April 23, 2013

me+ME: "Give the idiots Prozac (or another anti-depressive)!"
1.  "Prozac and SSRI's: Twenty-fifth anniversary"
Psychiatry gets fundamentally changed
What psychiatry is now
4.  Then what about the DSMs?
About ME/CFS


Today I am writing about anti-depressives, and in particular Prozac, because I have been on that pill for quite a while. My basic source is David Healy's site, and in particular his paper/blog "Prozac and SSRI's: Twenty-fifth anniversary".

Also, I will be talking about the DSM-5.

1. "Prozac and SSRI's: Twenty-fifth anniversary"

This essay starts as follows:

Prozac was approved in 1987 in the US, and launched in early 1988, followed by a clutch of other SSRIs. Twenty-five years later, we now have one prescription for an antidepressant for every single person in the West per year.

Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder – melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.

For me, that is stark, raving insanity - and I am not criticizing dr. Healy, who is one of the few making the argument.

First, note that this is something like a 1000-fold increase: Either humanity has radically changed, or else psychiatry has totally lost its marbles.

Clearly, I think the latter is the case.

Indeed, what I think is the case is that the whole of psychiatry was ready - and fit! - to be thrown out of science by 1980, when three things happened:

1. The DSM-III was introduced, and was introduced explicitly as if it were not science, because making any pretensions whatsoever was worse than making no pretensions whatsoever, and it did so by throwing out every theory, and replacing this by a mere "diagnosis", on the pattern of "you have X if you have at least 5 out of 9 of these marks".
2. For some strange reason, this worked: Instead of - as would have been quite just - ridiculizing psychiatry, and kicking it out of science, as being clearly not even theoretical, thiis was welcomed, especially since
3. there soon was Prozac - a supposedly fail-safe, totally non-dangerous, anti-depressant, that in fact was dangerous and helped few, but that was prescribed as if it were hosannah, and by all kinds of medical people.

As to 1.: You have no diagnosis if all you have is a statement to the effect that
"you have X if you have at least 5 out of 9 of these marks". Clearly, you may call this a "diagnosis", but it is one only if this implies a statement that relates the diagnosis to a disease, and the disease to a provable absence or presence of something that should not be there.

You may be wrong in this, but then psychiatry is very often wrong - and that is, by itself, no reason not to do it: What definitely is wrong is to insist that there is no theory, for that means that absolutely anything may be correct.

As to 2.: My best explanations for the strange fact that psychiatry was welcomed rather than ridiculed is in part that psychiatrists were at least as pretentious and dishonest as they always had been and in part that by 1980 the first segment of the new intellectual class had arrived on the scene: The far more stupid, far less well educated, buit also far more numerous baby-boomers.

As to 3.: The main problems with Prozac - and indeed with other SSRIs: Prozac is out of date because it patent was finished by the beginning of 2000 - are that it is quite dangerous for some, for reasons that again are not well understood, and  also that it has many unknown problems, notably with taking it a long time.

2. Psychiatry gets fundamentally changed

What then happened - in a space of 10 years or so, mostly because there simply was no science -was this:

Prozac has killed Generalism. It did so by focusing attention on mood in the way neurologists hyper-focus on nerves. Psychiatrists have become the doctors who deal in heroic combinations and doses of pills rather than doctors who, like generalists, step back and take a broader view.

Prozac has also killed therapy – just like Prozac CBT has a hyper-focus on thoughts rather than the big picture. CBT has also become a conduit into antidepressant prescribing as therapists regularly suggest softening up a depression with pills.

Generalism went out of the doors basically because of three reasons: First, with far more people diagnosed with "a mental disorder" there was no money for long time talk-therapies; second, since there were no theories, there was nothing to test; third, psychiatry itself radically changed: From someone trying to deal with 1 in a 1000 or 1 in 10.000 of people with whom clearly something was wrong, psychiatrists changed to pill pushers, "who deal in heroic combinations and doses of pills", and for just any kind of compaint whatsoever.

What is true is that psychiatrists still have a technique: Cognitive Behavioral Therapy aka CBT, but this is mere bullshit, as you can see for yourself by trying to find out what it is from Wikipedia. (If you think you succeeded, all I can assure you is that you led yourself be bewitched.)

So what was left?

3.  What psychiatry is now

What was left is this - and I quote the final piece from dr. Healy's article, who takes quite a lot for granted:

Twenty-five years ago, no one could have imagined that the bulk of the treatment literature would be ghostwritten, that negative trials could be portrayed as glowingly positive studies of a drug, that controlled trials could have been transformed into a gold-standard method to hide adverse events, or that dead bodies could have been hidden from medical academics so easily.  Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants could have been brought on the market and that almost as a matter of national policy people would be encouraged to take it for life.
"Ghostwritten": Much of what one reads in medical journals (!), by "the famous doctors X, Y and Z", in fact these days is written by totally other persons, and was only signed by X, Y and Z (if that was done). And the totally other persons who did write the stuff were employees of the pharmaceutical companies.

That is: One gets lied to - deceived, duped.

"Negative is positive": Much of what one reads in medical journals (!) is not the outcome of experiments, but got reported there only because it supports a drug - and everything else is repressed.

"Controlled trial": Because it now are the pharmaceutical companies that have the data, there is in fact no more objective experimentation: Again what you get to read
in medical journals (!) are merely those outcomes that are favourable to new drugs.

"Dead bodies": This is an outcome of the foregoing: People who suicided while on test for an anti-depressive are deleted, or their suicide is reported quite differently from what it was.

"Take it for life": This is what happens "automatically": Your psychiatric medicine remains with you for the rest of your life.

I take it that is the standard:

By now, there is no more understanding of how the human mind works, but there is an enormous amount of (very expensive) pills to be pushed that - somehow, for reasons no one really understands - may or may not help, but certainly do pay; there are no longer any large fair trials with fair outcomes that everybody can access, for there is an enormous amount of data that is kept secret; there are no more people getting cured from psychiatric complaints, but instead almost everyone - who is not a psychiatrist - these days is considered to be insane, or to have been insane, or (at least) will be insane.

4. Then what about the DSMs?

I am sure nearly all psychiatrists and psychologists will disagree with me, but then I am only a psychologist because I got denied the chance to take an M.A. and Ph.D. in philosophy: I never made any money through my degree, and never will.

Maybe even dr. Healy will disagree with me - but I do have an excellent M.A. in "the science" of psychology, and for me it is very simple:

There is NO science of psychiatry; almost everybody who seriously claims there is makes money from it; and in fact the whole show should be terminated, and the sooner the better, for it is almost all totally without real content.

Of course, there will remain people who are mad - insane, bonkers, out of their mind - and serious cases need help and treatment, but not by such methods or such pills as have been used massively for the last 25 years, possibly with a few exceptions.

Most cases will not be serious, and will go away.

And unless humanity has changed in major ways over the last 25 years, in fact at most 1-5% of ordinary people will have mental problems that are serious enough to try to get something done about it, instead of the - at least - 78% that "should be" on psychiatric drugs, if the DSM (IV in this case) is correct.

And see my
Brit. Jn. Psychiatry: 78% of the British are not sane, e.g. in case you doubt that 78% - and even it it is "just" a third, I still say all this shows is that psychiatry is mad, rather than the third or indeed four fifth of ordinary people psychiatrists declare insane really are insane.

Surely, there are only a few psychiatrists, and they all have a personal interest in it: It is much cheaper to stop their utter nonsense, and to take proper care of the few who are really mentally ill. [1]

Finally: I have not had and do not have any serious interest in psychiatry: Ever since I was 17, I rejected it as a science, and believed it only would help few, and I still think the same.

The only reason for me to write about it is that the disease I have since 1.1.1979 now has the serious risk to be diagnosed as psychiatric, and that I happen to be a psychologist. Then again, I will probably not be maltreated, if only because I will be pensionable in two years, and because there are no reasons of any kind to declare me mentally ill - apart from the fact that I am physically ill, with a disease that has no known explanation.

[1] About me and Prozac: I am not certain when I first got Prozac, but I think it was in 1998, and that was because I had remained depressed, as I described that in 1994, in Dutch: Over M.E., depressies en mijn woonsituatie. I took it first for about three to four weeks without any noticeable change, and then quite suddenly my mood got a lot better. Since then I have taken it for about 10 years (far too long, at the very least), and then gradually gave up on it, also without any problem that I am aware of (!). I do think I am one of those who had a fairly good reason to take it, but since I know a lot better what is involved, I am sorry I did do so.

About ME/CFS (that I prefer to call M.E.: The "/CFS" is added to facilitate (that I prefer to call M.E.: The "/CFS" is added to facilitate search machines) which is a disease I have since 1.1.1979:
1. Anthony Komaroff

Ten discoveries about the biology of CFS(pdf)

3. Hillary Johnson

The Why  (currently not available)

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2003)
5. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2011)
6. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

7. William Clifford The Ethics of Belief
8. Malcolm Hooper Magical Medicine (pdf)
Maarten Maartensz
Resources about ME/CFS
(more resources, by many)

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