former directors of the National Institute of Mental Health. As Richard Shulman, whom I quoted a few days ago, has noted: “Markedly different rules of science, logic and culture apply in psychiatry compared to medical science.” What other medical specialty would still be considered legitimate after its leading representatives publicly acknowledge that its diagnoses lack scientific validity? None. Of course, this isn’t going to happen: top oncologists aren’t going to reveal that tumors don’t exist, because they do exist. The illnesses in the DSM don’t. People don’t have chemical imbalances which are treated medically by these drugs. These claims are untrue, they’re stigmatizing, they’re extremely dangerous and harmful, and they’re used to deny people basic human rights.

To speak of a standard of care for the treatment of the illness of chronic depression is nonsensical. [I’d make a joke about how (bio)psychiatry has no standards, and they don’t care, but that wouldn’t be true; I’m sure many do care, and they have standards, but when you’re working within a false paradigm standards necessarily become perverted.] How can there be a standard of care for the treatment of a mythical illness? What’s the standard of care for treating chronic hysteria or acute demonic possession?

Greta Christina provides the example of homeopathy as a case in which it would be acceptable to speak out. Homeopathy is absurd quackery of the first order, but it’s far less dangerous in reality than, for example, neuroleptics, used to “treat” nonexistent illnesses like schizophrenia and BPD. People are being forced to take them, and they’re being used on children. Hundreds of thousands of people are dying from these drugs. I will continue to speak out against this model, as GC no doubt would if she knew the reality.

So I want this to be understood: I’m not seeking, in this immediate context, a “vigorous, rigorous public discussion and debate about medical standards of care — especially when it comes to mental illness.” I’m contesting what I believe, based on a substantial review of the evidence, to be dangerous and harmful pseudoscience and quackery. I’m asking people to appreciate that one can feel that a model “helps” by providing explanations for their suffering and experiences without that model’s being reality-based, and to recall that secular humanism and social justice activism are about seeking and promoting reality-based explanations and solutions. I do realize that it sounds to many like crankery to argue that what appears to be an established branch of medicine is really built on a dangerous foundation of pseudoscientific sand, but I ask that people at least acknowledge that this is what I’m arguing, and what compels me to write so insistently about psychiatry and its drugs (though I won't be continuing to attempt to comment at the blogs in question).

* In saying this, I’m NOT suggesting, in any way, that people’s experiences or suffering aren’t real or serious. I’ve (too slowly) come to understand that part of the problem in these discussions is that people often regard the degree or duration of suffering in terms of a scale that goes from unreal on one end to medical illness on the other, so when you explain that the “mental illnesses” of biopsychiatry don’t exist, people interpret that as the suggestion that their suffering isn’t real or that they could or should just snap out of it. But it’s not so. Rejecting this one false explanation for people’s experiences, problems, and suffering in no way necessarily entails denying the experiences, problems, and suffering. The tradition of humanistic psychology/psychiatry has overwhelmingly acknowledged the reality of people’s suffering and sought - not always successfully, to be sure - to understand and address its personal, social, and political causes and consequences. In reality, it’s biopsychiatry that denies people’s suffering and experiences any personal, social, or political meaning by falsely rooting them in people’s brain chemistry.

The roots of this problem lie in part in biopsychiatric propaganda itself, as suggested last year in Allen Frances’ assertion that the DSM-5 wanted to label “Binge Eating Disorder” what was really just “gluttony.” This is a false dilemma: we can recognize that people have serious and enduring problems with binge eating (or, what is far more likely, serious and enduring problems of which binge eating is a manifestation) without inventing a scientifically invalid label for it. I’ve seen the results of this propaganda in people’s comments in general, many of which have suggested, for instance, that they understand that they have the “real” illness of depression which is why they need drugs, whereas others have merely situational depression. There’s a real fear that rejecting the notion that this suffering is due to a problem with the brain means dismissing the suffering itself. We have to recognize and move past this false dilemma.*** It’s no more denying people’s suffering to say that it isn’t an illness in the medical sense or caused by a chemical imbalance than it is to say it’s not caused by an imbalance of chakras or bodily humors.

** And I’m angry that this model has become so entrenched that people just accept that others have to provide evidence of its falsehood, forgetting that it is psychiatry and the drug companies who are making the assertions of fact. There isn’t an equal weight of evidentiary responsibility on those making claims about the existence of these illnesses and those questioning their existence, much less a higher burden on the latter.

*** This is of course becomes complicated by the contemporary pathologization and medicalization of ever larger areas of life and experience, especially when it comes to the diagnostic labeling of children or others based on external evaluations of deviance or disruptiveness. But these complications shouldn’t obscure the fact of the false nothing/illness dilemma.

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