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Can Psychosis be Prevented?

I recently read an article in Discover magazine entitled “Stop the Madness.” It was about a new treatment program that allegedly can prevent schizophrenia and other forms of psychosis. I found it very disturbing.

The PIER (Portland Identification and Early Referral) program was founded by a psychiatrist, Dr. William McFarlane, in Portland, Maine. It has recently expanded to 4 other US sites and there are similar programs in several other countries. PIER is an effort to find and treat patients in the “early stages of deterioration towards psychosis,” so as to prevent the development of psychotic illnesses like schizophrenia, bipolar disorder, and major depression. The program involves various psychosocial interventions and psychotropic drugs.

On the surface it sounds promising, but there is a dark side. I’m particularly concerned about the use of antipsychotic drugs in people who haven’t been diagnosed as psychotic.

McFarlane’s own website points out that “With treatment, most people make a full recovery from a psychotic episode.” So what’s the rush? Why be so concerned about early identification? Is it reasonable to treat an illness before it’s diagnosed?

McFarlane thinks that a first psychotic episode should be prevented if possible because it might have lingering effects on the brain that would interfere with recovery. He is also concerned that a psychotic episode in a critical period of teen development can have lasting psychosocial repercussions. School is interrupted, budding careers nipped; people are shunned because they have been labeled as crazy.

The symptoms of schizophrenia include delusions, hallucinations, disordered thinking, movement disorders, flat affect, social withdrawal, and cognitive deficits. Before these overt symptoms develop, there may be prodromal signs or symptoms. PIER attempts to identify patients by prodromal symptoms before overt psychosis develops.

Common prodromal signs or symptoms can include the following, and it is important to note that a combination of symptoms rather than any one symptom would suggest a possible prodromal phase: Social withdrawal, a marked drop in functioning, uncharacteristic, peculiar behavior, increasing difficulty with concentration, heightened sensitivity to sights, sounds, smells or touch, loss of motivation or energy to participate in any activity, dramatic sleep and appetite changes, suspiciousness of others, unusual or exaggerated beliefs about personal powers or influences.

Some of these are characteristic of normal teens going through a bad patch. There is some overlap. Doctors who are looking for prodromes will have lower thresholds for deciding what behavior is peculiar and what constitutes a drop in functioning.

The most marked difference between prodrome and actual illness seems to be hallucinations, but hallucinations can also occur in normal people. It’s hard to draw a line where prodrome ends and illness begins. And we don’t know how many people fit the prodromal profile but never progress to psychosis.

We can identify risk factors even in people who don’t have prodromal symptoms. The risk factors currently identified by international research are:

Age: adolescence or early adulthood (12 – 30). The average age of a young person coming to our program is 17.
Family history of a psychotic disorder such as schizophrenia or bipolar disorder—particularly in a close or immediate relative (parent or sibling).
A history of difficulty making friends, along with unusual thoughts and odd or eccentric behaviors (schizotypal personality disorder).
A marked change in behavior, emotions, or thinking for a month or more, especially when accompanied by social withdrawal and deterioration in school or work performance.

These are only risk factors. They raise the probability of illness for the group but don’t predict illness for individuals. Two of them are objective, the other two subjective. The subjective ones are far from black and white. It’s hard to define things like “difficulty making friends,” or “a marked change in behavior.” Two observers might well come up with opposite answers. The two objective risk factors (age and heredity) can’t be changed. It’s not clear whether the two subjective ones are modifiable.

There are risk factors for diabetes, and there are measures that can be taken to reduce risk, such as weight reduction. There is also a prodrome with impaired glucose tolerance that is objectively measurable. Nevertheless, we don’t start pre-diabetics on insulin. We monitor them and advise health measures that would be good for them even if they had no risk of diabetes. We wait until they meet the criteria for diabetes before we treat.

According to one study, predictive algorithms for psychosis may reach an accuracy of 68-80%, “comparable to that in other areas of preventive medicine.” Is that good enough to justify this kind of intervention? I tend to agree with this analysis:

Early intervention” can refer to two different approaches–intervention when the psychosis is already evident and intervention before a psychosis is fully apparent. Each carries a distinctly different set of risks. The hoped-for benefits of early intervention in a fully evident psychosis are based on research that reveals an association between intervention early in the illness and good outcome. Those suffering from a psychosis of recent onset, however, are more likely to experience a spontaneous remission of illness, and this may readily explain the observed association. Early intervention in such cases of good-prognosis psychosis may lead to unnecessary and, sometimes, protracted treatment for those who would do well with no treatment. Intervention in the supposed prodromal phase of psychosis presents more serious hazards. The screening instruments currently available are inadequate for the accurate prediction of psychosis, and the risks of negative effects for the large numbers of people who screen false-positive are considerable. These risks include unnecessary fear of illness, restriction of life goals, use of medication and their side-effects.

The PIER website doesn’t offer unreliable testimonials, but it doesn’t offer any reliable references either, not even in the section for medical professionals. They say, “Early experience is showing that this approach clearly and dramatically reduces morbidity” but they have yet to publish any findings. What has been published in the medical literature doesn’t really support their approach.

A study of antipsychotics as sole prevention (by McGlashan et al.) gave inconclusive results. A study in Australia (by McGorry et al.) showed that risperidone plus psychotherapy was more effective at preventing psychosis than supportive care alone – but after the trial, several patients in the treatment group became psychotic, so the drugs may have been treating rather than preventing.

Neither McGlashan nor McGorry think the drugs should be used outside clinical trials. One researcher quoted in the Discover article said “current evidence does not support the use of antipsychotic medications as a prevention strategy in at-risk individuals.”

There are other things that really bother me. Schizophrenia as a diagnostic entity has been criticized as lacking in scientific validity or reliability.

Diagnosis depends largely on self-reports and on the reports of family members and others whose reports may not be reliable. Critics of psychiatry like Thomas Szasz think mental illness is a myth that is used by society to control people whose behavior doesn’t conform to society’s expectations. Mental illness was diagnosed for political purposes in the Soviet Union. In a famous experiment in the US, normal people got themselves admitted to a psychiatric hospital and found that they couldn’t shake the label: the staff continued to think they were crazy even though they behaved normally after admission.

The diagnosis of schizophrenia is so far from an exact science that the agreement between any two psychiatrists is only 65% or less. If the diagnosis of schizophrenia is this inaccurate, the diagnosis of prodromal symptoms must be even less exact. Using the prodromal diagnosis for prediction can’t be very accurate, and some normal people will inevitably be labeled incorrectly. Antipsychotic medications can cause serious side effects and even permanent damage, and we don’t want to give them to people who might not really need them.

On the one hand, if we can really prevent or delay the onset of psychosis we could alleviate a lot of suffering and give these young people a chance at a normal productive life. On the other hand, we might do more harm than good by overdiagnosing and overmedicating. Some say the illness is so devastating that we ought to do everything possible NOW, that we can’t afford to wait for better studies. Others say we’d better make sure of what we’re doing before we do any more of it. My opinion is that pharmaceutical interventions should take place only in a carefully designed research study. Meanwhile, we can still try to identify and help troubled young people.

PIER is doing much to foster public awareness of early psychotic symptoms. This is its real value. Maybe what we should be doing is educating the community, identifying young people with problems, involving their families, supporting them, helping them cope with the symptoms they currently have, and watching them for development of psychosis so they can be treated promptly and appropriately if and when the time comes – and not before.

For anyone who wants some insight into what these young people are going through, there is an excellent autobiographical book,  The Center Cannot Hold: My Journey Through Madness by Elyn Saks. It describes how she gradually became psychotic as a teenager, how she struggled with recurrent psychotic symptoms all her life, and how she tried all sorts of treatments and finally accepted that she needed to stay on medication. It’s particularly good at describing those in-between symptoms where it’s hard to say whether they are manifestations of disease or just part of life.

Posted in: Neuroscience/Mental Health, Pharmaceuticals, Science and Medicine

Leave a Comment (130) ↓

130 thoughts on “Can Psychosis be Prevented?

  1. AgnosticOracle says:

    The article sounded very interesting when I read it too, but the further I got into it the more skeptical I got. This line was particularly damning:

    “At the moment, the most powerful evidence for PIER may lie in the stories of its participants. ”

    If the most powerful evidence is anecdotes you have a problem.

  2. daedalus2u says:

    Very nice article. I will write a longer comment later. The link to Rosenhan’s experiment didn’t make it through. Here it is.

    http://en.wikipedia.org/wiki/Rosenhan_experiment

  3. pec says:

    Schizophrenia can’t be prevented or cured, because it is not understood by modern medicine. Psychiatric drugs can dull the symptoms, at best.

  4. pec says:

    And i completely agree with Harriet on this one. What an Orwellian nightmare this society would become if every teenager who acts a little strange were put on mind-numbing drugs.

  5. Harriet Hall says:

    daedalus2u,

    Thanks. I fixed the link.

  6. Harriet Hall says:

    pec said,

    “Psychiatric drugs can dull the symptoms, at best”

    As best, psychiatric drugs can get a patient out of a locked ward and allow her to lead a meaningful life in society. And they can abolish the symptoms, not just dull them.

    Read Elyn Saks’ book “The Center Cannot Hold.” She studied at Oxford, she is a lawyer, a psychiatry professor, author of several books, and has rewarding social and personal relationships. She is essentially normal as long as she takes her meds. Without them, she would probably not be alive, and if she were she would be gibbering on a locked ward. The meds do not “dull” her mind; in fact they allow her brilliant mind to function fully and contribute to society.

    No, we don’t understand schizophrenia. No, the treatments we have are not cures. Yes, the meds cause side effects, but those effects can be minimized and the newer drugs are not as bad.

    It’s easy to criticize the meds, but until we find a cure for schizophrenia, isn’t it more fair to acknowledge the benefits of these drugs? They have drastically reduced the population of our mental institutions and have revolutionized the care of the mentally ill.

  7. Fifi says:

    Harriet – Well said about the usefulness of psychiatric drugs when called for – even if some of our medications are still clumsy and we’re still in the infancy of being able to treat many psychiatric illnesses, it’s certainly better than burning people at the stake like in the pre-medical days when psychosis often got “diagnosed” as possession by evil spirits. And also much better than some of the bad old days of psychiatry as well. There are lots of legitimate criticisms that can be made of both contemporary and historical psychiatry – particularly some of the strange experiments undertaken by the US and other governments (strangely enough, General Stubblebine – married to a psychiatrist and promoter of supplements and energy medicine/new age beliefs – was involved in quite a few mind control experiments!).

    I know people whose lives (and minds) have been saved by the judicious use of psychiatric drugs and intervention – they’re strong supporters of medical intervention since it allowed them to return to their lives and they tapered off the medication as their grip on reality returned (obviously they were suffering from psychotic episodes, not full blown schizophrenia and bipolar disorder – which there has been a lot of interesting research on recently). To be anecdotal for a minute, in one case a friend was being told by others into yoga that his early symptoms of psychosis were actually indications of enlightenment! Fortunately his roommate was able to talk him into going to the hospital when he started to become dangerous to himself and others. (Many of the symptoms of “kundalini rising” or “enlightenment” are almost exactly like the symptoms of mystical enlightenment – as distinct from Buddhist notions of enlightenment as being “awake” to the world or aware. Many schools of Buddhism warn meditators against getting seduced by hallucinations, thinking one has psychic powers and other illusions of the mind.)

    I wonder if pec’s ever spent any time or cared about someone who suffers from a bipolar disorder, schizophrenia or who’s had a psychotic break? We know already that she blames her mother’s (unidentified) psychiatric illness on the medication that she was prescribed to help her manage her condition – and she’s expressed very little compassion towards her mother. Since pec blames medicine for having to look after her mother in her old age, we know already that she’s got a clear bias against medical treatment of mental and emotional illness.

    So pec, how do you think people with full blown psychosis or schizophrenia should be cared for and treated?

  8. pec says:

    “until we find a cure for schizophrenia, isn’t it more fair to acknowledge the benefits of these drugs? ”

    Ok I will go along with that, unless or until I learn more bad stuff about the drugs. If that women really does owe her extraordinary successful life to drugs, then I can’t criticize her decision to stay on them. People who simply cannot function without psychiatric drugs should probably take them.

    I would like to point out, however, that the movie “A Beautiful Mind” falsely claimed that John Nash overcame schizophrenia by taking psychiatric drugs. It was like a giant add for the drug industry.

    Maybe there are other, better, ways of dealing with schizophrenia that modern psychiatry is not aware of.

  9. Fifi says:

    pec – “Maybe there are other, better, ways of dealing with schizophrenia that modern psychiatry is not aware of.”

    Of course! That’s why there’s so much research that has and continues to go on in this area. This research also often gives us insight into the usual functioning of non-schizophrenic and bipolar brains.

    Or are you suggesting you already know of another and more effective (which is what I assume you mean by “better”) way of “dealing with” schizophrenia?

  10. weing says:

    I saw that movie. I didn’t see it as an ad for the drug industry.

    “Maybe there are other, better, ways of dealing with schizophrenia that modern psychiatry is not aware of.”
    Maybe using them as psychics?

  11. pec says:

    “I saw that movie. I didn’t see it as an ad for the drug industry.”

    weing,

    They changed the dang story so it looked like the new psycho drugs saved the day! After seeing the movie, I read that Nash somehow learned how to live with schizophrenia without drugs.

    Why add something false to the story, unless motivated by a generous contribution from Big Drug?

  12. Fifi says:

    pec is correct abut A Beautiful Mind misrepresenting Nash as taking medication he didn’t take (though the medication he would have been taking at that period was very different from contemporary medications). One issue regarding schizophrenia and many mental illnesses is diagnosis and mis-diagnosis – a psychotic episode viewed outside of the larger context can look like schizophrenia but isn’t. Until just the past decade or so and the invention of the MRI, we had no real way to look at brain function (not that we’re at the point yet where we can use this technology for routine diagnostics for mental illness but we are getting closer). With new tools come new insights and understanding.

    The other issue is that most psychiatrists (particularly in North America) focus on mental illness as a biological disease – and in the US talk therapy is often not an option under many medical insurance plans – so their solutions tend to be related to their area of expertize and what treatment they can offer within an insurance plan’s restrictions. (A psychologist will focus on the emotional, social and behavioral aspects and building relationships through talk therapy, because that’s their area of expertize). People who suffer from full blown schizophrenia often also have childhood abuse issues to deal with (it’s not uncommon for someone who is schizophrenic to have a schizophrenic parent since there’s a genetic basis). Full blown schizophrenia is just an extreme expression of something that often manifests in much milder and very useful forms as creativity and being adept at symbolic thinking. This, of course, doesn’t mean all creative people are schizophrenic or even on the spectrum – or that all schizophrenic people have creative talents and are undiscovered geniuses (though this IS a popular delusion!). People generally don’t get diagnosed with schizophrenia unless they’re markedly deluded, diassociated from reality and dangerous to themselves and/or others – in other words when it’s full blown. If they don’t have friends and family for support and to help them through their crisis, quite a lot of schizophrenic people end up homeless, drug addicted (as a form of self medication) and on the streets where they’re subject to being preyed upon and abused (by both other street people and the general public who is afraid of them).

  13. Fifi says:

    pec – One of the writers was married to a psychiatrist. It’s also possible that the inclusion of drugs – false and unethical as I think it happened to be – came of good and caring, if misguided, motivation. The movie does in some ways glamorize/romanticize schizophrenia (in any case we know it’s unrealistic!) and the writers may have thought it irresponsible and likely to encourage people to go of medication (which is quite different today than it was in Nash’s time). I’m not saying their actions were ethical, I don’t think they were (though, to put it into context, there’s hardly a Hollywood biopic out there that doesn’t distort reality for various reasons!). I’m just saying that not everything is a Big Pharma conspiracy or even a conspiracy.

  14. Fifi says:

    weing – I doubt A Beautiful Mind was a Big Pharma conspiracy – that seems slightly paranoid and ignores the other more obvious and simple potential reasons that they misrepresented Nash’s recovery in the movie. Either way though, misrepresenting the truth doesn’t serve anyone well and seems unethical to me no matter the motivation (not that I expect ethics from Hollywood! Now that WOULD be crazy!)

  15. psychability says:

    2 concerns:
    - You may have inadvertently given people the impression that Szasz and other mental illness deniers have some credibility. Because of the complexity of psychiatric illness and the challenges of studying the brain at the functional level, our medical specialty lags behind others. There is no question that brain disorders manifest with psychiatric symptoms and deniers only slow anti-stigma progress.
    - PIER’s work follows studies that show prognosis to be linked to the duration of symptoms in different psychiatric disorders, including schizophrenia. The theory is that if we can prevent or delay full blown symptoms, we can improve the prognosis. I agree that it is difficult to distinguish prodrome from normal specturm and that the evidence base for clinical treatment of prodromal symptoms is insufficient. However it is important for people to know that prodromal therapy may turn out to be a valuable strategy in our attack on schizophrenia and that it is worth research effort.

  16. vinny says:

    Another pilar of alternative medicine, Radovan Karadzic-one of the most wanted men in Europe, has been arrested in Belgrade.

    http://www.telegraph.co.uk/news/worldnews/europe/serbia/2444258/Radovan-Karadzic-was-disguised-as-doctor.html

  17. delaneypa says:

    As a practicing FP physician myself, I dread dealing with antipsychotics. Many have side effects that patients are surprised to learn about….for example, cataracts with Seroquel, diabetes with Zyprexa. Very real side effects and often prescribed for inappropriate conditons (dementia, sleep aids). No doubt a result of effective marketing in a country where genuine psychiatric care is all too neglected.

  18. J.G. says:

    Thank you for the post. I especially think that this bears repeating: “Antipsychotic medications can cause serious side effects and even permanent damage, and we don’t want to give them to people who might not really need them.”

    As does this: “until we find a cure for schizophrenia, isn’t it more fair to acknowledge the benefits of these drugs”

    Someone close to me has recently begun taking an antipsychotic and the difference is astounding–nowhere near a full recovery but leaps and bounds better than before. However, the side effects can be horrendous. She will have to live constantly in fear of developing uncontrollable muscle ticks, quite a frightening prospect for a professional painter, and she describes it as trying to think in a fog. Even the newer meds are indeed still “clumsy” and a lot of people go off their meds because of the severity of the side effects. Definitely not something to expose someone to until they unequivocally need it.

    Sadly, it has been my experience that politics, poor funding and illogical management do more for “drastically reduc[ing] the population of our mental institutions,” not to mention they make it very difficult to get people on treatment until they have hit rock-bottom–usually long after the window of “early intervention” has passed. Try to get someone with anosognosia to accept treatment and you’ll see what I mean. In trying to get help for this person, I had multiple social workers and psychiatrists advice not giving her money for food and letting her be evicted so as to put pressure on her to accept help and pressure on the system to help her.

    (Fifi and pec, I think you have to rent that movie again. He’s on meds for a bit and goes off of them because, among other reasons, he “couldn’t respond to [his] wife.” Then he starts having delusions again, nearly kills the baby, and when his wife is in the car leaving him, he jumps in front of the car and has a revelation about how the niece never grows up–a fact he can hold onto to remind himself that they are hallucinations. From then on in the film he controls himself through aggressively rational thinking and sheer force of will, not drugs. There are a great many inaccuracies in the film, not the least of which are that his hallucinations were auditory not visual and they don’t let the Economics awardee give a speech at the Nobel Prize ceremonies, but the plain truth doesn’t usually make for good cinema, so we forgive them and move on.)

  19. Jules says:

    If the prodromal syndromes are all that they’ve got to go by, it’s a miracle I’m not locked up yet! I was that kid.

    Still, there is something to be said for recognizing mental illness early on. I sometimes wonder what my life would have been like had I been diagnosed and treated for depression early on (in high school). Could I–or any other teenager–have lived down the “crazy” label? Or would I have made better choices in my life?

  20. Harriet Hall says:

    psychability said,

    “You may have inadvertently given people the impression that Szasz and other mental illness deniers have some credibility”

    I do think Szasz has “some” credibility, but not very much. He makes some good points but throws the baby out with the bath water.

    “prodromal therapy may turn out to be a valuable strategy in our attack on schizophrenia and that it is worth research effort”

    I hope I didn’t imply that I didn’t support research. I do. I just thiink it’s premature to be offering these treatments to patients outside of controlled trials.

  21. DavidCT says:

    There are more problems with mental health when it comes to diagnosis and treatment than other parts of medicine. The official list of conditions that can be diagnosed seems to be as much designed for insurance coding as a reflection of specific disorders. Questionable use of medications is common – being an active young male is sometimes considered a Ritalin deficiency.

    Mental institution populations are reduced but where are these people? Some are functioning members of society. Those who stop taking their medications often live homeless on our streets or find themselves in the default mental health facility – prison.

    I do not have the same level of confidence in diagnosis in the field of mental health as in organic of physical disorders. The risk/ benefit ratio may someday favor early diagnosis. For now the risks are still on the high side.

  22. pec says:

    “studies that show prognosis to be linked to the duration of symptoms”

    Sure, a worse case probably has longer duration. They’re assuming the opposite direction of causation.

  23. pec says:

    No J.G. I don’t need to see A Beautiful Mind again, even though I did like it. At the end of the movie it is clearly stated that he benefited from the new anti-psychotic drugs. It was like a pharmaceutical ad and I was skeptical even then, since the movie had made so much of his use of will power and rationality to overcome the symptoms.

    Later I read that the part about his using the new drugs was fictional.

  24. Stephen Wood says:

    Thanks for this article, which I read with interest as I work with Prof McGorry in Melbourne and have published a fair bit of prodromal research myself.

    You are right to note that our group does not support antipsychotic treatment of young people with prodromal symptoms of psychosis outside clinical trials, although I would argue that the real importance of the clinical trials we and others have published is the concept that the onset of frank psychosis can at minimum be delayed. You should not discount the usefulness of this – not least because of the known association between earlier age of psychosis onset and poorer clinical outcome.

    There are other clinical trials that do not use antipsychotics that have positive findings – for example Morrison et al (Schiz Bull 33: 682) used cognitive therapy, and an as yet unpublished study by Amminger et al suggests that an essential fatty acid may successfully prevent transition to illness.

    These latter studies have led our group to suggest an alternative model for diagnosing and treating severe mental illness – a clinical staging model derived from that used in cancer (McGorry, Am J Psychiatry 164: 859; McGorry et al, ANZ J Psychiatry 40:616). While this is currently only a heuristic, it does provide an interesting alternative to current diagnostic systems. In particular, it suggests that earlier stage mental illness (such as the prodrome) should have better prognosis and respond to treatment with more benign therapies. We are currently testing these hypotheses with a number of large, multi-centre intervention studies.

    Please keep up the good work; I enjoy this blog very much.

  25. wertys says:

    Schizophrenia is a diagnosis that is better understood as a syndrome rather than a disease. That is, it can be recognized by a particular constellation of symptoms and signs which tend to occur together in particular ways. It’s a bit like saying at ‘all back pain is due to disc pain’, in that there are tremendous variations within the syndrome which make it unlikely that there is only one cause of it. There is a wealth of research supporting the idea of a genetic susceptibility to shcizophrenia, as well as evidence from MRI studies that predictable patterns of brain degneration can be linked to the development of certain types of schizophrenic symptoms, eg disorders of the form of thought and poor memory and attention.

    Knowing this, I agree that there is a legitimate concern about the possible risks of exposing people to antipsychotic drugs if there is uncertainty about whether they will go on to develop the full spectrum of illness. Probably those with moderate or severe forms of the illness will benefit more from early treatment because the neurotransmitter dysfunctions which can be improved by antipsychotics will be corrected earlier, but if they have a type which goes on to develop neural degeneration they will do poorly in the long run whatever treatment they receive. What such studies need to answer as well as looking at the purely medical endpoints is to look at disability measures as well. Treating people early may cause increased side effects, but this may be dwarfed by the benefit over the long term when things like return to work, level of long-term care needs and hospital admissions are taken into account, let alone the burden on the carers over the lifetime of the sufferer.

    Echoing a recent Michael Schermer quote, pec’s criticisms are so far off the mark that they’re not even wrong. There are reasonable and serious ethical and scientific issues which can be discussed in this topic, and superficial uninformed ranting is enirely irrelevant. No doubt I am being a ‘close-minded skeptic’ but perhaps if pec the enthusiastic amateur scientist can’t demonstrate any learning she should refrain from poking the eyes of those who are trying to see more clearly.

  26. ama says:

    “Can Psychosis be Prevented?”

    The answer is simple: Could you prevent Dr. William McFarlane?

    No?

    So the answer is: no.

  27. quackdoctor says:

    “There is also a prodrome with impaired glucose tolerance that is objectively measurable. Nevertheless, we don’t start pre-diabetics on insulin.”

    Yes and medicine does not do much at all for these people. They should be managed aggressively. But most MDs just ley people with metabolic synrome slip into CV disease and diabetes. As a matter of fact when glucose levels are up but not high enough to be labled diabetes most of the time nothing is done at all. Yeah…yeah…you will say it is. But it is not.

  28. Harriet Hall says:

    quackdoctor,

    Are you suggesting that pre-diabetics should be started on insulin? Is there any evidence that that improves outcome? If not, my analogy stands.

    Please don’t change the subject.

  29. Fifi says:

    I find it interesting that so many promoters of alternatives to medicine both decry the authority of medicine AND propose that medicine just really isn’t fascistic enough and patients should be forced to do whatever the doctor thinks is best!

    Pec has promoted this idea (including blackmailing patients by withholding life saving medications) and now quackdoctor is doing the same thing! Apparently they don’t believe people should be able to make their own choices about what they do with their bodies and how they live and die! Or maybe they just want to force everyone into CAM health camps and force them to exercise, take supplements and pray five times a day! ;-)

  30. pec says:

    “Pec has promoted this idea (including blackmailing patients by withholding life saving medications)”

    Go soak your stupid head. I never said or implied anything like that. I am not answering you, in general, except when you try to slander me with stupid lies.

  31. Fifi says:

    pec, you were quite clear in another thread that you held doctors responsible for your mother’s ill health that you considered a result of a poor diet and lack of exercise (as well as her mental health issues, which you also blamed on doctors and the medication she took, by her own volition). You were quite clear when you said you felt that medications should be withheld to force people to conform to healthy lifestyles.

  32. pec says:

    I do know people who have been seriously harmed by the medical profession. I have commented at this blog that it is irresponsible of MDs to give harmful drugs when what is really needed is simple lifestyle changes. Maybe that’s what you are now twisting. I have seen it said many times at this and similar blogs that patients would rather not change their lifestyle and it’s easier to give drugs.

    I’m sure you like the idea of screening 8-year-olds for cholesterol and putting them on statins. You are a mean-spirited ignorant drug-loving imbecile.

  33. quackdoctor says:

    “Are you suggesting that pre-diabetics should be started on insulin? Is there any evidence that that improves outcome? If not, my analogy stands. ”

    No I am simply saying that medicine is neglegent with respect to recognizing patients trending toward type 2 diabetes. Patients need to be managed much mroe aggressively when approaching. When we see people starting to have higher glucose levels and putting on weight, trigycerides and BP rising this syndrome needs to be taken much more seriously. As seriously as if the patient was considered diabetic by standard values. It basically has to do with the posture the physician takes with the patient. Physicians instead of reaching quickly for statins, beta blockers, diuretics and eventually insulin to treat patients should be much more aggressive about treating the patient for their actual problem. Which usually is weight, diet and lack of excersize. I will not get into vitamins and minerals and reducing certain “toxins” in the body as those methods are not scientifically proven despite the fact I know they help. Metabolic syndrome should be treated as if it is cancer. As an extremely dangerous health problem. That is my position.

  34. Harriet Hall says:

    quackdoctor,

    I asked you not to change the subject.

    Whether or not doctors are doing a good job treating pre-diabetes is irrelevant to the topic under discussion. We know what they “should” be doing.

    The question is whether young people with prodromal symptoms “should” be treated with anti-psychotic drugs, which would be equivalent to treating pre-diabetics with insulin, which you don’t advocate.

  35. Fifi says:

    pec – No, you asserted that doctors should withhold needed medication to force people to make lifestyle changes. I’m sure that’s not what you’d like to think (or others to think) you said but it is. I remember because I was shocked by the ignorance and fascistic attitude, and obviously lack of respect for people’s right to choose for themselves. Particularly because I have some professional experience helping people make lifestyle changes. I do recognize that you may have been particularly passionate about the topic since you were looking to blame doctors for your mothers lack of self care (and you were angry about having to look after an ailing mother without any support from your siblings).

    We’ve discussed this before but since your memory seems a bit dull at the moment, I’ll refresh. I think drugs can be useful when appropriately used but they all carry risks of adverse side affects. I’m a big fan of prevention and self responsibility, and basic public health education about diet and exercise. I’m not about to start blaming other people because I didn’t look after my own health (and when I engage in risky activities, I accept responsibility for engaging in a risky activity and any consequences of my actions). I eat a healthy diet (I subscribe to a CSA), enjoy exercising alone and with friends, do yoga and meditate. The can’t even remember the last time I had a prescription filled…at least four or five years ago. That said, illness happens despite one’s efforts at prevention and I’d certainly weigh the pros and cons of taking any medication but have no bias towards taking medication. (My bias actually leans towards NOT taking medication unless entirely necessary and I fully recognize that pharmaceutical companies are profit driven corporations like any other for profit corporation. While it may be an unpopular view with some of the blog authors, I actually think profit-driven medicine is a recipe for disaster – whether it be “mainstream medicine” or “CAM” and supplements.)

  36. daedalus2u says:

    A significant part of my nitric oxide research is in trying to understand the physiology of extreme metabolic stress. I am pretty sure that a common final pathway in some instances of acute psychosis is extreme metabolic stress and ATP depletion in the brain.

    http://daedalus2u.blogspot.com/2007/08/low-nitric-oxide-acute-psychosis.html

    I am not sure how that relates to chronic psychosis, such as schizophrenia.

    Different acute psychoses that I think are primarily metabolically mediated are the psychosis of acute stimulant abuse including cocaine, amphetamine and PCP; psychosis of acute alcohol intoxication and of alcohol withdrawal (but the two mechanisms are different); postpartum psychosis; some types of toxicity such as solvent huffing; the psychosis of insulin shock or acute hypoglycemia; the manic state of bipolar; the hallucinations of some migraines. I think the “kundalini rising” that Fifi mentions is also.

    These different types of psychosis are reversible (provided there is no brain damage). That suggests that acute psychosis is due to acute regulation of brain function, and not due to changes in neuroanatomy. I think these are all mediated through reduced ATP levels in the brain, but produced through different mechanisms. How the brain modifies itself to restore the proper energy balance and ATP levels will determine the ultimate course. “Pruning” of neurons to reduce metabolic load may restore a balance between blood supply and metabolic needs, but once neurons are lost they don’t come back.

    First there is lack of oxidizable substrate in the brain, this can be due to hypoglycemia from insulin shock, from alcohol intoxication (the liver gets hijacked to dispose of alcohol, and can’t do gluconeogenesis), from acetate depletion (during alcohol withdrawal from the loss of the alcohol metabolite until the liver reconfigures itself for sufficient gluconeogenesis). Second there is acute oxidative stress, due to activation of cytochrome P450 enzymes by metabolizable substrates which make superoxide, stimulants which do the same which can then lead to expression of uncoupling protein (which causes ATP depletion by dissipating mitochondrial potential as heat which can lead to malignant hyperthermia). Superoxide lowers NO levels and the lower NO level reduces the ATP setpoint by modifying the ATP sensitivity of soluble guanylyl cyclase. Acute oxidative stress triggers ischemic preconditioning, which lowers ATP levels and ATP consumption. I think that a migraine is an inappropriate triggering of ischemic preconditioning. I think the kundalini rising or kindling is the invoking of ischemic preconditioning by breathing control, the inducing of hypoxia via breathing control, or perhaps neurogenic production of superoxide.

    I see these instances of acute psychosis as primarily a problem of energy status regulation. In all of these instances what is observed on MRI are white matter hyperintensities, a reduction in the diffusion of water in the brain and in particular a reduction in the anisotropic diffusion of water. I think that is not passive diffusion, but rather the active movement of water via entrainment during movement of cargo by ATP powered motors in axons. Everything out at the tippy ends of axons has to be transported there from the cell body where it is synthesized using nuclear DNA. That transport takes a long time, so it is something that can be shut down acutely during an acute ATP crisis. That transport is along the axis of the axons (in both directions simultaneously) which are the white matter tracts, resulting in anisotropic diffusion. All disorders characterized by decreased metabolism in the brain are also characterized by white matter hyperintensities.

    The mechanism by which anti-psychotics have their effects remains unknown. It is interesting that the major side effect of the atypical antipsychotics is weight gain, suggesting involvement in energy status regulation.

    There is another somewhat later paper by McGlashan et al (open access)

    http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/33/3/715

    which broadly talks about other interventions instead of just antipsychotics. I think that stress reduction would likely have a useful effect (it does for just about everything else).

    I agree with Harriet, that trying to prevent psychosis by giving drugs tested for treatment and not tested for prevention could be like trying to treat pre-diabetics with insulin. It could make it better, it could make it worse, it could cause side effects with no benefit. There is no basis for knowing which would happen for which individual.

  37. pec says:

    “you were angry about having to look after an ailing mother without any support from your siblings”

    Shut up, I hate you, you are a disgusting pig. I will not correct your nasty lies anymore. Whatever you say is crap. Shut your filthy nasty horrible mouth. This is not a place for insulting people about their mothers. I feel like saying something horrible about your mother, but I just can’t be as evil as you.

  38. pec says:

    I regret that I called Fifi a pig. I apologize to pigs everywhere.

  39. quackdoctor says:

    Well I think the facts are that organic mental disease does exist. To deny that is ignorant. However an extremely large amount of people are on powerful psychiatric drugs that do not need to be including children. This is bad for a variety of reasons. First the health of the patients. And second the cost to society. These medications are extremely expensive and tap insurance, medicare, medicade and other programs.

    I would say that almost all patients that see a psychiatrist are put on some form of medication. In other words what is the percentage of patients that see psychiatrists that are not medicated?

    Many times peoples problems come fromn other factors than organic disease. They are functionsl. Involving trauma, lifestyle, general health and even nutrition.

    For example in cases of depression how often does the psychiatrist not medicate and have the patient get more sunlight, eat better, exercise and make other changes?

    Now how is this related to this discussion. Well it is because there is a general trend in psychiatry to reach for the pen and pad way too fast many times. And the drugs these people are prescribing are usually a lot more toxic than drugs that are fairly loosly prescribed by GPs.

    The reasons psychiatrists behave the way they do run deep. I really cannot dissect that hereBut the profession is extremely out of hand. So the issue of anti psychotic drugs being used in a wrong manner is only one manifestation of a much more global problem in the field.

    Again I come back to the question. What are the percentages of patients that see psychiatrists that are treated with other modalties than drugs?

    Lastly…Once I knew a man that had chronic back pain. He suffered all the time. He went to this old chiropractor that was in practice for 50 years. He told the old man his problem. The old cjiropractor felt the kid’s waist and looked at him and said “Well son no wonder you have a sore back…Your pants are too tight” The guy started wearing looser pants and the problem was solved. He never got an adjustment from the old man.

    The deal is that the medications these shrinks are giving cause side effects in very very high percentages of patients. from functional problems like tremors to severe organ disease. Overprescribing statins is one thing. Overprescribing anti psychotics is another.

    And the bottom line is that everyone including physicians are totally out of touch with what actually goes on every day under the direction of psychiatrists. And now ECT is getting way out of hand. With 40% of ECT in NY state being invountary and court ordered. And patients are forced to under go extreme numbers of treatments. Like 40 or 50 sometimes and even more. This is just another manifestation of the mind set of psychiatry. And that mind set is what is causing too many anti psychotics to be used and bridging them into prevention.

    Maybe we should start giving chemotherapy to teenage girls to prevent breast cancer..

  40. Fifi says:

    Quackdoctor – Perhaps you didn’t notice in your reflexive hate-on for medicine but pretty much everyone here who supports EBM has said that they don’t support over-medicating or medication as the first or only resort. Psychiatry is actually perfect example of a discipline that shows how personal biases can skew observations and conclusions when there are poor or no objective tools to be had. MRIs and having the tools to actually observe the brain have blown all kinds of theories in this field out of the water (and supported others).

    The reality is most people go to see psychologists not psychiatrists. Often people going to see psychiatrists have problems that are predominantly organic (since psychiatrists specialize in that aspect of the brain where psychologists come from a different analytic tradition – or rather a whole different variety of analytic traditions). Psychologists generally aren’t MDs (unless they also trained as an MD), and generally don’t have prescribing rights.

    It’s all very nice to say “they should prescribe sunshine, diet and exercise” but if someone’s presenting with suicidal depression, schizophrenia or is incapable of motivating or organizing themselves that’s a pretty useless strategy (and poor diet, lack of exercise and agoraphobia are often a symptom/result of mental illness, not the other way around). It should also be noted – for the benefit of any self styled new age energy healers out there who also consider themselves as “alternative” psychiatrists or are evangelical about vitamins – that the “pull up your bootstraps and get outside” strategy that Quackdoctor proposes is potentially lethal.

    Most psychotherapists WILL suggest lifestyle changes (as will most therapists from a Behaviorist background) to people with mild depression (the evidence suggests it’s helpful for mild depression), alongside cognitive therapy. However, to put mild depression in the same category as psychosis or schizophrenia is just plain silly (though I can see how the general public may be confused about these things).

    If we’re going to talk about quackery in mental health, it should be noted that a lot of it is connected to new age quackery (and if we look at the misuse of psychiatry in the military, it’s often connected to people connected to the supplement industry and new age beliefs).

  41. Fifi says:

    quackdoctor – Actually cognitive therapy is longer and more expensive than medicating a patient, it’s a time based therapy, which is why insurance companies tend to limit coverage of talk therapies but not medications. It’s also why drug companies don’t do or fund studies that compare cognitive therapy with their medications anymore (there’s already some quite convincing evidence that cognitive therapy on it’s own is just as good for mild depression as antidepressants…of course, this requires a lot of mental and emotional work by the patient so not all patients want to participate in cognitive therapy and would rather take a pill). I’m quite open about my bias towards cognitive therapy :-)

    Since doctors don’t run insurance companies – CEOs who want to make a profit and gild their parachutes do – your beef here is really with the way the American medical system and access to healthcare works – or doesn’t. (This same insurance system also covers CAM therapies so the whole medicine vs CAM thing – and trying to tie the corrupt practices of insurance companies to medicine but not CAM is just ignorant and misleading.)

  42. Joe says:

    quackdoctor on 24 Jul 2008 at 3:05 am wrote “I would say that almost all patients that see a psychiatrist are put on some form of medication. In other words what is the percentage of patients that see psychiatrists that are not medicated?”

    Which is it, do you know or are you asking?

    quackdoctor on 24 Jul 2008 at 3:05 am wrote “Again I come back to the question. What are the percentages of patients that see psychiatrists that are treated with other modalties than drugs?”

    It appears that you wrote a lengthy post on a topic about which you know little (if anything).

    quackdoctor on 24 Jul 2008 at 3:05 am wrote “Now how is this related to this discussion.”

    It really isn’t related. It is just an anti-med rant based in ignorance. For starters, the topic is psychosis, not depression. Psychosis is not treatable with lifestyle interventions.

    I am not surprised that what you think is wrong. It should be a crime for you to convey that misinformation to your customers; because they mistake you for a health-care professional and might follow your bad advice.

  43. quackdoctor says:

    :I am not surprised that what you think is wrong. It should be a crime for you to convey that misinformation to your customers; because they mistake you for a health-care professional and might follow your bad advice.”

    I am not sure where you got the idea I practiced some form of health care or anything to do with it. But any way if you do not understand my point then …Oh well.

  44. Fifi says:

    pec my dear woman, I have only compassion and sympathy for your mother. It’s a shame for both you and her that you find caring for her a burden and are angry about the medical treatment she chooses for herself. As I’ve pointed out before, since my mother is a doctor you routinely slander her in ways I’d never talk about your mother (and you directly hurl the most childish “poopyhead” type of insults at me, obviously because that’s all you can come up with, though ultimately they’re so juvenile that they’re merely entertaining :-) )

    Since you actually have no interest in science-based medicine, and don’t like the people here who are interested in science-based medicine, why do you spend so much time here if you find it so upsetting? What motivates you to participate here? You come off as a troll so the irony of claiming you’re being victimized simply because your own words are being held up to the light for inspection is pretty rich!

  45. Joe says:

    quackdoctor on 24 Jul 2008 at 9:05 am wrote “I am not sure where you got the idea I practiced some form of health care …”

    I am not sure where I got that idea; I probably have you confused with a chiro that posts here. Surely you realize that your screen name is suggestive. Also, your rant sounds like what one hears from chiros. It is still wrong.

  46. daedalus2u says:

    Quackdoctor, I heard that anecdote about pant size too, but it was a tailor who diagnosed it not a chiropractor.

    http://www.dirtyjokesinc.com/joke-doctor_jokes-12326.htm

  47. nwtk2007 says:

    FiFi, before you call pec a troll, you need to look it up.

  48. nwtk2007 says:

    And that is trolling.

  49. quackdoctor says:

    Actually what I am saying is not wrong at all. I am not against medicine in any way. I am against the bad practice of it. That’s all. The reason why I talked about other things than psychosis is that they demonstrate a trend in psychiatry. Sure there are patients that need strong antipsychotic drugs. But the poin is that tyhere are man manyh people that are on them who do not need them. That’s all. When someone needs them that is one thing. And when someone does not that is another.

    The bottom line is that abuse in psychiatry is rampent. Psychiatry has morphed into a field whose only tool if pharmacology. And that is why we come back to the concept that it would be interesting to see whgat the percentage of individuals that consult or are referred to a psychiatrist is that does not get medication?

    We see psychiarty trying to broaden it’s patient base. Now we have 4 year lod kids in high percentages on extremely strong drugs. And the numbers are increasing. With new additions to che DMS4 and new drugs. So we come back to the concept of being too loose with the pen.

    You see any type of health care van become a religion. So the doctorbegins to not look for what will benefit the patient. But what therapy that they do will benefit the patient. So the question becomes not “How can I help” but “What drug will help”..

    So there is no debate here with respect to the need for good medical care in appropriate situations. The issue is with abuse. And there is one hell of a lot of abuse of patients in psychiatry. And one hell of a lot of it is beginning to involve young kids.

    In fact the entire field of psychiatry is built on drugs as basically the only therapeutic vehicle. And there is an increasing trend to turn normal human responses to life situations and inputs into organic pathology. And I am not dismissing the fact that organic pathology in the brain exists. It does. But the profession has gone over the top..

    Perhaps a study should be constructed comparing the frequency of psychiatric medication use on children of psychiatrists verses the general public. That might be interesting.

    So we come back to the concept that much treatment is not neeced and that care has extreme side effects and costs society big bucks. So what I am against is un needed care. Not proper care.

    You see psychiatry has as practiced has used the crebibility of medicine to lever it’self into a postion of authority. So if you think that psychiatry is evidence based medicine you are fooled. Some is. And they will posture in a manner to make most of it appear that it is. But all one has to do is start pulling individual charts and see how most of it is totally subjective. And with few if any checks and balances

    And finally I would say that if you think I am wrong I would ask you to look inside your self and ask…Do I REALLY know how patients are managed in the field? How much have I objectively read on how patients are managed. Not about how the field says thety maage things. But what is actually going on.

    So you do not have to believe what I say. In fact you should not. But please do consider it and in the future and with your own analysis based on evidence negate or confirm my view.

  50. Fifi says:

    nwtk – Are you really still arguing about whether you’re a troll or not? You’re a chiropractor who hangs out on an science-based medicine blog and promotes non-evidence based treatments and continuously denigrates EBM and science-based medicine (while trying to simultaneously pretend you base your “treatments” on science!). You’re not just a troll but a professional troll since you stand to gain financially by being disruptive here and disrupting actual discussions about EBM and science-based medicine. Plus you keep getting caught out in lies. so you’re a lying professional troll, based upon the evidence and your own claims of course! ;-)

  51. nwtk2007 says:

    I fully admitted to it above FiFi. And you haven’t sited any evidence that I have lied or any of the other stuff. When siting your evidence, please copy and paste my comments so that I can know exactly where you are mis-representing me.

  52. Fifi says:

    quackdoctor – I’d suggest you stop looking inside yourself for your ideas about psychiatry, it’s not where objective evidence usually resides (unless we’re talking physical evidence about an organic condition!). There are many valid critiques that can be made about contemporary mental health care – particularly in a privatized system and the US (there are valid critiques of other countries’ systems too, they’re just different) – but you clearly don’t know what you’re talking about if you think a bit of fresh air and exercise is an appropriate way to manage schizophrenia. And your comparison to breast cancer is not only hyperbolic but a ludicrous indication of either a conscious attempt to mislead or a very deep misunderstanding of the blog topic!

  53. Fifi says:

    nwtk – I did cut and paste to indicate exactly where you misrepresented yourself. Since you’re here as a professional troll who’s trying to denigrate the blog authors and science-based medicine and EBM while trying to promote your profession, and I’m here because I’m interested in science-based medicine and EBM, that would be a waste of my time. I’ll just continue to amuse myself toying with your evasiveness and lies since you provide continual evidence of being a professional troll and liar (denying something and only admitting it when caught out doesn’t make you honest, it just means you got caught out in one of your lies and are trying to pretend it wasn’t a lie).

  54. pec says:

    “What motivates you to participate here?”

    Fifi,

    I am here to have interesting debates with people who are scientific and rational. That excludes you.

    I am resisting, with all my will-power, to make the kind of vicious comments about your mother and your relationship with her that you direct towards me.

    I am ignoring all of your stupid idiotic attempts to sound rational.

    There is no reason for you to direct any comments at me about science or medicine because I am not interested in debating with a malicious, empty-headed moron.

    You won’t stop your horrendous insults regarding my mother, so I will ignore those as well.

    I am not going to let you ruin this blog for me.

  55. pec says:

    If I wanted to fight fire with fire I would say that I hope Fifi and her mother both get cancer and that Fifi goes broke taking care of her mother and both of them die in the street.

    But I would never say anything like that because, unlike Fifi, I don’t get joy out of hurting people.

  56. Harriet Hall says:

    pec said,

    “I am not going to let you ruin this blog for me.”

    You are ruining this blog for me by writing insult-filled comments like “Shut up, I hate you, you are a disgusting pig.”

    You are also making yourself look like a child having a temper tantrum rather than an adult who wants to “have interesting debates with people who are scientific and rational.”

  57. David Gorski says:

    If I wanted to fight fire with fire I would say that I hope Fifi and her mother both get cancer and that Fifi goes broke taking care of her mother and both of them die in the street.

    But I would never say anything like that because, unlike Fifi, I don’t get joy out of hurting people.

    pec, you are very, very close to the edge of what we tolerate here on this blog, if you haven’t already stepped over it with your multiple despicable comments directed at Fifi on this thread. I strongly suggest you cool it. (Fifi should probably try to chill, too, not so much because she’s done anything seriously wrong, but to help me deescalate this.)

    pec, what you are saying is akin O.J. Simpson writing the book “If I did it.” You throw up a hypothetical nasty statement about Fifi and then, like Emily Litella, say, “Never mind”–as if that absolves you for the responsibility for the nasty thing you just “hypothetically” said. It doesn’t. It’s a tactic that children use to try to get away with stuff, and parents recognize it right away.

  58. pec says:

    I stated directly what she has been stating indirectly, repeatedly, and I am sick of it.

  59. pec says:

    And I did regret calling Fifi a pig because pigs are intelligent and decent animals. Her attacks on me have been pure evil.

  60. pec says:

    No one who has ever been responsible for a person who is mentally and physically disabled and has no money would dream of attacking anyone in that way. That, in my opinion, is evil. Although, to be fair, it could be just extreme insensitivity and ignorance and stupidity. Repeated over and over and over.

    I have never ever resorted to insults on any blog before. She takes absolute delight in attacking me on an extremely sensitive subject, merely because I have philosophical differences. I admit I should have ignored her, and I really really tried.

  61. weing says:

    quackdoctor,
    Interesting allegations. And your knowledge of what goes on in psychiatry is based on?

  62. Fifi says:

    David and Harriet – I can happily not address pec and just observe her if you’d prefer I don’t address her – this is your blog and I am quite willing and able to respect any limits you set. However, not addressing pec seems to be caving into her temper tantrums and childish attempts to control others through anger and being verbally abusive. (I’d suggest she start her own blog if she wants to be queen of the schoolyard and in control of a blog though, or wants to promote her own ideas, rather than trying to ride on your coattails to get some attention and an audience and, in the process, disrupting your readership!) It seems that pec really wants other readers who aren’t chiropractors or uncritical supporters of CAM to disappear so she can dominate the conversation, promote her ideas about energy healing and demonize science, and have the doctors’ full attention focused on her! She seems to have a very love/hate relationship with doctors and medicine – on one hand she seems to want your approval but she also wants to express her rage about doctors not filling her needs and giving her unconditional approval. I do have compassion for pec if she is what she says she is (and I most definitely have compassion for pec’s mother!) – though giving in to childish demands and temper tantrums is not a compassionate or constructive course of action with either children or adults acting like children. If pec truly values being able to participate here, then perhaps she can show that through modifying her behavior and acting like an adult?

  63. Harriet Hall says:

    pec,

    The comment you objected to was “you were angry about having to look after an ailing mother without any support from your siblings”

    I thought that was what you yourself had said in another thread. Fifi has simply paraphrased your own words about your mother. If she misrepresented what you meant, it would be sufficient to correct the record without resorting to insult.

    Even before that, you called Fifi “a mean-spirited ignorant drug-loving imbecile.”

    Your behavior is unacceptable.
    You owe an apology to all the readers of this blog, not to pigs.

  64. pec says:

    Harriet, you never saw most of Fifi’s comments to me.

  65. Fifi says:

    If pec was here seeking help, support and/or science-based medical information in regards to looking after her mother or for herself, it would be an entirely different ballgame. As it is, pec is here to blame medicine and doctors for what she doesn’t like in her life and to claim she’s a victim (while in actuality she’s here being abusive and attempting to attack – rather ineffectively – science-based medicine). She simply doesn’t like the motivation for her trolling or her stories to be questioned since it gets in the way of presenting herself as the eternal victim or the ultimate expert.

  66. Fifi says:

    pec, just so you’re aware. I’ve been a primary caregiver for two friends who died of AIDS (back in the early days before there was effective medication), and a companion and friend to many others who are living with AIDS or have died of AIDS. The intensive period of providing primary care was in my 20s and 30s so quite a big chunk of my life has been taken up in caring for sick people, and death and dying. It’s one reason I find your attempts to demean medicine and promote vague energy healing ideas offensive and worth responding to (since the biggest con artist posing as healers pick on AIDS patients).

    I’m also not judgmental about mental illness, or afraid of it for that matter. I have friends who’ve got various neurological differences, I’ve got friends who’ve had psychotic breaks, and I grew up around psychology and neurobiology (since my mom is an MD/psychotherapist and my father was a researcher in neurobiology). Mental illness and neurobiological differences are nothing to be ashamed of – though it is good to be aware of how they manifest so we don’t get trapped in our own delusions and create more suffering for ourselves by rejecting reality in favor of an attractive illusion.

  67. pec says:

    Fifi’s sanity depends on her worldview being absolutely correct, and uncertainty is intolerable to her. So she attacks me and tries to make me leave.

    I ignored almost all of her attacks, because there was no intellectual content. But when she realized attacks on members of my family bothered me, she took immense delight in repeating it. I can’t begin to imagine the ugliness in her soul. Oh that’s right, she doesn’t have a soul, that would defy materialist ideology.

  68. David Gorski says:

    And I did regret calling Fifi a pig because pigs are intelligent and decent animals. Her attacks on me have been pure evil.

    ENOUGH!

    What did I just tell you?

  69. Fifi says:

    I think pec doth project too much!

  70. Harriet Hall says:

    pec and Fifi:

    Will you two PLEASE stop bickering?

    PLEASE, let’s talk about science and medicine, not about personalities and who said what.

  71. Fifi says:

    No problem. I’ll leave pec to you! :-)

  72. pec says:

    “PLEASE, let’s talk about science and medicine, not about personalities and who said what.”

    That’s what I have been TRYING to say to her. Unfortunately I kept losing it and getting angry. I will steadfastly ignore everything Fifi says from now on. I promise. No matter how evil she becomes. Ignore ignore ignore ignore. You can kick me out Harriet if i don’t keep that promise.

  73. daedalus2u says:

    What I would like to know about psychosis is how often is there an acute precipitating factor?

    People talk about a “psychotic break”, how acute is that?

  74. steff says:

    I have a form of schizophrenia (schizoaffective disorder — a cross between paranoid schizophrenia and bipolar disorder, featuring symptoms of both, including psychosis). I’m stable and functional these days thanks to meds, and I still want to hug the scientists who invented my medications.

    That said, I’ve also been through hell trying to find the right meds. For years my symptoms were exacerbated and exaggerated by the wrong meds. Plus the side effects were terrible. Psych meds don’t work the same for everyone, and different people have different responses to the drugs. I’ve had meds give me panic attacks, twitches, near-catatonia, suicidal and homicidal desires… It was horrible. I’m lucky I finally found the right combination. Not everybody does.

    Psych meds as they currently exist are so dangerous that I’m against giving them to anyone who isn’t having severe symptoms. I look forward to the day when better drugs are invented, medicine knows more about how medications work, and side effects are minimal. But it’s going to take a long time to get to that place. In the meanwhile, I think the best thing to do for kids with family histories of mental illness should be to educate the parents on what to watch for and what to do should their child become psychotic.

    I would have been treated as a teenager (in the early 90′s) if my mother had known the symptoms of psychosis and/or affective disorders, but instead it took ten years of suffering and a severe mental breakdown before anyone realized there was something wrong with me. Education of the public is crucial!

  75. quackdoctor says:

    Well people can achieve psychosis from different things. They can have true organic mental disease and it can surface for no reason that is apparent. Or a person can have organic disease in the brain aand the person can be under pressure and stress…Or abuse substances and bring it on.

    Alos psychosis can happen to normal people under extreme stress. You could induce it through sleep deprivation in a normal person. You could achieve it in a normal person with substance abuse. Either acute or over time. Cocaine is good at it. LSD can do it acute. There are lots ogf things.

    A psychotic break is generally thought of as a pretty complete detatchment from reality. It is in general acute when used. A person can be psychotic but then under go a psychotic break. Moving from psychosis to rather full detatchment from reality

  76. Joe says:

    weing on 24 Jul 2008 at 12:33 pm wrote “quackdoctor,
    Interesting allegations. And your knowledge of what goes on in psychiatry is based on?”

    quackdoctor on 24 Jul 2008 at 3:27 pm wrote “yada yada.”

    Where’s the beef?

    One does not have to “read between the lines” of previous QDoctor posts- it is blatantly clear that there is no basis in fact, just a vivid imagination and wishful thinking.

    I wish I knew a source of reliable information to which I could refer qdoc.

  77. Fifi says:

    steff you make some excellent points, thanks for sharing your personal experience.

  78. Harriet Hall says:

    steff,

    Thanks for your comments.

    I’m wondering if you’ve read Elyn Saks’ book. It would be interesting to hear an opinion of the book from someone who has been through an experience similar to hers.

  79. Joe says:

    Fifi on 24 Jul 2008 at 4:32 pm wrote “steff you make some excellent points, thanks for sharing your personal experience.”

    Yes. Thank you steff.

  80. quackdoctor says:

    “One does not have to “read between the lines” of previous QDoctor posts- it is blatantly clear that there is no basis in fact, just a vivid imagination and wishful thinking. ”

    Sometimes things we believe in that are correct make us assume that other things are correct. I will leave my statements for any one to consider. And hopefully those that are really evidence based and willing to look will do so.

    __________________________________________________

    Dr. Peter Breggin
    BIO Become a Fan Get Email Alerts Bloggers’ Index
    Psychiatry Makes War on “Bipolar Children”
    stumble digg reddit del.ico.us news trust Posted May 23, 2008 | 05:02 PM (EST)

    ——————————————————————————–

    Read More: Bipolar Disorder, Child Abuse, Childhood Bipolar Disorder, Newsweek Cover Story, Psychiatric Drugs, Living News

    The front cover of the May 26, 2008 Newsweek has a banner headline, “Growing Up Bipolar” with a split-face photograph of a ten-year-old boy. The headline should have read, “Victim of Psychiatric Assault.”

    In daycare 18-month old Max kicked, bit and spat on his larger peers. Apparently before he was two years old, his overwhelmed parents took him to a famous Boston psychiatrist — having been trained in psychiatry at Harvard, I can confirm that famous Boston psychiatrists are among the most arrogantly pro-drug — and within an hour the toddler had been diagnosed as bipolar. Right away he was put on the adult “mood stabilizer,” Depakote. Depakote is an anti-seizure drug that is so sedating that it can, however briefly, subdue a child, at least until the effect wears off.

    According to the parents, the doctor told them that the bipolar diagnosis was a “life sentence.” It was a life sentence — to being pharmacologically abused by psychiatrists. At the age of ten, Max is now eight years into his sentence, and getting increasingly abused by his physicians.

    The doctor must have put Max on a lot of drugs because a second famous psychiatrist wanted to “streamline” the meds. Reducing anyone’s drugs is nowadays a rarity in psychiatry; Max’s first psychiatrist must have been over the top.

    A mere ten years old, Max has already been on 38 different psychoactive drugs. “His parents aren’t happy about it, but they have made their peace with it.” Newsweek concludes, “Max will never truly be OK” because of his “disease.” In reality, toxic chemicals are impairing and distorting the growth of Max’s brain. Psychiatric drugs commonly drive suicidality in children and Max now leaves suicide notes. Tragically, he has become so afraid of psychiatry that after writing his last suicide note he sobbed, “Please don’t send me to the hospital.”

    From now on, Max, his family and his doctors will almost certainly have to face an increasingly impossible dilemma common to children who are prescribed multiple psychiatric drugs for a period of years. When trying to withdraw these children from multiple psychiatric medications, they almost certainly go through severe withdrawal problems with extreme emotional instability and the risk of worsening violence and suicidality. In fact, we are told that an attempt to take Max off his medications resulted in his displaying hallucinations and delusions, which Newsweek attributes to his worsening condition and his need for drugs. The odds are overwhelming, instead, that he went through a severe withdrawal reaction. So it can be very difficult to withdraw children like Max from multiple psychiaric drugs, but if they are kept on drugs indefinitely, their brain, mind and overall condition is almost certain to deteriorate.(1)

    It can be relatively easy and safe to withdraw a child from one or even two psychiatric drugs, especially if the parents are willing to learn improved methods of discipline. But when multiple drugs are involved, when the drugs have been taken for a long time, and when the parents are deeply distressed or cannot agree on how to raise their child, withdrawing the child from psychiatric medication can be difficult and hazardous.

    Newsweek makes clear that Max’s parents have serious conflicts over how to raise their son, but they have not pursued therapy, marriage counseling or, apparently, not even parenting classes. In every case of an out-of-control child I have seen in my psychiatric practice, either the parents were unable to reach agreement on a consistent approach to disciplining their child, or a single working mom was trying to raise a young boy without the aid of a male adult in the child’s life.

    In glimpses that we are given of this family, Max’s father is somewhat like his son; he doesn’t deal well with feelings, and he thinks his wife is much too permissive, calling her a “Caspar Milquetoast.” Reading between lines, it appears that Mom is left with the lion’s share of trying to discipline the desperate child, and perhaps has her hands full with her husband who has a “temper” and is “inflexible.” While not have the opportunity to personally evaluate Max and his family, we can speculate that Max might have trouble figuring out how he is supposed to behave. Meanwhile, this family’s story sounds like a clarion call for a combination of therapy, marriage counseling and parenting classes.

    Newsweek declares “At least 800,000 children in the United States have been diagnosed as bipolar, no doubt some of them wrongly,” but then immediately adopts the extremist psychiatric viewpoint, “The bipolar brain is miswired … ” After warning in passing that the drugs inflicted on these children can be useless and even dangerous, Newsweek then justifies them by declaring, “Yet untreated bipolar disorder can be disastrous; 10 percent of sufferers commit suicide.”

    Drug companies wrote this script and none of it is true.

    First, all of these preadolescent children are being wrongly diagnosed by conventional psychiatric standards. We have no evidence at all that temper tantrums and other unruly behavior, however extreme, is a precursor to being diagnosed with bipolar disorder as an adult.

    Second, since there is no known connection between children diagnosed bipolar growing into adults diagnosed bipolar, the data about a 10% risk of suicide is misleading and irrelevant.

    Third, there’s no evidence whatsoever that individuals diagnosed “bipolar” have a “miswired brain.” There’s not even any such evidence for a biological flaw in adults who suffer from full-blown manic-like episodes, let alone children whose parents and teachers cannot control them. (1)

    The concept that children have bipolar disorder and should be treated with highly toxic adult psychiatric drugs is strictly a drug-company marketing ploy. If it’s true that 800,000 children have been diagnosed, it has become an enormously successful marketing strategy with tragic results for children and their families.

    There’s an even more sinister aspect to all this. There has been a real increase in teenagers and young adults who display episodes of manic-like symptoms such as insomnia, excessive energy, racing thoughts, grandiose ideas about themselves, irrational and outrageous behaviors, extreme irritability, paranoia, and psychosis. However, in my three and one-half years of intensive psychiatric training in the 1960s, I saw only one case of a young person suffering from these symptoms. In the following years through approximately 1990, I saw few other cases. Yet nowadays I evaluate many teens and young adults with manic-like symptoms in my medical and forensic practice. The reason for the change? As I document in detail in Brain-Disabling Treatments in Psychiatry (2008), antidepressant drugs, so freely given to children and youth, cause a high rate of manic-like behaviors.

    According to Newsweek, Max already makes excuses for himself by saying “I don’t have control.” Setting aside that the drugs may indeed be causing him to lack self-control and impulse control, the idea that he cannot control himself is one of the most adverse effects of diagnosing and medicating children. They begin to believe that they have no self-control. This is a prescription for failure in life.

    These changes — diagnosing children bipolar and driving other youngsters into states of drug-induced mania — has not occurred by chance. Joseph Biederman, one of those famous Boston psychiatrists, has led the way in pinning the bipolar diagnosis on children who are having temper tantrums and outbursts of rage. Biederman, well situated at Harvard, is a long-time henchman of the drug companies, so much so that even the Wall Street Journal found it necessary to comment on his deep financial connections to his industry patrons. (2)

    The promotion of drugging “bipolar children,” has been enormously successful. Before the 1990s, doctors hardly ever diagnosed bipolar disorder in children. In fact, I do not recall hearing the diagnosis given to any children prior to the 1990s. A recent survey in the scientific literature showed that there was a forty-fold increase in diagnosing bipolar children between 1994 and 2003. (3) The survey found that 90.6% were receiving psychiatric medications, including 60.3% on mood stabilizers like Depakote and 47.7% on antipsychotics like Risperdal and Zyprexa, with most on combinations. To compound the tragedy, the study found that more children were being given the most toxic psychiatric drugs, the so-called antipsychotic drugs, than a similar group of adults labeled bipolar. Psychiatry is bombarding children more heavily than adults with similar diagnoses, even though the drugs are not approved for these purposes in children.

    The advantages to the drug companies are obvious. If most “bipolar” children get several drugs at once, several dozen over their childhoods, they transform from being patients into being cash cows from psychiatry and the drug companies. Further administration of multiple psychiatric drugs at once complicates the clinical picture so that it is impossible to pinpoint which drugs may be most responsible for the adverse reactions the child experiences. Because so many doctors and so many drug companies will share the blame for mistreating these children, they will be unable to seek redress against individual perpetrators through the courts when they grow up.

    It will be very difficult, if not impossible, for any child to outgrow his early behavior problems, and become a normal adult, while being pharmacologically overwhelmed with toxic agents for most of his childhood. The growing brain is literally being bathed in substances like antidepressants, stimulants, mood stabilizers, and antipsychotic drugs that cause severe, and potential permanent biochemical imbalances. All of these drugs have been shown to distort the shape of brain cells (neurons) and in some cases to destroy the cells. (1) Some of the drugs, including Risperdal, Zyprexa, Geodon and other so-called ‘anti-psychotics’ expose the child to permanent and potentially devastating drug induced neurological injury called tardive dyskinesia. They also cause potentially fatal diabetes and pancreatitis, as well as morbid obesity. (1)

    The mass drugging of America’s children has become such an outrageous practice with such vast public health and societal implications, it is difficult to know how to conclude my observations. I can understand how parents who feel confused and overwhelmed can be pushed by psychiatrists into trying to control their children’s behavior with drugs. But shame, shame, and more shame should be heaped upon a profession that has forsaken its sacred trust to protect and to care for children, and instead has become a major child abuser of epidemic proportions.

    (1) Breggin, P. (2008). Brain-disabling treatments in psychiatry: Drugs, electroshock and the psychopharmaceutical complex. New York: Springer Publishing Company.

    (2) Abboud, L. (2005, May 25). Treating children for bipolar disorder? Doctors try powerful drugs on kids as young as 4. Wall Street Journal, p. D1.

    (3) Moreno, C., et al. (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64, 1032-1039.

    ___________________________________________________

  81. steff says:

    Harriet,

    I haven’t read it, but I just checked and my local library has it on the shelf. I’ll be there tomorrow anyway, so I’ll pick it up and see what I think. Thanks for the recommendation!

  82. weing says:

    quackdoctor,
    OK, So you are a shrink, and you do not prescribe medications at all? I think some of my patients would love you. They don’t take, or won’t take, nor tolerate the meds their psychiatrists prescribe them. As far as I can tell, they are still suffering from their mental illnesses and are not productive members of society by any means. How are your patients doing?

  83. quackdoctor says:

    No I am not a psychiatrist. And I never said that there is no need for medications in specific cases. My issue is with the over use and abuse. It is very very common and totally out of hand. I am not some zealot that irrationally believes that meds are never appropriate. I never said that.

    The fact that the field is totally out of hand does not mean there is not good in it for some patients. I have stated my opinion throughout this discussion. You knoe it is possible to be highly critical of how psychiatry is practiced and still see the value it in appropriate cases.

  84. Joe says:

    Peter Breggin, MD, http://www.quackwatch.org/11Ind/breggin.html

    Don’t you have sources that are peer-reviewed?

  85. Joe says:

    Qdoctor- if the best info you can cite is a popular-magazine article about Peter Breggin, you may want to do some more reading http://www.quackwatch.org/11Ind/breggin.html Can’t you cite anything legitimate?

  86. daedalus2u says:

    quackdoctor, what basis are you using to decide that the specific case you talk about is abusive and inappropriate? I am looking for a rational reasoned basis, one based on facts and logic, not one based on personal incredulity.

  87. Fifi says:

    quackdoctor – To say the whole field of psychiatry is corrupt because of what you read in American magazines (Newsweek no less, hardly the most reliable source for science news) is hyperbolic and basing your opinion on sensationalist news stories (obviously effective but sensationalist none the same). There are many valid critiques to be made of psychiatry – though you seem to be totally ignoring the role insurance companies play in defining health care in the US – and individual psychiatrists. There are also some brilliant psychiatrists who are relieving some very severe suffering and helping people. The world is complex like that – few things are simply black or white.

    There are also valid critiques to be made of people who promote “alternative” “cures” for schizophrenia and bipolar disorders – and who make their money through demonizing psychiatry and convincing people to switch from their medication to a vitamin. (In an ideal world, people having this kind of difficulty coping would be getting social support through either friends and family, or a social worker or support group/halfway house until they were able to look after themselves without a helping hand.)

    I agree that over medication is an issue and that finding the appropriate medication is often a long process (as steff pointed out) – but to make sweeping, hyperbolic statements about the whole field based upon a sensationalist Newsweek article misses both the true cause of the tendency to medicate rather than provide talk therapy (which, by the way, is as much a part of the practice of psychiatry as prescribing medication – in some cases talk therapy is all that psychiatrists use to treat patients). The people who make money from selling drugs are insurance and pharmaceutical companies – psychiatrists who do so would be opening themselves up to losing their medical license and professional standing for unethical conduct.

  88. quackdoctor says:

    Again you guys are not doing what you claim to want in medicine. You read what I say and twist it. And please do not be stupid my iformation does not come from magazines. I have studied from many sources and seen how many patiens are managed working in a multidiciplinary clinic.

    The thing is that I am not out to prove anything. I have just stated some things. So if you come accross what I say then fine. If you do not Ok that is cool.

    But if one of your children or a family member is in the situation just consider what I say. If you find it is accurate or not. That’s fine.

    And yeah…OK insurance has something to do with it. But the bottom line is that if there is what I say going on. Then it is the fault of the profession.

    Again the last thing I will say is…Remember my two questions. What is the percentage of patients that are sent to or consult psychiatrists that do not get drug therapy? And also. What are the statistics od the children of psychiatrists on strong psychiatric mediation verses the general population?

    IO say there are large amounts of people on medication that do not need to be. That people are misdiagnosed in largee numbers. That there are little checks and balances in the field to determine if it is the drug altering behavior or other factors. And much more.

    Like I say we are talking about a lot of problems. Check into the numbers of children that are on these drugs in the USA and what their diagnosis are. Just looking at the kids alone. You know when some person goes and diagnosis a young child with a “disorder” and medicates them. There is a lot of damage if it is not needed. Along with damage from the drugs,,The kid carries the lable. And that lable will augment how they are treatet in school,,And what opportunities they have in life. Because when you apply to medical school or law school having a “mental disorder” since childhood aint all that positive a thing.

    So the profession better be pretty damn sure before they go diagnosing people and dosing them on meds.

    You knowe I would love for someone to do to psychiatrists what has been at times done to cvertain CAM people. For some evidence based person to take a normal child that has some behavioral problems to 20 or 30 different psychiatrists and document what treatment is prescribed and the diagnosis given. But I can tell you that no body is going to do it.

    So can I prove my point. Well no. However taking all information that is available on psychiatry in current practice and it’s alleged abuses that is freely available. There is more than ample evidence to challange and evaluate psychiatry to determine the truth.

  89. Fifi says:

    quackdoctor – Since you say you work in a multidisciplinary clinic and seem to be saying that where you’ve gotten your insights into psychiatric practices, can you please tell us what your profession is and what capacity you worked in at the multidisciplinary clinic? Do you have experience working professionally in the field of mental health?

    Perhaps the issue isn’t others “twisting your words” as much as you just aren’t expressing yourself clearly – communication is a two way street and sometimes we’re not expressing ourselves as clearly as we think we are (particularly when we’re passionate about something or riding a favorite hobbyhorse). I’m not discounting myself from this aspect of being human :-) A passionate belief can also get in the way of hearing properly – apparently in this case you’ve failed to comprehend that the general perspective here (both in the blog and amongst commenters) is that over-medicating is a problem and psychiatric drugs are still clumsy, diagnosis can be difficult, and drugs should be used only when necessary for a combination of these reasons.

    I’m not disagreeing that over-medication happens, I’m disagreeing with your hyperbolic assertions about psychiatry and psychiatrists which seem based in an emotional reaction not on evidence, and actually serve to obscure the very real driving factors behind this trend in the US so aren’t at all constructive or useful in terms of discussing solutions. You very much seem to be trying to demonize psychiatry and psychiatrists for what is ultimately a much larger social issue – if you’re truly interested in a solution this is not useful. Though it is useful if you’re trying to promote supplements or CAM, and a common sales tactic used by unethical peddlers of “cures” by, you know, quacks (sometimes quacks are bad, unethical or just plain insane doctors, they certainly exist, sometimes they’re just people pretending to be or playing doctors who have deluded themselves and sometimes they’re just con artists).

    You may not be aware of this but you’re making sweeping generalizations about psychiatry that are inaccurate and you posted an article from Newsweek to support your claims. You haven’t at all addressed issues related to psychologists or MDs (just as relevant to any conversation regarding over-medication but perhaps less on your radar) – or the economic and social context, not to mention the cultural one, that results in more Americans taking pills – or what other options there are for treating people who need help. You are, of course, just as entitled to your opinion as anyone else and we can all give it as much weight as we consider it worthy of being given – and vice versa, of course.

    quackdoctor wrote: “you knowe I would love for someone to do to psychiatrists what has been at times done to cvertain CAM people. But I can tell you that no body is going to do it.”

    Okaaay, so this is about vengeance for you? Or are you advocating for a much bigger budget and looser restrictions for psychiatric research? While I’m not for loosening of ethical or practical restrictions for psychiatric research, I’d certainly love to see more funding go towards research and public education.

  90. Fifi says:

    And please clarify what you think “has been at times done to certain CAM people” – what has been done and to what particular CAM people? (I’m assuming you mean practitioners of CAM therapies – people who practice CAM as their profession – but if you don’t please clarify). Thanks!

  91. weing says:

    So, you are making claims but do not have data to back them up. You want us to find the evidence for you?

  92. quackdoctor says:

    Well when I was working there I was administering testing of function and things like EEGs and other electrodiagnostic studies. To pay for school. I also worked in a psych unit at night. Watching and interacting with patients. Doing vital signs, keeping people safe…ect. During college. I have a DC and a PhD in anatomy focusing on the CNS. I taught anatomy and neuroanatomy in a chiropractic college and a medical school out of the USA. At present I whore myself out to testify in malpractice cases both for the defense and the plantiffs in cases of malpractice and injury. I will be attending medical school outside the USA shortly. Mainly because of my ability to teach there and attend at the same time and my age. I am mainly interested in getting involed in helping kids. Specifically kids with disabilities. I have enough money. So I would maybe like to move to Haiti and help people.

    And as far as your other statements. I have said what I have said and I know I am accurate. And I am not here to “prove” anything. I am simply here to make statements and cause people to think for themselves. To look deeper into the issue. Hell I mean you guys have the internet and common sense.

    And you say vengence? what the hell…? You have not heard me push any therapy or method. I have no benefit in this. I do not need money. You are talking to someone who rejects the whole model of modern society. I think you guys are just gun shy as you live in a sociopathic world. A world of excess.

    I mean like I have said to people many times. Our world is very very selfish. We have so much excess and many of us have many times over what we need and could give most of it away and be fine. And sociopathy is when we do not do that. And the psychiatric circus in the USA is a product of this sociopathy. Excess. The all might dollar. Too much time on peoples hands. I mean what…The psychiatric industry in the USA is like what 150 billion per year? I would speculate. And a significant portion is uneeded and that is not even considering the consequential damages in the long term from it. Yet people are starving in the world.

    I mean these people are playing around with BILLIONS upon BILLIONS in money. Money that could be used to fix the AIDs problems. Or be used for families that cannot afford health a care. It is very very selfish in many ways. That is how I see it. No a lot of psychiatry is a parasite on society and on people. It is sociopathy plane and simple. I mean when a child or an adult is on meds that cost society say 1500 per month and they are not really needed that money is diverted from valid medical causes.

    Look the bottom line is that I know that psychiatry is guilty of making fairly normal behavioral responses in children and adults pathology. And once a kid if on these drugs that are frequently not need in the first place they do not take them off. It is a life sentence. And yes like I said people hearing voices telling them to hurt people or those that think that their doctor is a bananna or christmas tree probably need medication. But many many other people do not. Especially meds long term.

    So trust me …Don’t trust me…believe me or don’t…I could care less. But the deal is that that if YOUR child is in the ssituation maybe what I say will ring true. If your family member is in the situation it may as well. Draw your own conclusions. Let’s just agree that there is abuse in the profession. And that I say the abuse is much more frequent than you do. As an excersize why does someone look up how many children in the USA are on psychiatric medication? See if you think the figure makes sense to you.

  93. Harriet Hall says:

    Quackdoctor,

    Actually I agree with a lot of what you’re saying.

    “there are large amounts of people on medication that do not need to be. That people are misdiagnosed in largee numbers. That there are little checks and balances in the field to determine if it is the drug altering behavior or other factors.”

    This is certainly true. Psychiatry is a tricky specialty because of its nature; we can’t diagnose psychiatric illnesses with a blood test like we can diabetes.

    You ask “What is the percentage of patients that are sent to or consult psychiatrists that do not get drug therapy? And also. What are the statistics od the children of psychiatrists on strong psychiatric mediation verses the general population?”

    I don’t know; it would be interesting to find out. But I’m not sure what that would tell us. What we really want to know is how many people on medications really need to be on them.

    It’s tempting to exaggerate and blame the whole profession, but I know there are a lot of very good psychiatrists who prescribe judiciously, have a lot of common sense, and are trying to follow the best available scientific evidence. They struggle, because there just isn’t much evidence to guide them.

    I personally know of a case where a 14 year old boy was taken to a psychiatrist because of behavioral issues and declining grades, and instead of starting him on meds or counselling, the psychiatrist simply reassured his parents that he was perfectly normal and said there was no need for a followup appointment. And Steff has told us how medication helped her. We hear about the abuses, but we rarely hear about the successes.

    Instead of expressing general opinions and recounting anecdotes, it is more productive to address specific issues, which is what I tried to do in this article.

  94. weing says:

    quackdoctor,
    You say you know that psychiatry is guilty of whatever and you know you are accurate but the data to support these claims is where? Or does this knowledge come from personal experience which you are generalizing to the rest? For example, you meet a white man and he beats you up and you therefore conclude that all white men are bad and to be stayed away from.

  95. Joe says:

    quackdoctor on 25 Jul 2008 at 8:54 am wrote “But the bottom line is that if there is what I say going on. Then it is the fault of the profession.” … “Remember my two questions. What is the percentage of patients that are sent to or consult psychiatrists that do not get drug therapy? And also. What are the statistics od the children of psychiatrists on strong psychiatric mediation verses the general population?”

    Sure, and if the world is run by the Babylonian Brotherhood, and Reptilians, as suggested by David Icke, then we are in trouble. … You don’t know the answers to your questions; yet, you rant as if you do!?

    Fifi wrote “Since you say you work in a multidisciplinary clinic …”

    I thought qdoctor said he has no connection to health care. I suppose if one works in a quack clinic, that is true.

    Nonetheless, the topic remains prevention of psychosis, not your imagined problems.

  96. Fifi says:

    quackdoctor – Thanks for coming clean about having a large professional stake in this issue on a number of levels. I appreciate the honesty you show in being open about your bias and associations. As noted before, my bias is towards cognitive therapy (with the recognition that sometimes other tools, including medications, are helpful to the patient) – simply because the evidence suggests that it’s effective (and it’s a non-invasive therapy, though certainly there is potential for harm). I also recognize that sometimes this isn’t appropriate treatment, or someone requires additional treatment as well. I’m personally not a big fan of taking pills when there are other (better) options – this includes vitamins alongside prozac. I have no professional stake in this – though I have worked in a pain clinic in the past, and my parents are doctors (neither is a psychiatrist, both deal with the body and mind – and my mom actually turned down an invitation to become a psychiatrist, so I’m quite aware of the history and both the “good” and “evil” nature of psychiatry, psychology and it’s hanger onners – whether it be Pavlovian Behavioralism, Freudian analysis, Transpersonal psychology or past-life regression).

    Um, you were the one who said – “you knowe I would love for someone to do to psychiatrists what has been at times done to cvertain CAM people.” That sounds pretty vengeful!

    You’re clearly very emotional about this topic and say you “know what you know”, which seems to prevent you from hearing what people are actually saying, and from considering evidence, accepting new ideas or actually having a discussion. Are you interested in discussion? Or are you just interested in promoting an idea?

  97. Fifi says:

    quackdoctor – I’m curious, when you say you want to work with kids with disabilities, do you mean neurological disorders?

  98. quackdoctor says:

    Well I do have an interest in kids with neurological problems. Like CP. But not limited to that. But with muscle and joint problems as well. And combinations of these. So I think I would like to use physical medicine/therapy. But I need the ability to use medications as well. I want to be able to take care of general health care as well. To treat infections, pain and the like. But no matter what I will never stop helping people with my hands as I learned in chiropractic. Hands contact is extremely important in my view as is the human connection in medicine…

    Now as far as the statement about “coming clean” and being bias and haveing “associations”. I do not thisk I am that way at all. I have no “association” with any one. I offend because I have new ideas. But my ideas are not irrational at all. I am not trying to promote anything. Just causing people to think and consider.

    Now dealing with this comment:

    “I thought qdoctor said he has no connection to health care. I suppose if one works in a quack clinic, that is true.”

    That has to be the most ass headed statement I have ever heard. Do you even know how I practiced? It is clear bigotry. Very very childish. A real jerk of a statement to make. And I do not have a connection to health care at this point. I do not practice it. And what the hell is a “quack clinic”. I have never been in one. I have heard about them. So you see my friend knowledge is knowledge. Guyton’s physiology is Guyton’s physiology. A neuro atlas is a neuro atlas. Whether you read it in the rain or in the shine.

    Now if your comment about the “quack” statement is about me having a DC. Well let me tell you something. Where I went to school at National. That was not an easy degree to get. I was taught there by one of the top neuroanatomists in the world and neuro-researchers for that matter. And the education there is first rate in the sciences. So don’t lay this quack crap on me. It is very immature.

    Lastly…What we have here is a failure for people to actually read what I have said. People get fixated in a form of thinking. Like the chiropractors that believe that subluxation is the cause of all disease. Well the same applies to medicine in some cases. I see this behavior as a religion. .

    Now if I was a “quack” I would not be so open minded as to want to prescribe medications or maybe learn something about surgery and more.

    Some people just don’t get it.

  99. Fifi says:

    quackdoctor – Ah, see you’ve assumed you’re presenting some new, radical idea that nobody gets because we’re all too close minded and “religious”. You’ve assumed incorrectly. The ideas you’re presenting aren’t new to some (most?) of us though they may be new to you! (Did you read Harriet’s blog?) Many of us have had very long, in-depth discussions regarding this issue – it’s one I’ve been around my whole life and I’m in my 40s. So, it’s an old conversation though still relevant – if not more so considering some of the issues with health care in the US (we have other issues here in Canada).

    Seriously, as both the topic of this blog and Harriet’s critique of the study indicate, this isn’t a new discussion within medicine and particularly mental health branches of medicine (it’s actually a very old ongoing one). I find it odd that you’re unaware of this since you seem to have such a passion for the topic. Some of the most well reasoned and incisive critiques of psychiatric practices come from evidence-based psychiatrists (there’s not a consensus within psychiatry or psychology for that matter). I’d suggest you find out a bit more about psychiatry if you think that all psychiatrists believe the same thing and practice their profession the same way.

    You add no validity to your perspective by calling people “assheads” – it merely shows a lack of ability to respond as an adult. Your accusations that people are being “religious” about this subject really only reflects upon your own beliefs since you “know what you know” based not on evidence but upon “knowing what you know” and most of the rest of us here who respect science are interested in evidence and are proposing caution when there is no clear evidence.

    Why do you feel that you’d be more qualified (if you graduated as an MD) to prescribe medication than other MDs? Would you consider yourself qualified to prescribe psychiatric medications as a GP or do you intend to train in a specialty? Why are “they” evil but you’re “good”?

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