1.
Corruption by Big Pharma
How did it become within responsible
professional standards for a two-year-old to get an ADHD
diagnosis, for a three-year-old to get a bipolar diagnosis, and
for toddlers to be prescribed multiple heavily sedating drugs?
The short answer is drug company
corruption of the mental health profession. Congressional
hearings in 2008 revealed that psychiatry’s “thought leaders”
and major institutions are on the take from drug companies.
On June 8, 2008, the New York
Times reported about psychiatrist Joseph Biederman:
“A world-renowned Harvard child
psychiatrist whose work has helped fuel an explosion in the
use of powerful antipsychotic medicines in children earned
at least $1.6 million in consulting fees from drug makers
from 2000 to 2007.”
Due in large part to Biederman’s
influence, the number of American children and adolescents
treated for bipolar disorder increased 40-fold from 1994 to
2003.
Pediatrician and author Lawrence
Diller notes about Biederman,
“He single-handedly put
pediatric bipolar disorder on the map.”
In addition to his popularization of
bipolar disorder for children, Biederman is one of the most
significant forces behind the expanding numbers diagnosed with
ADHD; and congressional investigators also discovered that
Biederman conducted studies of Eli Lilly's ADHD drug Strattera
that were funded by National Institute of Health at the same
time he was receiving money from Lilly.
Not only does the drug industry have
influential psychiatrists such as Biederman in their pocket,
virtually every major mental health institution is
financially interconnected with Big Pharma.
Congressional hearings also exposed
the American Psychiatric Association psychiatry’s premier
professional organization, as being on the take from drug
companies. In 2006, the drug industry accounted for about 30
percent of the APA’s $62.5 million in financing.
Most relevant here, the APA is the
publisher of the psychiatric diagnostic bible, the Diagnostic
and Statistical Manual of Mental Disorders (DSM), and thus the
APA is the institution responsible for creating mental illnesses
and disorders.
2.
Invalid Illnesses and Disorders
Psychiatry’s first DSM (1952) and
its DSM-II (1968) listed homosexuality as a mental illness.
Only because of a fierce political
fight waged in the 1970s by gay activists did the APA abolish
homosexuality as an illness and eliminate it from its DSM-III
(1980). Gay activists’ fight was not only a victory for
themselves but a service for everyone else, as it made public
the important scientific problem of psychiatric disorder
invalidity.
Specifically, are psychiatric
disorders scientifically valid illnesses, or are they simply
behaviors that create discomfort for some authorities at a given
moment in time?
While psychiatry lost homosexuality
as a mental illness in the 1980 DSM-III, the APA found other
groups it could pathologize, groups that could not mobilize and
resist, most notably children, who are now routinely given
psychiatric diagnoses for behaviors that many of us view as
normal for their ages.
Psychiatry sees it as within
responsible professional standards to diagnose three-year-olds
such as Rebecca Riley with bipolar disorder.
The symptoms of bipolar disorder
include irritable and rapidly changing moods, severe temper
tantrums, defiance of authority, agitation and distractibility,
sleeping too little or too much, poor judgment, impulsivity and
grandiose beliefs.
Psychiatry also sees it as within
responsible professional standards for Rebecca Riley to have
been diagnosed at 28 months old with ADHD.
The symptoms of ADHD are inattention
(easily distracted and bored, difficulty organizing and
completing tasks, losing things, not seeming to listen, not
following instructions); hyperactivity (fidgeting, talking
nonstop, having trouble sitting still, difficulty with quiet
tasks), and impulsivity (impatience, blurting out inappropriate
comments, interrupting conversations).
Today, children and teens are also
diagnosed with oppositional defiant disorder (ODD), the symptoms
of which include,
“often actively defies or
refuses to comply with adult requests or rules,” and “often
argues with adults.”
The standard for a medical disorder
should not be whether or not an individual causes friction.
3.
Scientifically Unreliable Diagnoses
Even if you believe that bipolar
disorder for three-year-olds, ADHD for two-year-olds, ODD for
teenagers, and all the other DSM diagnoses are valid disorders,
there is still the scientific issue of diagnostic unreliability
- the lack of diagnostic agreement among professionals examining
the same person.
A generation ago, psychiatrists
admitted that their diagnoses were unreliable and agreed that
this was a major scientific problem. So in 1980, in an attempt
to eliminate this embarrassment, they created the DSM-III with
concrete behavioral checklists and formal decision-making rules,
but they failed to correct the problem.
Psychiatric diagnoses remain
unreliable, but now psychiatry no longer talks about the
unreliability problem.
If a measurement is a reliable one,
then clinicians trained with it should be in high agreement on
the diagnosis. A major 1992 study, conducted at six sites with
600 prospective patients, was done to examine the reliability of
psychiatric diagnoses.
Experienced mental health
professionals were given extensive training in how to make
accurate DSM diagnoses. Because of the extensive training, one
would expect that diagnostic agreement would be much higher than
in typical clinical settings.
Herb Kutchins and Stuart
Kirk summarize the study in Making Us Crazy
(1997):
What this study demonstrated was
that even when experienced clinicians with special training
and supervision are asked to use DSM and make a diagnosis,
they frequently disagree, even though the standards for
defining agreement are very generous...
[For example,] if one of the two
therapists made a diagnosis of Schizoid Personality Disorder
and the other therapist selected Avoidant Personality
Disorder, the therapists were judged to be in complete
agreement of the diagnosis because they both found a
personality disorder - even though they disagreed completely
on which one!
So even with this liberal
definition of agreement, reliability using DSM is not very
good.
Kutchins and Kirk conclude:
“Mental health clinicians
independently interviewing the same person in the community
are as likely to agree as disagree that the person has a
mental disorder and are as likely to agree as disagree on
which of the over 300 DSM disorders is present.”
4.
Biochemical Imbalance Mumbo Jumbo
Just as nothing was more important
in selling the Iraq war in 2003 than
the Bush administration’s
certainty that Iraq possessed weapons of mass destruction,
nothing has been more important in selling psychiatric drugs
than psychiatry’s certainty of biochemical brain imbalances as
the cause for mental illnesses.
Prior to psychiatry’s proclamation
that depression was caused by too little of the neurotransmitter
serotonin, few Americans were taking antidepressants.
But by declaring that depression was
caused by a serotonin imbalance analogous to diabetes and an
insulin imbalance, depressed Americans became far more receptive
to serotonin-enhancing drugs such as the
“selective-serotonin-reuptake inhibitors” (SSRIs) Prozac, Paxil,
and Zoloft.
SSRIs can make some depressed people
feel better; however, alcohol makes some shy people less shy,
but that’s not enough evidence to say that shyness is caused by
an alcohol imbalance.
The truth is - and scientists have
known this for quite some time - that serotonin levels are not
associated with depression.
Researchers have used a variety of
methods to test the serotonin imbalance theory of depression,
including comparing serotonin metabolites in depressed and
nondepressed people, and depleting serotonin levels through a
variety of means and then observing whether this resulted in
depression.
Elliot Valenstein, professor
emeritus of psychology and neuroscience at the University of
Michigan, reviewed the research in his book Blaming the
Brain (1998) and reported that it is just as likely for
people with normal serotonin levels to feel depressed as it is
for people with abnormal serotonin levels, and that it is just
as likely for people with abnormally high serotonin levels to
feel depressed as it is for people with abnormally low serotonin
levels.
Valenstein concluded,
“Furthermore, there is no
convincing evidence that depressed people have a serotonin
or norepinephrine deficiency.”
In 2002, the New York Times
reported:
“Researchers knew that
antidepressants seemed to raise the brain’s levels of
messenger chemicals called neurotransmitters, so they
theorized that depression must result from a deficiency of
these chemicals. Yet a multitude of studies failed to prove
this precept.”
Yet even now, many psychiatrists and
other mental health professionals continue to promulgate the
serotonin imbalance theory of depression, and polls show that
the majority of Americans continue to believe it.
5.
Pseudoscientific Drug Effectiveness Research
There are multiple tricks that
psychiatric drug manufacturers and their researcher
psychiatrists and psychologists use to make their drugs look
more effective than they really are.
One of the most common depression
measurements used by researchers paid by drug companies is the
Hamilton Rating Scale for Depression. In the HRSD,
researchers rate subjects, and the higher the point total, the
more one is deemed to be suffering from depression.
On the HRSD, there are three
separate items about insomnia (early, middle and late) and one
can receive up to six points for difficulty either falling or
remaining asleep; however, there is only one suicide item, in
which one is awarded only two points for wishing to be dead.
The HRSD is heavily loaded with
items that are most affected by drugs, and it is therefore
especially damning for antidepressants that even with such
measurement dice-loading, these drugs routinely fail to
outperform placebos - even dice-loaded placebos.
Proper drug research requires that
neither subject nor experimenter knows who is getting the drug
and who is getting the placebo (a true double-blind control).
Drug company antidepressant researchers use inactive placebos
such as sugar pills (which don’t create side effects).
Independent research on inactive
placebos show that many subjects in antidepressant and other
studies can guess if they are getting the actual drug or not,
which changes their expectations and subverts the double-blind
control. In order to make it more difficult to guess correctly,
an active placebo (which creates side effects) should be used.
In 2000, a Psychiatric Times
article concluded:
“In fact, when antidepressants
are compared with active placebos, there appear to be no
differences in clinical effectiveness.”
Dice-loading depression measurements
and placebos are just two of many techniques drug company
researchers use to make antidepressants look more effective than
they really are.
But even with such dice-loading,
antidepressants have not fared well, at least when one examines
all the studies.
Drug companies try to ensure that
those studies showing antidepressants to be no more effective
than placebos are not published; however, all studies must be
submitted to the FDA.
So independent researcher Irving
Kirsch and his research team at the University of Connecticut
used the Freedom of Information Act to gain access to all data,
and analyzed 47 studies that had been sponsored by drug
companies on Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone.
Kirsch discovered that in the
majority of the trials, the antidepressant failed to outperform
a sugar pill placebo (and in the trials where the antidepressant
did outperform the placebo, the advantage was slight).
6.
Psychotropic Drug Hypocrisy
Chemists consider psychiatric
prescription drugs and illegal mood-altering drugs all to be
psychotropic or psychoactive drugs.
Cocaine and ADHD drugs such as
Adderall and other amphetamines affect the neurotransmitters
dopamine, serotonin, and norepinephrine; and antidepressants
used in combination also affect the same neurotransmitters.
Not only are prescription
psychotropics and illegal psychotropics chemically similar, they
are used by people for similar reasons, including taking the
edge off their discomfort so they can function. The hypocrisy
surrounding illegal and prescription psychotropic drugs is
harmful to society in at least two ways.
At one level, because people are
being misinformed about the realities of prescription
psychotropic drugs, they are more likely to gulp them down and
to give them to their children. This has helped create a tragic
phenomenon detailed by investigative reporter Robert Whitaker
in his book Anatomy of an Epidemic (2010).
Psychiatric drug use turning mild
and episodic conditions into severe and chronic ones has helped
create a huge increase of Americans with severe mental illness,
especially among children.
At a second level, this
psychiatric-illegal psychotropic drug hypocrisy allows for
unfair criminalizing and incarceration of people using illegal
psychotropics.
7.
Diversion from Societal, Cultural and Political Sources of
Misery
When we hear the words disorder,
disease or illness, we think of an individual
in need of treatment, not of a troubled society in need of
transformation.
Mental illness expansionism diverts
us from examining a dehumanizing society.
In addition to pathologizing normal
behavior, the mental health profession also diverts us from
examining a society that creates the ingredients - helplessness,
hopelessness, passivity, boredom, fear, and isolation - that
cause emotional difficulties.
We are diverted from the reality
that many emotional problems are natural human reactions to loss
in our society of autonomy and community.
Thus, the mental health profession
not only has financial value for drug companies but it has
political value for those at the top of societal hierarchies who
want to retain the status quo.
