From: rpattree2@gmail.com   
      
   Print this page   
   Psychiatry Now Admits It's Been Wrong in Big Ways - But Can It Change?   
   Wednesday, 05 March 2014 10:05   
   By Bruce E Levine, Truthout | News Analysis   
       
      
   3   
   font size  decrease font size  increase font size   
   Psychiatry.    
   (Photo: Steve Snodgrass / Flickr)   
   When I interviewed investigative reporter Robert Whitaker in 2010 after the   
   publication of his book Anatomy of an Epidemic: Magic Bullets, Psychiatric   
   Drugs, and the Astonishing Rise of Mental Illness in America, he was not   
   exactly a beloved figure    
   within the psychiatry establishment. Whitaker had documented evidence that   
   standard drug treatments were making many patients worse over the long term,   
   and he detailed the lack of science behind these treatments.   
   Whitaker's sincerity about seeking better treatment options, his command of   
   the facts, and his lack of anti-drug dogma compelled all but the most dogmatic   
   psychiatrists to take him seriously.   
      
   For Anatomy of an Epidemic, Whitaker won the 2010 Investigative Reporters and   
   Editors Book Award for best investigative journalism. This and other acclaim   
   made it difficult for establishment psychiatry to ignore him, so he was   
   invited to speak at many of    
   their bastions, including a Harvard Medical School Grand Rounds at   
   Massachusetts General Hospital, where he faced hostile audiences. However,   
   Whitaker's sincerity about seeking better treatment options, his command of   
   the facts and his lack of anti-drug    
   dogma compelled all but the most dogmatic psychiatrists to take him seriously.   
   In the past four years, the psychiatry establishment has pivoted from first   
   ignoring Whitaker to then debating him and attempting to discredit him to   
   currently agreeing with many of his conclusions. But will Whitaker's success   
   in changing minds result in    
   a change for the better in treatment practices?   
   I was curious about Whitaker's take on the recent U-turns by major figures in   
   the psychiatry establishment with respect to antipsychotic drug treatment, the   
   validity of the "chemical imbalance" theory of mental illness and the validity   
   of the DSM,    
   psychiatry's diagnostic bible. And I was curious about Whitaker's sense of   
   psychiatry's future direction.   
   Bruce Levine: In 2013, the director of the National Institute of Mental Health   
   (NIMH), Thomas Insel, announced - without mentioning you -  that he agreed   
   with your conclusion that psychiatry's standard treatment for people diagnosed   
   with schizophrenia    
   and other psychoses needs to change so as to better reflect the diversity in   
   this population. Citing long-term treatment studies that you had previously   
   documented, Insel came to the same conclusion that you had: In the long-term,   
   not all, but many    
   individuals who have been diagnosed with psychosis actually do better without   
   antipsychotic medication. Was it gratifying for you to see the US government's   
   highest-ranking mental health official agreeing with you?    
      
   Robert Whitaker: Shortly before Thomas Insel wrote that blog, I had posted my   
   own on madinamerica.com, related to a recent study by Lex Wunderink from the   
   Netherlands. Wunderink had followed patients diagnosed with a psychotic   
   disorder for seven years,    
   and he reported that those randomized, at an early date, to a treatment   
   protocol that involved tapering down to a very low dose or withdrawing from   
   the medication altogether had much higher recovery rates than those maintained   
   on a regular dose of an    
   antipsychotic.   
   I wrote that in the wake of Wunderink's randomized study, if psychiatry wanted   
   to maintain its claim that its treatments were evidence-based, and thus   
   maintain any sort of moral authority over this medical domain, then it needed   
   to amend its treatment    
   protocols for antipsychotics. I don't know if Dr. Insel read my blog, but his   
   post did nevertheless serve as a reply, and as you write, he did basically   
   come to the same conclusion that I had been writing about for some time.    
   I suppose I took some measure of personal gratification from his blog, for it   
   did provide a sense of a public acknowledgment that I had indeed been "right."   
   But more important, I felt a new sense of optimism, hopeful that maybe   
   psychiatry would now    
   really address this issue, which is so important to the lives of so many   
   people. A short while ago, The New York Times published a feature story on Dr.   
   Insel, noting that he had recently raised a question about the long-term use   
   of antipsychotics, which    
   had caused a stir in psychiatry because it contradicted conventional wisdom.   
   That is a sign that perhaps a new discussion is really opening up.    
   In Anatomy of an Epidemic, you also discussed the pseudoscience behind the   
   "chemical imbalance" theories of mental illness - theories that made it easy   
   to sell psychiatric drugs. In the last few years, I've noticed establishment   
   psychiatry figures doing    
   some major backpedaling on these chemical imbalance theories. For example,   
   Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011,   
   "In truth, the 'chemical imbalance' notion was always a kind of urban legend -   
   never a theory    
   seriously propounded by well-informed psychiatrists." What's your take on this?   
      
   The "disease model," as a basis for making psychiatric diagnoses, has failed.   
      
   This is quite interesting and revealing, I would say. In a sense, Ronald Pies   
   is right.Those psychiatrists who were "well informed" about investigations   
   into the chemical imbalance theory of mental disorders knew it hadn't really   
   panned out, with such    
   findings dating back to the late 1970s and early 1980s. But why, then, did we   
   as a society come to believe that mental disorders were due to chemical   
   imbalances, which were then fixed by the drugs?   
   Dr. Pies puts the blame on the drug companies. But if you track the rise of   
   this belief, it is easy to see that the American Psychiatric Association   
   promoted it in some of their promotional materials to the public and that   
   "well informed" psychiatrists    
   often spoke of this metaphor in their interviews with the media. So what you   
   find in this statement by Dr. Pies is a remarkable confession: Psychiatry, all   
   along, knew that the evidence wasn't really there to support the chemical   
   imbalance notion, that    
   it was a hypothesis that hadn't panned out, and yet psychiatry failed to   
   inform the public of that crucial fact.   
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)