A public debate, sponsored
by the James Nayler Foundation.
This house believes that
Psychiatric
drugs do more harm than good
Proposer Dr Peter Breggin,
seconded
by Dr Joanna Moncrieff
Opposer Dr Mark Salter,
seconded by Dr Trevor Turner
On Friday 7th April 2006,
coffee 5:30 -- debate 6 -
8 pm
at The Guardian Seminar
room, 60
Farringdon Rd, London, EC1R 3GA.
admission by ticket only
--
limit of 90 in all -- donations
welcome.
Bob:
Thank you. I would like to
welcome you on behalf of the James Nayler Foundation, which is a small mental
health charity of which I am the co-director. My name is Bob Johnson and I delighted to see so many of you
here. There are some very important
subjects that we are discussing tonight, and I hope we have lots of light and
not too much heat. I would like to
introduce you to David Brindle who is the Public Services Editor of the
Guardian. I am very grateful to
him for chairing this event, and I shall hand over to him, and ask him to
introduce the speakers. Thank you.
David: Well welcome to the News Room as we call it at the
Guardian. It needs to be said up
front that the mediaÕs coverage of the mental health could be better. But at the Guardian we like to think we
do a better job than most, and that goes to both fostering events like this
discussion and this coverage that you might have seen today -- quite a
substantial article from Mind in a writer reply on a piece we did on deep brain
stimulation and depression.
I am going to try to keep order this
evening. ItÕs going to be an
interesting debate, and passions will run high, but I plead for a civilised
debate if I may. Certainly letÕs
give the speakers on both sides of the issue the courtesy of a fair
hearing. We will have plenty of
time for discussion and contributions from you when weÕve heard from the four
speakers. The two main speakers
for and against will speak for 10 minutes and the seconders will speaking for 5
so by process of deduction we will have almost an hour for debate there
after. Two service notes -- please
check your phones are off or on silent mode as a courtesy to everybody
else. And secondly the event is
being recorded so that we can have a transcript afterwards -- so just be aware
of that, in anything you choose to say.
[Laughter]
David: So, the motion is ÔPsychiatric Drugs Do More Harm Than
GoodÕ. Proposing that motion we
are going to have Peter Breggin and seconding it Joanna Moncrieff. Opposing the motion is Mark Salter, and
seconding him is Trevor Turner. I
will introduce each as we go along.
We are going to start with Peter Breggin, who as most of you will know is
an acclaimed authority in the field, author of Toxic Psychiatry, founder of The
International Centre for the Study of Psychiatry and Psychology in the States,
campaigner now for thirty years or more on these issues, robust opponent of
Ritalin, fantastic track record and PeterÕs going to speak for Psychiatric
drugs do more harm than good. Peter.
Peter: Thank you for that warm introduction. To address the question of whether
psychiatric drugs do more harm than good, I am going to go into the lionÕs den,
right into the prototype of the psychiatric science, if it may be called
that. Which is the use of
Neuroleptics or antipsychotic drugs to treat people who are labelled
schizophrenic, because if that bastion of psychiatric authority has feet of
sand, than clearly so does the rest of psychiatry in terms of medications and
drugs. There are two basic arms to
the proposition:
1.
Neuroleptics can only work by damaging the brain and producing brain
dysfunction. That is, by
disrupting dopamine neurotransmission to the frontal lobes and also the
reticular activating system, these drugs inevitably, when they are given in
sufficient dose to work cause, a chemical lobotomy of the frontal lobes. And also of the reticular activating
system. Both of which are energised
by Dopaminergic. So it is a
scientific fact, not a metaphor, that we are dealing with a lobotomy
phenomenon. And what the patientÕs
experience is the disinterest and apathy typical of the older classical
surgical lobotomies. They donÕt
lose their so called hallucinations and delusions -- they lose interest in
everything about themselves, their family lives, rooting for their football
team, the whole array of human life within them is muted by the drugs.
ThatÕs the first general principle. Also remember that when the term
medication is used which weÕll be using tonight in drugs, weÕre actually
talking about this essential poisoning of the dopamine system. Blocking up to 90% of a major
neurotransmitter system, and the newer drugs block, as well as dopamine, the
serotonergic system which goes throughout the brain including to the highest
mental centres. ThatÕs the first
part that I want you to understand.
The second part is that the people we call
patients to which these drugs are given are actually people. They are human beings that run really
the full range of people in our society.
In many ways, in America today, children are becoming major targets of
drugs like Risperadol, Zyprexa, Seroquel, the so called second generation
drugs. All of which block
dopamine, I donÕt know how the professionals have forgotten this, they all
block dopamine.
These drugs are used everywhere that
control is required or wanted.
They were used in Russian psycho prisons, they are still used in China
and Cuba, they are used in nursing homes when old ladies get rambunctious, or
resistant, or restless. And they
are of course used on virtually everyone who was incarcerated in our great
state mental hospitals, which are now somewhat smaller but largely pretty much
everyone in them are going to be on these drugs regardless of their diagnosis.
What you may not know is these drugs are
being used in veterinarian medicine; theyÕre used in veterinarian
medicine. When you see the tiger
thatÕs been tranquillised by a dart itÕs got a Neuroleptic in it often as well
as a sedative. The main difference in veterinarian medicine theyÕre very
careful not to use it for a long period of time because they donÕt want to hurt
the animals.
.
Despite the blunting effects of these
drugs, the fundamental lobotomising effects which I believe is a self evident
truth, once you know the simple physiology of it all. The drugs also cause a great deal of suffering in particular
they cause akathisia this terrible inner agitation that forces people to move
about. The older drugs, Haldol,
and drugs like that, 50% or more of the individuals on these drugs get some
degree of akathisia it may be less now but itÕs hard to tell.
So the patient, the person -- let me turn
to that person for a minute. Our
classic model for the person who gets these drugs is a person labelled
schizophrenic, and who is that person?
Above all others thatÕs a sensitive individual, that is a frightened
individual, that is a hopeless feeling individual, that is a person who needs
more than anything on the face of the Earth a trusting relationship with
another human being. Because when
we talk about a loss of contact with reality, we really mean human reality. That person whoÕs in front of us no
longer believes that other human beings can be remotely trusted or related to
and is withdrawn into a nightmarish world.
The way out of that world we know from
multiple studies, and I get to mention some of them, is through a human
relationship, not through poisoning the highest emotion regulating centres of
the brain with Dopamine, and now Serotonin blocking agents. Because these drugs are so toxic,
theyÕre toxic to cells, theyÕre Cytotoxic and theyÕre particularly toxic to Dopaminergic
cells, the cells they block. Tardive
Dyskinesia in older drugs, a neurological disorder with abnormal movements and
brain damage, occurs at a rate of 5% to 8 % a year cumulative. ItÕs at least 15% the first three years
of people getting a disfiguring, and I also see as a consultant, disabling
cases of Tardive Dyskinesia.
Claims are made for lower rates with the newer drugs, but weÕre not
learning the tricks of the drug companies, the studies involve lower doses of
their Dopamine blocking agents, they cause Tardive Dyskinesia. I myself have probably evaluated a
dozen cases of Risperidol induced abnormal twitches in children, because weÕre
giving it to children so often.
Now we know the atypicals are also causing
obesity, hypercholesterolemia, the blood lipids going up, fatal diabetes, and
fatal pancreatitis. Let me tell
you how serious the diabetes and pancreatitis issue is. I was a medical consultant in a huge
class action suit for diabetes and pancreatitis caused by Zyprexa Olanzapine
and was settled for ¾ of a billion dollars by the drug company. You heard me right, billion
dollars. Probably no one here
knows it, I doubt it if my fellow psychiatrists know about the settlement. So much is the media in the U.S.
controlled by the drug companies that it barely squeaked out and all the data
was suppressed because the company settled, and I canÕt tell you the data
behind it.
Now NIMH [National Institutes of Mental
Health, Bethesda, Maryland USA] hot off the presses, April this month, the
American Journal of Psychiatry the bastion of the authority system, and we have
the CATIE study from NIMH being reported for Olanzapine, Risperidone, and
Zipraxadone and so on. What did
they find? They tried to do an 18
month study and they found the average drop out was 2.9 months. And why were the drop outs? Well this is an editorial, which sounds
like me; it was an editorial -- theyÕre catching up slowly here. This an editorial of this monthÕs
Journal of the American Psychiatry Association ÒSky high drug discontinuation
rates were seen, suggesting rampant drug dissatisfaction and inefficacyÓ.
The editorial says the side effects were
Òstaggering in their magnitude and extentÓ and warned my fellow psychiatrists
will have to become medical doctors just to treat the disorders. ÒBlood pressure cuffs, scales,
body tape measures, plasma chemistry monitoring, and electrocardiograms and
qualified consultants for medical questions become important components of
practice. WeÕre going to have to
be in the middle of medical clinics just to be testing for the diabetes, the
hypercholesterolemia, the obesity, and the drugs donÕt even hardly work when we
try to study them.
What do the follow up studies show? Clearly the drugs work. If we gave everybody in this room a
Neuroleptic, everybody in this room would loose interest in what IÕm
saying. It would work! YouÕd all be easily lead around, taken
out for a walk. TheyÕd work. But multiple studies indicate that they
have no specific effect on hallucination or delusions. How could they, on this integrated
brain of ours? We blow out
Dopaminergic neurotransmissions and thatÕs going to specific for something like
a thought or an action? Of course
it isnÕt.
All the studies done at NIMH and elsewhere
indicate that relapse rates are greater after the drugs are given than without
having had the drugs. Well, weÕve
got a lot of other things that might come up in terms of the social approaches
that have worked, Lauren Mosher of Soteria House. My own work as of 50 years ago as a college volunteer, there
are many social approaches to these patients and there are two big
lessons.
First people frequently recover on their
own or from psycho social interventions, but they rarely recover from long term
exposure to the Neuroleptics. So
just consider when theses fragile distressed out of touch human beings come to
us for help and they need a social relationship to begin with, human contact,
and instead we poison them. Thank
you.
David: Right, opposing the motion that psychiatric drugs do more
harm than good we have Dr. Mark Salter consultant psychiatrist in general and
community psychiatry in the East End.
Mark.
Mark:
Can you see that? [referring
to slide projected on the screen]
Is that bright enough for you?
ItÕs a picture of a nice smiling lady, a catalogue girl, a model, and
what is that sheÕs holding? SheÕs
holding a very large gun. I am a
member of Amnesty International a wonderful charity that represents the
importance of human beings. The
people Dr. Breggin so clearly stated, that we need to understand, respect and
love, show faith and help to. I do
that everyday talking to people.
WhatÕs my job? I look after
sick people who are stuffed, I mean stuffed by suffering. I mean to go through mental illness is
a pretty damned awful thing to experience. Ok, so IÕm a lobotomiser, IÕm a poisoner, IÕm a murderer of
souls basically if you believe Dr. Breggin.
Now weÕve heard a very radical, angry,
punishing argument here, and when weÕre talking about something like guns and
Amnesty International is satirising something where there is no good
involved. You donÕt need a good
application for a rocket propelled grenade launcher, I canÕt think of one. But if you give a drug skillfully --
now weÕre looking at something different.
These drugs, whatever Dr. Breggin will tell you, if used skillfully and
appropriately can transform radically an unhappy, unhealthy, chaotic life into
a healthy one. Now IÕm not for a
minute saying that these drugs are the answer, what IÕm saying is that they are
part of an answer. I see actually
no reason why a skillfully prescribed Neuroleptic, benzodiazepine, or Lithium,
remember tonight weÕre talking about psychotropic drugs not just
Neuroleptics. I see no reason what
so ever why one of those drugs if skillfully used at a far less toxic, non
lobotomising dose. What of these
words, lobotomy. The very words
carry this idea ofÉ forgive me I was thinking I was an S.S. doctor. This kind of polemicism is no help what
so ever, particularly to those poor unfortunate individuals who have to
struggle with psychotic illness day in and day out. And I will tell you something else, the people who take
these drugs for whom they benefit are quiet, but it is the dissatisfied that
speak the loudest.
It is the polemic, the extreme ranters of
this worldÕs profession who I find frankly are doing no good to the other 95% of
the patients who benefit tremendously from these drugs. And while weÕre at it, how do we
quantify this? If the people for
whom it is doing good are silent -- how do they know how much the other 5-10%
are actually being harmedÉ 20%...30%?
It is a very, very difficult thing to quantify. The notion of harm versus good is
something that is simply impossible to clock up with a straight forward
calculus, but what weÕre having instead thanks to Dr. BregginÕs radical angry
polemic approachÉ
[Random Woman In Crowd:] He wasnÕt angry!
Mark:
Éis, as I see it, a harmful approach. Because what weÕre really doing is throwing out the baby
with the bath water. Just because
the system doesnÕt work, or just because weÕre misusing the system, thatÕs no
reason to abandon the system.
Rather we need to think it more effectively how we use these drugs. Poisons? Yes, but subtle poisons.
One of the critics of psychiatry that I
admire the most in this country said this, ÒI do not doubt that the accidental
discovery of therapeutic chlorpromazine was a major breakthrough in the
treatment of severe mental illnessÓ.
Frequent trials consistently demonstrated in his experience fewer
psychotic complaints or rather Dr. Breggin would say ignoreÉ or encouragedÉ or
poisoned into ignoring their complaints is how he put it. But no -- look if skillfully used,
these people get better. I see it
day in, I see it day out. I know
that because I have a trusting relationship with my patients that Dr. Breggin
espouses.
What am I arguing for? This extremely and no doubt eloquent
supporter of the use psychotropic drugs, is a balanced appraisal, a balanced
scientific appraisal here, not necessarily raving passion. What we need here is something honestly
is about looking at the truth and denying all this. What we need to do is avoid straight forward blanket
rejecting of either argument on either side.
The author of that statement is a radical
activist psychiatrist known as Dr. Richard Bentall himself. This book is what I regard in many ways
as the U.K. equivalent of Dr. BregginÕs book, is a superb book. I advocate and strongly recommend all
of you read it. Buried in here is
a central argument. These
medicines if used at the heart of a much broader understanding that allows
people to look at their souls, their spirits, their relationships, work, life,
living in society that respects and values every single one of those citizens,
then these drugs can be used, and they can be used for good as well as for
harm.
More harm, more good? I donÕt know how to balance that one,
but my gut feeling in my day to day clinical job and my experience in my 20 to
25 years as a doctor is there is good in there. To label me as a lobotomising rocket propelled grenade
launcher frankly is unhelpful, unfair, and dishonest.
PeterÕs book is a book about remarkable
compassion and concern. Leaving
aside his obvious anger and his use of unhelpful examinations that misleads us,
itÕs a book that he stresses by making an utterly individual human value to
every single patient that we see.
ThereÕs nothing new about that, Hippocrates told us that years ago. Also what did he tell us? He tells us that the truth can come
from our understanding of the problems of the mind will come from the
brain. The brain, mind you is a
squishy thinking bag of molecules about the size of a bar sponge dipped in
margarine. ShakespeareÕs central
nervous system wrote Hamlet. My
central nervous system chemicals loves itÕs mum. ItÕs a complicated thing, the idea that somehow my love for
my mum is a meta-phenomenon and has nothing to do with chemicals is frankly
nonsense. The mind is the brain,
chemistry is solid. Anyone who
thinks other wise is frankly wrong.
[Random Outbursts From Audience: Indecipherable.]
Mark:
Let me help demonstrate this point with a very simple image. I want you to look at this slide.
[Laughter] What you will see when
you stop laughing and listen to me seriously, is a fact that there is either
two faces or a vase -- no great news about that. Now notice how difficult it is apprehend with some degree of
fullness, both of those images.
You can see the faces very clearly, you can create in your mind the
wholeness of the faces. You can
see the vase clearly you can create in your mind wholeness the vases, the one
single vase. Try now if you can to
hold both of those images in your mind at the same time and create that same
sense of completeness of both of them at the same time.
It is very hard to do. The fact of the matter is that human
beings have this desperate need of certainty. When confronted by complexity or an attempt to hold two different
images in our minds we have to lean on one side or the other. We are hard wired, our brain, our mind
call it what you want. So look at
the wholeness and we have to try and create something else. What we see here is very difficult. What we have here in understanding the
mind, drugs, versus toxicity.
Frankly is a similar conundrum to the one shown up by this
illusion. The truth of the matter
of course is Peter Breggin is right, and the truth of the matter is that I am
right. We are both right in
different ways. What we really
need, frankly, is not to throw out the benzodiazepines, which do remarkable
things in short term crisis. We
will not throw out mood stabilisers for people who lives are crippled by
bipolar disorder. WeÕre not going
to throw out Neuroleptics we should not throw out these things, babies with
bath water. But no more than we
should throw out the need to understand, cherish, and value the significance of
the pain and suffering of every single one of our patients.
More harm than good? I really donÕt think so. More good than harm? Yes, probably. And itÕs easy as IÕve heard from these
people giggling this afternoon, to boil it down into this angry snarling
sarcasm. But, frankly I donÕt
think that that is a mature or helpful way to take this argument forward. There are a lot of people out there who
are suffering, I mean suffering big time.
I know, theyÕre my patients, I do my best to help them. Frankly, I think saying weÕre going
around poisoning and lobotomising these people is doing more harm than good.
[applause]
David: Ok we move on to the seconders now, and seconding Dr. Peter
Breggin we have Dr. Joanna Moncrieff, Senior Lecturer In Social And Community
Psychiatry at University College London and honorary consultant psychiatrist
with the North East London Mental Health Trust -- Joanna.
Joanna: Right, thank you.
Mark SalterÕs talk made me think of quotation thatÕs in Andrew ScholeÕs
book, which I canÕt tell you word for word, but IÕll paraphrase. HeÕs talking about how doctors,
psychiatrists as doctors want to help their patients -- of course they do. The trouble is according to T.S.
Elliot, some of the greatest harm is often done by people who believe they are
doing good.
[applause]
But before the era of modern psychiatric
drugs, psychiatrists believed that they had some effective psychiatric
treatments. They believed that
they had Insulin Coma Therapy, which was thought to be highly effective, specifically
in schizophrenia. ItÕs
now known that it was not effective, no any better than just giving a placebo
and its mortality was a staggering 5%.
They also of course had ECT, [Electro Convulsive Therapy] which was
thought to be highly effective in mood disorders, particularly depression and some
people still think it is. I donÕt
have time to go into the evidence about ECT, but I think there are severe
doubts whether it is effective.
Certainly no one shown that it can be effective after itÕs stopped being
given, and we know that it causes cognitive impairment while itÕs being given,
and disorientation.
So what I would like to suggest is, that in
the same way psychiatrists were able to convince themselves that things like
Insulin Coma Therapy, ECT, and frontal lobotomy were effective. They have also been able to convince
themselves that the new generation of drugs are effective.
So what about the evidence that is supposed
to back up these convictions? IÕll
just say a few words about anti-depressants first because most of the debate
has focused on Neuroleptics. What
the research shows on anti-depressants is that basically there is only a very,
very small difference between the effects of anti-depressants and the effects
of a placebo. There are many ways
this difference could be produced.
For example, trials on anti-depressants are not properly double blind --
people who take anti-depressants can tell they are on an active drug, because
they have physiological effects.
Most people who go into trials want an active drug, and there for youÕre
going to get biased, because of expectancy effects. As well as that, anti-depressants cause a state of
intoxication and following the same sort of arguments that Peter Breggin was
making, this state of intoxication may itself dampen down feelings of depression. It may distract you, if youÕre
struggling to stay awake and struggling against the intense cognitive
impairment caused by a full, supposedly, therapeutic dose of the Tricyclics.
You probably havenÕt got much energy, thinking capacity left, to focus on your
problems, at least temporarily. Also, most anti-depressants have sedative
effects, depression rating scales have lots of items like sleep difficulties,
tension, anxiety, that are likely to respond to these sedative effects.
In conclusion, really we donÕt have any
evidence that anti-depressants have a specific anti-depressant action. Does it matter? I think that the epidemic of
anti-depressant prescribing is concerning not only because of the side effects
that are well known about, because of suggestions that they might make people
suicidal. But I think that the
most important thing is the psychological impact. That if you tell people that their problems are due to a
chemical imbalance and that the solution is a drug -- you are actually undermining
peopleÕs confidence in themselves, in their own ability to overcome their
problems, and I think very likely making people more vulnerable to relapse
because of that. Because people
donÕt learn that they can over come their problems themselves.
IÕll just say a couple quick words about
Neuroleptics. I donÕt want to say
much about the short term effects, but my concern really is about long term use
of Neuroleptics. Many, many
psychiatric people who have psychiatric problems are put on these drugs long
term. Anyone who has a psychotic
episode, especially if they are diagnosed with schizophrenia, is told they have
to take these drugs for at least several years. The evidence to support this recommendation is severely
flawed and thatÕs because psychiatrists have ignored discontinuation
problems. That what long term
trials show -- if people have been taking Neuroleptics for a while and then
come off of them, especially suddenly, there are a number of problems. They might get withdrawal syndrome,
part of that withdrawal syndrome might even be a psychotic episode. You can show that, there are some case
studies of normal people whoÕve been on similar drugs like Neuroleptics who get
psychotic when they stop them.
ThereÕs also evidence with anti-psychotics
and with Lithium in particular, that when you discontinue these drugs, you
become increasingly vulnerable to a relapse of the underlying problem. And your vulnerability is raised above
what it would have been had you never gone on these drugs in the first
place. So what I think the
evidence which is supposed to demonstrate that long term use of these drugs is
effective, really shows is thereÕs a huge iatrogenic problem. That weÕre actually creating recurrent
disorders and this is due to discontinuation problems in many cases.
David: Ok, thank you.
Seconding Mark Salter we have Trevor Turner consultant psychiatrist and
clinical director in the city of Hackney and senior vice president of the Royal
College of Psychiatrists. Trevor.
Trevor: Thanks very much for this. I hope that going in as Ôtale end of CharlieÕ wonÕt be too
difficult for you. IÕll try and
sum up some of the arguments that we are making, and IÕll try and focus on some
key points particularly on two or three points. Especially some historical facts, the nature of how the
brain works, and grows, and thoughts about the myth of perfection or ideal
states. Because IÕm afraid we
donÕt live in Eden, we live in a world where many people are dreadfully
handicapped by dreadful illnesses.
We take the instance for example diabetes; insulin can keep you
alive. Until Banting and Best
discovered it in the later part of the century people died within the space of
three or four years, now people live very good lives. Well then dreadful things gradually start to happen, because
the illness progresses despite the insulin, in thirty to forty years down the
track. So of course, JoannaÕs
argument about the problem when you go on with drugs. Well of course, the reason why is, thereÕs an underlying
illness thatÕs progressing. And
our ability to arrest this illness remains impaired; we are limited in our
therapeutic armoury.
Peter mentioned something about rooting for
a football team, and it reminded me of yesterday -- I was at a funeral when a
man had been rooting for his football team very happily for over 30 years,
supported a local club, liked music, all that kind of stuff, looked after his
mother, his elderly mother, died at the age of 78. This man was sent to hospital in the 1950Õs with dementia,
but then as the priest pointed out, thanks to new medications he came out of
hospital, and then spent the next 30 -- 40 years living at home, looking after
his mother, watching football, rooting for his football team, enjoying music,
and living a very normal life. The
type of dementia he had was what we used to call dementia praecox, which was
the old term for schizophrenia.
Part of the change of language was the view towards but it is actually
what was meant by introducing the term schizophrenia, which was used by Bleuler
at the turn of the century.
I just wanted to get that out as sort of a
starter. Can I also mention a
quote from Dr. Frank Ayd from the 1970Õs, about the pre drug era. This is the pre drug era and heÕs
talking about. This in 1970 ÒAn
attitude of pessimism and despair towards mental illness was prevalent. Within the bare walls of isolated,
overcrowded prison like asylumsÓÉ as PeterÕs mentionedÉ Òwere housed many
screaming, calmative individuals, whose behaviour required restraint and
seclusion. Catatonic patients
stood day after day, rigid as statues with their legs swollen or bursting with
dependant oedema. Others were
incessantly restless, pacing back and forth like caged animals, nurses in
attendance spent their time protecting patients from harming themselves and
others. They tube fed people to
sustain life. Even though trained
to be therapists, they were forced to function as custodians in a hellish
environment where despair pervaded and death offered the only lasting respite
for the suffering changes.Ó I
think when we think about the world as someone who might not be who they
are. A world of possibly someone
with chronic severe mental illness such as schizophrenia, and this by the way
is Max Ernst Òa man who can see anotherÓ 1993. In a sense IÕm trying to give you an image of the different
faces of people under this dreadful illness and how it effects you.
This is called ÒRaving man chainedÓ. I just studied in the Tyas House Asylum
which is a primary asylum for England, Sussex, 600 patients and I read the
books from 1853 to 1890. And one
of the major tasks of the nurses in that asylum was to force feed people, was
to sedate them with hot mustard baths, and some people got better certainly. But to watch people die from syphilis
of the brain, cured now by some anti-biotic. And about a third of the patients constantly grimaced,
muttered, and became restless, but do you know what happened to them? They developed Tardive Dyskinesia; did
they have a single dose of a Neuroleptic? No. ItÕs been published and there are other studies for example
1921 David Cooper the Anti-psychiatrist refused to give any of his patients any
anti-psychotics what so ever, and when followed up twenty to thirty years later
they had the same instance of T.D. as patients on medication. A further study of Monsoon and Medrets
carried out in India a couple of years ago, many patients in India donÕt
receive any medications at all, and you think ÒHey! How wonderful theyÕre free to
live their lives.Ó But the same
number of people had Tardive Dyskinesia in Indian patients who had no
medication as those that had had medication. The difference was the ones who had medication were on the
streets.
This is quite a wonderful thing -- James
Tilly Mathews and the air loom machine.
This was described in a wonderful book by Michael John Hasden in 1805 of
a complex delusions of a man who clearly had a severe schizophrenic illness,
indicating that this illness has been around for quite a long time, itÕs not a
product of modern civilisation or eating KelloggÕs Corn Flakes even.
You can see, this is actually the history
of the asylum in England. If we go
to the left, they built asylums, they built them. There were Lunacy Acts, and world wars -- but nothing can
stop the rise of this monstrous caging of impossible to manage people.
IÕve seen the insides of asylums, IÕve
heard stories of what went on.
There were some good things and some bad things but essentially they
were in the words of Andrew Schole a sociologist ÒMuseums of MadnessÓ. Somewhere around the 1950Õs as you can
see, the numbers start to come down, moving towards community care.
WhatÕs the reason for this? Well Chlorpromazine was introduced in
1954, but I donÕt think that was the only reason for this. I think it made it possible to do
things, it changed zeitgeist of the open door movement -- normalisation the
notion that these people are not to be locked up and put away. Even though we live in a government
now, that has a risk management and public safety -- terrified of public agenda
so you canÕt even have a tea party on the Westminster lawn. But you canÕt take away the fact that
this all the intents of open door normalisation went hand in hand with the use
of medication.
Let me show you a couple simple slides and
boring graphs of how medication works.
Number one is a depot injection.
The active one is the alpha, the beta one is the placebo at the top,
thereÕs a big difference, a 50% difference in symptom scores over the course of
weeks when given these medications.
This is a fairly traditional study.
Relapse rates after stopping
anti-psychotics, if you stop it gradually. Let me show you a picture of a brain, just to say that
actually hallucinations, delusions, thought disorders, the dreadful symptoms of
schizophrenia, theyÕre not just of the imagination, theyÕre abnormalities of
brain function.
I canÕt show you a picture of a brain
lighting up, IÕm sorry. IÕd like
to show you a picture of a brain lighting up. I mean PET scan lights up when someone is hallucinating,
when their brain lights up on a PET scan.
It is a real illness, it is a brain illness, we have to treat it with
medication. We know itÕs not the
end thing, we know theyÕre not perfect, but itÕs something that helps people
communicate with us. It gives us a
handle in to the psychosocial interventions and personal contact and the
ability to talk.
One of the most tragic statements IÕve ever
heard from one of the overcrowded acute wards that we all have to deal with
because people are not prepared to fund mental illness. As soon as patients can talk to us, we
discharge them. They come in mute,
confused, perplexed, frightened.
As soon as they can talk, any kind of sense -- theyÕre kicked out into
community care. Because thereÕs a
shortage of funding. Medications
help them to some degree, but we know that psychosocial is much more
important.
Finally, I would have shown you a slide of
a man crawling through the desert, sweating away, his tongue hanging out, the
sun beating down, and heÕs saying to himself ÒcounselingÉ counselingÉÓ. Counseling can help, talking to
counselors can help, but it canÕt help people who can not think straight for
themselves. I ask you therefore,
to think very seriously about this notion that psychiatric drugs do more harm
than good, because if youÕre saying that, youÕre asking to go back to the
terrifying era of that one terrifying thriller film by Warner Brothers of the
Snake Pit neglect, abuse, and so forth.
Just to give you an olfactory sense of what
it was like in the pre modern drug era, I have got here a little phial of stuff
called Paraldehyde. Paraldehyde is
horrible, itÕs a kind of anti-convulsant, and itÕs the only thing they had in
the 20Õs and 30Õs to calm down furious, very angry, enraged people. IÕll pass it around, have a sniff. Thank you very much.
[applause]
David Brindle -- the man at the back first.
My name is Donner McCloud, I want to put to
Mark and Trevor. Firstly youÕre
responding to distress by trying to be belligerent, you can make anybody in the
world happy by tampering with the brain in some way, in theory you can do
that. Ok, there are all
consequences as Peter says, but in theory maybe you can do that. I want to contrast firstly the method
of drugs, everything is physical, this conversation is physical
biochemical. But when youÕre
actually giving people drugs, youÕre actually cutting interpersonal
communication youÕre not communicating with the person like weÕre doing
now.
IÕve actually supported people through
psychotic states. IÕm not a mental
health professional, IÕm from your hospital. IÕm from Hackney. People were on Haloperidol, we actually
got them off the Haloperidol, weÕve set up support groups around them and
brought them through. But thatÕs a
biological process, we werenÕt using chemicals. ThereÕs a more appropriate biological process than the use
of chemicals. I just like to also
ask Trevor saying about the is an illness, this is like the abnormalities of
function, is there any scientific, objectifiable, or verifiable kind of
evidence of that, if you can actually verify.
Irene Clayton: Hi I am Irene Clayton, Manic Depressive of this term. IÕm of Mind and we are user run, user
lead. I would like to say thank
you very much to Peter Breggin from a very personal deep heart felt thank you
for giving me hope, because on this side of the table I donÕt get any. On this side of the table I donÕt see a
recovery model, on this one I can recover. The more iniquitous part of this, the deeply iniquitous part
of this whole debate is the medical model the one that says thereÕs something
wrong with my dopamine or my serotonin or what ever it is pathways, is due to
something thatÕs wrong here.
And therefore nothing to do with whatever
trauma or abuse I might have suffered in my past. And therefore and this is why theyÕre still desperate to
find a genetic cause for my illness, society is exonerated. So long as itÕs something in my brain,
society doesnÕt have to worry that this British wonderful society I live in, is
the worst society one of the worst I know for child abuse, let alone abusing
women, let alone for abusing everybody, IÕm afraid except for certain middle
class white men.
Odi Artist: I would like to stand up, my name is Odi. I am from Brighton, I am diagnosed
schizophrenic. But I am not. I am a good artist as you can see what
IÕve done. People have a line of
personality. By this I mean, if
you treat people with love and understanding, then there will be no need to
think of helping people with medication.
But when you think about holding the mind, or trying to justify how the
mind works, we all came from different backgrounds. You canÕt use the same medication that you used on me, on
that kind of person, that can react into many kinds of things.
IÕm a shaman, IÕm an African, IÕm a shaman,
IÕve been a shaman, and a doctor too.
I can understand at the same time understand how the mind and how... get
into the space or get into the mind of people, which you donÕt believe if I say
something like that. Say spirit or
say my ancestors. But if you can
look back into history on how black people seeing slavery, seeing how they are
generally being put down, or seen what is nigger and all these things. So why canÕt people see how the
institution has made people mentally sick and again in trying to help people
without their own understanding by pushing needle into your hand. ThatÕs what I wanted to say.
Susan Wolfe: Hi I am Susan Wolfe and I am from Laramie Wyoming in the
States. And I am a social
historian and I have studied and done primary research in the States and
territorial mental asylums in the late 19th century and early 20th
century. And IÕve studied social
records of young women who were locked away for having sex with their
boyfriends as late as 30Õs, 40Õs, and 50Õs. Of men who were locked up in asylums for masturbating,
children at age seven who were locked up for life for masturbating. So IÕm sorry Trevor you can not tell
me, you can not show us pictures of people from another century tied up in
chains and talk about how the drugs of this era have freed them from the
chains. Those are two separateÉ
IÕm É inarticulate with my response to your argument because it makes no sense,
it doesnÕt follow. That if you lock
everyone up in chains they are going to have an emotional response to it. If you take anyoneÕs personal freedoms
away and put them in horrendous conditions, there is going to be a negative
response to it. And so to justify
the use of these drugs and say how much better people are then they were in
those days when people were locked up with those things, is not an appropriate
argument.
Man:
that would be exactly the same as shooting the patients.
David: Trying to keep the balance is there anybody who wants to
speak against the motion. Right,
that gentleman right there.
Terry Williams: ItÕs true IÕm afraid; I like many people here have a very
sincere interest in this debate.
My name is Terry Williams, and we have a son, our third son who has been
diagnosed variously as schizophrenic, bipolar disorder, manic depression in
those days. So for 18 years weÕve
been trying to do what we can to help our son, and I must say when I read Peter
BregginÕs book Toxic Psychology I was bowled over by it. Because it said to me, the experts here
with impeccable credentials are disagreeing. In any other branch of science that does not happen, and
that made me understand that psychiatry is not a science. ThatÕs for sure. However over those 18 years we haveÉ
because of PeterÕs very instructive and well researched book, we have agreed with
our son, that least medication equals best. And if least means nil, thatÕs great, and for some periods
it has been nil. None the less
there have been relapses and when I say periods, IÕm talking about two years,
two and half years -- no medication what ever. However still relapses, and these relapses have become more
frequent, so the question that arises now is fine, PeterÕs critique of the
toxicity of these pharmaceuticals É
If psychiatry is not a science, then surely
what we must do is use every weapon in the weaponry, and if that means
psychology and it means some medication.
Then certainly some medication may help. More for the research, but I would like to hear from Peter
if there is a mass movement for this, just as there seems to be a mass movement
to give medication.
David: Any more speakers against the motion?
Lady in Audience: I want to say the drug company marketing is extremely good
for my shares, but I must admit this, IÕm sorry. And also I would like to know a little more about the actual
marketing of these drugs -- because itÕs very aggressive indeed, and despite
people are supposed to be healthier it seems to me more people are being
drugged on these drugs and becoming ill.
One of example of this is diabetes, that needs help, and you need
insulin. And it can be controlled
just like the psychiatric drugs control... . A little at the right time controls some people.
The debate here is Ôdo psychiatric drugs do
more harm than goodÕ -- and the way theyÕre used they do. That is the point. Occasionally they might help someone
through a trauma. They might help for a limited period of time, as sort of the
case weÕve heard before. But what
weÕve never had is a full physical examination of that patient to see if
theyÕre sensitive to any foodÉ I know of a kid on Ritalin because he canÕt
tolerate egg whites for goodness sake.
As simple as that, that can be worked out without putting a kid on
Ritalin which is an extremely dangerous drug. The marketing, how aggressively is the marketing in the
Royal College of Psychiatry please?
David: Ok, weÕll come back with that. Any
more against the motion ?
Male Nurse: IÕm Ray Rowden, and I used to give Paraldehyde to patients
in a 1,000 bed mental hospital in the early 1970Õs as a nurse. I remember doing it, and it came out
through the skin and the whole of the room stunk. IÕm not sort of saying IÕm totally pro the arguments on the
other side of this debate, but I do have a lot of friends who have used
medication who have experienced different experiences. And I find that if people can feel they
can have some sense of control of their medication along side of other choices,
diet, exercise, leisure, friendship, work, education, people I know who use
services have some sense of choice and freedom about when they choose to
use. Can I have a drug holiday
please? Can I have a planned
period where I might come off of this and try a different set of choices? I think thatÕs a wise use of medication. To say itÕs all harmful I think, is not
on, I think if you help people
make their own informed choices that support them on that kind of journey, some
of these drugs can help. Because I
can remember these old asylums of a 1,000 beds and I wouldnÕt want them back.
Lady in Audience (again): But can I ask in your work as a nurse,
how often were people given a complete physical examination before they were
started on the drugs, and how properly and comprehensively monitored on those
drugs, the physical damage because they do a lot of damage.
David: Ok, thank you.
Gentleman there, yes.
Cliff Bollard: My name is Cliff Bollard and I came with my son, along with my
wife of about 15 years, sadly he committed suicide two to three years ago. I really donÕt want that to influence
what I am saying, but I just wanted to give you an illustration. You guys may be experts in
schizophrenia and manic depression but I, and my wife, and my colleague are
experts of the illnesses of our sons.
We see the symptoms and we see the side effects of the medications not
just 20 minutes every so often but every day of the week. One of the points I wanted to make is
this. When my son died I said to
the psychiatrist that I thought it was possible that his suicidal ideation
would of started as a result of surgery because frankly before that he had
never talked about suicide, and she denied it categorically. She said thereÕs no chance, I wasnÕt
seeking a causal connection, and I was merely suggesting that it was a
possibility, but it was dismissed.
And this is a reflection of the attitude of the mind. In fact within a few weeks there were
stories coming out about it. But I
want to hasten on, because we belong to a very active carersÕ group in
Hertfordshire and our view in fact from direct experience is that frankly the
efficacy of pharmaceutical treatment of serious psychiatric illness is not very
good. That is our experience. WeÕve shared it with other groups who
agree with us. Mind we think, say
yes you have a point. WeÕve made a
very positive suggestion to the government and also to the Institute of
Psychiatry, we said itÕs about time that you asked the users and carersÕ for
their views of the efficacy of treatments and its side effects. And of course no one wants to hear
that, and thereÕs very good reason for it I think because probably theyÕre very
afraid of the result. But until we
know what the real situation is in the real world, to my way of thinking weÕll
never make any progress.
One very other quick comment, our
observation of modern psychiatry is it looks that way [Pantomiming tunnel
vision], but it doesnÕt in fact look that way [Pantomiming open vision]. Clinical trials are the God and frankly
as far as psychiatric medicine is concerned there must be a big question over
clinical trials. Because as a
psychiatrist said to me that 30% of his patients benefited from Olanzapine. What about the other 70%? And of course, he couldnÕt forecast
which of the 30% in fact would benefit, so this puts a question over the
scientific method. But what has
been neglected is in fact the experience in the real world. The effect of for example of nutrition,
thatÕs just one example, the effect of talking therapies. But the vision is tunneled and what we
really need to do is open it up as it were to all the other possibilities that
there are for treating these dreadful diseases.
Bob:
IÕm going to try and get this machine to do what I wanted it to do, but
it would seem as it is already temperamental. What I want to say is, that the drugs dull the patientÕs
mind, which is why theyÕre given, worse they drug the doctorÕs mind. My book here, is Unsafe at Any
Dose. The reason IÕm now happy with
that title, which I wasnÕt ever so much to begin with, is because it deflects
the medical mind from other approaches to this problem, which as weÕve heard is
a quite severe one.
What I want to do now if my machine will
cooperate even a slight degree, is to show you a very painful video. ItÕs only two and half minutes, if it
once goes weÕll be in business.
Now what this shows is a patient suffering acute psychosis, I apologise
in a sense because itÕs very painful to watch. But this is the reality as weÕve heard of mental illness
itÕs extremely painful or can be extremely painful. And what I want you to look for -- this patient starts off
by saying that sheÕs full of hatred, she gives very clear evidence of thought
block, thought disorder, she canÕt string a sentence together, she is paranoid,
sheÕs clearly deluded, she thinks sheÕs going to die, sheÕs hallucinating,
sheÕs in a great deal of misery, sheÕs in a lot of pain.
SheÕs actually weeping, and here she isÉ [trouble with the
machinery]
David: Bob a question has been asked about the precise nature of
this client, and the consent issue I think. Can we just ask aboutÉ?
Trevor: Has she given consent?
Bob:
Yes. She had given full consent.
She asked if she would be blown up on a full screen
[Video of Woman weeping]
Bob:
She said she is dying, IÕm asking her why. SheÕs thinking about it, very slow thinking as you can see.
[Video ContinuesÉ]
Bob:
So this is in the same interview.
[Video ContinuesÉ
Bob: ÒMy emotions are telling that without
my Dad, IÕm dead -- this is WRONGGGGGG.
Say that.Ó
Hatty: ÒMy emotions are telling that
without my Dad, IÕm dead -- this is WRONGGGGGGÓ [giggles]
Bob: Now that is within half an hour. What I want to say there is that is
talk therapy as it should be done, uhÉ that is the way I do it I should
say. If you are writing
prescriptions and relying on a chemical approach, then youÕre going to ignore
these three factors IÕve highlighted here which is: Ignoring the Fear, Ignoring the Mind, and Ignoring the
Software. If itÕs not a hardware
problem, then itÕs a software problem, and the way to remedy a software problem
in a disturbed mind is to talk, but you have to talk with the expertise as I
tried to demonstrate a bit of there.
I might say, IÕm a consultant psychiatrist and I very much enjoy my work
because by talking to people about their earlier traumas or in this case their
earlier mal-attachments, you can in fact get really dramatic results and
sometimes the technology can show that.
Thank you.
Lady in Orange: I apologise I arrived late. When I read Peter BregginÕs book on Toxic Psychiatry I had
already been well on the way in going to autism conferences where individual
biochemistry is absolutely essential in recovering these young children and
older people on the autism spectrum as well. I would like to understand why the clinical studies and the
effective results that psychiatrists such as Abraham Hoffer have achieved in
recovering schizophrenia why orthomolecular psychiatry has been marginalised
and whole idea of a personÕs individual genetic biochemistry is totally ignored
in the field of psychiatry, in one size fits all drugs. If he has a diagnosis of schizophrenia
then itÕs two anti-psychotics two strikes youÕre out, then itÕs Clozapine. I donÕt understand how every other
health issue takes into account a personÕs individuality and this isnÕt the
case in psychiatry.
David: Ok, thank you.
Um, yea the hand there and then the gentleman in the back.
Lady with Black Bonnet: I am a mother of a young man whoÕs been
diagnosed with schizophrenia several years ago, at the age of 15 in fact. I think one of the most terrifying
things IÕve found about contemporary psychiatry is that if a patient starts to
deteriorate on medications year after year, including clozaril they are then
seen as chronic treatment resistance and there is no question from the
psychiatrists that my sonÕs seen that this could have anything to do with brain
damage from medications. IÕm
watching this process with absolute horror, and the quantity of drugs heÕs been
on maybe 8É 9 different anti-psychotics, anti-depressants, Benzodiazepine, mood
stabilisers, from being a coherent intelligent sensitive young person, heÕs now
almost like someone with severe dementia.
He can not speak, he can not do
anything. HeÕs only 26 and IÕm at
my wits end about how to help him, where to go, so somebody will give him a
chance and see how he is, off drugs, withdrawn gradually. And then if itÕs too late, or if he
canÕt be helped I of course will go along with any drug possible or any form of
help possible. But itÕs never been
given this chance, once people get the label of schizophrenia, they are in a prison
of drugs, of care in a community, or in a hospital. And one slight action like throwing something, breaking a
vase, or shouting in the street or whatever, and thatÕs it, straight back into
hospital more and more drugs, and these sometimes isolated incidents, are never
forgotten, even if itÕs two or three years back. ÒOh well itÕs a risk in the community, we canÕt ever have
him off drugsÓ. This is horrific
for someone who has never harmed someone in the community or who has never self
harmed, and that is my nightmare.
David: Thank you very much.
That gentleman right there.
Michael Corry: My name is Michael Corry, and I am from Dublin and IÕm a
psychiatrist. IÕve trained in
other branches of medicine, and very fortunate of having trained in obstetrics,
I did my paediatrics in England and was trained in Liverpool, and I worked in
Alderney, and I worked in Africa as a surgeon. I then came back to Ireland and I studied psychiatry. The one thing that stuck me with
psychiatry is that there is fundamental fault line running through. You never get physicians, you never get
cardiologists, you never get people actually criticising its own profession.
The reason there is an anti-psychology movement
has to be looked really, really seriously. There is a whole vast constituency of people out there. Go out to the internet, there are
gazillions of sites of people who are seriously worried about the way
psychiatry is conducting itself.
You do not get that in any other branch of medicine, and I have
qualifications in three other branches of medicine. You donÕt get that.
And this flaw has to be recognised, from my own perspective and weÕre
all sharing interpretation, and IÕd like to get my own view and IÕll be very,
very quick. WeÕre not dealing with
a disease, and this is the issue, weÕre dealing with something
existential. WeÕre dealing with
something about spirit, weÕre dealing with something that is psychosocial.
Take a very, very simple example,
depression which is sweeping throughout the nations throughout the world. The pharmaceutical companies want to
make it a disease, they want to make that an endless threat. If you loose your job at the Guardian,
and you have to meet financial commitments. Very simple example, you run into your financial problems,
and you go into your family GP, and he prescribes an anti-depressant. As youÕre about to cash it in to get
your prescription, your phone rings and you are told got your job back and you
got promotion. Your depression is
going to lift, and that does not happen in any other branch of medicine. Whether itÕs cystic fibrosis, or
multiple sclerosis, so weÕre not dealing with a disease. IÕm a scientist, IÕve trained in
medicineÉ IÕve no agenda, IÕm interested in scholarship. We have to take on board thereÕs a
fundamental fault line running through the practice of psychiatry.
David: Ok, thank you. Just about 15 to 20 minutes to go, if
you can keep the contributions as brief as possible we can get in as many as we
can. That gentleman right there
has been trying to get in for quite some time.
Peter Bennet: Thank you, Peter Bennet and for thirty years IÕve been a
police officer. So IÕve dealt with
an awful lot or come face to face with a whole range of people with so called
mental illnesses or ill health.
IÕve seen those on drugs and then I saw a rapid increase in the number
of people, particularly young ones with pockets full of various drugs,
prescribed drugs, not so much the other ones that often gets the blame, you
know for things like asthma. To
jump ahead, I started looking at other factors, and looked into the background
of psychiatric treatments going way back 100Õs of years. And thereÕs one thing that kept on
niggling me, itÕs been mentioned tonight several times, itÕs a four letter
word, called diet or food.
And just as an illustration and a side
track if you forgive me, in America in particular they have the Food and Drug
Administration, food and drug both four letter words, actually going
together. Food comes first, but
the emphasis on concerns diseases and treatments particularly in America and
thatÕs repeated over here is -- drugs come first. I find that, and I work with people, particularly young
people and they get ASBOÕs and a lot of them are immediately, first or almost
first consultation with the GP and then perhaps some of them going on to
consultants are put on the various drugs weÕve been mentioning tonight. There is no proper assessment of them,
thereÕs no routine consideration of other factors such as food, diet,
nutrition. I repeatedly find that,
and yet underlying all mental illness and a lot of physical illnesses there is
a nutritional element. Now itÕs
not just a matter of identifying those and finding them, itÕs usually some
concomitant deficiencies in essential minerals, I will just quote a couple of
themÉ
David: No, your point is clear and we really must move on. IÕll take the hand here and the lady
over there please.
Blonde Lady: Yea, I think thereÕs a practicality about all of this in
that when a person becomes very mentally distressed or emotionally distressed,
they may find that they are unable to work. In this country, and I presume it is much the same as in
America in order to get any kind of income if you canÕt work, you have to be
signed off not signed off as distressed but signed off as sick. So you've got to go to a doctor and
say, ÒIÕm sick can you sign me off of work, so I can get the benefits I need to
live on?Ó Not only are
psychiatrists prescribing drugs, but theyÕre also determining whether you get
an income or not. ThatÕs how it
works in this country, and people are in a trap... Many people with severe
mental distress are unable to work for many years, and we are virtually trapped
by this whole situation we find ourselves in. YouÕre literally railroaded into the psychiatric system and
once youÕre there youÕre on drugs.
I would like psychiatrists to appreciate that not only do they wield the
power of getting people drugs, but they even wield power over our incomes and
livelihoods.
Katherine Duncan: My name is Katherine Duncan and I am a patient at Maudsley
Psychiatric Hospital in London. I was
first prescribed Benzodiazepine when I was 16 years old. I am now 53 and I am still on
them. I can not imagine how any
psychiatrist can justify that. Of
course IÕm addicted to them now.
Recently, in January I was changed from the SSRI I was on at the time to
an SSNI a new drug Duloxepine. The
side effect of that was, I could not sleep, I have not slept for more than 2 to
3 hours a night since January. So
what did they do? They gave me
Temazepam, to try and help me sleep on top of the Diazepam. I have tried asking to talk to
somebody, no thereÕs no psychologist available, you can see your psychiatrist
in a few months. ItÕs unbelievable
and I totally agree with the lady who talked before me, that if I do not
continue attending my programs at the Maudsley I will not continue to get the
income I need to live on. So I
feel I am in a catch 22 situation.
I either go and I get the tablets or I have no income. IÕve now been a teacher with such a
long history of mental health problems, IÕm never going get back to being a
teacher again. So because of an
initial diagnosis, actually I donÕt even remember what that is. Right now they say I got bipolar
disorder, IÕve had so many diagnoses I canÕt even remember them all. Because of that, because of the number
of hospital admissions IÕve had, I have now even been denied the opportunity to
return to the job for which I am trained, and that is down to diagnoses that
have put me in boxes and labeled me by psychiatrists.
David: Thank you.
Peter and Mark will be formally summing up at the end, IÕm just going to
ask Trevor and Joanna if they want to just at this point say anything in reply
to some of the points that have been raised.
Trevor: There are many proper points raised by people tonight, and I
deeply sympathize with everyone who feels theyÕve been badly treated or whoÕs
had a bad illness, because these are awful conditions to have. We know that. I entirely sympathize with the last personÕs point, we spend
our time being forced to fill out DLA forms, stacks of them everyday, and we
think ÒWhy do we have to do this? Why canÕt the person just carry on, theyÕre
obviously in control and canÕt think straight or whatever. Why are they making us do it?Ó We hate doing this sort of stuff. 90% of mental health consultations
donÕt take place with psychiatrists, but with GPÕs. Which is perfectly reasonable and a more holistic approach,
and with regards to the issue about, which is a very important one. The Royal College of
Psychiatrists and drug companies -- everyone agrees within the College and
thereÕs been a change in policy the last 5 years or so, actually it was
inappropriate the amount of sponsorship we were receiving. Partly because no one else is prepared
to fund research in this country on mental health, by the way, literally no one
else. You can get more money for
old donkeyÕs homes that you can for looking after mentally ill people. And you can spend more time in
parliament arguing about fox hounds then getting a new Mental Health Act
through. So I entirely sympathize
with all those points.
David: Ok, Joanna.
Joanna: I wanted to support LynnÕs point about the politics of it
all I think thatÕs so important.
Psychiatry is drugging children who find the school regime difficult,
drugging people who find jobs over pressurizing. And instead of society saying ÒHey! What are we doing wrong?
Maybe our working environments are wrong, and maybe our school systems are
wrong. What can we do about this?
Ó WeÕre labeling these individuals
as ill, and giving them drugs and this is such an important point, keep in
mind. And thatÕs why the drug
industry promoting these drugs, making them so wide spread telling everybody
that they are depressed -- everyone theyÕre hyperactive -- is so dangerous.
The other points is just to pick up on are
the carers points, because I think it is such a difficult thing to answer. If the drugs arenÕt any good what on
Earth do we do? And I really donÕt
think there is any easy answer at all.
I think we need to help people to develop to their maximum potential and
to try and create an environment where they can do that. I donÕt necessarily feel that thereÕs
absolutely no role for drugs in that, but my problem is that the way theyÕre
administered at the moment, they're being given as if theyÕre a cure as if
theyÕre going to change a person into a different person and they are going to
correct some biochemical abnormality.
And instead we should be encouraging people to be themselves, and try to
maximize what they can do, and be proud of what they can do, and to be proud of
themselves, and to come out into the world as themselves rather than trying to
change themselves into something else.
David: Lets take some rapid fire points from people that havenÕt
had a say so far.
Dark Haired Lady: Who is making the money out of all of this? TheyÕre forgetting all of this, theyÕve
just done a big campaign on stop smoking, stop smoking, why? Because theyÕve invented enough drugs
that you can become addicted to instead of a cigarette. Why didnÕt they stop smoking years ago
and itÕs the same with bloody mental health drugs theyÕre handing out?
David: Next.
Sally: IÕm a mother of a 32 year old man with AspergerÕs
syndrome. For 14 years he was
treated for schizophrenia. He was
therefore tried on Neuroleptics and lots of other psychiatric drugs, none of which
helped what so ever, and our experiences when the drug didnÕt work, they upped
the dose. Then they added another,
and then add another. Fortunately
seven years ago, we found a doctor, to cut a long story short, heÕs weaned my
son off all medications and has been medication free for six years. And I wanted to talk about
misdiagnosis, and it seems to me that psychiatrists are not willing to share
their ideas, or contact someone that is an expert in autism and I know lots of
people that I believe are being treated for schizophrenia who are not
schizophrenic.
David: Right, thank you very quickly now.
Man Dressed in Blue: From the University Hospitals of
Geneva, evidence is highly suggestive of a causative role of atypical
anti-psychotic in the induction of manic hypermanic symptomology. Gentlemen?
Young man: In any other branch of medicine, such as pediatrics or letÕs
say cardiology or whatever you have consent you are allowed to say no, in
psychiatry you canÕt.
David: Good point.
Lady there.
Young Dark Haired Girl: If I had any honesty with my psychiatrist
when I was first taken into hospital, they wouldÕve labeled me schizophrenic
but fortunately something inside of me told me it was a really dangerous place
and donÕt tell the bastards anything.
My follow up point to that is that after 10 years, going through the
drug chemical nightmare hell, I finally took myself off of all medications
completely alone, and changed my diet, wheat, dairy, and sugar were my
allergens and my life is completely different now.
David: That lady over there.
Old Lady: I have a very keen interest in the matter raised by our
shaman friend, because of my own personal connections as it seems to me that an
awful lot of ethnic minority people get diagnosed schizophrenic but all theyÕre
really suffering from is that fact
that racism is a central issue 24 hours a day to them, to us it is
peripheral. We hardly notice it,
and if society would just accept responsibility and treat everybody decently
there would be no problems arising and theyÕre certainly not
schizophrenic. TheyÕre simply
being subjected to improper pressures.
David: WeÕre going to run over by 10 minutes. That lady there.
Woman Behind ManÕs Head: My sister, sheÕs been in psychiatry,
diagnosed with schizophrenia, and she told the doctor she wanted to do support
therapy and they said no you canÕt do that, and I just wondered why it wasnÕt
possible to have alternative therapy?
David: A couple more I think, that gentleman over there.
Irish Man: IÕm a practicing psychotherapist and IÕm from Ireland as
well, and an ex-cop with an interest with human rights issues. And I think with all due respect to the
debate, we are probably uncovering one of the greatest human wrongs in
history.
I want to give you a taste of what I am
saying. In Ireland in the 30Õs the
most respectable institutions in our country being Catholic, were the priests
and the institutions who we entrusted our children to in thousands. Those children now, it has been
discovered, were being abused by priests.
Priests who were trusted by a very compliant majority who were
positively stigmatized by the then doctrine that was prevailing.
Presently the doctrine that prevails at the
hands of psychiatry is the good doctor.
In the institutions of good medicine, there are so called psychopaths,
as there were in these institutions.
IÕd like to see someone do a trawl for psychiatry in the same way as
they did a trawl for priests like they did 50 years ago and find out what
shenanigans are going on, and whatÕs going on in this institution. And most importantly of all, the agenda
that sets out because itÕs a very cruel and like the African gentleman said
ÒBad medicine...Ó, to say to someone and this is well known in Africa, ÒAnd
youÕve got an illness and thereÕs no recoveryÓ, that is bad medicine. ThatÕs being practiced by doctors
everyday.
Man at the front. Yea, I was a part of a research study about Haloperidol and
other Neuroleptics a few years ago.
I havenÕt had to have it ever again. And I was just wondered if Mark Salter or Trevor Turner have
ever actually had Neuroleptics and what they made of the side effects. Or whether they should actually be a
part of the psychiatric nurse training.
And the doctors I know who have tried it themselves are actually more
cautious about prescribing it in the future.
David: ThatÕs an excellent cue for Mark to sum up his arguments for
the evening against the position that psychiatric drugs do more harm than good.
Mark:
Just a comment on that last point in 1985 I thought two and half
milligrams HaloperidolÉ two and a half milligrams a tiny dose and I could
frankly not respond to these questions quite frankly had I taken that today. I took Procyclidine because IÕm a coward
just in case I got acute dystonia -- one of the side effects of it, so IÕm not
joking, I know exactly what these drugs are like, itÕs like having a hang over
that lasted for 24 hours. That was
a very tiny dose. Indeed as I said
I did, a two and half milligrams.
I took Lithium for a month. Well I must say I found it a very
strange experience. To answer that
question, yes.
Someone in the Audience: I think youÕve been unfairly treated
and I know you to be a very good doctor.
And drugs isnÕt what itÕs all about, and I know you work in the
community and you work with a complex amount of cases and have a great approach
to level of care.
Mark:
The one thing thatÕs fascinating listening to whatÕs been said here this
evening, I think I agree with virtually everything IÕve heard this evening, to
be totally honest -- thatÕs come from the floor. And what it tells me about, frankly this is a matter of
utter complexity that no oneÕs got the right answer. And IÕm still thinking right now, that the little tricky
thought experiment that I asked you at the end to imagine that all of us are
right, or that maybe none of us are right -- is the truth.
Of all the things IÕve heard here today
however, I must say thereÕs one guy thatÕs impressed me the most, with a
clarity of his vision, and thatÕs this bloke here. [Points at Male Nurse] This guy said, ÒLook, given choice --
itÕs all about what you want.Ó
ItÕs about giving you power to make decisions, and drugs are just one tool
that may or may not be a powerful thing for you. They may be deadly, if used properly or incorrectly
otherwise they may not be, but I think the real enemy here is polemicism.
I think our anger and our passion is
getting in the way of this little thing. All over this country, there is an army of people, I
work as part of it, where nurses and doctors, social workers, occupational
therapists, mumÕs, dadÕs, rabbiÕs, vicars, milkmen -- we are a silent army of
people that are trying to show love and respect to a large number of people
whoÕs suffering was rather cheesily portrayed up there on that screen just
now. I feel pretty uncomfortable
watching that.
I see it day in, and day out. I wouldnÕt want to go to that guy. I didnÕt like the way he spoke to his
patient. I found that
offensive. I personally feel that
he snubbedÉ how do we work that one out?
Simply resorting to notions of poisons in the body, frankly is a
dangerous over-simplification.
Outburst from the Audience: He doesnÕt examine the particular
culture of the personÉ so how can you suggestÉ
Mark:
Sure I donÕt take a full dietary history of every single person. The point is that surely all of us are
right and have won prizes, it seems to me, and at the end of the day the
essence, is as this gentleman was saying, [Points at Male Nurse] we have to
give our patients the right to speak out as human beings and not as struggling
victims. But, isnÕt our society a
little out to lunch, and addresses us as victims and donÕt we look elsewhere
for an expert whoÕs going to fix us?
And are we not shooting the expert, the messenger? When actually itÕs human nature, or
rather our crazy take on it in western civilization that is truly at
fault. Put it this way... Jesus,
Gandhi, Nelson Mandela -- you name the sage from historyÉ what do they do? They say give people respect. Do we?
[from the audience -- several voices in a chorus] No you donÕt!
Woman: Peter donÕt be too angry, heÕs such a sweet man.
Peter: I am proud to be called angry and to be in the same company
of people called schizophrenic.
ItÕs another way of assassinating the word of whatever is being
said. I want to address choice,
thereÕs a few things I want to address.
Choice -- psychiatry is the only branch of
medicine that exists on absolutely not given choice to patients. If psychiatry did not have involuntary
treatment, it would have collapsed two hundred years ago. The whole basis of psychiatry is civil
commitment and now being linked to disability. So you have to take your drugs, or you wonÕt get your disability. The entire house is built on brutality
and always has been, sadly. We
have now, in the United States something which is growing here as well --
outpatient commitment. Where if
the doctor happens to agree with one of them, instead of one of us, you are
forced into treatment. They come
right into your home in the U.S.
Do you have that
here?
The second specific point I want address
and howÉ
Trevor: The Royal College of Psychiatrists opposed it.
Peter: I presume that means you wonÕt practice it, the law.
Trevor: I will practice that law if I need to save someoneÕs
life.
Peter: But youÕre interrupting me. The issue of respect should be so clear here about the
nature of respect. What kind of respect
is built into us as psychiatrists now with our current attitudes and
training? ThatÕs an aside.
I want to address one scientific issue
Tardive Dyskinesia -- the idea that it is caused by the schizophrenic
patient. Oh my God! We have more
science on that issue than on any other single issue in all of psychiatry. Maybe a thousand controlled clinical
trials. I can produce trials when
these issues came up, 10 controlled clinical trials on old ladies and men in
nursing homes who have no psychosis who developed TD at the rate of 20% a year
is what the aged get that disorder.
Shame, shame, shame -- on attributing it to the patient.
Now for the most shocking comment of all,
and that is in May of this Year IÕm going to be 70 years old. Now, first of all thereÕs a lot of
important things about that. One,
IÕve survived that long speaking truth to power, to use the Quaker phrase. More important, IÕve been in practice
for 40 years now. IÕve never
started a psychiatric patient on a psychiatric drug, although I am forever
helping people come off of them.
IÕve never had a suicide, IÕve never had an act of violence by one of my
patients, and maybe six or five in my career have gone to mental hospitals
during my treatment, unfortunately we didnÕt have havens to go to. They had to go to mental
hospitals. Am I a mad
magician? No. I just donÕt shoot people with
drugs. ItÕs like, if somebody
comes to you in a state of conflict and youÕve got a gun, and they donÕt, and
youÕre in a conflict and youÕre talking -- you can shoot -- you can drug, you
donÕt resolve, you donÕt solve, you donÕt work with, you donÕt make contact
with, you donÕt relate to, and you donÕt talk to because you can end it by
saying the other person is angry and out of control, or schizophrenic or
something else.
But the other part of being as old as I am,
that is more interesting are these pictures that were shown, as archival -- I
worked in those hospitals. I began
my career in reform in 1954 -- the year that the drugs were coming in. They hadnÕt hit our hospitals yet, I
was running, well, the first year I was a volunteer, the second year I ran the
Harvard Radcliff Mental Hospital volunteer program. I was a college student seeing with open eyes things that
later might get trained out of me.
So when the doctor said ECT killed brain cells, I knew it would have
been ridiculous. I hadnÕt trained
been yet.
But more important we forced the
superintendent to allow us to develop a case aid program. And here I want to talk about this for
a few moments if I can, about therapy and help. Because I got started as a helper. We convinced the hospital to allow us to have fifteen back
wards patients -- so sick even we couldnÕt hurt them. And our only supervision was one courageous social worker
for two hours a week for all of us, and we were given these patients just to
relate to. We got thirteen out of
fifteen out of the hospital within the first year. This is supposedly incurable backward patients that
hopefully we wouldnÕt injure.
How did we do it? We tried to figure out what they needed. Some needed companionship, some needed to
re-hook up with their families that they hadnÕt seen in ten years. My particular patient had a phobia that
heÕd have a heart attack if he walked or if he took little steps. So, I gave him little baby steps to do
and so on. Literally thatÕs what I
did as a volunteer, talk to people about their feelings. This program became a part of the
Harvard curriculum, and we got credit for it after I left. It became a center piece of the
presidentÕs report on mental health and rehabilitation in Õ62. But by Õ75 with the biochemists coming
fully in charge of the profession, a program like that had to be killed because
it rejects the whole basis of the profession.
Now was this new? No. In Great
Britain you have the whole 18th Century period of time and even earlier for
moral hospitals to the Quakers -- they didnÕt even have physicians in the
beginning. ThereÕs been intensive
studies of that period of time, Bachoven and others, books, articles -- their
rate of improvement for the worst sorts of patients coming in was almost
everybody leaving the hospital.
So let me tell you, itÕs not schizophrenia
that made people deteriorate in those hospitals. As volunteers we had to debrief each other after four hours
in the hospitals. People got
raped, beaten, and starved, and if that didnÕt work they got lobotomized, they
got shot, those horrendous conditions were produced by psychiatrists not by
schizophrenia, but by psychiatrists.
The same conditions did not prevail in the moral era in the moral
hospitals by Tuke, Pennel at least
began to get rid of them in France, but certainly not the great liberator that
the Quakers were in this country.
We have lots of examples about what people
need, about the moral support, the social support, the family support, the
economic support. Which is what I
try and do in private practice.
But which we could do far better if we were allowed to have havens and
weÕve have had them. WeÕve had
Lauren Mosher and others produce voluntary havens, supervised by one social
worker. The criteria for being a
therapist was that you didnÕt judge people and the rates and controlled
clinical trials -- these are controlled clinical trials -- could carry into a
residential home with ordinary folks helping you, dedicated to your liberty and
to your developing of your relationship and getting over being crazy. The rates of improvement were better
than in mental hospitals and since they werenÕt getting Neuroleptics they
didnÕt get Tardive Dyskinesia at a rate of 15% to 20% after three years.
And finally -- I mean obviously I can do a
workshop on this issue, all these issues -- someone brought up the user carer
model. ItÕs one I deeply believe
in. Judy Chamberlain and other
Survivors of Psychiatry as they call themselves, have built models that have worked
of people whoÕve been labeled and gone through the system helping other
people. Some combination of
dedicated professionals and consumers is needed. The current problem is that every time they develop, theyÕre
killed off. If you want to stay in
touch with what people are doing, you can go to the web to www.icspp.org an organization I founded in 1972
with my wife, and that my wife turned into an international organization, about
15 years ago and that I no longer run.
I donÕt have anything to do with it, I gave it over to younger men and
women to run, and theyÕre actually doing it. And thatÕs a group that among other things seeking the
humane, the caring solutions of which thereÕs already a tradition in moral psychiatry. And I volunteer to come back to Britain
and consult with free, with any consumer user group that manages to get the
funding and the wherewithal to actually set up an alternative approach.
David: Thank you. Well
IÕm starting to detect the mood of the meeting. WeÕve had a formal debate, so weÕll have a formal vote. And the proposition is, and it is a
very bald proposition, bear this in mind ÒPsychiatric drugs do more harm than
good.Ó. All those in favour? And against. Thank you, and abstention.
[about 85 for, and 3 against, with 8
abstentions]
Bob:
I just want to close now -- putting my hat on again for the James Nayler
Foundation. I do want to thank you
all for coming, I think itÕs been an interesting evening. I particularly want to thank the
panel. [applause] I believe weÕve
all behaved remarkably well under the circumstances. Now the difficult bit, that was the easy bit, donations. We put this event on, and it does cost
over a £1000.00, we would ask you to give £10 if you can, or £20 if you can,
for those who canÕt we do offer it free for those who canÕt pay. If youÕre interested in more on our
conference tomorrow ÒSuccessful healing of emotional distressÓ, that takes
place tomorrow in Friends House Euston Road and youÕre very welcome to
attend. Thank you for coming this
evening.
* * * *