Friday, March 20, 2015

The miracle of psychiatry

Like Robert Whitaker (see previous post), I bought Shrinks: The Untold Story of Psychiatry by Jeffrey Lieberman (see eg. another previous post) because I intended to blog on it, but after reading it, I initially thought I wouldn't bother (see Robert's blog post).  Lieberman makes claims about brain abnormalities associated with mental illness, which need challenging. However, it's difficult to do so, because there are no references in the book, although there is a list of sources and additional reading at the end. I'm also not sure what has been untold about his story of psychiatry, because there doesn't seem to be much new in the book. Perhaps he thinks that what he calls anti-psychiatry has the dominant narrative in the history of psychiatry and he needs to replace it with his own.

Like Robert, what grated on me was the messianic nature of the book. Lieberman needs to be more circumspect about his claims for psychiatric treatment effectiveness. His tale of psychiatry, as he himself says, is of the "dramatic transformation from profession of shrinks to profession of pill-pushers". Although he is "under no illusion that the specters of psychiatry's past have vanished, or that my profession has freed itself from suspicion and scorn", he believes in the "mind-boggling effectiveness of medication". Steady on! He describes what he calls the "accidental discoveries of miracle medications". The introduction of psychiatric medications may well have been serendipitous but was it miraculous? When chlorpromazine was first introduced in state-funded mental institutions in America, as far as he is concerned, "the results were breathtaking". His enthusiasm for psychiatric medication extends to ECT. This is because he's seen "patients nearly comatose with depression joyfully bound off their cot within minutes of completing their ECT". As Robert Whitaker says, this is "a modern-day story of Jesus, curing the lame, who could now throw away their crutches and walk".

At the beginning of the book, Lieberman gives the history of a psychotic patient he calls Elena Conway, the daughter of a well-known celebrity. Three weeks treatment with risperidone, "a very effective antipsychotic medication", as far as he is concerned, and care in hospital led to a "dramatic improvement". The trouble is that he doesn't say what happened to Elena long-term, apart from suggesting that if she had carried on with aftercare treatment she would have had a "good recovery". Shouldn't we be told if she had a poor long-term outcome?

The combination of psychiatrists' belief in their treatments and patients' faith in psychiatrists may produce a powerful placebo remedy. Psychiatrists, like Lieberman, may be deluded into believing that their prescribing is having specific effects. Lieberman suggests that "instead of Daniel Amen's unproven claims for SPECT-based diagnosis of mental illness [see previous post], we will have scientifically proven methods of diagnosis [in the future] using brain-imaging procedures". But such simplistic and biologically reductionist accounts of mental illness are no different from those of Amen or some of the historical treatment excesses Lieberman describes in the book. Such faith and self-deception still sustains modern pharmacotherapy. The wish-fulfilling claims of modern psychiatry need to be shrunk to more realistic proportions.


Anonymous said...

I agree.

In 2002 I was coerced to take Risperidone, detained for 72hrs under the Mental Health Act, in a Fife psychiatric ward, until I agreed to take the drug. I was experiencing a menopausal psychosis or altered mind state. I'd had two other similar experiences 18 years and 24 years previously, after painful, induced childbirths.

The antipsychotic did take me quickly out of the psychosis, plus the fact I had to get out of the mental hospital quickly. It was a very risky place. Mixed gender ward. Male patients in single rooms down same corridor as female dormitory. I got discharged after a week. But the drug had take away my agency and motivation. I wasn't able to return to my FT job of managing volunteers. I got demotivated and low in mood, was prescribed Venlafaxine which flattened me further. Then given Lithium to "augment" the antidepressant.

None of it worked, in terms of allowing me to take up the reigns of my life. I had to taper the drugs under my own steam, eventually going against the psychiatrist, coming off the Lithium, last. Making a full recovery in 2004/5.

Risperidone was not a miracle cure. Neither was Chlorpromazine in 1978 and 1984, which I was forcibly injected with until I would voluntarily take the liquid Largactyl then the pill form. It was only when I got off the drugs that I got my life back. And was a stronger person for resisting and surviving the treatment. That's how I look at it.

I want to see alternative ways of working with people in psychosis, altered mind states, that doesn't just mean antipsychotics, forced if resistant.

TTlk said...

Sorry to hear that Chrys.

As far as I know, Duncan Double practices coercion and forcibly drugs people, he's probably the wrong person to be looking for sympathy from, given he sleeps at night after committing this violence upon others.

Don't think for a second that the UK Critical Psychiatrists don't support grabbing you and jagging you as you say. They are good for some occasional blog posts to read but don't lull yourself into a false sense of solidarity with them, these people don't give a fuck if you're the collateral damage of them having the powers they believe they are morally entitled to have in a "crisis".

DBDouble said...

I do agree society needs a Mental Health Act but that it is overused and coercion should be minimised. The current needs reform to protect patients' rights better, particularly for supervised community treatment.