unsafe

at

any

dose

Sales of this book help support the work of

The James Nayler Foundation – www.TruthTrustConsent.com

unsafe

at

any

dose

exposing psychiatric dogmas –

so minds can heal

Dr Bob Johnson

Consultant Psychiatrist GMC speciality register for psychiatry

formerly Head of Therapy, Ashworth Maximum Security Hospital, Liverpool

Consultant Psychiatrist, Special Unit, C-Wing, Parkhurst Prison, Isle of Wight

MRCPsych (Member of Royal College of Psychiatrists),

MRCGP (Member of Royal College of General Practitioners).

Diploma in Neurology & Psychiatry (Psychiatric Inst NY),

MA (Psychol), PhD(med computing), MBCS, DPM, MRCS.

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Published in 2006 by Trust Consent Publishing,

P O Box 49, Ventnor, Isle of Wight, PO38 9AA UK. www.TrustConsent.com.

All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise, without the prior written consent of the publisher.

© 2006 Dr Bob Johnson

Dr Bob Johnson is hereby identified as the author of this work in accordance with Section 77 of the Copyright, Designs and Patents Act 1988.

British Library Cataloguing in Publication Data. A CIP record of this book is available on request from the British Library. ISBN 0-9551985-1-8

ISBN-13 is 978-0-9551985-1-9

10 9 8 7 6 5 4 3 2 1

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If you have comments please send them either via the publisher or via www.TruthTrustConsent.com. Sadly, time and age will limit my replies.

Please note This is a HEALTH WARNING.

Psychiatric drugs are increasingly powerful, they wreak great changes on the chemistry of our brains – so do not stop or change their dosage abruptly, nor attempt to do so without adequate support.

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foreword

“Psychiatric drugs do more harm than good” – not a comfortable statement to read. Your first reaction is likely to be shock, your second, disbelief. After all, doctors have a long and rigorous training – if something was wrong, surely they would be the first to point it out. Sadly, too many doctors share your disbelief. They keep splashing out psychiatric drugs, as if their futures depended on it. For the last 50 years doctors, with few honourable exceptions, have steadfastly ignored the solid, irrefutable evidence that psychiatric drugs prolong disease.

Robert Whitaker’s book Mad In America gives chapter and verse on the full range of damning scientific evidence. Whitaker himself hoped that by presenting this data, in a calm straightforward manner, matters would improve. Sadly his endeavour has failed. This book is therefore a further effort in the same direction – in effect it says, “Wake up! There’s more to psychiatry and to life, than the current psychiatric approach allows.”

Unless this psychiatric approach is changed, we are all destined to be treated as mindless unfeeling robots, gummed up by psychiatric drugs. Indeed closer scrutiny shows that today’s psychiatric foundations are built on sand, as I reviewed in my earlier book Emotional Health. Here I describe what it looks like from the psychiatrist’s point of view, and show how a reawakened psychiatry could heal more. We are a sociable species – emotional distress of all varieties is curable. Read it, and see if you agree that public pressure is now urgent.

This is not an anti-psychiatry book. I have been a member of the Royal College of Psychiatrists since 1973. I have studied psychiatry intensively since 1963, and have been a Consultant Psychiatrist since 1991. I love it. Since emotions inflict such terrible agonies, it is imperative that we control them, not them us. Emotion Support Centres – where “recoverers help others recover” – aim to do just that, which is why I now give them my fullest support.

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list of chapters

1) WHY IGNORE 50 YEARS OF ADVERSE SCIENTIFIC EVIDENCE? 1

2) WHAT EXACTLY ARE YOU TREATING? 21

3) THE DAMAGE IN DETAIL 45

4) SAFER PSYCHIATRY 73

5) EMOTION SUPPORT for Lenny 95

6) EMOTION SUPPORT for Louise 115

7) EMOTION SUPPORT for Ann 129

8) WHERE WE GO FROM HERE. 163

APPENDIX 179

The Case Against Antipsychotic Drugs: A 50-Year Record Of Doing More Harm Than Good 181

Contemporary Psychiatric Anomalies – 195

Lancet letter – Ashworth: The Horrors of Misdiagnosis 199

Levels Of Violence And Medication In A Special Prison Unit, 1986-1995. 201

Evidence Prepared For The Joint Committee On The Draft Mental Health Bill 205

Web sites of interest 211

SELECTED READING LIST 212

contents

list of chapters vii

contents ix

1) WHY IGNORE 50 YEARS OF ADVERSE SCIENTIFIC EVIDENCE? 1

dogma 1 – ignore the fear 1

denial 3

dogma 2 – ignore the mind 6

despair 9

drunk 11

short term benefit – long term disaster 16

dogma 3 – ignore the software 17

2) WHAT EXACTLY ARE YOU TREATING? 21

medical realities 21

psychiatric nihilism 24

daffy diagnoses 27

pigeonholing people 31

recipes for unicorn blood 34

DSM-IV sanctifies the three dogmas 38

3) THE DAMAGE IN DETAIL 45

a personal story 45

Robert Whitaker’s preface 48

Professor Ebmeier’s presumption 52

shocking electrical ‘treatment’ 57

anorexia from the inside 61

Scott Maloney 64

4) SAFER PSYCHIATRY 73

a guided tour of the human mind 73

consent/intent as housekeeper 77

denial re-visited 80

The Healing Hand Of Kindness 83

Dr Peter Breggin’s support and inspiration 84

micro‑Darwinism 87

erasing psychiatric dogmas. 91

5) EMOTION SUPPORT for Lenny 95

6) EMOTION SUPPORT for Louise 115

SESSION 6 117

SESSION 7 123

7) EMOTION SUPPORT for Ann 129

8) WHERE WE GO FROM HERE. 163

reality and insanity 163

to my psychiatric colleagues (& everyone else) 166

to talk therapists (& everyone else) 169

towards a safer psychiatry 174

APPENDIX 179

The Case Against Antipsychotic Drugs: A 50-Year Record Of Doing More Harm Than Good 181

Did Neuroleptics Enable Deinstutionalization? 182

Establishing Efficacy: The Pivotal NIMH Trial 182

The NIMH Withdrawal Studies 183

Drug Treatment Versus Experimental Forms of Care 183

The World Health Organization Studies 185

MRI Studies 186

Relapse Studies: 186

Doing More Harm Than Good 187

A Better Model: The Selective Use of Neuroleptics 188

The Atypicals: Dawn of a New Era? 188

Summary 189

A Timeline for Neuroleptics 190

Clinical History/Standard Neuroleptics 190

References 192

Contemporary Psychiatric Anomalies – 195

etiolated aetiology 195

emotionless nosologies 196

pull yourself together 197

References 198

Lancet letter – Ashworth: The Horrors of Misdiagnosis 199

Levels Of Violence And Medication In A Special Prison Unit, 1986-1995. 201

introduction 201

method 201

results 202

discussion 203

Evidence Prepared For The Joint Committee On The Draft Mental Health Bill 205

Preamble 205

the Committees’ Questions 206

Web sites of interest 211

SELECTED READING LIST 212

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1) WHY IGNORE 50 YEARS OF ADVERSE SCIENTIFIC EVIDENCE?

dogma 1 – ignore the fear

P

sychiatry is now a dismal failure. From a strictly medical viewpoint – it doesn’t work. Its insistence on a banal mechanistic approach is simplistic and grossly inappropriate. Its obstinate over-reliance on drugs results in epidemics, not cures. Meanwhile, a thick veil of fear hangs over all. Psychiatrists themselves, are often cast in a fearsome light, partly through their association with insanity, which is itself frightening. But also because they repeatedly compel fearfully damaging ‘treatments’. Fear impedes rational thought – it’s the only thing that does. How can you possibly assess whether psychiatric drugs do more harm than good, if the whole topic comes to you overburdened with forebodings? My advice would be to take the book steadily and calmly. Keep hold of a thread of reason at all times. Make sure you can see some sense in what I write, by relating it to what you are already familiar with. Above all, never stop looking for fear of what you might see – that way madness lies. For my part, I shall endeavour to keep the thread simple, calm and straightforward, relying on the maxim that you should first taste what I write, but swallow only when you see enough sense in it to do so: but when you do, please act.

Insane people are frightening. They are unpredictable and can be dangerous – in fact irrationality is always destructive. My first experience of such dangers occurred in one of my training group therapies in 1963. A man sitting only six chairs away from me, half rose out of his chair, turned and, out of the blue, punched his neighbour hard in the face. All of us were shocked. The man himself, let’s call him Jonathon, appeared more shocked than most. I remember him still shuddering at the thought of what he had just done. Once we’d recovered our breath, we asked him what had happened – but he could only mumble incoherently about being ‘upset’ at the way families were being discussed in the group. He had not participated in the discussion verbally – he communicated his feelings more directly, indeed too directly for comfort.

The psychiatrist running the group at the time had no better idea of what had happened than I. However 30 years later, the 60 murderers I worked closely with in Parkhurst Prison taught me that violence comes from fear. Generally this fear is itself obscured, as it was with Jonathon above. But if you want to unpick an act of violence, look for the fear beneath. In fact, over the last 45 years it has become increasingly obvious to me that emotions play a vital role in all mental disease. And of all the emotions, the one that matters most is fear. In my earlier book, Emotional Health, fear is described as the Master Emotion, highlighting the impact it can have, especially when unacknowledged – the so‑called buried or obsolete terror.

Fear is the key component in every mental illness. It manifests itself obviously enough in phobias or panic attacks, and in anxieties of all varieties. Paranoia by definition, is fear incarnate; and no psychosis is ever fear‑free. Despite this, fear still finds no place in established psychiatry – only dogmatic presumption can keep it out. In real contact with real suffering humanity, it soon becomes obvious that there is a clear analogy between infection in general medicine and fear in psychiatry – unless and until both are detected and controlled, health, physical or mental, is unlikely to be robust.

This is not the first dogma to undermine medical progress – looking back 150 years, we find that bacteria were similarly unacknowledged, and progress was similarly obstructed for many decades. In Victorian times, doctors and especially male midwives actually took pride in not washing their hands when moving from post mortem room to operating theatre. Exposing themselves to soap and water somehow offended their dignity. So they declined – vociferously. There was no evidence they could see, or would look at, which entailed them altering their time-honoured practices – after all, the supposed ‘microbes’ were entirely and invariably invisible to the naked eye. The very existence of micro-organisms was not readily conceded, and even when it was, their relevance to disease was actively disputed well into the early years of the twentieth century. The absence of recognisable evidence, or at least evidence deemed adequate, allowed the continuation of a pattern of behaviour which today would rightly be regarded as appalling.

It is instructive to look more closely at the circumstances prevailing at the time. Doctors in those days, worked under ferocious pressures. The death rate during operations, especially child-birth, was horrendous, infantile mortality a constant refrain – almost perhaps something to be accepted as an inextricable part of the human condition. So pesky suggestions that they were doing something to make matters worse, attracted spontaneous eruptions of contempt or suppression.

Doctors, especially when pressed, become ever more conservative, one might say dogmatic – what worked before is likely to be less harmful than what is now proposed. Caution becomes the watchword – and unorthodox innovations, especially those suggesting that present remedies do more harm than good, are seen as likely to make matters seriously worse. Accordingly such suggestions are discarded or even crushed with no lack of vigour. After all, viewed through the old orthodoxy – current practice cannot be bettered – it is all there is, else they would have been taught differently in medical school. Sadly today’s psychiatric dogmas have long precedents.

denial

Under conditions of fear or stress, rational thought is impaired. How this comes about is actually straightforward enough. The mind has given us our evolutionary advantage by providing us with a mental model of our surroundings. Likely scenarios can be explored in our heads, allowing us to work out a way through our many impending pitfalls, before actually falling prey to them. In particular the mind enables us to construct, and keep in good repair, the social networks which are so essential for our sanity, and indeed our very survival as a species. But this modelling falters if an issue or a subject becomes too painful, or too fearful to contemplate – a flaw which once recognised, can be seen cropping up all over the place.

It is hard enough at the best of times, keeping an up-to-date picture of our ever-changing world in mind – old patterns are constantly being displaced by new, nothing ‘out there’ is ever static. If stress is added to the mix, life becomes even more difficult. Add overwhelming fear or terror, and rational thought ceases – terror actively induces mental paralysis. Serious discrepancies can then begin to occur between what we think is ‘out there’ and what actually is. At this point the mind is no longer able to serve its proper function. It can no longer provide reliable guidance as to what to do next. Indeed its overreaction to fear can itself become the main impediment to healthier progress. The mind is ill.

Not only is it helpful to think in terms of the analogy between fear and infection as far as general mental health care is concerned. It is also useful to tease out the correlation between fear and pain, which closely resemble each other. Everyone knows that a painful leg leads first to limping, and can then lead to disuse of the leg entirely. It is common knowledge that pain readily leads to physical immobility, so it is hardly surprising to find that fear does the same for mental agility.

The function of fear is directly parallel to that of pain – both serve to warn us that ignoring them risks further damage. Chest pain is a prime example – ‘working through’ chest pain is not to be recommended : likewise ignoring a healthy fear of walking across busy motorways is equally life-threatening. Fear becomes toxic however, when the mind is too frightened, and thence too paralysed, to bring itself up to date – earlier threats are perceived as still being operative – unexamined life‑saving fears then become life-curtailing.

At its mildest, wilful disregard of present day realities is well recognised as ‘wishful thinking’ – a conscious preference for what we would like to be the case, when the evidence around indicates otherwise. Unchecked, the next stage along this path is ‘day dreaming’. Further down the line, it becomes ‘dissociation’ – where the mind finds today’s reality far too much, so it decides to leave it behind, and move into a world of its own making. The most extreme, of course, is psychosis, where reality is not only abandoned, but re-constructed anew – though even here elements of reality will always tend to seep back, except where drugs dull the appetite to try.

All these mental anomalies fall under the general term ‘denial’ – in essence, the mind ‘denies’ what is obvious, and prefers something which appears more benign. So here we have a working definition, a blueprint, for mental illhealth – once the mind no longer relates to the reality around its owner, it is no longer functioning healthily, it is ill. The remedy is also equally clear – supply sufficient quantities of emotional support to allow the mind to cease ‘denying’, and re-connect itself to current realities. This is the thrust of Emotional Education, of Emotion Support Centres – all aimed at re-gaining control over the emotions. The analogy with a broken leg is sharp – plaster casts support the bones, but the healing is done by the living leg – apply emotional support in an appropriate way, and all minds heal.

Denial is therefore entirely straightforward. A fixed idea already implanted in the mind resists being displaced by a novelty, unless there is adequate reason to do so.

Everywhere in human society, incentives are constantly being proffered to encourage you to change your mind, to change your viewpoint – the advertising industry would not otherwise exist.

Equally however, there are a number of disincentives to changing one’s mind. The proposed change may appear vague or uncertain; you may be feeling somewhat insecure with what you already ‘believe’; it can seem more trouble than it’s worth to make the change. I suspect the last partly explains why psychiatry has not yet updated its views on the longer term impact of psychiatric drugs.

Of course as we have seen, there is a whole spectrum of denial, ranging from wishful thinking through day dreams to dissociation even psychosis – and each is accompanied by a similar range in intensity of the disincentive involved. Thus at the milder end, one would expect mild discomfort – “Oh I wish I hadn’t missed the bus”. More severe would be “I’ll wait until all my problems are solved by winning the lottery”. Yet more sinister are those pressures we carry over with us from childhood – these can be highly potent, but worse, they are the more actively ‘denied’ because of that. Childhood traumas can impose the deepest denials. Life support systems in dysfunctional families are not conducive to encouraging the change from infantile dependencies to adult mutual inter‑dependencies. These are often the most difficult to remedy. However human beings are nothing if not resilient – given the right support and the appropriate ‘education’ – change and indeed cure can be expected for all.

dogma 2 – ignore the mind

I want now to try and describe quite what it is like when a medical student is first confronted with mental disease. (Just to be clear, both psychiatrists and psychologists deal with the mind, but only the former, being fully medically qualified, prescribe drugs – so far.) Medical training itself represents the imposition of a whole new way of looking at life, at human beings, indeed at human bodies. This wrench from the norm is accompanied by an entirely foreign vocabulary of some 3000 words which are conspicuously different from everyday usage.

I well remember being confronted with my first abdominal examination. Here in front of me was a torso, the shape and external appearance of which was entirely familiar to me. But such familiarity counted for nothing. Hiding behind the leathery surface were dim, and shifting outlines of vague organs I was called upon to describe immediately in confident detail. Fumbling about with spade shaped hands, I struggled to feel ‘the edge of the liver’, I delved inexpertly to touch the ‘pole of the kidney’. The spleen of course, utterly escaped me. It seemed quite impossible that anyone could make sense of the slightest twinge, the smallest resistance to the probing fingers in a way that would satisfy the critical questions being demanded. And for the neophyte it was impossible – only long careful training could make sense of the entirely unobvious differences that these oh-so-soft organs made to the enquiring hands. Later of course, I became more skilled – my especial expertise being in palpating colons, but that’s another story.

If such difficulties attend the examination of something as tangible as the abdomen and its vital contents, imagine the problems that arise with the mind. First of all you have no fingers to poke this intangible organ. Second, your own mind may have blind spots, resulting from unexamined ‘denials’ on your part, which render accurate examination difficult if not impossible. Thirdly, the sense of awe which all naïve medical students feel for their superiors – such people can even hear a fourth heart sound – this sense of being in the presence of superior knowledge and skill can seriously distort your precepts.

Though the mind is the most important organ in the body, the ‘socialising’ organ, it is entirely intangible. There are no external lumps or bumps you can feel to distinguish a healthy organ from its sick counterpart. Despite these problems, which have been known throughout history, it is still curious to observe that established psychiatry ‘solves’ them by ignoring the mind altogether – giving us dogma 2. The problem is – what you are first taught in medical school, forms the foundation stones for your understanding in later life. If the foundation stones are sound, then so will be your subsequent understanding; if they are faulty, because your first teachers had only a dim view of their topic, your later view is liable to be similarly hampered.

The remedy, as for all items taught in medical school, is to have these basic teachings tried and tested in clinical practice. This entails being open and confident enough to accept clinical axioms that continue to make sense, and to ditch those which fail to improve your patients. It’s not always easy. Remember that medical schools hold exams every few months – in these you are required to recite the conventional wisdom of the day. You may disagree, but others have already decided what the correct answers are, since they set the questions in the first place. And they are the ones who fail you, not the other way around. A certain amount of regimentation is inevitable in any medical training – only confident exposure to a wide variety of clinical conditions can rescue this, and indeed save more lives as a result.

By resolutely ignoring the mind, psychiatry today has no alternative but to make psychiatry as inflexible as concrete. This is not so hard to accomplish as it might seem. Indeed it falls in nicely with a profound, persistent, and almost irresistible psychiatric ambition to put the whole troublesome topic on a par with physical medicine – a kind of fallacious psychiatric holy grail, driven by a desperate yearning to make the wonderfully intangible and creative mental organ as concrete as say the liver or the brain.

Humans are forever trying to concretise this most wonderful of all attributes, to regulate it, to make it predictable. There is an entirely regrettable tendency to find, or if need be invent, a clear anatomy of the mind – something comparable to the anatomy of the brain. This leads to enormous difficulties and to much illhealth, as Freud himself exemplifies.

Sigmund Freud was perhaps the sharpest clinical observer of his day. Unhappily he was an indifferent philosopher (though vastly superior in this regard when compared to those currently commanding our psychiatric heights, as the next chapter explores). He started out life as a neurologist, where the superficial anatomy of the brain was there for all to see. Then he embarked on an ambitious quest to secure ‘The Science of the Mind’. He had no difficulty in dividing the human mind into various parts – he had the greatest difficulty in making them stick. For what is obvious to one mind, is obscure to another; what sounds like an instinct, a complex, an ego to one, is mere tittle-tattle to another – and there is no solid, reliable, objective way of deciding the issue between them. Nor ever will be.

despair

Freud for all his flaws, and they were considerable, had two great contributions to make to our understanding of the human mind. Firstly he took a stand against dogma 2 – he asserted that the mind existed, he asserted ‘psychic reality’, he proceeded on the basis that there was something called the mind, that it was of crucial importance, and that the primary way to access it was to talk to it. This may count as small beer to non‑psychiatrists – but I recently read through 10 years of the British Journal of Psychiatry, and found only two mentions of ‘mind’: one was decidedly shame-faced and tentative, and the other was by that professional amateur, the Prince of Wales. So Freud is to be applauded for saying we each have a mind that demands respect and fully deserves to be talked to.

The second asset he provided was to insist that part of the mind was not immediately accessible. He made a series of painful, costly blunders as to what to do about that, but the notion that the individual in front of you is not disclosing the key emotional fact in his or her case is crucial to any successful progress in psychiatry. This falls under the heading ‘denial’ as described above, though that is not quite how Freud himself would have expressed it. And it arises from fear, which Freud ignored as heartily as any modern psychiatrist, and for much the same reasons (see Emotional Health).

The impact of this last point, of denial, is unusually profound. Elsewhere in general medicine, the clinical process relies on the individual patient describing the symptoms, relating them to past circumstances, and generally telling the truth about their disease. Indeed the most valuable clinical aphorism I took with me from medical school was Sir William Osler’s – “Listen to the patient s/he is telling you the diagnosis”. Since the key pathology in psychiatry is denial, then this is no longer the case. Indeed the patient is determinedly keeping from you, and from themselves, the key emotional fact without which progress is impossible. It is simply too painful for them – all they can do is ‘deny’ it. While this certainly adds to the apparent complexity of psychiatry – once mastered, it is tremendously exciting and fruitful to watch human minds blossom out of their frozen pasts.

Sadly psychiatry reacted adversely to Freud – his flaws were too extensive, his ‘anatomy’ too rigid and too singular, and even his method of treatment too inflexible and longwinded. Accordingly Freud proved a false god. The rigidity, precision and reproducibility that this branch of the medical profession so craves, which Freud appeared initially to offer, has never materialised, and there are sound philosophical even logical grounds to indicate it never will. The human mind is the most creative, delightful, fluid and inventive entity in the entire cosmos – it does not take kindly to regimentation, dissection, anatomisation or any of the other false structures which a beleaguered profession might wish to inflict upon it. The psychiatric holy grail for which so many yearn must in reality, be exorcised. There are alternative strategies which being more realistic are also more successful – but they can never see the light of day, while this addiction to concretism, this dogma 2, holds sway.

What psychiatry has failed to find in reality, it has decided to invent and impose. The problem is that any structure you invent is the categoric opposite of what the mind actually is. Rigidities, inflexibilities, lack of creativity or consent may make for a fine wish list – but as these characteristics grow, their relevance to the entity they are trying to represent, shrinks.

Given the collapse of Freud, given the intense desire, nay need, to be as physical and organic as general medicine – the outcome has been despair. A deep psychiatric nihilism has descended on the profession I love. A whole catalogue of daffy diagnoses has been compiled as a bulwark against a protean, amorphous and constantly changing psychic scene – I review it later. The mind delights in picking holes in arguments, in creating exceptions to rules and regimentations – sadly the current psychiatric insistence that mental disease is essentially chemical, genetic or biological is not only counter-intuitive to the non-psychiatrist, it turns out to be doubly flawed. It is wrong on two counts. Firstly there is solid evidence that this approach is failing globally – Robert Whitaker, who will be mentioned frequently anon, counts the number of mentally disabled as growing by 400 a day – a number that should be shrinking, if the current psychiatric foundations were realistic. And secondly, the drugs which are currently thrust into the widening gap between agonising mental symptoms, and out‑of‑touch psychiatrists’ rigidities, have themselves proved pathogenic – thus the crutch built of mind-altering chemicals has not only buckled under the weight of reliance that psychiatry feels increasingly obliged to place upon it, but has proved corrosive in the process.

In short, psychiatry today prescribes damaging drugs because it despairs of anything better. Unhappily the ever increasing evidence that these drugs inflict damage coincides with a parallel increase in the pressures under which psychiatry currently finds itself, leaving ever less room for rational evaluation of the growing scientifically proven evidence that these drugs do far more harm than good.

This book is intended to awaken wider interest in and understanding of this dilemma, so that more humane, more secure and more successful psychiatric approaches can prevail. Any drug that alters the mind is grasped with both hands – why bother with a chemical that is psychically inert. However, given that chemically altered minds think and talk less well, and given that talking is the main gateway to the mind – all mind altering drugs must inevitably be unsafe at any dose.

drunk