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Psychiatry’s enduring fairy tale

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As someone who strives for a paradigm shift away from the ‘illness like any other’ approach to human suffering and overwhelm, I try and keep myself up to date with what’s happening in the murky world of Western psychiatry. I remain hopeful that the comprehensive debunking of traditional psychiatry pseudoscience that has occurred over the last 20 years or so will reshape the messages emanating from the psychiatry profession. Sadly, when I dipped into the ‘Google alerts – Psychiatry’ updates today (23.10.18), I encountered the familiar drivel.

There was an interview with an award-winning psychiatrist, Gavin Andrews, reflecting upon his 60-year career. He described the impressive progress he had witnessed in the course of his working life regarding the development of ‘cures for mental disorders’ and boldly stated that, ‘The prognosis for mental health care has improved far more than for diseases like diabetes’. (I wondered which impenetrable bubble he had been living in for the last half a century, apparently oblivious to the World Health Organisation studies demonstrating much better recovery rates for the ‘mentally ill’ in third-world countries like Nigeria as compared to the psychiatrised West. And he had clearly filtered out the stark fact that despite an exponential increase in the prescribing of psychiatric drugs – particularly the misleadingly-named ‘antipsychotics’ and ‘antidepressants’ – the number of people identified with mental health problems has never been greater.) The learned psychiatric veteran continued, ‘I think the community as a whole is starting to talk about mental disorders in no different terms than they talk about diabetes or asthma’, implying that such conversations were helpful, (thereby failing to grasp that medicalising human distress in this way is stigmatising, hope-quashing and fuels the gross overuse of psychiatric drugs).

Dismayed by this unhelpful nonsense, I searched my ‘Google-alerts’ for a formal research study. Surely, the academic researchers will no longer be colluding with this psychiatric fairy tale? I found a recently-published study from the Journal of Clinical Psychiatry titled ‘Effects of psychiatric disorders on suicide attempts’.

An investigation of almost 35,000 people who had acquired various diagnostic labels had concluded that ‘psychiatric disorders affect suicide attempt risk regardless of age’. The authors announced that the mediator of suicide risk was ‘a general psychopathology factor … … across all psychiatric disorders in all age groups’ and highlighted ‘the need for prevention strategies focused on the general psychopathology dimension’. In actuality, the study had provided further evidence of the lack of validity of diagnostic labels: no diagnosis predicted suicide attempts more strongly than any other. Cutting through the self-serving psychiatric mumbo jumbo, all the study had shown was that people in distress are more likely to attempt suicide than people who aren’t. Wow, what a revelation! 

But maybe I was being unfair. Google-alerts – with its apparent American bias and need for an attention-grabbing headline – might not be representative of the views and focus of contemporary psychiatry. So I accessed the latest issue of the highly-respected British Journal of Psychiatry.

At first glance I felt encouraged. My eyes were drawn to articles addressing pertinent issues. There was one about child abuse and its impact upon adult functioning. And another article describing the detrimental physical health consequences of some psychiatric drugs. I felt a flicker of optimism that here there might be some indication that the psychiatric establishment was, at last, taking a long hard look at itself and shifting its gaze onto things that matter for the people it purports to serve. But, as I reflected further, my enthusiasm was tempered.   

The research investigation exploring the link between early abuse and subsequent psychiatric difficulties concluded that, ‘Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health’. Does this (already well-established) link still need to be demonstrated? Are psychiatric researchers going to persist with these sort of studies until they find one that doesn’t demonstrate an association and they can claim support for  their Holy Grail of bio-genetic causation of ‘mental disorders’? But, on the other hand, I guess it is encouraging that psychiatric journals are now publishing such studies that highlight how adverse life experiences increase the likelihood of subsequent emotional distress.

As for the paper addressing the physical damage associated with some psychiatric drugs, the main finding was that two drugs commonly prescribed for mood swings (carbamazepine and valproic acid) significantly increased the subsequent risk of stroke, whereas two other ‘mood stabilisers’ (lithium and lamotrigine) did not. A more detailed reading of the study revealed two classic examples of psychiatric chicanery on show here. Firstly, the researchers attempt to downplay the extent of the damage associated with their drugs. The study was restricted to exploring the effects of ‘acute exposure’ to these substances and therefore the implication that two out of the four drugs do not increase the risk of stroke is misleading. These drugs are commonly prescribed over long periods of time, so focusing on only short-term use is likely to significantly underestimate the detrimental impact on physical health. The second sleight of hand concerns the repeated reference to ‘in bipolar disorder’, in the title, body of the paper and in the conclusion. Statements like, ‘Use of carbamazepine and valproic acid … is associated with increased risk of stroke in patients with bipolar disorder’ misleadingly suggests that there may be something distinctively pathological in the biological makeup of this group of patients that makes them susceptible to this adverse effect. Casual reference to diagnostic categories in this way implies that these labels are valid, underpinned by a demonstrable biological defect not present in ‘normal’ people, a message that is both inaccurate and stigmatising (but one that helps maintain the psychiatric fairy tale).

 

My earlier flicker of optimism that the psychiatric profession might, at last, be engaging in some honest self-appraisal was now almost quenched. The flame was totally extinguished when I read the title of the next study in the British Journal of Psychiatry: ‘Prevalence of personality disorders in the general adult population in Western countries’. Apparently, one-in-nine people are inflicted with a ‘personality disorder’ and the study concludes that ‘efficient treatment should be a priority for healthcare systems to reduce disease burden’. Give me strength!

From now on I’ll restrict my fairy-tale reading to Hans Christian Andersen and the Brothers Grimm.

 

 

 

 

Photo courtesy of AKARAKINGDOMS at FreeDigitalPhotos.net

 

4 thoughts on “Psychiatry’s enduring fairy tale

  1. Don Karp / Reply 1st November 2018 at 4:59 pm

    Thanks, Gary–

    I really appreciate ALL of your articles in “Tales . . . ”

    You made mention of suicide and I want to refer you to something I saw, wondering your opinion:
    “. . .suicide is frequently less about ‘psychiatric problems’ at all, and so often more about alienation, isolation, and not having basic needs met.”
    https://www.facebook.com/don.karp.39/posts/1085930091568789

    This quote has no references to any studies, and may be incorrect.

    What do you think?

    Thanks, Gary.

    –Don Karp

    • Gary Sidley / Reply 1st November 2018 at 11:49 pm

      Hi Don
      You ask a really important question. As far as I’m aware, there is no compelling evidence that psychiatric interventions (drugs, ECT, compulsory admission to hospital) reduce suicide. A much more human, less risk-averse approach is urgently required.

      I’m about to leave for a weekend in London, so maybe can discuss further when I return.

      Thanks for your interest in my blog, and taking the time to comment.

      I’m

  2. G&G / Reply 29th November 2018 at 5:58 am

    Great article! Keep up the good work Gareth!

    • Gary Sidley / Reply 4th December 2018 at 1:57 pm

      Thank you – the positive feedback is appreciated.

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