Winter 2002 Edition

 

Editorial: Hope and Fear: Mental Health in the 21^st Century

 

            Before the ICSPP International Conference fades into memory I feel compelled to recall some of the highlights and then dwell on what I hope will develop from the conference and perhaps constitute part of the agenda of our next major organizational meeting. (Bob Johnson and Mary Sue Laing reflect on the conference, pages xx and xx).

The conference was a powerful and positive experience for me personally and I returned home energized and certainly more hopeful than before. Since joining ICSPP I feel that I have connected with an extended family of highly intelligent, well-educated scientific professionals who have simultaneously maintained their humanity, integrity, and senses of humor in the face of the adversity each has experienced. It was wonderful to be able to integrate the disembodied minds represented by books, articles, e-mails and occasional phone calls with the flesh and blood to which each of these minds belonged. I felt honored to be in the company of scholars, teachers and scientists whose work will continue to shape the direction of our field in the new century. It was delicious to share drinks, meals and personal lives with folks I am proud to call friends. I feel supported by my new family and have been literally given reason to continue my work as a professional. (Although, I still occasionally feel as if I would like to walk away from the entire enterprise.)

In my own presentation I argued that all human beings are both scientists seeking to describe, explain, predict, and control the physical and social worlds between and within themselves as well as moral philosophers seeking to achieve that which is good and beautiful. In one way or another, every presenter sought to expand our scientific understanding of some aspect of our field as well as critique the field while creating a vision of what should be instead of what is. What I found very heartening was the general moral commitment of every participant toward creating a psychiatry (and this includes clinical psychology, social work, and any other contributors to what we refer to as the mental health field) that is humanistic and avoids the dehumanizing activities of mainstream psychiatry. There was unanimity in decrying forced treatment, the overuse (and for some participants any use) of psychiatric drugs especially with children, the use of ECT and psychosurgery on any patients, the acquiescence of the profession to their purchase by the big drug companies as well as the general poor respect for humanity in so many psychiatric conceptualizations.

I am always moved listening to Peter Breggin describe, the frequent destruction of children and their families. Typically, children react badly to Ritalin and other stimulants only to have physicians create newer diagnoses and prescribe additional mind and brain damaging drugs to the child. In ?Psychiatric Violence against Children: BI-Polar and other Fad Diagnoses? Peter couched his excellent descriptions and analyses in unmistakable moral outrage as he

1036 Park Avenue Suite 1B

New York, N.Y. 10028

(212) 585-3758

traced the frequent downward spiral of these children from active and curious to lifeless and docile. Moral outrage is in very short supply in our culture as, it too, is a victim of a general philosophy that emotions represent pathology and the loss of cool requires psychotherapy or more likely a good dose of some drug to restore one?s mental health. In this regard I shared a powerful emotional response with others in the room to comments made by Kevin McCready that perhaps the most important element required in the treatment of severe ?mental illnesses? is the integrity of the therapist. 

I think it not enough to oppose bio-psychiatry with moral outrage. I opine that what is also necessary is a two pronged attack on the scientific level that not only refutes every aspect of psychiatric reductionisms and dehumanizations but replaces them with nonreductionistic and humanizing imagery and conceptualizations. I believe that part of the success of bio-psych (in addition to money and political connectedness) are the multiple failures of Psychoanalysis, Behaviorism, and every other major theory that still dominates the thinking of psychotherapists as they seek to justify and demonstrate that psychosocial modes of treating mental illnesses are superior to medical methods.

We have become so caught up in fighting the hydra of biological psychiatry and staying alive professionally that we no longer seek to examine, integrate, and recreate the grand theories of Psychoanalysis, Behaviorism, and Humanism/Existentialism that were debated as a matter of course half a century ago. With few exceptions, to be noted below, the conference lacked the kind of psychosocial theorizing that can and must replace the pathetic slogans and mantras comprising bio-psychiatric theorizing. I suggest that the strengths of the conference also revealed its weaknesses in this regard. There was much good science presented at the conference but with few exceptions this dealt with refutations of many of the biological assumptions comprising bio-psychiatry and explications of the flaws in psychiatric research paradigms. I will discuss the biological sciences first and then return to my main contention that what is needed, among other things, to defeat bio-psychiatry are theoretical formulations superior to, and compelling for, the professionals active in our field. Our endeavors require a much superior scientific foundation than is now present. In short we need to recreate our field along very different lines than it now exists and build our own house from the foundations up.

 Grace Jackson and Jonathan Leo, among others turned the bright lights of science on the claims of psychiatry and the drug companies concerning the safety and effectiveness of psychiatric drugs and the research protocols that justify their claims. The results of their analysis leave little that is credible for bio-psychiatry to defend. Evidence mounts that it is a combination of faith, fraud, and slick advertising that supports the contentions that mental disorders derive from known bio-chemical or other neurological disorders and that psychiatric drugs are either safe or work as advertised. Grace made clear that the advertising of SSRI?s so overly simplify the operations of the brain and the manner in which these drugs effect the brain and its chemistry that it would be laughable if the results weren?t so tragic.

All of the discussions concerning the complexities of the brain; the facts that reveal that at present there is little understanding of either the mechanisms by which psychiatric drugs work or the extent of their effects on the human nervous system; and the desultory manipulations by the drug companies were important, brilliantly done, and emotionally satisfying. They are however, inadequate to the task outlined above: to create a theory with enough broad, multiple perspectives to underpin, justify, and organize into a single scientific paradigm all of the treatment efforts presented at the conference. We know what we are against but are not scientifically unified to state what we are for. Too many of us do not know how little we do know about human behavior and its development and this often leaves us just as naked as the bio-psychiatric emperor of whom we are critical.   

   The workshops were all excellent (I was sorry that I could attend only one at a time) but still reflected the lack of a unifying paradigm that would demonstrate that our psychosocial efforts are more than just direct competitions with bio-psychiatry. In general, the underlying philosophy of the workshops were still based on the medical model that suggests that we are providing the better therapy to treat serious forms of mental illness. Listening to my colleagues throughout the weekend convinced me that virtually every ICSPP member believes that mental illnesses do not literally exist but are the social constructions of the profession and represent moral labels rather than medical diagnoses. Listening to members describe their efforts to help those labeled mentally ill convinces me that their efforts have little or nothing to do with medicine, but rather represent something more akin to education and moral guidance. The goals of our work have little or nothing to do with cure except in the most metaphorical sense. Yet the efforts of my valued colleagues are advertised as form of therapy designed to ameliorate the symptoms of mental illnesses and disorders. I believe that our best efforts are undermined by our refusal to attempt to create a unifying paradigm that demonstrates that our work is not simply incompatible with mainstream psychiatry but incommensurate with it as well. It is time to leave the house of psychiatry and build and furnish our own abode.

Rick Winking writes, ?sometimes we in the non-medical profession seem to think that because we are not prescribing dangerous drugs, we are the saviors of mankind. Junk science is junk science, and I believe that we should be held just as accountable as the shrinks and Big Pharma. This ?Psychotherapy is the answer and it is proven that it works? is often just as much b---s--- as saying that SSRIs work for depression. Talk therapists do tend to fragment into competing schools. I believe that we know as much as psychiatry when it comes to what is really going on, and yet we make these outrageous claims, and then bash psychiatry for making outrageous claims. Our colleague Ian White opines: ?But ?people? work when given (-offered) the correct tools, not ?therapy.? It's never the ?therapy? that works; it's the clinician's approach to the business of re-empowering the human soul, mind and body. The proposition that we can ?advise? disempowers our clients. The proposition that we can ?diagnose? disempowers our clients. The proposition that we can ?heal? disempowers our clients. The proposition that we can ?orchestrate management? disempowers our clients. Real re-empowerment to self-heal, self-regulate lies in respect. Simple ?respect.??

Where should our dialogue begin? I believe we need to explicate our social roles as clinicians and the manner in which we are constructing the selves and relationships of our society. Two presentations fit well with the theme of social contructionism. The first was Clemmont Vontress? discussion on racism in the mental health movement. Dr. Vontress made clear that we are the products of a particular culture and little concerning human behavior can be understood without reference to the culture in which behavior develops and which provides the context for all that we do. This theme reappeared with David Cohen?s observations that we cannot understand bio-psychiatry and psychiatric medications unless we recognize the full social implications of them as socially constructed phenomena. Other topics related to social constructionism that require fuller discussion involves the inevitable use of language as rhetoric and our roles as citizens in the political process.

A second theme demanding explication involves the role of biology in the development of human behavior. While it is clear there is no evidence supporting bio-psychiatry?s contention that either genes or brain disorders play a role in the development of mental disorders we cannot continue to implicitly maintain that our underlying biology and genetic inheritance play no role in who we are. Just as we are the products of our culture and the roles played by language, economics, politics, religion, etc. so too are we constructed by the evolutionary forces of our shared past. We are born with different sensitivities, temperaments, and proclivities and to deny these is open ourselves up to the justifiable charges that we are just as reductionisitic as our biologically trained counterparts. We are embodied beings whose mental activities cannot be understood without understanding the inherited nature of those bodies and the manner in which those biological characteristics create and color human consciousness. Our individual differences, whether judged as normal or pathological, are, in part, the products of differences in our biological make-up. 

A third area of theorizing must begin to integrate the work of developmental psychologists such as Jean Piaget, Jerome Kagan, and Robert Kegan into our ?clinical? theories. I have argued for two decades that our patients are not ?irrational? but utilize preoperational thinking in areas of functioning that our culture demand be replaced by the formal operations so admired by trained professionals. A perspective offered by developmental psychology, particularly that of cognitive constructivism, could illuminate so much of human behavior. The meaning of the world to the individual, be that person a psychiatrist or a schizophrenic is constructed by that individual out of the tools inherited through evolutionary processes; those provided and shaped by society; and those invented by the individuals themselves. It is all of these things together can provide meaningful clues to behavioral adaptations judged normal and abnormal, sick and healthy. 

Finally, our theorizing must also begin to deal with a variety of philosophical issues such as the mind-body problem, the nature of causation and time, and the subject-object dichotomy. We must decide just to which discipline we belong and if, as I hope, we choose psychology just which psychology would best serve our needs. Are we to remain with a psychology that models itself on physics and chemistry or one that recognizes its kinship with the humanities and other studies concerned with subjective experience and the nature of the human ?soul.? I close by suggesting just one workshop that might begin to draw all of these neglected theoretical themes together: ?Psychiatry and Schizophrenia, Incommensurate Modes of Being in the World: Biological, Social, Developmental, Religious, Political, Economic, and Existential Perspectives.?

What do you think? Send your comments to me at either wsimon@optonline.net or Lsimon@kbcc.cuny.edu.

 

 To ICSPP NEWSLETTER EDITOR: Should we have a hunger strike

Submitted by David Oaks

ICSPP is one of 100 Sponsor Groups in MindFreedom Support Coalition

International, which is open to the public but led by psychiatric survivors and mental health consumers. (For more information see www.MindFreedom.org.) Below, SCI board member Mickey Weinberg discusses plans for a possible hunger strike to protest biopsychiatry.

 

Should we have a hunger strike to protest biopsychiatry?

By Mickey Weinberg

There's really not much doubt, the biopsycho/pharmaceutical complex has out-flanked and boxed-out all of us, dissident mental health professionals and academics, along with labeled survivors of biopsychiatry. It's a rare event, indeed, when an ICSPP member appears in the popular press with an opinion piece, or as "a noted mental health expert." And it's rarer still that the voices of dissatisfied psychiatrically-diagnosed people are heard.

Biopsychiatry influences the media, academia, the courts, the entertainment industry, and the public mind. Yet, "it's all done with smoke and mirrors," as Mary Boyle wrote in a recent Clinical Psychology article. And the situation is unlikely to change until public confidence in the integrity and "scientific" foundations of biopsychiatry is somehow shaken. Only then will the good work and critical analysis of the ICSPP membership receive the attention they deserve.

Well, a plan is in the works, which just may have the potential to raise sufficient doubt with current mental health orthodoxy to begin a redistribution of power within the mental health system. But it requires significant risk from a limited number of Support Coalition International (SCI) members, and hardly any risk, but major assistance, from substantial numbers of ICSPP members.

As of this writing, nine SCI members have begun planning what they call a Fast for Freedom in Mental Health. Sometime next spring, they will refuse all solid food for an indefinite period of time while they challenge five leading organizations, which advocate or support biopsychiatry (APA, NIMH, NAMI, PhRMA, WHO), to meet seven deceptively simple demands. The hunger strikers plan to ask only that their target organizations "produce scientifically-valid evidence" for the public claims they trumpet and advice they give -- claims such as an alleged causal relationship between "chemical imbalances" and emotional distress, and the preventative value of psychotropic drugs vis-?-vis suicide and homicide (see Fast for Freedom in Mental Health).

But why a hunger strike? It was only after careful analysis of the tools available to the respective parties to this "dispute," their assets and liabilities, that the hunger strike tactic was chosen. The power of biopsychiatry, touched on above, is obvious. Though screened from media, courts, and public by a cloak woven of trust in the essential integrity of psychiatry as a medical profession, this trust is entirely misplaced.

The soft underbelly of psychiatry is its betrayal of the public trust. For SCI, a virtually unknown interest group comprised largely of stigmatized psychiatric survivors, to wound institutional psychiatry appears to be a daunting task. First, it must gain public attention. Next, it must bring its conflict with biopsychiatry out of professional journals and into the public arena. Finally, it must put its targets on the defensive, shake public confidence in them, and command the terms of debate.

Psychiatric survivors are stigmatized, poor, and spread thin. They cannot be counted on to take direct action, because many fear the loss of financial benefits and the "friendship" and love of therapists and family. For some, a medical diagnosis explains an unsatisfactory life. A hunger strike is initially inexpensive, is traditional and dignified, and requires only a limited number of persons, disciplined and respectable, willing to take a risk.

The strikers calculate that, given the reasonableness of their demands, and with advance PR, there will be pressure on psychiatrists, medical doctors, to save the strikers and end the fast. Efforts of psychiatrists to fend off this pressure with "junk science" will remove the cover from their lies and deceit once one final piece is in place. The "fraudulent" and deceptive junk science must be neutralized with clear analysis and forceful explication. The hunger strikers will need your help.

No matter how respectable and disciplined they are, the people fasting will be unable, on their own, to match the authority and apparent gravitas of the "experts" they will confront. For this reason, SCI leaders will, in days to come, be attempting to construct their own panel of experts from ICSPP membership to duel in mainstream media and other public forums with representatives of their target organizations. More than that, they will need the words and letters, and yes, financial support from you all. Next spring, survivors and dissident professionals TOGETHER.

For more information and a copy of the new issue of MindFreedom

Journal (with cover photo of Peter Breggin, MD) see www.MindFreedom.org. Below is a rough draft of the proposed hunger strike statement.

 

FAST FOR FREEDOM IN MENTAL HEALTH - DRAFT

A Hunger Strike to Challenge International Domination by the Biopsychiatry Industry

This fast is about human rights in mental health.

The psychiatric/pharmaceutical industry is heedless of its oath to "first do no harm."

 

Psychiatrists with impunity:

* Incarcerate citizens who have committed crimes against neither persons nor property.

* Stigmatize, defame, and besmirch persons with meaningless diagnostic labels.

* Induce proven neurological damage by force and coercion with powerful and unreliable psychotropic drugs.

* Stimulate violence and suicide with drugs promoted as able to control these activities.

* Destroy brain cells and memories with an increasing use of electroshock (also known as electro-convulsive therapy).

* Too frequently sexually and physically molest clients under cover

of intimidation and confidentiality.

* Employ restraint and solitary confinement in preference to patience and understanding.

* Infantilize and humiliate individuals already damaged by traumatizing assaults to their self-esteem.

These human rights violations and crimes against human decency must end. While the history of psychiatry offers little hope that change will arrive all at once, or even quickly, initial steps can and must be taken.

At the very least, the public has the right to know IMMEDIATELY the evidence upon which psychiatry bases its spurious claims and treatments, and upon which it has gained and betrayed the trust and confidence of the courts, the media, and the public.

WHY WE FAST

There are many different ways to help people experiencing severe mental and emotional crises. People labeled with a psychiatric disability deserve to be able to choose from a wide variety of these empowering alternatives. This self-determination is important to achieve real recovery.

However, choice in the mental health field is severely limited. One single approach dominates, and that is a belief in chemical imbalances, genetic determinism and psychiatric drugging as the treatment of choice. This medical model is sometimes termed

"biopsychiatry." Far too often this approach has been exceedingly harmful to both the body and the spirit.

Governments and the mental health industry use extensive taxpayer funding, judicial edicts, and repressive laws to enforce a biopsychiatric approach. The mental health system rarely offers options other than psychiatric drugs, and still more rarely offers people full, accurate information about the hazards of psychiatric drugs. The mental health system is coercing increasing numbers of people to take psychiatric drugs against their will, even on an outpatient basis in their own homes. Electroshock is quietly making a comeback.

Biopsychiatry is now one of the most profitable of all industries, and its power is globalizing rapidly. The World Health Organization and the World Bank have multi-billion dollar plans to spread biopsychiatry to developing nations.

Given all these facts, citizens have a right to ask: "Has science established, beyond a reasonable doubt, that so-called 'major mental illnesses' are biological diseases of the brain? Does the government have compelling evidence to justify the way it singles out for its primary support this one theory of the origin of emotional distress and of pharmaceutical remedies for its relief?"

We challenge psychiatric trade associations, pharmaceutical corporations, and government agencies to produce objective scientific evidence to support their claims. Both public and personal health and safety are dependent on their response.

This fast is not about judging individuals who choose to employ biopsychiatric approaches in an effort to seek relief. We respect the right of people to choose the option of prescribed psychiatric drugs. Some of us currently make this personal choice, or have done so in the past.

We must act in the nonviolent tradition of Cesar Chavez and Mahatma

Gandhi by saying "No!" to oppression with our bodies and spirits through fasting, while affirming the humanity of those people to whom we make our demands.

THE UNDERSIGNED WILL REFUSE ALL SOLID FOOD for an indefinite period of time as we await our challenge to be met by the following:

1. American Psychiatric Association (APA)

2. National Alliance for the Mentally Ill (NAMI)

3. National Institute of Mental Health (NIMH)

4. Pharmaceutical Research and Manufacturers of America (PhRMA)

5. World Health Organization (WHO)

WE DEMAND THAT YOU PRODUCE scientifically-valid evidence for the following, or you publicly admit to media, government officials and the general public that you are unable to do so:

1) EVIDENCE FOR LABORATORY FINDINGS that can reliably diagnose and establish the validity of "schizophrenia," "depression" or other "major mental illnesses" as biologically-based brain diseases.

2) EVIDENCE FOR A PHYSICAL DIAGNOSTIC EXAM -- such as a scan or test of the brain, blood, urine, genes, etc. -- that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs), from individuals without these diagnoses.

3) EVIDENCE FOR A BASE-LINE STANDARD of a neurochemically-balanced "normal" personality, against which a neurochemical "imbalance" can be measured and corrected by pharmaceutical means.

4) EVIDENCE THAT ANY PSYCHOTROPIC DRUG can correct a "chemical imbalance" attributed to a psychiatric diagnosis, and is anything more than a non-specific alterer of brain physiology.

5) EVIDENCE THAT ANY PSYCHOTROPIC DRUG can reliably decrease the

likelihood of violence or suicide.

6) EVIDENCE THAT PSYCHOTROPIC DRUGS do not in fact increase the

overall likelihood of violence and suicide.

7) FINALLY, that you reveal publicly evidence published in mainstream medical journals, but unreported in mainstream media, that links use of some psychiatric drugs to structural brain changes.

Until the above demands are met to the satisfaction of an internationally-respected panel of scientists and mental health professionals, we plan to drink only liquids and to refuse solid food for an indefinite period of time.

Signed by Fast for Freedom Participants:

[initial core group committed to fasting:]

Judi Chamberlin

George Ebert

Krista Erickson

Leah Harris

Mike Hlebechuk

David Oaks

Larry Plumlee, MD

Mickey Weinberg, LCSW e-mail: <mickey37@earthlink.net>

 

IEPA in Copenhagen-original

By Loren Mosher, M.D.

Date:   10/23/2002  2:36 PM

RE:    Third International Early Psychosis Association Conference, Copenhagen, Denmark. 

Here it is folks-it ought to cause a stir somewhere

PHARMASUBTLE-reflections and impressions of the Third International Early

Psychosis Association Conference, Copenhagen, Denmark.  September 23-25,

2002.

 Or, Big Pharma Has Its Way with us Again -Two Big Mc's and all aboard -the train may have already left the station.

 

This was an extraordinary event - in large part orchestrated by the two big Mc's - Drs. Patrick McGorry (University of Melbourne) and Thomas McGlashan (Yale University).  Presumably their drug company sponsors may also have had a role in the conference's organization.  It drew over a thousand folks so it's got to be fashionable.  On second thought, maybe not quite fashionable-the pharmaceutical companies packed the house to some unknown extent. It was a waste of time for those of us who went expecting a discussion of important scientific/methodological and ethical issues in this controversial area of psychiatry.  There was only one last-day debate devoted to whether or not the field was ready for an attempt to prevent psychosis/schizophrenia.  The two nay-sayers, Drs. Richard Warner (Boulder, CO) and Joseph Parnas (Copenhagen) were brilliant but had only 8 minutes each to try and slow the train.  Sixteen minutes out of nearly 4000 devoted to plenaries and paper sessions!

 Briefly, to be a bit more specific, there are at least 4 methodological issues that should be addressed by a conference on the prevention of psychosis: 1.  The predictive validity of the screening instruments used. 2. The quality of the condition's diagnostic validity. 3. The presumption that minor or transient symptoms are specific predictors of later full-blown psychosis and 4. The validity of the assumption that drugs used to treat manifest "schizophrenia" would be best for its prevention.  For this observer, these issues were given short shrift-Warner's and Parnas' attempts not with standing.

            As for ethics, there was one 15 minute paper co-authored by Dr. McGorry on the ethical issues of intervention in "at risk" for "schizophrenia" subjects. As he is the train's engineer it is hard to imagine he'd find any serious ones-to do so would call his own research enterprise into question. In terms of unbiased discussion of the ethics of this enterprise by independent bio-ethicists- forget it.  Preliminary results were presented from several centers already treating "at risk" youth. So, based on the conference's content it would appear there are no such issues -only the practical ones of identifying and signing up these kids for the experiment.

 Discussion of critical ethical issues that stem from the labeling process-self-fulfilling prophecies, the Hawthorne effect and stigmatization were not raised-in part because there was almost never any time for discussion.

Before proceeding with this critique a demystification of the organization's title is warranted.  The title actually refers to treatment of two different groups of subjects-those who are "prodromal" or "pre-schizophrenic" or "at risk" and those who actually present themselves for treatment in a first episode of psychosis. It is the first group's treatment to which I am extremely opposed because of the scientific and ethical issues noted above. I also object to those studies of the second group ("First Episode") that do not include a group treated with intensive psychosocial measures with no or low dose anti-psychotic drug therapy. 

Although it was hard to be sure, it appeared as if only the studies reported by Cullberg from Sweden and the Finnish First Episode Study contain this design feature.  Few seem to realize that the outcome of schizophrenia is worse now than it was before the anti-psychotic drugs were introduced and that rarely neuroleptic drug maintained persons with schizophrenia in developing countries have superior outcomes to drug treated subjects in western industrialized countries. In addition, placebo or non-drug treated subjects have been shown to have better outcomes in a number of controlled clinical trials.

Until Big Pharma got on board in 2000 "schizophrenia" prevention was relatively small potatoes - the two Mc's were slowly gathering samples. Suddenly, after a drug industry sponsored meeting in NYC, multi- center trials were planned and implemented.

The Wall Street Journal's Rachel Zimmerman reported on July 26, 2000:

"A group of doctors, academics and drug-industry executives are meeting this week at New York University's Medical Center to hash out the details of what could be a $25 million multinational study that would involve 1,500 potentially schizophrenic teenagers"

Now the locomotive had power (money)-the train could really begin to move-McGorry the engineer and McGlashan the fireman. Guess what  - one arm of nearly every new prodromal intervention study used an "atypical" anti-psychotic - Big Pharma's best selling expensive new wonder drugs.  Never mind that they're not more effective than the old "bad" ones and have an emerging pattern of very worrisome adverse effects.

Also it is impossible to conduct a "blind" study with these drugs due to their obvious side effects.

The four "atypical" makers were "discretely " present in Copenhagen - Janssen  (Risperdal), Lilly (Zyprexa), Pfizer (Geodon) and Astra-Zeneca (Seroquel).  Their muted presence belied their true influence ?large members of "prevention investigators" and others were flown in - I heard from a reliable source that 18 Aussies were flown first class from down under (McGorry is from Melbourne). Oddly, it was also reported that they funded 50 Polish participants - my guess is that they were paid for because the market share of the expensive atypicals is low in the poorer former Eastern block countries.  This group was rarely seen ?seemingly Copenhagen's wonderful shopping was just too attractive.  Of course, they all stayed at one of Copenhagen's finest 5 star hotels.  I really wonder how many of McGlashan's Yale team and his multi-center collaborators were directly or indirectly (from their drug company grants) funded by the pharmaceutical houses.   Financial disclosure statements were not published and only one plenary speaker disclosed his. Since this is all hearsay and I don't think the companies have to report these buyoffs they will, of course, deny their "unseen" control of presentations at the meeting (remember, most of the first episode studies also use the atypical anti-psychotic drugs as the first line of treatment).

As for presentations, in addition to 9 plenary lectures and one debate, there were over 200 papers given at 15-minute intervals in parallel sessions.  Because of the very tight schedules, the normal over-talkativeness of presenters and little exercise of discipline by session chairs, there was never time for discussion.  So much for dialogue

as a central process for the advancement of science in areas of controversy. There was no real expectation that the "Big Dudes" giving the plenaries would be asked questions.  Why Dr. Jeffrey Lieberman and his Walt Disney like power point plenary presentation of various hypothetical CNS changes in schizophrenia was relevant to this topic escapes me.  I suspect he was there not because of any relevance to the topic but because Big Pharma

wanted to be sure a dazzling biopsychiatric view would be presented by one of its most dependable spokesperson. Of course he completely filled his allotted time and skipped town immediately before the attendees could ask the obvious question - how are these unproven CNS developmental aberrations relevant to this conference?

Whether they knew it or not the conferees were being force fed the organizers' message - "see what wonderful work we're doing."  The two Mc's were co-authors on more than 20% of the more than 200 papers presented - party line anyone? By the last day I felt somewhere between having been subject to thought control, thoroughly propagandized or just plain brainwashed.

The few really interesting and methodologically sound papers by Bola, Cullberg, and the Finnish First Episode group and some others were outliers. They, like the less rigorous and "preliminary report" papers, went undiscussed.  Bola's paper was a real barn- burner.   The concept of "duration of untreated psychosis"(DUP) is a central precept of early intervention studies. The notion is that intervention will reduce the DUP and thereby prevent the neurotoxicity (that results in poorer outcomes) associated with the occurrence of psychosis.  This notion was proposed by Wyatt in the early 1990's and has taken on the status of revealed truth.

Well, when looked at more carefully, it turns out that a longer DUP is not predictive of poor outcome. Oops, back to the drawing board on that one folks!

All in all it was a successful marketing effort that helped deliver a new, younger, basically non-psychotic group into the arms of Big Pharma. How could almost 200 "scientific" papers be wrong?  This group needs treatment because the atypical anti-psychotics are "safe, effective and well tolerated" (Big Pharma's favorite mantra.). They should be first line treatment.

            Anyone who attended the meeting with doubts about the schizophrenia prevention enterprise were overwhelmed by the sheer volume of "go for it" presentations and given no chance to even put a pebble on the tracks of this train. Nothing could be discussed.  Get out of the way group ? the early intervention train is out of the station and gathering speed.  Above all, don't even think about the unsuspecting "at risk" folks whose lives may be ruined on the altar of "science".

 I would like to hear from attendees who were not there on the drug company dole about their experiences of the meeting.  Maybe shopping was the highlight? 

Loren Mosher MD  10-23-02 (Grace Jackson MD provided a framework for the scientific and ethical discussion herein).

Mosher /Schreiber

Soteria Associates

2616 Angell Avenue

San Diego, Ca. 92122

www.moshersoteria.com

 

 

WOW - What a conference !

BY Bob Johnson, M.D.

Wow, call that a conference? This was my first ICSPP conference, and if they are all going to be like this one, then I shall have to go into training for the next one. But count me in ? you can be sure that I shall be there!

There were so many highlights it?s hard to know where to begin. However, if we start with the highest of them all, then we need to go to almost the last moment of the final day.  How many conferences can boast such a dramatic finale, as this one had ? something I, for one, will never forget. What a testimony to the quality of the participants, the inspiring nature of the speakers, and the general overall milieu, if I can put it that way.    This is not something you arrange to have happen ? you can arrange as much as you like, but this final moment, with what I shall call ?The Deborah Contribution? does not come about, unless something special is in the atmosphere. Can you think of any other conference which can give enough time, space, support and encouragement to such a disclosure as we saw, just minutes before the end?    Throughout the conference, we had already seen several accolades and awards handed out ? but this ?Contribution? was a tribute to the whole conference ? men, women and children! This sort of occasion does not grow on trees ? it is surely worth its weight in gold.

MY CONFESSION

Before I get on to that one, I have really to start with the nitty gritty. Would you believe I have a confession to make? I hope you won?t judge me too harshly, and I am sure this is the best place for me to get it off my chest. Well, the truth is, I had a run in with Dominic Riccio. I actually had a disagreement with him. I know, I know, it seems to have become something of a rite of passage -- everyone must, at some stage have a tiff with ?The Major Domo?. But what can you do when you find out, as in the last session, that the man has a heart of gold ? How can you argue with that? You can have a beef with someone who is only doing things by halves ? but here is a man who has such conviction regarding his patients, that he is fully prepared to go way beyond the text book for them.   If this means becoming their grandfather for a while, Hey! He just takes it in his stride ? whatever !

The bones of the disagreement were that I seriously wanted to hear Richard Shulman and Kevin ?My-Mac-Is-Ready? McCready describe the philosophy behind their treatment centres. Since I am thinking about to starting one up myself, I was desperately hoping to pick up some tips and indicators not only as to how best to set about it, but also what pitfalls to look for and so avoid. Dominic Riccio meanwhile was, as ever, concerned with the proper running of the conference. He didn?t seem to notice that he had overlooked the little matter of discussing a suitable title with me, of what a putative workshop run by me, might be called. Nor that I had simply no contact with the other presenters. I put a great deal of weight on consent in my work ? yet here, I don?t remember consenting to anything. But those of you who know Dominic Riccio, will know that he has a clear vision of what the conference should look like, how it should go ? and off he goes and gets it done. It is perfectly clear that he had worked extremely hard to get the thing running, so my confession peters out at this point.

GONE WITH THE WIND?

What happened when I did eventually join the workshop I wanted to, was again quite unexpected. I was not sure if I had come to the right place, or had I perhaps stumbled into an audition studio for ?Gone with the Wind?. Kevin McReady was at the front, as befits a workshop giver ? but he seemed to be acting more as linguistic interpreter. The main speaker when I arrived was Deborah Proverbs, who was holding forth on what a treatment centre should look like. The trouble was that she spoke, as she does, with a quite splendid New Zealand accent ? hardly surprising, since that is where she hails from. I had not the least difficulty in understanding what she said, nor, as it happened agreeing with it.  But then I have several cousins from those antipodean islands, so this was nothing new to me.

Others however, were puzzled by what she was actually saying. For them, she might just as well have been talking Greek. But there was worse to come. Encouraged, even provoked one might say, she courageously recast what she said, in the nearest she could get to a United States accent. The one she chose had the workshop in fits of laughter ? she was clearly auditioning for the role of a Southern Belle ? and for my money, she gets the part everytime. Not so much because of her actual talents of elocution, more for her splendid attempts to carry on communicating whatever the terminological obstacles, even if some of these emanated from Brooklyn.

FROM THE VERY START

I suppose I should have suspected something out of the ordinary from the minute I set foot on US soil. Having got my bags, I found myself facing searching questions from the immigration officer ? he wanted to know why I was coming to the United States.  Perhaps because I had set off at 1 a.m. local time, it being then around 2 in the afternoon Newark time, I was somewhat light headed. However I summarised my visit by saying I had come to reform psychiatry, adding that I didn?t think it should take much more than 3 days. And that I planned to return late Sunday night. Oh, he said, that?s interesting. And he seemed to be giving me encouragement to say more. I added that I was sorry, but if I added more details and explanation, then clearly I would have to begin to charge him ? psychiatric chat rarely comes free. He was up to this however, and quick as a flash, he said ?if you do that, I would have to refuse you entry, since you have no work permit.?   He gave me a thin smile, when I asked if perhaps, he could manage a tip. This may have triggered something off in his mind, because as I picked up my passport, by now duly stamped and stapled, he throw out one final remark. ?This wouldn?t be connected with L Ron Hubbard, by any chance?? he said. I?m still not sure quite where that particular comment came from.

THE JINXED HOTEL

I loved the conference, but have to admit the hotel left something to be desired.   For a start they allocated my room to another conference participant, who confidently marched into my room, only to find it already allocated to a somewhat jet-lagged Brit.    Not content with this bungle, when I later came back to my room, to my astonishment I found my ?key? would not work the lock ! They had given me the wrong combination, so a further trip to reception was called for, to get the right one.  

All this of course, was as nothing when I discovered that the enormous quantity of work I had put in to ensure that my video was compatible with the local NTSC television standard was in vain ? no video equipment could be found !  Karen Effrem obviously had had advance experience of this, and showed what I should have done by bringing her own.  As it happens, my small charity had just gathered all its pennies together, and had invested in a new projector.  We bought one for our conference the following Saturday ? I should just have brought it with me too ? I?ll know for next time.

THE BEAR TRAP

In the final session, all the speakers were ranged in a row behind the podium ? all, that is except for Dominic Riccio, who had a firecracker up his sleeve. He suddenly wanted to know what we each would do if faced with a poor unfortunate insomniac who had not slept a wink for a full 72 hours ? surely the implication was, that we would all take pity on her or him, reach for our collective pens and sign out 5 mgs of valium as a minimum.  Surely we could not be so hard hearted as to withhold such a small crumb of medical succour.  

This sounded a bit like a bear trap. But again, Dominic Riccio?s methods produced unexpected bonuses. For a start David Cohen with his razor sharp mind sliced through the problem and proposed abolishing prescriptions altogether ? help yourself over the counter. Then Peter Breggin summed up the whole conference by succinctly stating that it was not the side effects (alone) that dissuaded him from prescribing, it was the fact that the drugs available simply missed their target altogether. When my turn came to handle the hot potato, I turned it aside with my accustomed aplomb, as many an experienced politician does, by answering a quite different question altogether ? ignoratio elenchi as the Latin has it (I put that in for Grace Jackson, my hero).  I told the story of Lenny a murderer I treated in Parkhurst Prison, who told me not to stop his tranquiliser injections. He had tried it himself, 4 months before I arrived, and his temper came back. After 3 months, we dealt with the roots of his anger, and he has never had an injection since.   

Bert Karon?s response was joy to watch. He ducked nothing, he picked up the issue with more grace, wisdom and plain common sense than can rarely be found compressed into such a short space of time ? what a delight. Steve XXXX answered in his usual skilful away, by inventing a new syndrome ? Excessive Conference Obstreperous Syndrome ? he explained that the longer the conference went on, the more obstinate he became, so he refused point blank even to look into the bear trap, let alone fall into it.   I wish I?d thought of that.

THE CONTRIBUTION

But the finale was entirely spontaneous. It was beautiful. It was totally unplanned.   And more than anything else, it showed how psychiatry in this new century can contain more hope than fear. Deborah Proverbs, yes the one who had been auditioning for Gone With The Wind, apparently wished to address a question to the panel. She raised her hand, waved it about, for at least 10 minutes and eventually was taken notice of.   Standing at the front, gripping tightly to the microphone, she started by saying her knees were weak. We still had no inkling of what was going on. She asked if she could tell a story ? well this was not really on the agenda (this was final question time, remember), but with a little encouragement she set out.

Well, she had barely started, when she was struck down with what I well recognised as emotional strangulation ? all her feelings were bubbling up to the front at once, and she could not tell what to do next. Happily I was close enough and awake enough to be able to say ?take your time, take your time?. She then rewarded the entire conference, by revealing prodigious courage. In front of a large audience, and a weighty panel she was brave enough to disclose a severe trauma that had felled her over 20 years before. She managed to unburden herself of this dire event. It helped her. But look at what it said about the conference. This was real. This was what had actually happened.   And the conference was actually doing what it preached ? it was providing an honesty, an integrity and a support which allowed a healing to take place. As I said, what a conference ! Wow !

 

Conference Reflections

By Mary Sue Laing, M.Ed.

 

            ?What?s in a name?  Would a rose smell as sweet by any other name?? asked Romeo of the names Montague and Capulet.  Of course, different idea.  As he explained at the beginning of a workshop during the Romeo implied a positive answer, but David Cohen, Ph.D. might have a October 2002 ICSPP conference, language has an enormous influence on how people think and act.  Referring to a rose as ?hay fever flower? or ?guilt gift? could easily influence its perceived scent, human persons being the complex creatures they are. Calling mind-numbing prescription pills ?antidepressants? may well be the advertising feat of the century. Another speaker at the conference explained that a new Ritalin derivative would be named Focasin. The manufacturer got the idea from a Simpson?s show in which Bart needed Focalin. The company expects Focasin to be very popular.

            When I worked as a summer camp counselor I quickly discovered the disadvantages of calling the twinge of sadness campers often felt during the first few days ?homesickness?. When children thought they were ?homesick? they would actually become physically sick. I quickly learned to distract campers from such thoughts by getting them interested in the activities.

Several conference speakers pointed to the value of thinking and reality contact. They also discussed a lack of reality orientation as characteristic of people who need help.  Clement Vontress, Ph.D. explained the importance of truth, trust, and consent in therapy.  Kevin McCready, Ph.D. spoke of the value of a free, exploring mind. David Stein, Ph.D. listed a difficulty in thinking, especially in connecting behavior with consequences as characteristic of children labeled ADHD. Bertram Karon, Ph.D. stated, ?You?re not sick because you?re confused. You?re sick because you?re sure of what isn?t true.? Peter Breggin, M.D. defined psychosis as loss of contact with human reality.

            Larry Simon, Ph.D. spoke about preoperational thinking during psychotic episodes and providing correction for that type of thinking as a counseling method.  According to researcher Jean Piaget, preoperational thinking is characteristic of children ages two to seven. In this intuitive stage, as Piaget terms it, the child responds to outward appearances without comprehension of underlying principles.  For example, the preoperational thinker assumes that a tall, thin jar holds more that a shorter one, even when the water that fills the taller one doesn?t fill the shorter one.  Another characteristic of preoperational thinking is the failure to connect behavior with its consequences.  Preoperational thought is quite magical and neither logical nor realistic. If a person is to live a mature, principled life, preoperational thought has to give way to higher ways of thinking.

            Magazine and TV advertisements for drugs that appeal to preoperational thinking rake in millions of dollars for pharmaceutical companies. These ads often connect consoling family scenes and/or exciting outdoor activities with the drug being advertised.  One ad features an asthmatic mom playing soccer with her children! During another ad people in a field of flowers advertise a ?purple pill? for acid reflux (bad heartburn). Side effects include headache, diarrhea, and stomach pain according to the quickly-spoken, hushed voiceover. A magazine ad last winter promoted a pill for flu symptoms that caused flu symptoms! A Paxil ad shows Mom embracing family members and becoming herself again. The ad used to say that Paxil is non-habit forming, but, since the judge in California objected, another phrase has been substituted. An ad for ADHD medication shows a smiling mother and cheerful children doing schoolwork. The Zoloft ad presents a cartoon egg with a sad face before taking the pill, but bouncing up and down happily after the pill. A few ads mention neither the condition they are supposed to treat nor the side effects, but only advise viewers to ?talk to your doctor?.

            What thinking persons would such advertising persuade?  They would have to be preoperational thinkers, of course. They would be those who fail to perceive that the unwanted effects of a drug may be worse than the original illness, or that eliminating the cause of distress may be far more effective than just numbing the pain. They would be people suffering so much, so lonely, so desperate for a cure that they?ll believe anybody who offers them the slightest hope, even in cartoon form. They would be those who are duped into thinking that swallowing a pill will produce satisfying family relationships and exciting good times on the outdoors just because they see pictures on TV.

            In this environment of primitive, unrealistic thinking it?s woefully simple to promote mind-numbing substances as cure-alls for almost any human problem. Just use a scary name to identify the problem and a soothing name to cure it. Presto! The pharmaceutical company earns billions. The purpose of words is to carry meaning.  However, in a fantasy world atmosphere words can readily produce unrealistic meanings that lead to destructive choices.

A case in point is the word ?attention?. The word ?attention? appears to have mesmerized American educators and enslaved millions of children to mind-bending substances. When a teacher thinks that the child has an ?attention? problem that only a pill will cure, the teacher stops identifying and solving the educational problems that the child might have.  Just this week I saw a grade for ?attention? on the report card of a fourth-grade tutoring student. I have groaned inwardly for years over ?effort? grades on report cards, but the attention grade seems even worse, especially in addition to the effort grades in every subject. The effort and attention grades seem to be more a function of how the teacher feels about the student at the moment of assigning the grade than anything else. 

My student achieved a grade of ?fair? in attention. I?ve tutored this child since second grade and others from that school also. When a child doesn?t understand a word, concept, or directions for an assignment no teacher helps. When the student gives several wrong answers on the same paper no extra teaching is done at school. If a grade is low, the parents are told that the child has an ?attention? problem. Not surprisingly, teachers routinely pressure parents to take their children to doctors to cure this ?attention? problem. Recently I saw a bulletin board proclaiming the school as drug free with numerous student signatures underneath. The attention idea has so dominated the thinking of this school staff that they don?t realize that much of their student body is now drug addicted!

In past years I tutored a developmentally delayed student whose parents spoke an Asian language in the home. This student threw regular temper tantrums from kindergarten through sixth grade when the problem was finally solved. I attended several Individualized Educational Plan (IEP) meetings. When I met with her teachers I would tell them that she had a language problem, but they would say that she needed medication.  Finally her mother relented. After several months the stimulants had too many side effects, so the psychiatrist prescribed Desipramine (reported in the professional literature to have caused the deaths of several children). When the child became visually impaired shortly after starting the medication, I wrote a note to her psychiatrist. He paid no attention until he got a message from an ophthalmologist stating that she couldn?t see very well and withdrew the medication. Her mother then obtained a note from a pediatrician saying that the child was unable to tolerate psychoactive medication. After the teachers finally forgot the attention idea and began to think about how they might help with her communication problem, they quickly created an effective solution. They paired the Asian student with a regular class student to help with communication in stressful situations. The temper tantrums stopped, and the Asian child is now successful in a middle school special education class. How sad that the child had to suffer for six years because the attention fantasy prevented her teachers from seeking a real solution!

            Language is, indeed, powerful, but we don?t need to let that power in the hands of the snake-oil salesmen who sell poisonous placebos. We can proclaim psychoactive medications as emotional painkillers that produce both tolerance and dependency.  We can say that pills solve no problems and that turning off pain?s warning signal is like silencing a psychological smoke alarm. We can talk about the numbing and dumbing effects of the so-called ?smart pills?. We can speak of children being turned on and off chemically like their parents? computers. We can point to the pseudo-science as clever advertising, and advise people to follow the money trail if they want to know what?s happening and why.

            If enough of us use our language with enough people, slowly, one person at a time, one group at a time, people will see what?s really happening and say ?No? to drugs for themselves and for their children. Let?s go to it and do it!   

 

MENTAL HEALTH PARITY

By Dolores Puterbaugh, MS, LMHC

A therapist in private practice in Largo, Florida

 

The current debate concerning parity for mental health coverage with medical coverage leaves much unsaid.

The media have focused on the ?major? diagnoses of schizophrenia, bipolar disorder and depression.  Leave aside that there are no scientific tests to prove the existence of these ?brain disorders,? drug companies? and psychiatry?s statements to the contrary; there is still much to discuss.

With millions of prescriptions written annually in this country for Prozac, Paxil, Zoloft, and other ?antidepressant? drugs, there must be millions of people diagnosed with a major mental illness.  As a mental health professional, I wonder how many people receiving these prescriptions understand that, forever after, they will have to mark ?yes? on every licensing form, job and volunteer application, medical history form and lease application that asks if they have ever been treated for a mental illness.

Groups with an interest in expanding the definition and incidence of mental disorders are constantly reinventing and redefining the parameters of mental illness.  The Diagnostic and Statistical Manual of Mental Disorders grows ever thicker.  The ?bible? of mental health managed care, it comprises hundreds of checklists which define, subjectively, the diagnostic criteria of so-called mental disorders.

The passion for using health insurance for counseling and psychotherapy services has led most mental health professionals to play the diagnosis game. Example: I frequently get calls for premarital counseling services.  Thus far, wanting to marry is not symptomatic of a mental illness and thus no therapist can bill an insurance company for premarital counseling.  If the couple does not want to pay out of pocket (why spend money to prepare for a lifetime commitment?) they will seek a therapist who will agree to see them together but bill one or the other?s insurance company for individual counseling.  This means, giving a mental illness diagnosis to appease the insurance company and forever labeling the customer as a mentally ill patient. Chances are, this process has not been explained to the client, but the client is happy to save with only a co-payment  rather than the whole fee. Similarly, family counseling is billed by picking one member to be the diagnosed patient ? the one with the ?problem.? It may be a very natural process ? for example, the blended family? where some adjustments makes sense. But insurance companies are paying for a ?medical? service and that means some one must be the patient.

I find this unethical. It concerns me on many levels. I believe it is irresponsible that the common practice in my profession is to diagnose clients to save them a few dollars in the short term. Clients usually have no inkling that there can be many, long-term and serious ramifications of this decision to literally save just a few dollars.   In a divorce or lawsuit, will your previous treatment for ?mental illness? be used against you?  It has affected the outcome of custody and divorce litigation; it can keep you from a hunting license and may create fences between you and other life goals seemingly unrelated to your short-term counseling long ago. How often have you read the account of some incident in the newspaper, where a subject?s previous treatment for depression with medication is listed as a salient fact?

The number of Americans, now estimated as one in five, diagnosed with a mental illness each year is to great extent a result of this disease-izing of life. Getting through adolescence, adjusting to an empty nest, grieving a loved one, negotiating the ups and downs of marriage ? these are not mental disorders. These

are facts of life. By dishonorably folding these figures into the number of persons with real, persistent emotional troubles, the pharmaceutical and psychiatric industries inflate their importance while realistic and appropriate services are often unavailable for both the severely troubled and the getting-through-life clients.

In linking psychotherapy and counseling services with a mandatory diagnosis of mental illness, the leaders of the mental health professions have effectively stigmatized services which for years served to facilitate insight and personal growth for countless persons. People are increasingly resistant to counseling because they perceive it to mean one is ?mentally ill,? which it does, on paper, if one uses a health insurance program or community mental health center. 

Psychotherapy can be a godsend to persons struggling with many life problems: overcoming abuse, bereavement, breaking bad habits. But the mandates of diagnosis are stern; bereavement, for example, may last only two months before the wise men and women of the American Psychiatric Association determine it is no longer grief but some sort of mental illness, a major depressive disorder. This says more about the emotional state of the deciding board members than it does about a husband of many years who has lost a beloved wife.

Switching to a purely pragmatic gear, if I am paying a health insurance premium so that my funds, and the funds of thousands of others, are pooled to pay for services, should not those services be rendered accurately, rather than manipulated based on the ethics of the particular professional?

If the current debate on parity in mental health services can include honest, educated and public dialogue on the widespread misuse of diagnostic categories as well as the benefits of psychotherapy and caring support in times of emotional pain, it will be a useful process.  Otherwise the medical, pharmaceutical and insurance industries are just continuing to misrepresent the reality of mental health services to the public.

 

In Search of the Chemical Imbalance: How Psychiatry Has Reduced the Brain and Ignored the Mind

Grace E.  Jackson, MD

The TV commercial shows a bouncing ball, frowning before the onset of therapy with the appropriate pill. The announcer reminds viewers that they may be suffering from a chemical imbalance, for which medical help is readily available.  They should ask their doctors if they have symptoms of clinical depression (or general anxiety) for which Zoloft should be taken.  The ad closes with a picture of the animated ball (post-Zoloft), smiling broadly before skipping out of view.

A psychiatry residency program drills its junior psychiatrists in the art of  ?medical clearance.? Before any patient may be admitted to the inpatient psychiatry ward, the admitting resident must demonstrate that symptoms are NOT the result of an undiagnosed or unstable ?medical? condition. To this end, vital signs are taken; EKGs and x-rays are performed; and a variety of blood tests and urine tests are obtained. Only if, and when, a patient?s neurobehavioral symptoms are determined to be ?non-organic? in origin (or if organically caused, then the product of a stable underlying condition) is the patient deemed appropriate for treatment on the psychiatric ward of the hospital.

?Non-organic in origin.?  ?Medically cleared.? But then, the same psychiatrist determines that the patient must be ?treated? for a medical condition, with pharmaceutical agents.  The doctrine of biological psychiatry commands its adherents to medicate people for ?speculative? or ?presumptive? chemical disorders, despite the lack of evidence that such a disturbance ever exists.

There are at least five problems with the chemical imbalance model of mental ?disease?:

1)      the model ignores the reality that there has never been a consistently reproducible biological marker, to substantiate the levels of ?normal? or ?abnormal? neurotransmitters in the human nervous system

2)      the model fails to respect the enormous complexity of  neurotransmission in the human brain: a) there are over five kinds of dopamine receptors which have been characterized to date, and even the best researchers know nothing about the D5 subtype. b) there are five separate kinds of cholinergic receptors. c) there are fifteen different kinds of serotonin receptors. d) neuroscientists do not yet understand the relationship between neuroreceptor density, sensitivity, or neurotransmitter turnover.

3)      The model fails to consider the fact that many of the neurochemicals which are presumed to be the basis of ?mental disease? are, in fact, broadly distributed throughout the body.   This fact raises questions about our conceptualization of ?brain tissue? (i.e., it is NOT limited to the cranial vault) and also raises questions about the reliability of serum or urine tests,  as those assays may be capturing levels which reflect non-brain locations of neurotransmitter activity a) over 85% of  the serotonin in the human body is made by the enterochromaffin cells of the

stomach and small intestine,  rather than the raphe nucleus of the midbrain and pons b) a broad variety of cells in the human body possess receptors for many of the neurotransmitters, including white blood cells and platelets.

4)      The model fails to acknowledge the  impossibility of measuring discrete events in the human brain,  due to the speed of neurotransmission; and due to the relative ?bulk? of  our measuring devices, relative to the size and complexity of each synapse 

5)       the model fails to acknowledge the impossibility of studying the brain in reductionistic terms. That is to say, the ?organic whole? may so far exceed the sum of the component parts, that science will never be able to fully explain the workings of this amazing system. Part of the problem here is that the brain is never capable of being studied in a vacuum ? the system is forever ?open,? due to the conscious, and unconscious, processes of the subject who is being observed.  Part of the problem, too, arises from the phenomenon of diaschisis, or non-local effects, through which changes in one part of the brain reflect, and then precipitate, complex cascades of events in multiple locations throughout the nervous system.  Thus, it is impossible to speak of ?serotonin? or ?dopamine? without analyzing the interactions of ALL chemicals, peptides, and amino acids upon each other, but far too little research has occurred to study the complex array of these intercommunications.

The human brain consists of over 100 billion neurons, an equal number of support cells (glia), and dozens of neurochemicals, all of which participate in the most complex system known to man.   Superimposed upon this incredible system of cognition, sensation, movement, and imagination is the human will. Biological psychiatry, and its TV commercials, seem to have completely dismissed this essential element of the species.   While it has become fashionable to compare the human brain to the activities of a computer ? the brain tissue, comprising the hardware; and the neuronal circuits and chemical events, comprising the software ? it has become disturbingly acceptable to reject the existence of a third component: the operator, who sits at the keyboard.

To be truthful, humans are corporeal beings, who record the events of life with electrical and chemical fluctuations of a highly refined nervous system. But the chemical model of ?mental illness? has too often confused association with causation. And worse, still, it has failed the species entirely, by suggesting that randomly occurring fluctuations in brain activity are more important than the processes through which the human organism comes to sit at the keyboard of such an amazing machine.

 

TWENTY EIGHT YEARS OF ICSPP ACCOMPLISHMENTS:

Stopping the worldwide resurgence of lobotomy and psychosurgery on adults and children, and all psychosurgery in federal and state institutions.

?        The creation of a federal Psychosurgery Commission by Congress (1970's)

?        Alerting professionals to the dangers of tardive dyskinesia in children (1983). Tardive dyskinesia is a potentially devastating neurological disorder caused by neuroleptic or antipsychotic drugs.

?        Alerting professionals to the dangers of dementia produced by long-term neuroleptic drug use (1983).

?        Motivating the FDA to force the drug companies to put a new class warning of tardive dyskinesia on their labels for neuroleptic drugs (1985).

?        The withdrawal of a large multi-agency federal program to perform dangerous invasive experiments in inner-city kids in search of supposed genetic and biochemical causes of violence (the violence initiative) (early 1990's).

?        The initial cancellation and later modification of a potentially racist federally sponsored conference on the genetics of violence (early 1990's).

?        Alerting the profession to danger of down-regulation and dangerous withdrawal reactions from the new SSRI antidepressants such as Prozac, Zoloft, and Paxil (1992-4).

?        Monitoring, and at times modifying or stopping unethical, hazardous experimental research on children (1973-present).

?        Encouraging that NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder to raise serious concerns about "ADHD" and stimulants for children.

While each of these critiques and reform projects was initially considered highly controversial, and while each was frequently opposed by organized psychiatry, most are now widely accepted as rational, ethical, and scientific. For example,

Psychosurgery is no longer widely practiced and not at all in state or federal institutions or on children in the United States; the multi-agency federal program aimed at using invasive biological procedures on inner-city children has been disbanded; the conference on the genetics of violence was delayed and then vastly modified; all experts now recognize the dangers of tardive dyskinesia in children; many researchers have confirmed that the neuroleptic drugs produce dementia, and experienced doctors now recognize the potential for dangerous withdrawal effects from the SSRI's.

       

 

 

 

 

 

 

 

International & North American Offices

Peter R. Breggin, MD., Founder and

Director Emeritus.

 

Intl. Executive Director Emeritus, Advisory Council Member  Ginger Ross Breggin

The Breggin?s address:

101 East State Street, PBM 112

Ithica, NY 14850-5543

(607) 272-5328

 

International  executive Director

Dominick Riccio, Ph.D.

1036 Park Avenue, Suite 1B

New York, NY 10028

(212) 861-7400

 

United States regional Director

Lloyd Ross, Ph.D.

1 Greenview Way

Upper Montclair, NJ 07043

 

Editor-in Chief, Newsletter

Laurence Simon, Ph.D.

2717 Belle Road,

Bellmore, NY 11710

 

Director of Communications

Andrew Levine, CSW

267 N. Central Park Avenue

White Plains, NY 10606

(914) 633- 1905

 

Director of Membership Services

Robert Sliclen, Ph.D.

450 Washington Avenue

Twp of Washington, NJ 07676-4031

(201) 664-2566

 

Intl. Consultant in Clinic Development

Kevin McCready, Ph.D.

3114 Willow Avenue

Clovis, CA 93612

(559) 292-7572

 

Editor - Ethical Human Sciences & Services: An International Journal of Critical Inquiry

David Cohen, Ph.D.

 

 

 

 

For International/National membership, newsletter, advocacy, and technical

information contact the international office. For regional activities contact the regional

directors and watch this newsletter for announcements.

 

CSPP Australia

Brian Keen, M.A.

Lecturer in Education

Southern Cross University

PO Box 157, Lismore, NSW, 2480

Austral