Posts Tagged ‘American Psychiatric Association’

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Therapists revolt against psychiatry’s bible

Wednesday, December 28th, 2011

Mental health professionals say new diagnoses will lead to overmedication

Salon Magazine, December 27, 2011

by Rob Waters

“epidemics of over-diagnosis in child psychiatry” have caused "huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications."

Anyone who’s ever tried to get reimbursed by a health insurance company after seeing a psychiatrist or psychotherapist, or taking a child or teenager to one, has no doubt noticed the incomprehensible numbers that appear on the clinician’s statement, perhaps preceding some slightly less imponderable phrase.

Maybe you are a 296.22 (major depressive disorder, single episode, mild) or a 300.00 (anxiety disorder NOS–not otherwise specified). Hopefully, you are not a 301.83 (borderline personality disorder). Your kid might be a 313.81 (oppositional defiant disorder) or, more likely, a 314.01 (attention deficit hyperactivity disorder, predominantly hyperactive-impulsive type).

Since 1952, a tome called the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been reducing to a few digits the psychological malady said to afflict a patient. This bible of mental health treatment, published by the American Psychiatric Association (APA), provides a list and description of every mental health condition known to—or invented by—psychiatry, from histrionic personality disorder (301.50) to transvestic fetishism (302.3).

Over the decades, the manual, adapted from a guide for mental diseases developed by Army and Navy psychiatrists, has ballooned. The number of listed disorders tripled to nearly 300. A few have been discredited and dumped along the way. Most famous were battles over the inclusion of homosexuality. Successive iterations of the manual listed homosexuality as a “sociopathic personality disturbance,” then modified that to describe a more limited “sexual orientation disturbance” among people who were “in conflict with” their attraction to people of the same sex. That was later replaced by a disorder called “ego-dystonic homosexuality,” applied to those whose homosexual arousal was a source of distress. That item was dropped in the DSM-III-R, published in 1987.

The great book’s coming edition, the DSM-5, is slated for publication in May 2013. As the task force producing it has posted drafts on its website, an undercurrent of dissatisfaction has exploded into a full-scale revolt by members of U.S. and British psychological and counseling organizations. The chief complaint is that the newest version will lower the criteria needed to diagnose some conditions, creating “subthreshold” disorders, and generally making it easier for healthcare professionals to label a person with a psychiatric disorder and medicate him or her.

The latest rebellion against the DSM-5 began with a salvo from across the Atlantic. In June, a special committee of the British Psychological Society complained in a letter to the APA that “clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences.” The committee criticized the proposed creation of an “attenuated psychosis syndrome”—a sort of poor-man’s psychosis with less severe symptoms—“as an opportunity to stigmatize eccentric people.” They also objected to a proposed reduction in the number of symptoms needed to diagnose adolescents with attention deficit disorder (ADD) because it might increase diagnoses and the use of meds.

Then David Elkins, professor emeritus at Pepperdine University and president of the Society for Humanistic Psychology, a division of the American Psychological Association, formed a committee to discuss similar objections and draft a petition enumerating them. In October, he posted the petition online. “I figured we’d get a couple hundred signatures,’’ Elkins said.

The response stunned him and his colleagues. The petition attracted more than 6,000 signatures in three weeks; as of mid-December it had topped 9,300 signatories and garnered the endorsement of 35 organizations. On Nov. 8, American Counseling Association president Don Locke jumped in with a letter to the APA objecting to the “incomplete or insufficient empirical evidence” underlying the proposed revisions and expressing “uncertainty about the quality and credibility” of the DSM-5.

“This has become a grassroots movement among mental health professionals, who are saying we already have a national problem with overmedication of children and the elderly, and we don’t want to exacerbate that,” says Elkins.

For many critics, Exhibit A is childhood ADD. As the disorder describing fidgety, easily distracted kids morphed from “hyperkinetic reaction of childhood” to the current “attention deficit hyperactivity disorder,” the number of children given the diagnosis exploded, fueling, by one account, a 700 percent increase in the use of Ritalin and other stimulants in the 1990s. Diagnosis requires checking six of nine boxes from a list of symptoms that include “often does not seem to listen when spoken to directly” and “often fidgets with hands or feet or squirms in seat.” Sound familiar, parents?

Two other newly proposed disorders singled out as problematic in the petition are “mild neurocognitive disorder” in the elderly and “disruptive mood dysregulation disorder” in children and adolescents. Both lack a solid basis in research and may fuel the use of powerful antipsychotic medications, which cause weight gain, diabetes and a host of other metabolic problems, the petition says.

“We are gravely concerned that if this is published as is in 2013, it will create false epidemics where hundreds of thousands of children and the elderly who really are normal will be diagnosed with a mental disorder and given powerful psychiatric medications that have dangerous side effects,” Elkins says. “That is not tolerable.”

David Kupfer, the University of Pittsburgh psychiatrist who chairs the task force overseeing the manual’s preparation, says he expects the final number of disorders included in the DSM-5 to be about the same as in the current book. He says he welcomes the criticism and that nothing is final. The task force has been testing proposed new diagnoses in 2,300 patients at seven adult treatment centers and four adolescent centers that are acting as field-test sites, he says.

“There’s a myth that all the decisions have been made, when in fact, all the decisions haven’t been made,” he says. “Just because [things have] been proposed doesn’t necessarily mean they’ll end up in the DSM-5. If they don’t achieve a level of reliability, clinician acceptability, and utility, it’s unlikely they’ll go forward.”

The most surprising critic of the DSM is a one-time pillar of the psychiatric establishment. Allen Frances, professor emeritus at Duke University, chaired the task force that created the DSM-4. Now he’s railing against both the process and proposed content of the new DSM in blogs on the website for Psychology Today that blast the new revision as “untested” and “unscientific.”

Psychiatric diagnoses are loose enough already, Frances  told me, and that laxity has led to “epidemics of over-diagnosis in child psychiatry” causing huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications.

“DSM has to be a safe, reliable and credible guide to current clinical practice,” he says. “It can’t be an untested program for future research.’’

The user revolt against the DSM-5 has emerged as a major challenge to the document, Frances says, and its future is looking unclear. He and Elkins are proposing that an independent committee of experts review the proposed draft and make recommendations.

The fight over the DSM-5 pits some of the greatest minds and biggest egos in the world of psychiatry, but it’s more than a battle among 301.81s (narcissistic personality disorder). For people seeking help for life’s problems who don’t want to be labeled mentally ill or have their treatment limited to medication, and for clinicians who want to help people without reducing them to a category, the stakes are high.

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/singleton/

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Psychiatry bible ‘turns sorrow into sickness’

Saturday, December 3rd, 2011

The Age
By Jill Stark
December 4, 2011

IT’S been branded a “dangerous public experiment” that could turn normal human experiences into an epidemic of mental illness with healthy people being drugged unnecessarily.

In radical changes to the way mental health conditions are diagnosed, what was once considered a child’s temper tantrum could be labelled ”disruptive mood dysregulation disorder”. If a widow grieves for more than a fortnight she might be diagnosed with ”major depressive disorder”.

If a mother in a custody battle tries to turn a child against the father, it might create ”parental alienation disorder”.

These are among new conditions proposed for the fifth edition of the psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due to be finalised next year.

Some doctors in Australia are arguing the revised manual – used globally to diagnose mental disorders – is pathologising unhappiness.

The changes have also caused an international outcry, with the American Counselling Association, American Psychological Association, the British Psychological Society and others calling for the draft of the new edition to be independently reviewed.

They fear it is so inclusive, it risks labelling millions of healthy people as mentally ill.

”It’s such a narrow and limited view of human experience, to want to reduce every bit of suffering to medical diagnosis,” said Jon Jureidini, professor of psychiatry at the University of Adelaide. He said the changes would lead to increased prescribing.

The authors say ”misinformation” about the manual, produced by the American Psychiatric Association since 1952, is creating unnecessary fear and any inclusions will be based on robust scientific evidence. Psychiatrist Ian Hickie, director of Sydney University’s Brain and Mind Research Institute, rejects claims that the new manual would medicalise unhappiness. ”When people are in pain and suffering elsewhere we don’t say people are pathologising that. We say, let’s try and do the best we can to relieve that and get them back to function in the appropriate way,” Professor Hickie said.

The rift reflects division within the mental health community over a global rise in the use of antidepressants, stimulants and antipsychotics, with many clinicians critical of drugs with potentially serious side effects being favoured over more costly talk-based therapies. Others argue that medication can be life-saving where other therapies have failed. The inclusion of conditions such as attention deficit hyperactivity disorder (ADHD) and autism in previous DSM editions is believed to have contributed to increased prescribing.

In the new edition, the diagnosis threshold for some existing disorders is also being lowered so that

over the death of a loved one can qualify as a major depressive illness.

The authors of DSM-5, however, argue that a bereaved person who is suffering from major depression is currently ineligible for that diagnosis, preventing them from getting help if they need it.

”A broad range of evidence … shows that there are little to no systematic differences between individuals who develop a major depression in response to bereavement and in response to other severe stressors – such as being … raped … or the loss of your treasured job,” Dr Kenneth Kendler, a member of the DSM-5 mood disorders group, said.

The changes also mean children only have to display six of 13 possible symptoms for a diagnosis of ADHD, compared with six of nine in the previous manual.

”Under the new criteria it’s almost harder not to get diagnosed with ADHD than it is to get diagnosed with it,” Martin Whitely, a West Australian Labor MP and anti-ADHD medication campaigner, said. ”There were about 60,000 Australian children on ADHD medications in 2010 – a lot of money has gone into marketing and selling the disease.”

One of the manual’s biggest critics is the man who developed the last edition, American psychiatrist Allen Frances. He told The Sunday Age the fact that the authors of the new edition have described it as a ”living document” makes it a ”dangerous public health experiment”.

”The DSM-5 is used in real life-and-death decisions – it shouldn’t be a set of hypotheses to be tested,” he said. ”The worst outcome of this would be all these suggestions get included and a lot of people get medicine they don’t need. But an almost equally bad outcome would be that psychiatry gets so tarred by this aberration that people who really need psychiatry and need the medicine stop taking it.”

http://www.theage.com.au/national/psychiatry-bible-turns-sorrow-into-sickness-20111203-1ocmm.html

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Psychiatry’s Diagnosis Manual Under Fire – will feed culture of overdrugging/overdiagnosing

Saturday, November 26th, 2011

San Francisco Chronicle – 11/26/2011
by Erin Allday

"Another diagnosis, dysphoric mood dysregulation disorder, is basically temper tantrums," Robbins said. "Next thing you know, you could have 2-year-olds on psychotropic medications."

The “bible” of American psychiatry – a manual of mental health used around the world by doctors, consumers and insurance providers – has come under fire from a growing group of psychologists who worry that proposed revisions will feed into a culture of overdiagnosing, and overtreating, otherwise healthy people.

The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, is undergoing its fifth major revision in the more than 60 years since it was first published by the American Psychiatric Association. The last update was in 1994, and the new manual is expected to be released in spring 2013.

Revisions to the DSM are often hotly debated, but after two decades of major, and frequently controversial, shifts in how mental health problems are diagnosed and treated in the United States, this latest update has become especially contentious, many mental health providers say.

Last month a group of psychologists with the Society for Humanistic Psychology posted a petition against many of the suggested DSM revisions, citing what they see as a broadening of the definition of mental health disorders, which, in turn, would lead to overtreatment with drugs.

7,000 signatures

The petition now has more than 7,000 signatures, and last week it won the support of San Francisco’s Saybrook University, with roughly 60 faculty members who emphasize a holistic approach to treating mental illnesses.

“There’s this propensity to push pills instead of looking at what’s really going on with the person,” said Saybrook President Mark Schulman. “When we saw in the DSM-5 that there was going to be a push in the direction of a more medical, less holistic way of doing things, we felt we should take a stand.”

A work in progress

The American Psychiatric Association has posted an online response to the petition, welcoming critiques to and comments on the proposed revisions. Their response notes that the manual is still a work in progress and, as more scientific evidence becomes available, some of the changes may become more palatable to critics.

Since the last diagnostic manual update, research has increasingly pointed to biological causes for a wide variety of mental health conditions and, in response, treatment has turned toward pharmacological answers, some psychologists say. Drugs are being used to solve mental health problems that aren’t problems at all, they add.

In 2010, 1 in 5 American adults was using some type of mental health medication, a 22 percent increase over the past decade, according to a report released last week by Medco Health Solutions, a pharmacy-benefits management company.

Therapy is still popular, but part of the problem is that there simply aren’t enough trained counselors to fill the mental health need. Patients are turning to primary care doctors for medical relief from symptoms for everything from depression and anxiety to attention deficit disorder, many mental health providers say.

Because many primary care doctors rely on the DSM to help them understand and diagnose mental health problems, it’s critical that the manual be as accurate and science-based as possible, say psychologists who have signed the petition.

While trained psychiatrists might be able to distinguish between a mental health disorder that needs medical intervention and a so-called normal human response to a difficult time or situation, primary care doctors may struggle.

Critics’ concerns

Critics of the DSM update say that the task force assigned to make the revisions has suggested broadening the definitions of too many mental health problems, opening the door to even more diagnoses and treatments.

Grief after the death of a loved one, for example, may be included under the diagnosis of major depressive disorder. That means a person’s grief could be labeled a pathological disorder, and not a normal human experience, said psychologist Brent Robbins, a professor at Point Park University in Pittsburgh and an author of the petition.

2-year-olds on meds

“Another diagnosis, dysphoric mood dysregulation disorder, is basically temper tantrums,” Robbins said. “Next thing you know, you could have 2-year-olds on psychotropic medications.”

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Those in favor of Psychiatry’s Billing Bible? The American Psychiatric Association. Against it? Just About Everyone else

Thursday, November 3rd, 2011

Click image to watch video (explaining in simple terms, what the “problem” with psychiatry is….)

Psychology Today – November 1, 2011

by Allen Frances, MD (Psychiatrist and former Chairman of the DSM task force)

So far, opposition to DSM 5 has been expressed by the following organizations: British Psychological Society; American Counseling Association; Society for Humanistic Psychology (APA Division 32); Society for Community Research and Action: Division of Community Psychology (APA Division 27); Society for Group Psychology & Psychotherapy (APA Division 49); Developmental Psychology (APA Division 7); UK Council for Psychotherapy; Association for Women in Psychology; Constructivist Psychology Network; Society for Descriptive Psychology; and the Society of Indian Psychologists.

An editorial by the Society Of Biological Psychiatrywondered whether DSM 5 was necessary at all. The community of personality disordersresearchers is virtually unanimous in its opposition to the DSM 5 personality disorders section. There has also been widespread opposition to the sections on somatic, autistic, gender, paraphilic, and psychotic disorders.

Last week, a petition was posted quietly be several divisions of the American Psychological Association. It demands reform of the DSM 5 process and the elimination of a number of its most risky and ill conceived proposals. The petition is gaining increasing support and has already been signed by almost 3000 people. It can be accessed at http://www.ipetitions.com/petition/dsm5/ )

Strikingly, there seems to be virtually no support for DSM 5 outside the very narrow circle of the several hundred experts who have created it and the leadership of the American Psychiatric Association (APA) which stands to reap large profits from its publication. There is no group and precious few individuals outside of APA who have anything good to say about DSM 5. And even within the DSM 5 work groups and the APA governance structures, there is widespread discontent with the process and considerable disagreement about the product.

http://www.psychologytoday.com/blog/dsm5-in-distress/201111/dsm-5-against-everyone-else

 

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Drugging of children for “ADHD” has become an epidemic

Thursday, October 13th, 2011

New York Times – October 13, 2011

by Dr. Peter Breggin

click image to read Psychiatric Disorders - The Facts Behind the Billion Dollar Marketing Campaign

The drugging of children for A.D.H.D. has become an epidemic. More than 5 million U.S. children, or 9.5 percent, were diagnosed with A.D.H.D. as of 2007. About 2.8 million had received a prescription for a stimulant medication in 2008.

The A.D.H.D. diagnosis does not identify a genuine biological or psychological disorder. The diagnosis, from the 2000 edition of the “Diagnostic and Statistical Manual of Mental Disorders,” is simply a list of behaviors that require attention in a classroom: hyperactivity (“fidgets,” “leaves seat,” “talks excessively”); impulsivity (“blurts out answers,” “interrupts”); and inattention (“careless mistakes,” “easily distractible,” “forgetful”). These are the spontaneous behaviors of normal children. When these behaviors become age-inappropriate, excessive or disruptive, the potential causes are limitless, including: boredom, poor teaching, inconsistent discipline at home, tiredness and underlying physical illness. Children who are suffering from bullying, abuse or stress may also display these behaviors in excess. By making an A.D.H.D. diagnosis, we ignore and stop looking for what is really going on with the child. A.D.H.D. is almost always either Teacher Attention Disorder (TAD) or Parent Attention Disorder (PAD). These children need the adults in their lives to give them improved attention.

Stimulant drugs “work” by suppressing all spontaneous behavior in normal children — and even in chimpanzees and other animals. This suppression of behavior and production of compulsive activities looks like an improvement in a classroom or home where the child has seemed uncontrollable and required a great deal of attention. The drugs do nothing to improve learning or psychosocial development. I document these observations in many scientific articles and books, most recently in the second edition of my medical textbook “Brain-Disabling Treatments in Psychiatry.”

Drug company marketing has focused on selling the diagnosis and the drugs to American parents and teachers.

Why are the A.D.H.D. diagnosis and the use of stimulants so prevalent in America? The idea that American children are somehow genetically or even culturally predisposed has no scientific or common sense basis. For several decades, starting in the 1970s, drug-company marketing has focused on selling the diagnosis and the drugs to American parents and teachers. As I first documented in my book “Toxic Psychiatry” in 1971, “Astroturf” organizations like Children and Adults with Attention-Deficit/Hyperactivity Disorder and National Alliance on Mental Illness masquerade as representing families while taking millions of dollars from drug companies in support of their promotion of psychiatric medication for children. The National Institute of Mental Health, the American Psychiatric Association and even the American Neurological Association have promoted the A.D.H.D. diagnosis and stimulant medication, which leads to considerable business for mental health clinicians.

As the American market gets saturated, promotional efforts are increasing in other countries, like Canada, Britain, Australia and Germany, which are also experiencing increased rates of diagnosing and drugging children. In Australia, the controversy has been especially heated in recent years. Everywhere that A.D.H.D. and stimulants are promoted, they substitute for needed modern reforms in education and family life.

In all cases of so-called A.D.H.D., the diagnosis is harmful. The child instead needs a real medical and psychosocial educational evaluation, and usually the child will quickly respond to improved teaching and parenting. We are diagnosing and drugging millions of our children instead of providing them the improved educational and family life that they truly need.

Peter R. Breggin, a psychiatrist in Ithaca, N.Y., is the author of more than 20 books

http://www.nytimes.com/roomfordebate/2011/10/12/are-americans-more-prone-to-adhd/adhd-is-a-misdiagnosis

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CCHR exposes list of psycho-pharma front groups

Monday, August 29th, 2011

Natural News
By PF Louis
August 29, 2011

A highly effective public relations technique is the “third party technique” of creating front groups to endorse or promote the need of any service or product. The first party is the original group or client that would benefit more from increased public trust or affinity. The second group is the public or consumers. A third group is created with a contrived name to appear publicly as a disinterested party endorsing the industry of the first party.

Often, the third party, or front group, uses a name that implies authority or concern for the public’s welfare or concerns. You can be sure these bogus front groups are usually only concerned about their clients welfare and themselves.

Edward Bernays Pioneered Front Groups

Edward Bernays, a notorious spin doctor throughout the 20th Century, is considered USA’s original front group creator as well as the father of public relations. The public relations industry is concerned with creating a favorable image more than direct sales advertising, although they can be closely associated at times.

The womens rights movement peaked in 1919 with the passage of the 19th amendment, granting women the right to vote. A very few years later, Edward Bernays created an image to help promote the tobacco industry. He had photographs published in newspapers and magazines of several women marching in a New York City Easter parade brazenly smoking cigarettes, which until then was considered unladylike. The idea was to link a womans struggle for more rights with openly smoking anywhere, just like the guys.

Besides making tobacco appear healthy over several years using fake doctors to promote various cigarette brands, Bernays also used front groups to glorify fluoridating water supplies. He was a very important contributor to our mass poisoning.

Psychiatry, Big Pharma, and Front Groups

The Citizens Commission on Human Rights International (CCHRI) focuses on psychiatry’s irrational and barbaric treatment of mental illness with its propensity for categorizing behavior in order to dispense harmful drugs. It’s a cozy arrangement with the American Psychiatric Association (APA) and Big Pharma.

Ever since the APA was accepted as a regular medical organization a few decades ago, Big Pharma’s sales for psychotropic drugs have gone through the roof. What was once pen and pad for taking notes by a psychiatrist during talk therapy became the pen and prescription pad.

For children, psychiatry’s categorizing behavioral problems enables educational and child care institutional personnel virtual prescription power as well. Children are kidnapped “legally” by social services agencies if parents refuse to medicate them according to psychiatric decree. Big Pharma’s reach into TV advertising enables depressed adults to demand prescriptions for drugs that lead to bad health, actual insanity, and death.

Front groups exposed by CCHRI include the following: The National Alliance on Mental Illness (NAMI), Children and Adults with Attention Deficit Hyperactivity Disorder (CHAAD) and several bipolar, depression or ADHD “support groups” that flourish on the internet.

CCHRI has several more front groups listed on one of their site pages with links to explanations of who they really are and how they function for psychiatry and Big Pharma. (see CCHRI source below)

CCHRI’s depth of investigative reporting offers the premier site for understanding the true nature of psychiatry and its relationship with Big Pharma’s destructive psychotropic drug racket.

Front Groups Everywhere

Front groups can also lobby directly to government officials, elected or appointed. And they are created for almost any controversial issue that needs to be white or green washed.

A former health insurance insider, Wendell Potter, became a whistle blower with his book Deadly Spin. He explained that a front group “Health Care America” was used to attack Michael Moore’s “Sicko” documentary.

APCO Worldwide created Health Care America with Big Pharma money. The insurance industry used APCO in 2007. APCO recruits think tanks and other agencies as allies for their campaigns. The public is unaware of who is really supplying the media’s information.

Earlier in 2011, New York Republican Congresswoman Nan Hayworth submitted a press release photo of her receiving a plaque from a representative of a purported senior citizen support group called 60 Plus Association. The sign above those two declared in large letters “Senor Citizens Thank You for Protecting Medicare and Social Security.”

There are two lies here. Nan Hayworth had voted against Medicare, and 60 Plus has hardly any senior citizen members at all. They remain afloat financially from Big Pharma’s funding, according to AARP.

All this crassly corrupt activity backed by government and corporations continues to escalate through the mainstream media. A lyric from a 1980s jazz tune rings true “We are Caught in a Blizzard of Lies.” The upside is we are forced to distinguish between truth and fiction and become our own informed authority.

Sources for this article include:

List of Front Groups for Psychiatry and Big Pharma http://www.cchrint.org/psycho-pharm…

Main page CCHRI site http://www.cchrint.org/

Insurance whistle blower Wendell Potter http://www.commondreams.org/view/20…

60s Plus Group outed by AARP as Big Pharma front group http://my.firedoglake.com/junkyardd…

Edward Bernays pioneered third party technique of PR and advertising http://www.frontgroups.org/node/418

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Scandalous Off Label Use Of Antipsychotics: Another Warning For DSM-5

Monday, August 8th, 2011

Psychiatric Times

By Allen Frances, MD | August 5, 2011

I never would have entered the DSM-5 controversy were it not for two of its proposals that risk furthering the already frightening overuse of antipsychotic medication, particularly in children and teenagers. DSM-5 plans to introduce two new and untested diagnoses that would offer natural targets for poor drug prescribing–psychosis risk syndrome (AKA attenuated psychotic symptoms) and temper dysregulation (AKA disruptive mood dysregulation). There is no evidence whatever that antipsychotics would confer any benefit on the kids so labeled (and too often mislabeled), but great reason to worry that this would not stop their being used needlessly and recklessly.

The DSM-5 supporters of these two proposals believe my concern is ill founded, or at least excessive. They argue that they would not recommend antipsychotics for the new diagnoses and that there is no FDA approved indication for their use. This misses the crucial point that new DSM categories, once made official, take on an independent life. If they can possibly be misused (and clearly these can), they will be misused. And experience teaches the clear lesson that antipsychotic overuse will insinuate itself insidiously and inappropriately whenever any crack of opportunity opens up.

A recent paper by Mojtabai and Olfson1 presents a chilling testimony to the spreading creep of antipsychotic misuse. In 1996, antipsychotics were prescribed for patients with an anxiety disorder in 10% of office visits. One decade later, this had more than doubled despite there being no evidence that antipsychotics work for anxiety disorders and clear evidence that they cause dangerous side effects. Because antipsychotics have no FDA indication for anxiety disorders, all this massive overprescription was done completely off-label.

This is truly alarming, but unfortunately it is not really surprising. Antipsychotics have managed to become the top class of drugs– generating the highest revenue with sales of $15 billion per year– despite the troubling facts that much of the prescribing is off label, unsupported by scientific evidence, and likely to cause the dreadful side effect of obesity with all its consequent risks. This is an astounding reflection on the lack of caution in everyday medical practice. Used appropriately, antipsychotics are extremely valuable and necessary tools– but what could possibly justify their becoming such promiscuous best sellers?

DSM-5 cannot off-load responsibility for causing harmful unintended consequences– especially when these are so obvious that they smack you in face. It is foolhardy to risk causing a further wave in the antipsychotic deluge. I continue to despair of a process that allows such smart and well meaning people to make such really dreadful decisions.

 https://member.cmpmedica.com/index.php?referrer=http://member.cmpmedica.com/cga.php?assetID=422&referrer=http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1921927

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Harvard Expert Ties Mental Illness “Epidemic” to Big Pharma’s Agenda

Friday, July 29th, 2011

Minyanville
By Minyanville Staff
July 28, 2011

When the DSM-II was published in 1980, it became “the bible of psychiatry,” writes Angell, who adds, “but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions.”

For any mental illness or passing mood swing that may trouble a person, the Diagnostic and Statistical Manual of Mental Disorders — better known as the DSM — has a label and a code. Recurring bad dreams? That may be a Nightmare Disorder, or 307.47. Narcolepsy uses the same digits in a different order: 347.00. Fancy feather ticklers? That sounds like Fetishism, or 302.81. Then there’s the ultimate catch-all for vague sadness or uneasiness, General Anxiety Disorder, or 300.02. That’s a label almost everyone can lay claim to.

These codes are used by doctors, psychologists, and regulators to maintain a mutual language; it’s a handy shorthand system for bureaucratic purposes. But over the past few decades, the staggering, ever-expanding influence of the ever-expanding DSM, which is published by the American Psychiatric Association, has also played a lead role in building wealth and off-label product uses for the major drug manufacturers. In an insightful essay in this week’s New York Review of Books, Marcia Angell, a senior lecturer in social medicine at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, explains how.

The medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported."

Angell’s essay is based on a review of three current books examining the psychiatric industry: The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker, and Unhinged: The Trouble with Psychiatry–A Doctor’s Revelations About a Profession in Crisis, by Daniel Carlat. She also cites the DSM-IV, the most recent edition of the manual, while her review traces big pharma’s role in our current mental disorder epidemic to the DSM-III, published in 1980.

To begin, Angell describes the psychiatric profession’s backlash against a developing perception in the 1960s and 1970s that the practice was a “soft” almost pseudo science:

In the late 1970s, the psychiatric profession struck back–hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible.

Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.

These efforts to enhance the status of psychiatry were undertaken deliberately. The APA was then working on the third edition of the DSM, which provides diagnostic criteria for all mental disorders. The president of the APA had appointed Robert Spitzer, a much-admired professor of psychiatry at Columbia University, to head the task force overseeing the project. The first two editions, published in 1952 and 1968, reflected the Freudian view of mental illness and were little known outside the profession. Spitzer set out to make the DSM-III something quite different. He promised that it would be “a defense of the medical model as applied to psychiatric problems,” and the president of the APA in 1977, Jack Weinberg, said it would “clarify to anyone who may be in doubt that we regard psychiatry as a specialty of medicine.”

When the DSM-II was published in 1980, it became “the bible of psychiatry,” writes Angell, who adds, “but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions.”

Despite its lack of citations, that DSM named 265 disorders doctors were meant to identify by matching (or mostly matching) a list of symptoms in the book with symptoms described by a patient. The drug companies were quick to see this radical shift in psychiatry as an opportunity. From the 1980s until now, as Angell demonstrates, the drug makers have supported the move away from talk therapy to the drug therapy, which also benefits practitioners, since doling out drugs and tweaking prescriptions earns a psychiatrist more money for less time spent with a patient.

Here Angell explains how companies influence the DSM itself. The bold typeface is ours.

Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.

The drug industry, of course, supports other specialists and professional societies, too, but Carlat asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that.

Eli Lilly gave $551,000 to NAMI

In addition to the money spent on the psychiatric profession directly, drug companies heavily support many related patient advocacy groups and educational organizations. Whitaker writes that in the first quarter of 2009 alone, “Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.”

And that’s just one company in three months; one can imagine what the yearly total would be from all companies that make psychoactive drugs. These groups ostensibly exist to raise public awareness of psychiatric disorders, but they also have the effect of promoting the use of psychoactive drugs and influencing insurers to cover them. Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:

“In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.”

And now here we are in 2011, with almost everyone we know taking two or three different mood disorder drugs. (This trend is not limited to mental disorder, mind you. See Disease Branding.)

Work started on the DSM-V in 1999, which is due out in 2013. It will contain many new disorders, such as “binge eating” and “restless leg disorder.” It will also expand existing categories by tacking on words like “spectrum” to the end of a known disorder, Angell reports. “It looks as though it will be harder and harder to be normal,” she writes.

But the curtain gets pulled back further still.

In her review of Daniel Carlat’s book, Angell calls attention to the “disillusioned insider’s” frank admission that when he prescribes a drug, his decision process is largely guesswork. Carlat’s view is that although any psychiatrist will acknowledge that he or she has had great success with mental disorder drugs for say, depression or anxiety, no doctor can say with certainty whether the drugs are working or if a placebo effect has taken effect.

[Carlat's] work consists of asking patients a series of questions about their symptoms to see whether they match up with any of the disorders in the DSM. This matching exercise, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels.” Often patients meet criteria for more than one diagnosis, because there is overlap in symptoms. For example, difficulty concentrating is a criterion for more than one disorder. One of Carlat’s patients ended up with seven separate diagnoses. “We target discrete symptoms with treatments, and other drugs are piled on top to treat side effects.” A typical patient, he says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa).

As for the medications themselves, Carlat writes that “there are only a handful of umbrella categories of psychotropic drugs,” within which the drugs are not very different from one another. He doesn’t believe there is much basis for choosing among them. “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep.”

Messy. And, of course, the whole system is now being exported to China and other countries where the middle class is growing and the mental health industry is still in a developing stage.

Angell’s latest book is The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

Read the rest of her essay, which examines the controversial use of brain chemistry drugs to treat children, here.

http://www.minyanville.com/dailyfeed/2011/07/25/harvard-expert-links-our-mental/

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America conned: Psycho pharma drug pushing empire under fire

Tuesday, July 26th, 2011

NaturalNews – July 26, 2011

by Monica G. Young

"psychopharma is looking like an idea whose time has passed."

Is America truly stricken with widespread mental illness? Do tens of millions need mind-altering drugs? A recent flurry of media articles lead readers to a realization that Big Pharma and the “mental health” industry have deceived Americans on a grand scale.

The “New York Review of Books” two-part article by Dr. Marcia Angell, Senior Lecturer at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, summarizes it extremely well. She analyzes three books by authors Irving Kirsch, Robert Whitaker, and Daniel Carlat. Each deconstructs the apparent mental illness epidemic and theory that mental disorders stem from brain chemical  imbalances which can be corrected by drugs.

Dr. Angell’s review has sparked a host of other journalists to applaud her and fuel the fire. An article in Forbes even concludes, “psychopharma is looking like an idea whose time has passed.”

As an overview:

Ten percent of Americans over age six take antidepressants. Antipsychotic drugs, once reserved for schizophrenics, have become the top-selling class of drugs in the US, with over $14 billion in sales in 2009. ADHD, bipolar and autism diagnoses have exploded in the past two decades with at least 5 million US kids now on psychiatric drugs.  Ten percent of boys take drugs for ADHD. Half a million kids take antipsychotics, including preschoolers.

The chemical imbalance theory rose to fame when Prozac hit the market in 1987, accompanied by massive hype that it corrected a chemical deficiency in the brain. In the years that followed, the number of people prescribed drugs for mental illness skyrocketed. Today, “treatment” for mental disorders is synonymous with psychoactive (mind-altering) drugs.

Tracing the origin of this theory shows it wasn’t that chemical imbalances were discovered in the mentally ill and then drugs were devised to correct the imbalance. Instead, drugs created for other purposes were incidentally found to also affect brain chemicals and blunt mental symptoms. Drug companies, hungry for new markets, and   psychiatry, eager to build stature in the medical arena, leapt on this. They conducted a vast campaign to popularize chemical imbalances as the cause of mental disturbance and push drugs as the answer.

As Dr. Angell writes, “instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.” “Or similarly,” she says, “one could argue that fevers are caused by too little aspirin.”

Many scientific studies disprove the chemical imbalance theory. After fifteen years of research, Irving Kirsch – psychologist and author of “The Emperor’s New Drugs” – concludes, “It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong.” Research studies show psychoactive medications actually disrupt brain chemistry and causes the brain to function abnormally. This year prominent neuroscientist, Dr. Nancy Andreason, announced proof that antipsychotics shrink the brain.

Studies also demonstrate that long-term recovery rates are higher for nonmedicated patients. For instance, the World Health Organization conducted an investigation in fifteen cities around the world and out of 740 depressed individuals studied, those that weren’t on psychiatric drugs had the best long term outcomes.

In the pre-medication era, it was known that with time, people usually recovered from depression. If kids had tantrums, were unruly or shy, they were apt to outgrow it. Today, individuals branded with disorders are likely to receive long-lasting diagnoses, endless prescriptions and the poorer ones tend to remain on disability for life.

Big Pharma manipulation

Dr. Marcia Angell says the author of each of the three books agrees on “the disturbing extent to which the companies that sell psychoactive drugs – through various forms of marketing, both legal and illegal, and what many people would describe as bribery – have come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated.”

According to IMS Health, an information and consulting company, pharmaceutical companies spent $6.1 billion in 2010 in marketing to US doctors. Another $4 billion was spent on direct-to-patient advertising.

Drug trials, used to bring a drug to market, are funded by drug companies, heavily biased and misleading. Companies may sponsor as many trials as they like until they have just two positive ones to submit to the FDA. Great care is taken to hide negative trials. The highly positive results of placebo trials are downplayed: a high percentage of patients recover on a fake drug (like a sugar pill) – proving that the more a person believes he will benefit from a treatment, the more likely he will experience a benefit.

In regards the Diagnostic and Statistical Manual – the psychiatric bible of mental disorders, used in prescribing drugs – Dr. Angell points out “in all of its editions, it has simply reflected the opinions of its writers.” The majority of the psychiatrists involved in creating the current edition had financial ties to drug companies.

Author Daniel Carlat points out that “psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies.”

Crime against humanity

And where has the “mental health” industry and “drug therapy” brought our nation?

As Americans line up at their local pharmacy, documented side effects are legion: weight gain, deadened emotions, diabetes, heart problems, liver damage, stunted growth in kids, shortened life spans and on and on. Those prescribed one psychoactive drug are commonly prescribed another to address side-effects, with many on daily cocktails of meds.

An estimated 2.2 million Americans are hospitalized each year for adverse drug reactions. Over 100,000 die from them.

Instead of decreasing, the number of adults on disability pay for mental illness has soared 250% since 1987 and for kids it’s a 35X increase.

The greatest  crime to humanity is the mass drugging of children. Yet it’s perpetrated within schools, doctors offices, foster homes and juvenile facilities daily.

There is good news. In the past few years, drug companies have faced a rise of multi-billion dollar class action suits. The key popularizer of childhood bipolar and antipsychotics for kids, Dr. Joseph Biederman, was publicly sanctioned by Harvard Medical School for failing to report $1.6 million he pocketed from drug companies. Some drugmakers are steering away from pursuing new psychoactive drugs.

Nazi chief propagandist Joseph Goebbels once said, “If you tell a lie big enough and keep repeating it, people will eventually come to believe it.”

This chemical-imbalance/drug therapy lie has been told big enough and repeated enough, that much of America believes it. Isn’t it time we all put a stop to it?

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“How do I get off all the depression drugs?” We asked an expert

Thursday, June 30th, 2011
Foodconsumer.org
By Martha Rosenberg

Phillip Sinaikin, MD, is a Florida psychiatrist who has been in practice for 25 years. Author of “Get Smart About Weight Control” and co-author of “Fat Madness: How to Stop the Diet Cycle and Achieve Permanent Well-Being,” his new book focuses on excesses and industry influence in the field of psychiatry.

Rosenberg: Your new book, Psychiatryland, traces how deception, conflicts of interest, medical enabling and direct-to-consumer advertising have resulted in millions being on psychiatric drugs they don’t need. One patient you describe has legitimate mourning and grief work to do after his wife leaves him for his own cousin. But his grief is pathologized into “bipolar disorder” by the system, including his own mother.

Sinaikin: By the time I saw this patient, he was on Wellbutrin and another antidepressant, the mood stabilizers Eskaltih and Keppra, the antipyschotic Abilify, the tranquilizer Klonopin and Adderall for ADD. Calling grief a psychiatric disorder deflates and dishonors the spiritual dimension of loss and grief and the sadness which is a marker of the lost love. By the time this patient came under my care (three years after the loss of his wife) his “case” had become such a jumbled, incomprehensible and irrational mess of overdiagnosis and overmedication that the only word I can use to describe it is CRIMINAL.

Rosenberg: Can you explain the popularity of such drug cocktails? The drugs haven’t been tested together so the patient is a guinea pig. And their total cost can exceed $1000 per month, often shuttled onto taxpayers because the people are considered disabled under federal entitlement programs.

Sinaikin: Psychiatry mimics science but is not a real science. The symptoms it treats are subjective and have not been demonstrated and cannot be demonstrated at the cellular level. That gives psychiatrists free reign to just experiment and symptom chase, often insanely chasing the side effects and negative interactions of the current drug regimen with more and more drugs. Polypharmacy is also a way psychiatrists can distinguish themselves in an increasingly competitive market. No one believes you need a specialist for one drug — any primary care physician can give you Zoloft — but for multi-drug therapy you do. If you don’t write a prescription as a psychiatrist, you won’t work these days. It is like being a pacifist and having no choice but working in a bullet factory.

Rosenberg: A lot of this trial-and error polypharmacy is buttressed by the concept of “treatment resistance” and “Prozac poop-out.”

Sinaikin: I write in the book that an antidepressant not working anymore is no different than getting used to anything that used to thrill us. We buy our dream house with two bedrooms and a garage and after a while it doesn’t make us happy anymore and we are eyeing the house with three bedrooms and a pool. Another example, of course, is falling in and out of love.

Rosenberg: You document in Psychiatryland the creation of new diseases to sell drugs including adults now diagnosed with childhood disorders like ADD and children with adult disorders like bipolar and depression.

Sinaikin: One scientific article I read about the new childhood disorders sounds like a satire. Two well-respected “thought leaders” in psychiatry were debating the underlying pathology of a three-year-old girl who ran out in traffic. The first doctor believed her dangerous behavior was indicative of an Oppositional-Defiant disorder. The other doctor argued her impulsive act represented grandiose delusions where this girl believed she was special and cars could not harm her. She was, therefore, bipolar.

Rosenberg: Another shocker in your book is how everyday drug and alcohol addicts were recast as having psychiatric conditions for money.

Sinaikin: The insurance companies told the rehabs they would no longer pay for inpatient rehab for heroin, cocaine or alcohol unless there was also another Axis 1 psychiatric disorder like bipolar disorder or major depression. I was working in a drug treatment facility when the change happened. Since addicts typically complain of anxiety and depression, a completely understandable emotional response to their toxic lifestyles, it was “no problem” to add a new label and throw a few psychiatric drugs at their now relabeled “dual diagnosis.”  Of course the central tenet of recovery, taking personal responsibility, was buried by the new victim narrative of self-medicating a previously undiagnosed mental illness.

Rosenberg: Treating addiction with psychiatric drugs before or instead of seeking a higher power is antithetical to the 12 Steps of Alcoholics Anonymous.

Sinaikin: As I say throughout my book, human beings are indescribably complex. There are times when the dual-diagnosis concept is necessary and helpful but clearly not applicable to 100% of the cases of addiction as it is now applied. I believe that the 12 Step model is an ideal model of recovery. Patients can have the help whenever they are truly ready, not just when someone decides to foist it on them. Most importantly, the addicts helping other addicts are doing it to facilitate their own recovery and not for ulterior motives such as money. Amazingly, in a world gone profit crazy 12 Step recovery programs are still free. I conceptualize the 12 Steps as a distillation of the spiritual principles world’s great religions but no one is forced to believe in anything including God.

Rosenberg: Given conflicts of interest at the American Psychiatric Association, which drives psychiatric diagnoses, in the FDA drug approval process itself and the legions of doctors willing to huckster for pharma as thought leaders or Key Opinion Leaders (KOLs), do you see any hope of rescuing people from Psychiatryland?

Sinaikin: The system is unbelievably bad and even worse than it looks. But, I think a goal that could be achieved would be a repeal of direct-to-consumer advertising. Patients now come into my office asking me if they have ADD or bipolar disorder or if they can have Cymbalta. When I began practicing psychiatry, long before direct-to-consumer advertising, this would never have happened.

Psychiatryland

Author: Phillip Sinaikin, MD
978-1-4502-5290-4 (pbk),
978-1-4502-5289-8 (cloth)
978-1-4502-5288-1 (ebk)

Publisher: I Universe
Published Year: 2010
available online at
Amazon and Barnes & Noble

http://www.foodconsumer.org/newsite/Shopping/Books/depression_drugs_0629110547.html

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