Somatic Symptom Disorder

Editorial Note: Richard commented on Peter Gotzsche’s recent post Psychiatry Gone Astray. He was invited to develop his comment and does so here.

My name is Richard Lawhern. I advocate for nearly 5,000 chronic pain patients as a volunteer moderator and content writer at “Living With TN“, a social networking website. We support people with Trigeminal Neuralgia – the worst pain known to medical practice.

In this note, I offer a message to the American Psychiatric Association (APA) on behalf of millions of patients with chronic pain and rare medical disorders. The APA is bringing real harm to millions of people. In May of last year they published the 5th edition of a book which defines much of the practice of psychiatry and psychology. Despite APA disclaimers, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a de facto standard for mental health practice and teaching, used around the world by medical doctors, psychiatrists and researchers. DSM categories are the basis for a lot of mental health treatment and insurance reimbursement.

During 14 years of its development, the DSM-5 has become controversial among medical patients and with many psychiatric and medical professionals. As critics have pointed out, much of the DSM is unscientific in origin and unreliable as a guide to psychiatric interventions. Data to show validity are missing for over half of the defined DSM categories. Many are difficult to distinguish from one another – even for psychiatrists. In many other categories, effective therapies are largely missing.

At least two disorders newly defined in the DSM-5 may inappropriately label millions of people with a psychiatric disorder. These are the so-called “Conversion Disorder” (Functional Neurological Symptom Disorder) and “Somatic Symptom Disorder” (SSD). The unproven assumption underlying both is that emotional distress can be “converted” into physical pain, seizure-like incidents or other symptoms not explained by physical disorders known to medical doctors.

With SSD,  you can be labeled with a mental problem simply because you have deep distress about your health that a doctor judges to be “excessive” or the doctor thinks your life has become dominated by your illness and symptoms. The same label may be applied to you if a doctor considers you as “over-involved” in the symptoms of a child for whom you are a care-giver. Cases have already occurred in which children have been removed from the custody of parents deemed to have facilitated their “illness behaviors”.

While psychosomatic disorders appear in previous editions of the DSM, the new SSD is particularly problematic. The scope of the disorder and diagnostic criteria are greatly broadened from the DSM-IV. SSD may now be applied to patients with either diagnosed or undiagnosed problems. Only one criteria of several need to be applied as a basis for the diagnosis.

There is reason to believe that SSD may be widely assigned to patients in the early stages of relatively complex medical problems such as Lupus, Lyme Disease, cancer, diabetes, cardiac problems, Chronic Fatigue Syndrome, Irritable Bowel Syndrome or fibromyalgia. Many fibromyalgia and CFS patients already report being told that their medical problems are primarily emotional rather than medical in origin.

Patients have deep concern that once placed in their records, psychosomatic labels will deny them further medical assessment and effective care. The dangers of assigning a psychosomatic diagnosis are shown in a March 2013 article by Alice Philipson in the Telegraph of London. The title is: Professor Dies of Lung Cancer After Doctors Dismiss Illness as ‘Purely Psychological.’ If the DSM-5 SSD category is widely used in its present form, this patient fatality could be joined by many more. Rare disorders and chronic pain patients are already frequently dismissed or marginalized as “head cases.”  DSM-5 will only make this problem worse.

Thus this message to the APA:

‘you’re talking to your peers when you should be listening to your patients. Pending the outright withdrawal of the DSM-5 as a failed effort, it is time to start over, employing evidence based medicine instead of ivory tower surmise. Next time, include patients and non-psychiatrists among the voting members of your task force and throw out any category that isn’t strongly supported by consistently reliable medical evidence’.

The alternative may be to see your profession discredited for its willful ignorance of simple common sense and its arrogant rejection of the patient as the most reliable reporter of their own health issues.


RxISK: Research and report prescription drug side effects on RxISK.org.

Search. Report. Contribute.


You and your meds. Give the real story. Get the real story.

Pharmageddon

Pharmaceutical companies have hijacked healthcare in America, and the results are life-threatening.

 

Dr. David Healy documents a riveting and terrifying story that affects us all.

 

University of California Press (2012)

 

Available on Amazon.com

 

Comments

  1. I too, find the diagnosis of SSD abhorrent. I am not in pain, thank God, nor do I yet have the SSD label, However, I am very close to it with MUS of fatigue and weakness in my chart (assigned by my GP). And, I can speak to the distress this causes when I see the reactions other doctors have to it. They look at me like I am a leper. I don’t really know how much they fail to do for me with it, but I can say that many try to force the depression label on me. As a patient, it is like you are fighting on three fronts, one, your disease and just to keep functioning, two, to be taken seriously, and three with the those in your life that think you are weak or worse a liar. I won’t go into what it increases the chances of because you don’t mention it here, but I will say that it comes to mind frequently.

    Even though I am strongly against this false diagnosis, I think at heart it is a way to deny care to save money. My concern is that even if SSD is erased, the fight against this won’t be over; something else will be used to replace it because it doesn’t pay to look for the cause of anything not immediately obvious.

    • Thank you for your comment, RB. From what I have observed in 18 years of volunteer work on behalf of chronic face pain patients, I would say that just about all so-called “psycho-somatic” diagnoses by medical doctors are basic admissions the the doctor doesn’t understand what they are seeing, and wants to get this frustrating and time-consuming patient out of their practice. In the US, insurance companies become accessories to such malpractice by imposing pernicious financial disincentives against protracted or complex evaluation procedures.

      From what I’ve read, one of the most vulnerable populations in this atrocity of refused treatment might comprise five million US fibromyalgia patients, who are frequently told that their bodily pain is emotional in origin. My succinct response to such claims is “poppycock!”

      I wish you wellness. Go in Peace and Power

  2. http://dxrevisionwatch.com/2014/02/24/new-paper-by-wolfe-et-al-on-reliability-and-validity-of-ssd-diagnosis-in-patients-with-rheumatoid-arthritis-and-fibromyalgia/

    The above post arrived at the same time as David Healy’s post. Both are good reads.

    Many many years ago, subsequent to immunizations I didn’t want, but was coerced into taking, I ended up in a wheelchair with ‘atypical inflammatory arthritis’ and profound muscle weakness. A chorus of doctors insisted it was chronic fatigue syndrome/fibromyalgia and ‘as everyone knows’ it was all psychological. (I recovered – more or less – with no thanks to doctors.)

  3. That’s so true. I know personally that as soon as your medical records start to mention any kind of psychiatric diagnosis or previous treatment the “normal” doctors start dismissing you if you only have symptoms of something other than flu. I have spent months trying to get a diagnosis for my symptoms (close to chronic fatigue syndrome) and all I got was a doctor telling me that I may be depressed. Sure, if you’re sleeping 16h a day and still feel tired it can make you pretty depressed. And the worst scandal is that psychiatrists are the only doctors who can treat people involuntarily and restrict your personal freedom based on their bogus criteria (danger to self and/or others which is a form of pre-crime).

  4. At the September 18-19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting, NCHS/CMS proposed to insert DSM-5’s Somatic symptom disorder into ICD-10-CM, as an inclusion term to existing code F45.1 Undifferentiated somatoform disorder.

    If CMS does approve this proposal (and it may already be a done deal with CMS) and SSD is inserted as an inclusion term to the existing ICD-10-CM F45.1 code this may leverage the potential future replacement of several existing ICD-10-CM F45.x Somatoform disorders categories with an SSD-like construct, to more closely mirror DSM-5.

    What action have U.S. professionals been taking to oppose this move?

    • Not to sound like I jumped on a band-wagon, because I didn’t, I usually go the opposite way of the crowd, but I found a change in diet helps me a great deal. Dairy is worse than gluten for me, and corn is just as bad as gluten. If I can stick to avoiding those, I feel much better. Just a suggestion as it costs little to do a trial of changing your diet.

      • I am sorry, this was in response to B comments above, not the ICD issue.

        • http://isepp.wordpress.com/2014/02/25/mother-of-justina-pelletier-collapses-after-judge-says-shell-stay-in-state-custody/
          A great illustration on how one can take a physically sick person and turn them into a “mental patient” against their will or against the will of their legal guardians. I feel like some people have too much unchecked powers…

        • Actually what helped me was … Prozac. Prescribed by a neurologist who said he has no idea why it helps but he’s known it from his clinical practice. I took it for a month and got better though I’m still not perfectly OK. Why it helped is probably not because of the “depression” (I actually had super bad anxiety problems on it, that’s why I only took it for a month) but I think because it’s affecting the immune system (in a not well understood way – there are some studies on it’s interaction with EBV virus in lymphoma cases) and some cases of chronic fatigue system are linked to viral infections. Speculations on my part but it’s well known that physical diseases including viral infections can cause psychiatric symptoms. With the new psychiatric disorders on the books one will get less real diagnosis and treatment of the underlying cause and more stigma and mistreatment in all sense of the word.

  5. I really do feel for people with people living with Trigeminal Neuralgia having suffered with cluster headaches for eight or nine years now. So I have a fair idea of the sort of pain they are experiencing. From reading this the only thing that keeps me from fitting into a SSD diagnosis is a runny nose and a droopy eye.

    But my wife fits right into this SSD nonsense. She has suffered with severe hand and wrist pain and weakness (among many other things), ever since withdrawing from venlafaxine in 2010.

    She has seen her Doctor about this numerous times who has referred her see to all sorts of specialists to have all manner of tests, all of which have come up normal. Any notion that the problem is related to her time on or in withdrawal from SNRI’s was quickly dismissed…as we expected.

    When the tests ran out the tone of the doctor visits seemed to change. So my wife backed off and has since decided to keep her mouth shut and put up with the pain. She felt the visits increasingly slipping toward discussions of her state of mind and she just wasn’t going to go down that route again.

    Because of her earlier diagnosis of depression, the nightmare of what happened next, and the end result of her refusal to take any more psychiatric drugs against her Doctors recommendation, she feels she is in a very weak position. Not only does she have well documented mental health problems, but she blames most of these problems on the medication. It’s just too easy for the doctor to dismiss her and say it’s all in her head.

    She is now afraid to go to her doctor and discuss a pain that affects her every day of her life for fear of being told she is mentally ill again. How sad is that?

    I suppose someone like me, who researched mental illness and psychiatric drugs up to 8hrs a day, and spent a lot of time trying to convince my wife to try and get off the drugs and openly challenged the medical professionals in charge of her care, could no doubt be seen as having facilitated her current ‘illness behaviours’. At the time they said I was a controlling husband who was probably depressed.

    Dr Dawson said on his blogs that it was all about the side effects, while at the same time denying the existence of most of the side effects. It seems now he has a handy diagnosis to go with the usual ‘disease worsening’ excuse, for those who claim they are being harmed by side effects of their medication that he doesn’t think are real.

    “you’re talking to your peers when you should be listening to your patients”
    Well said, that just about sums it up.

    • I am a writer and moderator for “Living With TN” (a social networking website for chronic face pain patients, with 5100 members in 117 countries). A year ago, I conducted an online volunteer survey among medical patients with rare disorders. I wanted to describe treatment outcomes among patients who had been referred by a medical doctor for mental health evaluation.

      Although we didn’t get a huge number of responses and results cannot be broadly generalized, the responses we did get were highly telling. More often than not, patients felt they had been rail-roaded by threats of being discharged if they didn’t cooperate. In quite a number of cases, they reported that mis-handling by mental health professionals increased their depression and anxiety, by invalidating their reports of their own symptoms.

      Results of this survey are summarized in an April 2013 article by Dr. Allen Frances on his blog at Psychology Today: “The Medically Ill Speak For Themselves — And don’t want to be labeled as mentally ill. ” See http://www.psychologytoday.com/blog/saving-normal/201304/the-medically-ill-speak-themselves .

      Since I began studying psychiatric literature on behalf of patients labeled as “head cases”, I have come to the belief that quite possibly the entire field of psychosomatic medicine offers more of mythology than method. I sometimes write of this field as “a professional delusional system” imagined by financially self-interested psychiatrists and psychologists, and abused by medical doctors unwilling to do the work of evaluating patients with unusual medical problems.

      I personally suspect that when learned professionals start referring us back to 19th Century observations of Charcot or Pavlov, then somebody may be engaged in the practice of shamanism rather than medical science.

      • Well, I stopped treating the psychiatrists seriously when once I was “evaluated” by a guy who first asked me about my family, clearly expecting that I’ll have some huge trauma in my childhood. When all my answers clearly showed that I had a completely normal family relations and was a happy child he turned around and said “well, then they must have been too good to you”. It’s like catch 22, they can diagnose you with anything based on such logic. If you have a symptom you’re sick, if you don’t have it you’re sick too and not realising it or not wanting to admit it. This whole field needs some serious “treatment”.

  6. This is truly a frightening scenario. I have lived with chronic pain for many years as the result of multiple major accidents. The first accident occurred before MRIs were widely available, and most docs said I was just “drug-seeking.” When I finally had an MRI the surgeon said to me, “My God, were you in a plane crash?” Despite all the evidence, I still get comments about my mental health–and insurance company refusals to pay for treatment that would relieve the pain. I know how helpless I felt and how much I considered ending it all; this will have unbelievably horrible effects if it’s actually adopted.

  7. The DSM-V is very likely to be the worst mistake medicine made in the last quarter century. The consequences of this document for already very sick and burdened people are going to be appalling.

    Those responsible for this blatantly unscientific and unethical power grab should be shamed and driven from the profession.

  8. This is absolutely sickening.

    I am a long term survivor of fluoroquinolone toxicity. There are tens of thousands of us walking around , ( thats if we still can ), with various misdiagnoses of conditions such as Fibromyalgia ( which we know as Cipromyalgia ), M.E , CFS, etc, when instead we have actually been literally poisoned by these synthetic , neurotoxic , chemotherapeutic agents , that actually masquerade as antibiotics. The fluoroquinolone antibiotics ( Cipro, Levaquin, Avelox, Norfloxacin) are literally straight from hell

    We are already disbelieved, thanks to wilfully ignorant Drs who have absolutely no idea of the extremely toxic profile these drugs carry, due to misinformation from the pharmaceutical Industry, & therefore who refuse to even look at the many thousands of peer reviewed cited articles, that show EXACTLY what these drugs are capable of .They are being prescribed for the simplest infections , not for the reason they are meant for, which is when all other options have been exhausted, & the only alternative you have left is death Instead we are told time & time again ” It is all in our head.”

    I myself developed acute toxic psychosis from two little Ciprofloxacin pills 25 years ago, given to me for a simple UTI. This unfortunately then triggered a FQ induced affective illness, almost an identical situation to Stephen Frieds wife Diane , ( from the book ” Bitter Pills ).I was unfortunately misdiagnosed with Bipolar disorder. I lost 12 years of my life because of this.( & gained a psychiatric diagnosis I will never be able to get rid of ) I finally got my life back & then months down the line I was then given IV Levaquin, ( I had no infection ) & then got yet another misdiagnosis, this time M.E.

    Fast forward to 2010, I was again prescribed Ciprofloxacin, this time along with an NSAID, completely contraindicated, AGAIN I had no infection The NSAID enhanced the neurotoxicity of the FQ, (although god knows these drugs do enough damage all on their own ). This time I fell apart completely, both physically & cognitively.
    I am now in severe intractable neuropathic pain 24/7 Pain which sometimes even opioids will not touch , my connective tissue is disintegrating, I have not been able to sleep more than 3 hours a night since 2011. This only scratches the surface of my issues.

    The fluoroquinolone class of antibiotics now have 2 boxed warnings, & recently an updated enhanced warning has been added for the for the possible risk of permanent peripheral neuropathy. MOST of have this, & for too many of us, YES It is permanent.

    Unbelievably, Some Drs are STILL unaware of these warnings & of course we are STILL being told the ” These drugs do NOT do this ”
    The DSM issue will only makes things far far worse for us.

    I tell my Drs now that this is no longer up for debate, If they try to tell me that” it is all in my head ” I now agree.
    I say YES, part of it is. IT IS IN MY HEAD PHYSICALLY, where this synthetic neurotoxic chemotherapeutic cocktail has crossed the blood- brain barrier & permanently damaged my brain.

    When is this going to stop !

    • Fluoroquinolones , Cipro, Levaquin, Avelox etc
      (ciprofloxacin, levofloxacin, moxifloxacin etc.)

      I am glad, and thankful, that you (Debs) told your sad story about fluoroquinolone-toxicity.

      I live in Sweden and I had no idea that people could be “floxed” until a close friend became confused and I started to look for information about his medications in 2005. That`s when I realised that you can get terrible and long lasting adverse effects, including psychosis.

      Thanks to the Internet I, too, discovered Stephen Frieds book – Bitter Pills.
      As a matter of fact, I have “donated” it to the clinic (for infections) where X spent some time. I guess no-one has read it.

      I also found many patient stories on http://www.askapatient.com (Cipro, Levaquin etc.) and other sites.

      X:s story is very long – too long to go into detail, but he passed away in 2007.

      Recently, I googled “floxed” and “floxies” and found a very interesting site that I would like to recommend, http://www.floxiehope.com.

      Here´s a link to an article – I AM (with permission).
      http://floxiehope.com/2014/02/24/i-am/

      P.S.
      When it comes to pains – cholesterol lowering drugs as Zocord (=simvatatin), Lipitor (=atorvastatin), Crestor (=rosuvastatin) are also wellknown for causing different types of pains. Please visit http://www.askapatient.com, http://www.spacedoc.net, http://www.peoplespharmacy.com (search for statins) etc.

      • David_Healy says:

        These other site are of course excellent but its worth mentioning that there are also a lot of narratives on problems from Floxes and Statins on RxISK DH

  9. Angela Kennedy (@AcademicAnge) says:

    People might well interested in my book, published in 2012: “Authors of our own Misfortune? The Problems with Psychogenic Explanations for Physical Illnesses’ which is a culmination of about 10 years of research (I am a sociologist of science). Within it I demonstrate key problems with psychogenic explanations and their adverse effects on patients. It is available via Amazon and other outlets, and the Amazon page has a ‘look inside’ facility.

  10. Angela Kennedy — thank you very much for contributing. I will buy your book immediately and apply its information in defense of patients written off as head cases. I encourage you to share insights and authoritative resources in further comments here.

    For all who have commented: I suspect that what must ultimately happen in the ongoing disaster which is psychiatric practice, is that perpetrators of the best-documented frauds and harms must be successfully sued or criminally prosecuted. One step in making this process happen might be to develop a list of authoritative, referenced, incontestable books and articles which demonstrate the realities faced by mis-treated patients. I will recommend that project with David Healy, if he hasn’t already done a reading list. Meantime, everybody please feel free to recommend important readings here.

    FYI all: On behalf of chronic pain patients, I have become a frequent contributor at DxSummit.org, “The Global Summit for Diagnostic Alternatives” of the Society for Humanistic Psychology. I’ve also written one piece on “mad in America”, and had one online survey summarized by Dr. Allen Frances in his Psychology Today blog. If we get a really interesting list of “psychiatric survivor books”, I will make every effort to get the list widely disseminated.

    Regards, Red

  11. Perhaps someone might like to explain to me, why, the biggest fraud in the history of pharmaceutical bamboozling, on our doorstep, in the UK, despite having had legal aid funding for hundreds of cases for *an experiment* * being tried out* on our doctors. for over ten years, has led to *political gagging* by the support agency.

    The legal evidence was clear in 2002; the legal evidence is here, twelve years later.

    The hypothesis of chemical imbalance is dead. Doctors won’t catch up, it is not all in the head.

    How is the digging going getting Paxil Study 329 out in the open?

    I don’t like experiments played out on me and my family could have gone the way of Justina. Safety of my child was a consideration when I met a backward individual, but if GlaxoSmithKline want to play up safety then we can play up, too.

    Thank you for all your very well considered comments and for being so honest with us, Mr. Lawhern.

    Our Government, our MHRA and our Support Agencies do not want to uphold justice, in this instance.

    It is political. Special advisors to David Cameron are not easy to push off their perch.

    And, David Cameron and his Health Departments have no idea what a media storm could take off, about all this, if we all put our minds to it……………

    The psychological inference and interference is so dangerous, I can attest to that, and, if litigation can succeed about Paroxetine in the USA, then I see no reason why it cannot happen here.

    Thanks for your support. Is it not time, everyone put their cards on the table?

  12. “Psychogenic!” “Depression!” ” Mass hysteria!” “Socially contagious!” Doctors responded to the complaints of fatigue and headaches from ten individuals in an open office. When two electricians lost consciousness in the crawlspace below my desk (above a garage) the diagnosis became “carbon monoxide poisoning” and the prescription pads were hastily put away. The inability to diagnose correctly is rampant among doctors. Had any of us accepted the antidepressants offered and reacted adversely, we would have been told the pharmaceuticals had unmasked long-standing issues. And been offered more drugs……

  13. I have a conversion disorder. Psychiatry gives me a pain in the ass.

    • David_Healy says:

      nice one

    • Thank you, David. (It made ME laugh!)

      Let us all finally realize and admit that no, there is no one whom psychiatric drugs help, even once, even short term.

      Psychiatric drugs are toxic substances that harm the brain, usually severely, often permanently. Harming the brain, even just a little bit, is not the solution to any problem.

      The brain operates the body, it doesn’t think. We need all of it to work at all times – even when we are in distress. Perhaps especially then.

      Even at the extreme, if a person is in such severe distress that they are a danger to themselves or others, if someone can force them to take psychiatric drugs, that same person can simply talk to them, or even isolate them, if necessary, until they calm down. (People always calm down. Even psychosis resolves if left alone.) Then they can help them.

      I still read (in Whitaker and from others) the brainwashed, hedging, perhaps even pandering fiction that psychiatric drugs are useful some of the time. That is like saying that other brain-damaging “treatments” are useful some of the time, such as lobotomy or electroshock.

      No, I repeat; they are not. None of them. The problem isn’t in the brain. It is in the thinking.

      Thinking can become disordered, often due to trauma or simply plain overwhelming fear that cannot be resolved in a short period of time.

      Fear or trauma can cause stress. Stress can cause changes to hormones (adrenalin flooding is common; contrary to popular belief, cortisol does not stress, it relieves stress – it is the anti-adrenalin), which stress the body.

      Physical stress can be misinterpreted by the mind as paranoia, leading to projection or delusion.

      Change thinking, and both the mind and the body heal.

      (I’ve written about it here. http://cathicarolblog.wordpress.com/2014/02/14/harris-dennett-and-i/ )

      • David_Healy says:

        Carol

        Well while we both enjoyed the quip, we’re not entirely on the same page here. The original form of mental illness (insanity) was delirium. While this will often improve with time, treating the body can make a big difference. Catatonic states where the person is mute and stuporose do not respond to talking but may respond within minutes to benzodiazepines. There are a number of other severe condition where medication may help.

        At the end of the day though is the issue not much more a case of whether you or I or anyone else should be let dictate what a third party has? I’d imagine there are many people out there who wouldn’t want you or me or anyone else to dictate what they can or can’t have. Where pharma scores so well is in subtly influencing the game to what people get is de facto dictated to them.

        David

        • I know we don’t agree exactly, David (you are a doctor and have a certain training and many experiences which I do not; I am pure analyst).

          But that’s OK – getting the word out about the dangers of psychiatric drugs is what’s important right now. I applaud you for that. If you’d hadn’t been through it, would you?

          Delirium can be caused by infection. Catatonia by many things physical. These are physical problems, not mental. That’s my point.

          And what comes after the benzos? They treat a symptom but then cause problems of their own.

          That’s what I worry about. To discover the truth, we must go layers deep, not simply look at the surfaces of things.

          Cath

          • Benzos can cause the very same symptoms they’re supposed to treat including psychosis and aggression. They also cause anterograde amnesia (actually are used for this very reason before some surgical procedures to minimise the trauma but if you ask a psychiatrist about it he’ll tell you that’s not going to happen).

        • Maie Liiv says:

          Orthomolecular psychiatry and catatonia – from the memoirs of Canadian psychiatrist Abram Hoffer :

          “We deduced from our biochemical theories that large doses of vitamin B-3 and vitamin C might be therapeutic. ….. Our first patient Ken was a catatonic schizophrenic … He had had insulin coma and also ECT and had been left in a coma and was dying. We decided that he must be our first patient to be given niacin and hoped he would not be our first victim. We used a stomach tube and gave him a large dose of niacin and ascorbic acid. He survived. The next day he sat up and drank it and thirty days later he was well. He was discharged and remained well.” (events of 1952)

          “Each bottle of pills (pharmaceuticals) should have a poison label with skull and crossbones, and the word “poison” in large letters.”

          “How can something that makes well people sick, make sick people well?”

          Hoffer went on the treat more than 5000 individuals labelled schizophrenics with micronutrients and not drugs. Most were restored to health.

          At the first appointment Hoffer asked his clients what they were going to do when they were well. Many broke down in tears because no one had ever suggested they could get well. And most got the idea and they did get well.

          Dr. Hoffer died in May 2009 at age 92.

      • I remember a dean of medical university I studied on and a neuroscientist saying to medical students during a lecture: “we don’t do lobotomies anymore but the drugs that we are giving to patients these days are not really any different, they cause CHEMICAL LOBOTOMY.” No more comment needed.
        As to efficacy of these drugs check up studies on antidepressants and placebo by Irving Kirsch. I bet it’s only a tip of a mountain.

      • I noted this comment by C. Carol:
        “Let us all finally realize and admit that no, there is no one whom psychiatric drugs help, even once, even short term”

        I understand the frustration at being told “it’s all in your head” and similar untrue and non-helpful things by the medical community, and yes, “drugs” for psychiatric patients are not always the answer.

        That being said, any sweeping statement will not tend to be accurate. I work in inpatient and emergency psychiatry, both as a nurse and over this past 2 years (or so) as a student NP (intern). I’ve seen that drugs can help – and that they are not and cannot be the “whole” answer. It’s very frustrating.

        I see that people in pain are routinely under-helped, and I see people with psychiatric issues completely disrespected and not listened to – it’s as if once the fact of a psych diagnosis is known, some providers … oh their brains drain out their ears or something.

        I don’t know that there is “an answer”, and probably there isn’t. But what I have seen and wanted to correct makes me all the more enthusiastic to create and shape a new approach.

        Diane

        • On the drugs being “helpful”… Well, I guess that depends on what you call help. Most if not all the psych drugs are essentially tranquilizers of sorts which are meant to numb your emotions, hyperactivity or other types of distress and misbehaviour. The question is whether this effect (let’s forget all the physical and mental side effects for a moment) is really in any way beneficial to the patient. Many people who find these drugs helpful would also find cocaine or meth helpful – people who are in emotional pain look for fast relief but that relief may not always be really beneficial to them in the long run. I have a friend who used to abuse every sort of drug, both legal and not as long as he was in a toxic relationship – as soon as he recovered from it he cut down on all the drugs. Maybe it is indeed helpful in short term for some people (certainly not all) to gain a perspective and solve some of their problems but I doubt that it has any long-term benefit unless you like to live a zombie-like life. Essentially it feels to me like these drugs allow a person with a broken leg to run without collapsing from pain. Maybe in some cases giving them this possibility to run for a short distance until they can find a better solution is helpful but if you run like that for too long or sometimes even at all you’re likely to mess up your leg in addition to any other problems that you have. I know I’m using a metaphor here but guess you see what my point is…

  14. I want to come at this from what I think may be a slightly different angle. I have bipolar disorder and hang out online with lots of other people with various physical and mental impairments/disabilities. Sometimes I go on websites where there is a forum or a blog and the subject comes up of people with ME/CFS/similar and all hell breaks loose with people saying they’ve got it and they’re being offered CBT or graded whatever and they’re being treated like mental illness, which obviously leaves them offended and angry.

    When I read this, apart from the obvious issue of whether anyone believes they have the symptoms they have – and I often point out to people that some mental illnesses such as depression can have physical symptoms – I think it’s more about the attitude to mental conditions.

    Sticking a mental label on someone should not be a way of diminishing them, of denying their symptoms, of treating them badly (in both senses of the word treat). If having a mental label automatically meant taking people seriously, respecting their experiences, opinions and preferences, it wouldn’t be a problem, would it?

    Turn it upside down. Let’s suppose that you feel depressed (taking the term broadly) and you go and see your doctor. Let’s say he focusses on the physical symptoms and sees the low mood as secondary. Are you going to feel offended? Are you going to expect to be taken less seriously? No.

    Until people with mental problems and mental labels are taken seriously and treated with respect, sticking a mental label on someone with physical symptoms will continue to be a problem. Until it’s the case that if, for example, I say I have sleep problems, whether they are seen as relating to, say, depression or sleep apnoea will make no difference to how I feel respected and taken seriously, whether you classify something as physical or mental will be more important than it needs to be.

    After all, if I break my leg and have pain, the fracture is physical, but my perception of pain is in my brain, isn’t it? When I go to the hospital, it gets treated as a physical problem and I do not feel diminished by my ‘feeling’ of pain being seen as a physical problem even though it involves my brain.

    If I went to the hospital with a broken leg and it was labelled as a mental problem, I would be offended and upset. Why? Because of the way I would be treated, the way I would be dismissed, the way I might have all sorts of unpleasant labels stuck on me such as ‘manipulative’ ‘demanding’ ‘timewaster’. I might be seen as less deserving than someone with a physical label.

    That’s the real problem. Not so much whether we think a problem starts in the mind or the body, but the fact that which we label it as makes such a radical difference to how we are treated.

    Until we can see a problem that we might currently label as being all in the mind as being as genuine as one we see as all in the body, classifications like this will remain a problem; and until a problem that is labelled as being in the mind is no longer seen as a reason for dismissing real experiences as either not genuine or irrelevant, classifications like this will remain a problem.

    • Thanks for a very thoughtful sharing, Sue. In one way or another, I sense that you are speaking to the issue of “stigma” or “psychiatric shaming.” And while I think I understand where you are going with this, my own concern feels (to me) somewhat more pressing: patients are being KILLED because medical doctors can get away with sloughing them off as mental cases and denying them effective medical investigation of real medical disorders.

      Many psychiatrists and psychologists seem perfectly willing to accept referrals and to reinforce an un-trained medical doctor’s assessment of psychosomatic disorder. Since he or she can’t find anything definitely medically wrong with a patient, then the patient presumptively must have a mental problem — ergo, an issue that some other professional should take on, thus relieving the referring doctor of responsibility for the consequences to the patient of their own impatience or ineptitude.

      This issue is particularly acute for female patients, who have long been mislabeled as “hysterical” or “suffering from menstrual stress”, or like fictional disorders. I sense that until psychosomatic diagnoses are widely understood to be invalid and inappropriate, the worthy goal of balanced treatment of personal distress will remain unfulfilled.

      At times (figuratively), I honestly wonder if any professional who uses the term “psychosomatic” should have their mouths washed out with soap!

      Thanks for weighing in.

      • As I woman I can agree with women being sometimes “hysterical” and “suffering from menstrual stress” – that’s real mental effects of hormones which almost every woman has to struggle with on a monthly basis. This is however different from real physical issues that may come with it (like migraines which often accompany menstruation), which can and should be addressed. Not mentioning that severe or prolonged physical suffering can lead to depression or anger and if doctors can’t find an easy reason for it they turn around and flip the cause and effect like for chronic fatigue syndrome.

    • Angela Kennedy (@AcademicAnge) says:

      I think there are a number of points here Sue that need to be raised.

      Firstly, If you have a serious physical illness, being misdiagnosed with a psychogenic illness is dangerous to your health: and people have died because of psychogenic misdiagnoses (I discuss this at length in my book).

      Secondly, the ‘physical symptoms of depression’ are often vaguely expressed by those claiming there are ‘physical symptoms of depression’. For example, what do you believe are ‘physical symptoms of depression’? Because of the vagueness in which these are claimed – it is often very unclear what is even meant by ‘physical symptoms': and this often means serious physical symptoms are attributed to ‘depression’ or ‘stress’. Note I am NOT trying to claim depression is not serious, or experienced easily: just that I have seen this claim about ”physical symptoms of depression’ before, and one can never pin down what they are supposed to be.

      Thirdly, I discuss the problem of conflating ‘mind’ and ‘brain’ in my book, something you’ve unfortunately done here. No matter how it is experienced by someone in their ‘mind’, a blocked airway will lead to death if not cleared, as will uncontrolled blood loss. But psychogenic explanations are used to deny people medical treatment (i.e. to find and treat the physical cause of illness of the body). The mind is NOT synonymous with the brain, yet many make that attribution error.

      Fourthly, the issue of ‘mental illness’ itself, and how confused psychiatrists and others get when they use the term, is a massive problem. All sorts of normal behaviour is deemed ‘mental illness’ (including reactive distress), and neurological conditions. Until psychiatry gets its act together and thoroughly engages with these issues in a logical fashion, there will always be mistreatment of and prejudice against people with such a diagnosis (whatever the presenting symptoms). This does not mean that it doesn’t matter whether an ‘illness’ is to be seen as ‘mental’ or ‘physical: it really does.

      Fifth, people with ME/CFS object to promotion of CBT/GET because these ‘treatments’ are unefficacious, and are contra-indicated in the disease (ME/CFS is classified by the WHO ICD-10 as a neurological illness). Both treatments have been demonstrated to be enormously problematic. I discuss this issue in my book.

      The ‘real problem’ is that beliefs in psychogenic illness are subject to various fallacies in medical reasoning, which not only are dangerous, but give rise to contempt for the victims. I discuss these and other problems at length in my book. Therefore the notion that an illness is ‘all in the mind’ as you put it, actually very harmful, in various ways.

      • Some people (mostly from the antipsychiatry movement) now turn to use of “extreme states of mind” rather than mental illness. In general to me it looks like some mental issues may have physical causes like brain tumours, infections, aging etc. and require non-psychiatric medical interventions while others may be “diseases of the mind” if you like and have sociological and/or psychological causes which can only be really helped by a change in someone’s life circumstances. I don’t know if there is much place in between these two types of “mental illness” for psychiatry as we know it. Psychiatric drugs in essence are at best placebos and at worst toxic chemical lobotomisers aimed at preventing the symptoms to be visible but not really dealing with a cause.

    • Richard and Angela said it better than I will be able to as they have more experience with this; I only have my own. However, as much as I understand the stigma you are fighting, it is a different issue. [I even hesitated using the line “looked at me like I was a leper” in my first comment. After all a leper has a medical condition that should not be stigmatized either. But, I used those words to describe the expressions of my doctors because I didn’t know how else to describe them.]

      In my case, I firmly believe in differential diagnosis and there were a number of things I explored with my GP’s help and without it. On my own, early on and over 12 weeks, I had sessions with two PhDs in Psychology (one under employee assistance and one attached to a sleep clinic that specialized in sleep disorders) to see if I had depression. And, if they found I didn’t, on how to deal with a debilitating medical condition and the medical establishment that was intent on doing the bare minimum of testing and prescribing an antidepressant. Neither one found any evidence of depression and both encouraged me to continue to look for a medical cause. One even saying at termination, when I asked what type of CBT they used in our sessions, “I didn’t use any. That is not your problem.”

      So, when I continued to explore why I was having wicked fatigue, and the depression card kept coming out, yes, I was very offended. Not only were they negating me but two mental health professionals – and the mental health professionals spent much more time with me than the ten minutes they did.

      I pay for and expect to have my physician treat me for what I have, not for what they invent that I have. In your example, if I had depression and my doctor wanted to treat me for a broken leg, I would be equally offended. You do not get better, and as mentioned before, you can easily lose your life, by getting treated for the wrong illness. And, this includes patients with mental conditions. They have physical illnesses too, and are as equally harmed by these psychosomatic misdiagnoses just like anyone would be.

    • I like your idea of diagnosis – it should be a description, nothing more. Not blaming, not shaming, just a label.

      Recently I was at a regulars meeting of the “joint Medical – Psychiatric rounds” at the facility where I work. It’s a place to discuss cases that cross the lines of what providers expect. Recently a case was discussed where a woman came in, and what she wanted to be seen for was depression. As it turned out, what she had was malaria. Someone who can’t look outside “the box” would not have been able to ask the right questions to find it.

      Diane

      • Diane, this case might confirm our understanding of one of the major weaknesses of all psychosomatic medicine: diagnosis is entirely subjective and often reflects the biases of the medical professional rather than any reliable signs or symptoms displayed by their patient.

        There is a train of thought which suggests even the “description” can be harmful when it misleads us into believing that we understand something that in truth we do not. And we should remember the fundamental purpose of such a description. It should suggest a course of action or treatment by which the patient or client or person can reach a more positive and self-empowered state in their own life. In psychosomatic diagnosis labels, I would assert that there are no reliable courses of action. None. There are no validated treatment protocols that do better than placebo in helping people labeled with psychosomatic diagnoses to feel better and function better. We might all do better if the medical profession forbade the assignment of psychosomatic labels, as a requirement under the basic principle of “first do no harm”.

        • You noted: “one of the major weaknesses of all psychosomatic medicine: diagnosis is entirely subjective and often reflects the biases of the medical professional rather than any reliable signs or symptoms displayed by their patient.”

          If by psychosomatic, you mean the way diagnosis is used by the psychiatric profession (referring to the DSM-IV-TR and now the DSM-5) and the medical profession (disease and condition names) and the Health Care Business (as in ICD 9 &10) then I would agree in a limited way.
          Medical diagnosis generally incorporate a high objective element in that (for example) a broken leg on X-ray is often a pretty valid and a pretty reliable indicator of what the problem is; an abnormal T-3 and/or T-4 can also point in pretty clear directions.

          I actually think that the DSM-5 is poorer at providing a “diagnosis” than the DSM-IV-TR, as it discards the 5 axis model – that was one of the few places that the medical community was forced to think holistically despite itself.

          I personally think a high level of subjectivity can be very useful in a diagnosis – when it is the subjectivity of the patient. This is where nursing diagnoses have their greatest strength; there is an inherently subjective quality when you are attempting to describe the reaction of the patient as compared to the “condition” of the patient. I am a strong believer that the patient’s experience of their situation is one of the most important aspects of dealing with a patient.

          You commented: “There is a train of thought which suggests even the “description” can be harmful when it misleads us into believing that we understand something that in truth we do not.”

          I’ve heard this argument before, and while I concede that it has some merit, it’s also a good excuse to devolve into arguing one’s self into a corner and unthinkingly bashing any description as shaming – which is impractical, doesn’t actually address the issues and ends up being a waste of everyone’s time.

          You commented: “In psychosomatic diagnosis labels, I would assert that there are no reliable courses of action.”

          In the original article, it stated: “Conversion Disorder” (Functional Neurological Symptom Disorder) and “Somatic Symptom Disorder” (SSD). The unproven assumption underlying both is that emotional distress can be “converted” into physical pain, seizure-like incidents or other symptoms not explained by physical disorders known to medical doctors.”

          One obvious weakness here is that there is no recognition of cultural competency. I spent a long afternoon with a highly skilled Neurologist who worked in a very busy pain clinic. He noted two particular cultural groups with low socially acceptable recognition of emotional pain and high incidence of emotional pain and life stressors presenting (experienced by the patient) as physical pain. He did not label it as a conversion or anything like that – he recognized that his cultural background prepared him to utilize different ways of seeing and different modes of helping than his patients were used to. He noted that his colleagues who were not treating “the whole person” (mind/body/situation) would often “spin their wheels doing nothing useful very expensively” (his words not mine).

          I’m in a doctoral NP student in a psychiatric program, and I’m really lucky that nursing as a field has an inherently holistic view of the patient. It helps me “think outside the box” (as compared to some other specialties) because really … there is no box.

          Diane Inda, BSN, RN, PHN

          • If the question is: can emotional pain especially if chronic lead to some physical symptoms? It surely can, any person who had or witnesses say a panic attack knows that. But to call that a psychosomatic condition and label as a mental disorder that’s a bit much? I mean a lot of if not most “mental disorders” are not really medical conditions: they are psychological problems caused by somebody’s bad quality of life, be it for social reasons, relationships or else. And usually this kind of physical problems are related to effects of stress hormones and have so quite distinct symptoms (chest pains, difficulty breathing, muscle problems) which experienced doctors can recognise. For such cases SSD diagnosis is absolutely unnecessary, I can’t see how it should help your doctor do anything that he can’t do already (like tell you to take time off work, relax, get massage, psychotherapy etc.). I can really only see this as further bloating of psychiatry to encompass patients who don’t belong there.

          • Diane, you wrote:

            ” I spent a long afternoon with a highly skilled Neurologist who worked in a very busy pain clinic. He noted two particular cultural groups with low socially acceptable recognition of emotional pain and high incidence of emotional pain and life stressors presenting (experienced by the patient) as physical pain. He did not label it as a conversion or anything like that – he recognized that his cultural background prepared him to utilize different ways of seeing and different modes of helping than his patients were used to. He noted that his colleagues who were not treating “the whole person” (mind/body/situation) would often “spin their wheels doing nothing useful very expensively” (his words not mine). ”

            Are you not simply arguing here in different words for the same basic premise — that emotional factors cause physical pain symptoms? Though I recognize and rather often see the severity of pain increased through stress and emotional anxiety, I do not accept emotions as “original cause”. The historical conception of conversion disorder is precisely that, and I believe that this conception must be confronted for the professionalized self-delusion that it is.

          • You noted:
            “But there is a second dimension of diagnosis that we ignore to our peril: diagnosis should lead to a more focused and effective treatment or intervention for the patient. It also provides the framework within which physicians of all kinds are trained. Without a systematic and rationally grounded diagnostic science, we are all left groping in the dark or practicing as shamens.”

            I do agree that the usefulness of a diagnosis (of any kind) is that (ideally) it illuminates the problem/causes and by so doing, indicates potential treatments. That being said, shamans (spelled with two ‘a’s) are practitioners in a spiritually based tradition who get decades of training and do some fairly impressive things – totally different than medicine or nursing. As an aside, I did my world religions paper on the similarities between “schizophrenia” as defined by western medicine and “shamanic crisis” as defined by multiple indigenous experiential spiritual paths; and the point I found most interesting is that western medicine, by comparison, gets crappy results. But that is really far afield for this discussion.

            However, it does bring me sort of around to another point you made. I talked about cultural norms shaping experience and defining how pain is understood by the patient.

            You commented:

            “Are you not simply arguing here in different words for the same basic premise — that emotional factors cause physical pain symptoms?”

            Yes and no. Yes, because such things as the average widower dying within a couple years of his wife, and people “living until X event” are pretty well documented. So yes the mind, the experience, the emotions can strongly affect the body. That is where I see the greatest strength of the DSM-IV-TR 5 axis diagnosis (I. Clinical disorder/focus, II. Ongoing maladaptive personality/cognitive factors, III. Relevant medical conditions, IV. Environmental problems/stressors, V. Global Assessment of Functioning) or a nursing diagnosis (Clinical situation/contributory or causative factors/current symptomology). Both take a wide view of the person/situation, rather than just pointing to one “bit”. I also note that in many (not all) cases when a mental health problem is treated without addressing the “rest” of the person/situation, not much changes.

            “Though I recognize and rather often see the severity of pain increased through stress and emotional anxiety, I do not accept emotions as “original cause”. The historical conception of conversion disorder is precisely that, and I believe that this conception must be confronted for the professionalized self-delusion that it is.”

            This is where my “no” comes in. I see mental disorders as akin to cancer (wait for it!) in that usually you cannot point to one single thing/germ/incident and say “that caused it” in the way that a broken leg was caused by a fall, or strep throat was caused by a particular infection. For both cancer (often – probably not always) and many (maybe not all) mental disorders you cannot say with authority “this caused it”; it’s more like “this, that, the other and possibly 5 other things contributed to it”.

            I don’t like the diagnosis of conversion disorder not because I don’t think it’s possible for strong emotions to be expressed through the body (and even be a first cause), but because I don’t like how it’s abused by too many providers. Now saying that, I also must say that there are many things contributing to that abuse: insurance regulations, profit margins, lack of time with patients, and probably a lot more. Ultimately though, I think that having this diagnosis, in this culture, promotes and supports that abuse. For that reason, I would like to see it dropped.

            Diane Inda

        • Exactly. How about a diagnosis of “I don’t know”. It’s at the very least honest and it does not harm the patient or plain insult him or her. Medicine isn’t able to answer all the questions yet and we may be better off with admitting that and trying to look for a reason rather than labeling it “psychosomatic” and not only still not being able to help the person but also effectively calling them “crazy”. It sounds for me like some fundamentalist religious people who when they can’t explain something in the natural world say “God did it” as if that explained anything and they’ll burn you if you try to discuss.

          • My understanding is that when something isn’t certain, a diagnosis can be prefaced with ‘provisional’ or several can be listed as “rule outs” which are basically fancy ways of saying that here’s the providers’ best estimate of what’s going on, but the search for clearer understanding is ongoing.

            As an aside – much of the “need” for diagnoses seems to be coming from insurance, politics and billing. If you can’t “name” it, apparently you can’t get paid for helping deal with it.

            Of course with logic like this it starts to make sense to me why nursing rarely gets to bill directly for it’s services; it’s the most honest “diagnosis” you will ever get. Possibly I’m a bit cynical at the moment.

            Diane

          • Diane, I believe you are correct in your remark that much of the need for diagnosis comes from third party insurers. In my view, this is unavoidable. Reality is that much of health care is subsidized by such third parties, either insurance or government. Those who find themselves in the most distress are often economically isolated.

            But there is a second dimension of diagnosis that we ignore to our peril: diagnosis should lead to a more focused and effective treatment or intervention for the patient. It also provides the framework within which physicians of all kinds are trained. Without a systematic and rationally grounded diagnostic science, we are all left groping in the dark or practicing as shamens.

  15. I’m not in a position to split hairs over what’s the mind and what’s the brain because I think that we have different ideas of what the mind is. I don’t see it as separate from the brain. I can’t justify that scientifically not being an anatomist, I just have never been satisfied that there’s anything in my head that isn’t my brain, unless you want to argue that the bodily fluids that flow round it aren’t part of it. When someone can show me a scan/picture/brain taken out of the skull and physically separate mind from brain, then I’ll accept there’s a difference.

    That being so, I’m not sure what symptoms you would or would not see as physical or mental, so I’ll chuck out some random symptoms that I don’t think are seen by the average member of the public as ‘depression’ and that I think respond perfectly well when treated as physical conditions. Years of hanging out with other manic depressives tell me that these symptoms are not in any way unique to me.

    The sensation of pain throughout my body without any obvious source, more intense and distressing than that of any physical cause I’ve known. A slowing down and reduction in physical co-ordination. Difficulty responding to things with my eyes, making tracking harder. A change in the quality and length of sleep. A difficulty maintaining body temperature even during warm weather. A reduction in bowel motility.

    Incidentally, I experienced these symptoms cyclically with hypomania/mania in between for many, many years before taking any psychotropic medication whatsoever, so they weren’t side-effects of anything. I would say that for the first 20 years, the cycle was approximately 18 months, so it wasn’t a seasonal cycle.

    I do not negate the need for people to have correct treatment. I do not advocate a particular type of treatment for, e.g. ME/CFS. I merely make the point that the biggest problem here is not in the abstract whether something really is physical or mental but rather whether what sort of label we stick on it affects whether it is treated properly.

    Let us take a fictional example. Let us say that you have a disease that causes you to develop green triangles all over your body. Let us suppose that the best way to deal with this is to eat rhubarb, go swimming and sleep 17 hours a day. It should not matter one jot which catalogue of diagnoses green triangle disease fall into, what should matter is whether you get your rhubarb, swimming and 17 hours sleep.

    Therefore what is wrong with this diagnostic category is not so much that it appears in a catalogue of psychiatric diagnoses, nor that it has a ghastly label, but rather that its presence there may be seen as an excuse for not giving someone the best possible treatment.

    My argument would be the same in relation to conditions seen as normal in old age, where that is seen as a reason for not treating them appropriately or in broadly the same as you would if they were not labelled old people’s conditions.

    So don’t just insist that your green triangles are physical, also insist that whether someone thinks they’re physical or mental you need your rhubarb.

    • Angela Kennedy (@AcademicAnge) says:

      Sue, with regard to your comments about the ‘mind’ and ‘brain': if the brain and mind WERE synonymous scientifically and conceptually, a brain tumour would be a mental illness. It isn’t your ‘mind’ that controls your autonomic nervous system: it is your brain. For these and many more reasons, clarity is essential when deliberating about these things, and your ease at conflating the two concepts, if done by doctors, scientists, and others, can be very dangerous to patients, as many of us have demonstrated to you even on this thread. The ‘mind’ is a linguistic construct, denoting the act of ‘thinking’, not a place in the body (any more than the ‘soul’ does). It is not meant to denote the brain, even though some people confuse the two.

      Your own particular list of symptoms could indeed be caused by physical dysfunction independent of ‘depression’ (another problematic construct). If you haven’t be adequately investigated for causes of such problems, then even your ‘depression’ diagnosis may be unsound (I feel justified in addressing your own personal issues here because you are bringing them up to ‘prove’ the points you are trying to make). It might be that your ‘manic depression’ (now usually called bipolar disease?) is, as a neurological dysfunction, causing physical symptoms. Or there could be other reasons: adrenal dysfunction, ‘overdoing’ things in ‘manic’ phases, whatever. But that it might be ‘the mind causing physical dysfunction’ is rightfully critically interrogated, because the evidence for such a belief is not sound, and can cause terrible problems for patients, again as discussed already on this thread (thank you all by the way, for such a productive discussion, including David’s original post! One of the best discussions I’ve had in years). One problem with ‘depression’ diagnoses is that they are subject, like psychogenic explanations, to various potential attribution errors as well, especially around what constitutes ‘normal’ or ‘abnormal’ distress.

      I’m glad you understand that the label of ‘mental illness’ does cause mistreatment, for many reasons around category errors, general attribution errors, moralistic belief systems, social expectations etc. But this does NOT negate the problem that psychogenic explanations can cause death and deterioration in physical health into severe disability, which is basically what you appear to be having trouble understanding.

  16. If I am given a highly toxic dangerous drug, by one person, then exhibit severe symptoms when I am taken off it, abruptly, by another, lesser person, is it not common sense, that, instead of ‘derailing’ me with ‘mental’ problems, then obviously the drug is to blame.

    As I have said many times before, if a psychiatrist puts someone on an ssri to help them dampen down their emotions to get over a personal crisis, but, then a gp from a surgery, with no psychiatric training, enters the equation – this can be the difference between life and death.

    The chain is wrong and doctors, who are not psychiatrists, should play no part in hypothesising, interfering and meddling in such important work.

    My mistake was to ask my doctor if it was ok to cease medication and her gung ho attitude, and subsequent failure to protect me, even led a Clinical Psychiatric Director, to say that he fully understood the profound distress and offered me sincere sympathy.

    Is this good enough?
    I nearly lose my life and I receive sincere sympathy, when, in front of both of them I am hysterical, manic, psychotic, anorexic, blubbing and falling apart.
    Is this good enough?

    I was caught up in the blame game and I keep telling them, this is not a competition – this is real life playing out here and as frustrating as I find it my mental faculties seem to be more astute than theirs.

    How oddly that they are so busy blaming each other, that they forget this mother is quite capable of accusing them of inadequate, incompetent, life-threatening, and completely soul-less behaviour……..

    It begins to get pretty petty when individuals write books about ssri withdrawal, when, clearly they have no idea what they are talking about…..You have to live it, to believe it……and the only person who has lived it, is the real expert here……..

    This constant dripping on about depression is not the culprit.
    The culprit is pharma supplying doctors with drugs so dangerous that all common sense flies out of the window.

    It was a psychiatric decision to give me an ssri.
    It was not a psychiatric decision to chuck it, and to chuck away my life at the same time.

    Doctors surgeries have no right to even begin to think about addressing ssri or even benzo problems when it is not their chosen field of expertise…..

    Latest news is that you wait three weeks for an appointment.
    Gives you time to establish that you don’t need mind-bending medication.
    Then no-one will have any knee jerk reactions……

    • Actually psychiatrists are doctors of medicine who have chosen that as their specialty. If you want a doctoral level health care provider who was trained in psych as the main focus of their advanced education, then go to an advanced practice nurse.

  17. This thread seems to veer off the rails from the actual subject at hand frequently. The subject isn’t about labels or the disease-of-the-month club or treatments or treatments that are poison. About the poisons, Dr. Healy addresses that frequently here. I suggest you read some of his work.

    For the current discussion, I think I have lost all hope in the public if they are unable to see that the crux of the SSD issue is – what is the correct diagnosis and what do clinicians choose to do if they can’t find it. Labels are entirely inconsequential to this and the correct treatment decisions, to the best of our knowledge, should follow the correct diagnoses. If it is hard enough to treat an accurately diagnosed illness, how can one possible treat a lie correctly.

    If you think I am off base here, please try this experiment the next time you are even mildly incapacitated. Write a bunch of diseases on a dart board and when you speak to the doctor, blindfold him, and ask him to throw a dart at it. Where it hits, there’s your illness. You can be progressive and accept this diagnosis so as to not show prejudice, and you can also choose the treatment or rebel against it because it is poison. But, it never changes the fact that it is still the wrong diagnosis and still the wrong way to go about diagnosing. [I will coincide a remote possibility of it being correct, due to the laws of chance]

    • RB, It may be as you suggest that we go a little off-track from the original premise of the article which has generated this thread. That may be inevitable on a blog site where many readers and participants have been mis-diagnosed, mis-treated, and substantively harmed by the use of medications which cause more harm than good for large numbers of people. I have no complaint of that “drift” (if what we’re seeing deserves the term).

      The core point that I was trying to make is that psychiatry and psychology now face a multi-dimensional crisis of confidence. The medicalization of daily life and over-medication of distressed people who are labeled “depressed” is one dimension of that crisis. The use of psychosomatic myths to stigmatize and deny patients appropriate medical care, is another and somewhat differently acting dimension. But both can be seen to be grounded in a common issue: medicine and mental health practice are jointly suffering from a lack of science and an over-abundance of uninformed or badly informed opinion on the part of standards-setting organizations and practitioners of psychiatry and psychology.

      Undeniably, both physical and mental health medicine do some patients a great deal of good. But I would argue for a recognition that mental health treatment presently suffers from a lack of practice standards grounded upon careful science. To preserve the good which psychiatry and psychology may potentially do, a weeding-out process is very much needed, to identify what actually works from what is merely claimed to. This process is inevitably going to be disorderly, as Big Pharma, health insurance companies, professors with more ego than common sense, and self-interested others pursue their own agendas and try to obstruct change that affects their pocket books.

      This is something I’ve been agitating about for several months at the Global Summit for Diagnostic Alternatives (DxSummit.org). Patients, the public, and the healing arts need an integrated action plan to get from the mess where we are, to some place better. Discussing the matter ad nausea isn’t going to do it. For one version of an action plan, see my article on DxSummit, titled “Lead, Follow, or Get Out Of The Way.”

      I wonder how many of us might be willing to engage on development of such a plan — and who among us is empowered to enlist the assistance of funded professional groups other than the US APA, to make it happen?

      Regards and best,
      Red

      • If only depressed. On top of that you have so called “personality disorders”. Where a diagnosis is basically: you have a f**ed up personality. Solution: get drugs that will keep you under and pay huge sums of money to talk to a person who’s going to explain to you why you’re so messed up because surely you don’t know it (must have been childhood you don’t remember). The whole problem with so called mental health is that it’s based on a lot of shady theories and little real knowledge. And as it is now you can’t take stigma from the diagnosis because you’re essentially your brain so if someone tells you you’re brain is messed up means you’re messed up no matter how nicely or otherwise you put it.

        • Personality disorders or adjustment issues are indeed problematic in their own right, especially when treatment amounts to permanent walking sedation. But we must also understand that significant numbers of people are in real distress and want help — either medical or otherwise therapeutic — to reach a more positive state of personal function. Some don’t want help but can’t function without it — a truly basic ethical dilemma for families as well as professionals.

          I personally don’t think we can just throw out medication as an answer for some people, some of the time, under limited and carefully observed conditions. Having been in therapy myself for both the residues of early childhood battering abuse and young adult adjustment issues, I’m not comfortable or convinced that talking therapies do much for even more severe problems than i had — delirium or hearing voices, or massive mood swings that disable possibly millions of people from participation in work or society.

          My point in all of this is “where is the action plan for sorting out and cleaning up the mess?” Not of just individual patients, but of the professions which offer their practitioners as guides in the process. I’ve already published an outline for what I think might need doing. Maybe that outline is wrong, or maybe partly right or even mostly right. But we won’t know unless both patients and professionals are willing to sit down and talk with each other about it or about some improved version of it. So far, nobody at DxSummit (The Society for Humanistic Psychology) has been willing to engage meaningfully on such a project. Response to “Lead, Follow Or Get Out of the Way — A Layman Perspective on Change” has been a crashing silence. I would welcome a re-publication of that piece here on David’s excellent blog, with continuation of the rich discussion we’ve seen on Somatic Symptom Disorder.

          See http://dxsummit.org/archives/1290

          Kind regards,
          Red

          • Well, maybe one should acknowledge that this is not a perfect world and some problems just don’t have a solution? The fact that someone is in a state of extreme psychological suffering doesn’t always mean there is anything to be done about it nor that it is necessarily a pathological thing. Suffering is in a way a human condition. And drugging someone only makes it more difficult to deal with your life problems and/or accept some things about your life. As to forcing people to “treatment” – one should have a right to his/her life and to ending it or making it shitty. You can try to help someone but you shouldn’t be able to force it on them.

          • Added note: I’ve just finished reading the article and I couldn’t agree more with the points you made. However, what makes me most concerned about the field of psychiatry today is the coercive nature of a lot if not most of its practice. I essence in other fields of medicine treatment is almost always voluntary (except for some cases of infections diseases when isolation and treatment or immunisations can sometimes be forced) while in psychiatry a diagnosis often means immediate loss of all or parts of basic human rights (such as ownership of your own body). People who are diagnosed based on bogus criteria are often subjected to pre-crime punishments based on “dangerousness to self and/or others” criteria which have not been shown to be predictable by any study I could find. This is not only a violation of people’s rights but it also has severe consequences for those who are first misdiagnosed and then as an effect of this wrong psychiatric label stripped of their right to seek alternatives and forced to take drugs which often make them worse.

  18. My apologies. I never addressed the other part of this hateful diagnosis. It is new to DSM 5 and I frequently forget about it. It is the fact that anyone with a diagnosed medical condition that spends “too much time” thinking about or researching it could receive an SSD diagnosis. Although this may help a few that are overly concerned about their condition cope with it, it leaves the door open for physicians to fob off anyone that annoys them to much with questions. It is an equally travesty that bears an article all its own.

    And, if anyone thinks I am diminishing the impacts of stigma or harmful medications, I assure you, I am not. I just think they are different issues then the current discussion about SSD.

  19. Labelling a physical illness as psychiatric has to be one of the most frightening things that can happen to a patient.

    As an ME sufferer of 30 years, I heartily agree with Angela’s comments in reply to Sue’s. My ME was triggered by the Coxsackie B4 virus (an enterovirus of which there had been an outbreak in west of Scotland) at the end of 1982 – I was at university, not yet 19 yrs old. After 18 months of illness, I was lucky to be diagnosed by a consultant neurologist who found a ‘full house of abnormalities’ after EMG and muscle biopsy and immune profiling.

    Sadly, such specialist intervention for ME at a neurology clinic, such as I received in early-mid 80s, is a rare thing now in UK. I had a plasma exchange with immunosuppression, and anti-viral therapies to name just a couple of the treatments.

    It was hard enough having this neurological illness punch into my life – I always say it can take a decade to adapt to living with ME – without a core of UK psychiatrists muscling in at the end of 1980s and trying to claim the illness as their own, conflating ME with unexplained, psychiatric/chronic fatigue and causing harm to hundreds of thousands of sufferers in the process by 1. not believing them and 2. by applying harmful walking/talking therapies.

    Exercise makes ME symptoms worse, we have mitochondrial dysfunction, our muscles do not provide us with energy in the normal way. We experience post-exertional malaise (PEM) and can’t sustain any activity (physical or mental) without our symptoms becoming more severe. Resting and pacing is how we survive, ie NOT forcing ourselves to exercise!

    I personally have never had to face these therapies of GET and CBT for my staggeringly obvious physical symptoms, but I feel very angry on behalf of those people with ME who are subject to such inappropriate treatments. Imagine you had the worst flu you’ve ever had, multiply that ghastly feeling of weakness and awfulness by ten, for weeks, months, years on end, and then imagine you were told you were mentally ill?

    I reiterate that no one is saying that depression is not a serious illness, but people with ME are not depressed (unless they develop this as secondary to the primary neuroimmune illness). It is frankly a wonder we are not all clinically depressed at the way the psychiatric profession have hijacked our illness. Their arrogance and power is simply breathtaking.

    If anyone is interested, I fictionalised my experience of ME in my novel The State of Me, HarperCollins, 2008. The book is my weapon against ignorance and expresses much more than I can say here. And can I also wish everyone commenting on this thread who is ill better health.

    Thank you for reading a longer than intended comment.

  20. Maie Liiv says:

    My first psychiatric label: Years ago. Recently married, in my late thirties, advised by a doctor that I should have a rubella shot in case I got pregnant – “we wouldn’t want anything to go wrong.”

    I had 13 little godchildren plus siblings at the time and let the doctor convince me I was at risk if any of the kids got rubella. She also proceeded to bring my other immunizations ‘up-to- date.” So a whole bunch of shots in one day in one arm . Within a couple of weeks I was barely able to lift my head, I had severe ‘atypical inflammatory arthritis’ and severe muscle weakness.

    The diagnosis was ‘Chronic Fatigue Syndrome’ and I was told: “As everyone knows this is purely psychological.” My husband believed what the doctors said and told me to “get over it.” It was not a great start to a marriage.

    We didn’t have children – I was too crippled – and now doctors refer to me as “short haired, bespectacled, middle-aged, childless”

    Regarding immunizations – there are degrees of damage – damage which often gets a psychiatric label.

  21. Dr. Lawhern, I would be the last choice for any committee, fund-raising, protest or organizational endeavor; they are all foreign to me. However, I will share two “grass-roots” websites with you.

    To raise money: http://www.gofundme.com/
    To start and obtain signatures on petitions: https://www.change.org/

    Best wishes on your efforts,
    RB

    • RB — as I suggested, there are profound ethical quandaries to be confronted in changing practice standards for treatment of those in medical and non-medical distress. In the real and imperfect world, quite a number of our homeless suffer from severe mental disorganization on top of drug and alcohol addiction. But they do not suffer alone. How would you advise the family of a homeless person? “Joe (or Jane) has chosen to reject medication and therapy, but that choice is one which we must honor, even though Joe’s family may soon join him under the overpass.”???

      I do not mean this question unkindly, RB. But if we are ever to work through real change, it is one with which we must engage and for which we must attempt to find better answers.

  22. Severe mental disorganization with drug and alcohol addiction and living under the underpass is a sight we all see on a daily basis.
    I see very little done to help these people.
    In London and other large cities, they lie under newspaper and forage around food bins. Usually, the most important thing is the meths or whatever liquid they can consume to take them out of the total misery of their lives.
    They seem used to it. They are not angry people. They shuffle about in some sort of world.
    These people are let down by the politics of the country who allow them to sleep on the streets.
    There are so many empty halls, properties, houses which could accommodate these people, but, nobody really cares.
    That is the problem with society today.
    Boris, as Mayor of London, could orchestrate ‘tramps’, and give them a bed and food, if nothing else. It is not difficult for police to move people on to some sort of boarding arrangement.
    Nobody can be bothered, is the bottom line, and it is good to see Red take the time to point out the problem.
    It is not honourable to walk past people who have nothing, when so much could be done for them.
    I am sure everyone of them has a story, and many of them, now, were professional family people and somewhere along the line it all fell apart.
    No one should ever be deserted and this is the problem that we can come back to with modern medicine.
    The basic principals of human conduct has put today’s public at the mercy of people who they consider superior, but we put our life in their hands and this is of such profound importance.
    Is your point, that nobody is looking out for these people or is your point that with all the wealth in the country, nobody cares?
    We could all go down the route of the homeless person, but, the question is, why inflict medication on people who don’t want it and perhaps drive them to the streets themselves…….put them in their car and dump them….that is what modern medicine is all about…………..
    Move on to the next patient, and don’t look back……if you do, the carnage might shock you…………….ethics don’t come into it.
    I would advise the family of a homeless person not to allow J J anywhere near a doctor because the fresh air on the streets would end up locked up in a mental hospital and these places are the worst places in the world.
    Being sent to a mental hospital, to me, was the most shaming experience of my life, but I met people there. I talked to them, and I felt so sorry for them.
    I could get out and get on and wish the world would fall on the head of the woman who sent me there because of ‘drug abuse’, but, I learnt something quite profound.
    I learnt that medication is cruel, people are cruel, and it woke me up to a great sympathy for my fellow man who cannot ever get out……ever getting out of such a low place that other people put them in.
    I was always taught to be in charge of my own destiny, but, along come people who I put on a pedestal and that was the biggest mistake of my life.
    I have never in my entire life experienced such appalling abuse as those who drugged me and manipulated me and made me cowed…….so, I would rather live under newspaper than go through all that again……nothing will persuade me to allow one more person to question my personal authenticity.
    And, so, my tin roof is better than newspaper, but I am quietly apoplectic that in this world of ours people take over your destiny who don’t care and who are never apologetic and who don’t deserve to earn their crust living off us…..parasites living off us.
    I engage and I will help find better answers.
    Thanks for keeping up the dialogue, Red.

    • I share a lot of your experience Annie. From what I saw with my own eyes these institutions have nothing to do with helping people, they have everything to do with control, intimidation and abuse. Which is to be expected if you give a certain group of people institutional power over another group. It happens in prisons and it happens in mental institutions, it’s simple psychology as exemplified in Stanford experiment. Let’s not kid ourselves: psychiatric hospitals are have less to do with hospitals and more to do with prisons.

      • I did a clinical rotation at the St. Peter forensic hospital and it as just that; both a prison and a hospital. What I find the most scary/depressing was the family backgrounds of many of the patients I saw. Reading through some of it, I couldn’t honestly say if I had to go through a childhood/young adulthood like that; I might have come out much worse.

        But what do you do? What do I do with a person who at this point is very damaged by their experiences, so paranoid that their reaction to any situation where they might suffer loss of face – is to initiate violence. And that includes hearing someone speak quietly nearby (because “they must be talking at me”) or being looked at directly in the face (because “they disrespected me”). I don’t know what else to compare it to but a feral animal (this is NOT meant disrespectfully – I am involved in feral rescue, and let me tell you a cat born to several generations of feral ancestors is profoundly different than a domesticated cat – and I mean even if taken at the age of 18 days and raised by hand.

        Yes, most of the people willing to work in prisons should never be allowed near them. At St Peter (as an example) there are a lot of good people trying to do their best and a revolving door of upper management who may have been well-meaning but really truly don’t understand what is going on in a way the front line staff do.

        That being said, again I say it’s time to think outside the box, because our box is not working.

        Diane

        • What about approaches such as Open Dialogue in Finland or Soteria Network? I really don’t know much about them and I don’t know how well they really work in practice but if anything I’ve heard is true that may be a way to go.

  23. As long as the role of mitochondria is ignored, we will be unable to find physical causes for “mysterious” illnesses like fibromyalgia, chronic fatigue syndrome / ME, gulf war syndrome, many mental illnesses and most adverse drug reactions. Many of the answers to the mysteries surrounding these illnesses lie in the mitochondria and the chemical signals produced by mitochondria (ROS, RNS, antioxidants, etc.). The vital role of mitochondria in cellular health has been ignored – largely because pharmaceuticals and environmental chemicals damage mitochondria and lead to mitochondrial dysfunction and resultant oxidative stress (which does a number on the brain). When mitochondrial function is evaluated, there becomes a culprit – big pharma and big ag companies – along with their inept regulatory agencies. Rather than looking at the mitochondria, then looking at what damages mitochondria, it is easier to blame the victim and tell him or her that all of the pain, anxiety, suffering and loss of mental faculties is “all in their head.”

  24. The story has become a cause celeb in the US. The story of Justina has direct bearing on many of the issues identified in my original article on SSD, above. In my opinion, both SSD and pretty much the whole of psychosomatic medicine is more mythology than science.

    Here is a recent update from Twitter: http://www.prnewswire.com/news-releases/personhood-usa-justina-pelletier-tells-parents-i-feel-like-im-in-jail-249052611.html

    Meantime, I continue to invite participants in this thread to post references which establish the medical evidence for roles of mitochondria in medical disorders and disease.
    Regards, Red

  25. Headline news in the UK.

    STATINS HAVE NO SIDE EFFECTS.

    Yes, this really will be the front page headline of tomorrows Daily Telegraph.

    “Statins have virtually no side effects, with users experiencing fewer adverse symptoms than if they had taken a placebo, a major study claims”

    Do you see what they are saying? Placebo has more side effects than the actual drug, therefore most side effects reported by people on statins come from the mind and not from the drug….Maybe I picked them up wrong?

    “research published on Thursday in the European Journal of Preventive Cardiology suggests that only a small minority of reported symptoms are attributable to the drugs.

    “Almost all would occur just as frequently on placebo,” said Dr Judith Finegold from the National Heart and Lung Institute in London at Imperial College.

    “Most people in the general population will not feel perfectly well in every way on every day. Why should they suddenly feel well when taking a tablet after being warned of possible adverse effects?

    “We believe that patients should be empowered to make their own decisions, but we must first make sure they have top quality unbiased information. This is why we call on drug regulators to highlight in the long lists of side effects those few whose rate is incrementally greater than that experienced with a dummy tablet.”

    Nope, I definately didn’t pick them up wrong :(

    If you were to combine this with recent guideline changes to Statins, it seems to me you could have another 12million people in the UK as potential SSD customers?

    No doubt the ones who do get the occasional real side effect have some genetic defect, because you do know that the drugs are perfect don’t you?

    Just wait until they find the gene that is most prevelent in people that report drug side effect that aren’t supported by the ‘evidence’ or who report unexplained symptoms of any sort. I mean there is apparently a ‘Violent video game’ gene, so why not one for SSD?

    The only question I would ask Judith Finegold if given the chance would be: HOW THE HELL DO YOU SLEEP AT NIGHT?

    http://www.telegraph.co.uk/health/healthnews/10693895/Statins-have-virtually-no-side-effects-study-finds.html

  26. http://saveyourself.ca/articles/anti-depressants.php

    This is a good guy.

    As he highlights The David Healy Affair, near the bottom of the post, Notes: 2, he might be a candidate for an input in our DH blog about the iniquitous safety of anti-depressants, statins, benzodiazepines and other much heralded innocuous little pills……..

    • Annie, so that Paul Ingram’s very insightful article doesn’t get lost in the shuffle, let me quote from it here:

      SSRI Antidepressants Are Not Medicine

      Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to

      “Contrary to what I once assumed, the side-effects of anti-depressants are actually numerous, severe, potentially life-threatening, and not widely known or even understood. They cause a low but measurable rate of psychotic mania, for instance — equal to millions of people who have been reduced to quivering wrecks, their behaviour drastically altered, careers, marriages and lives lost. Withdrawal symptoms from SSRIs are even more problematic.”

      also and importantly,

      “If you are considering antidepressant medication, please do your homework first. If you are already taking antidepressant medication and want to quit safely, it is not sufficient to simply ask your physician. You must educate yourself.”

      I have personally distributed the link you provided to over 200 friends, colleagues, and website moderators in chronic pain communities. My recommendation to each was as follows:

      If someone you care about has been diagnosed or struggled with depression, then I believe Ingram’s article provides a necessary wake-up call. Literally millions of people may need to be assisted to recover from the debilitating effects of a dangerous class of medications. And very few people in US and European governments seem to give a tinkers damn. Too many have been bribed by political contributions of major pharmaceutical companies.

      I urge you to read this article, print it out, and provide copies to your personal physician, the Chief Resident of your local hospital — and in the US, the offices of your congressional representatives and senators:

      ================
      The suggestion I made to people whom I know myself, might be multiplied by others now active in this discussion. Read the article. If you find value in it, send it on to others.

      Regards all,
      Red

    • Annie, the article you reference is excellent and deserves widespread dissemination. With that in mind, I have distributed the following to over 100 friends and colleagues. I recommend that other participants in this discussion to consider doing the same:

      ===============

      SSRI Antidepressants Are Not Medicine

      Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to

      by Paul Ingram, science writer, former massage therapist, and the Assistant Editor of Science-Based Medicine since 2009.

      In this article, Ingram writes:

      “Contrary to what I once assumed, the side-effects of anti-depressants are actually numerous, severe, potentially life-threatening, and not widely known or even understood. They cause a low but measurable rate of psychotic mania, for instance — equal to millions of people who have been reduced to quivering wrecks, their behaviour drastically altered, careers, marriages and lives lost. Withdrawal symptoms from SSRIs are even more problematic.”

      also and importantly,

      “If you are considering antidepressant medication, please do your homework first. If you are already taking antidepressant medication and want to quit safely, it is not sufficient to simply ask your physician. You must educate yourself.”

      ==============

      If someone you care about has been diagnosed or struggled with depression, then I believe Ingram’s article provides a necessary wake-up call. Literally millions of people may need to be assisted to recover from the debilitating effects of a dangerous class of medications. And very few people in US and European governments seem to give a tinkers damn. Too many have been bribed by political contributions of major pharmaceutical companies.

      I urge you to read this article, print it out, and provide copies to your personal physician, the Chief Resident of your local hospital — and in the US, the offices of your congressional representatives and senators:

      http://saveyourself.ca/articles/anti-depressants.php

  27. http://www.theguardian.com/society/2014/mar/13/statin-side-effects-minimal-study-finds

    These 78 comments might help, Neil.

    As one smart cookie commented:

    Dear Guardian

    Please do not print advertisements that masquerade as reporting……

    We rest our case….

    • I just left the following comment –

      “Statins have been shown to be damaging to mitochondria. Here is an article about how statins mess up mitochondria – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849981/. If you mess up mitochondria, all sorts of multi-symptom illnesses can result – diabetes, neuropathy, chronic fatigue, etc. Per Dr. Richard Boles, “Mitochondrial dysfunction doesn’t really cause anything, what it does is predisposes towards seemingly everything. It’s one of many risk factors in multifactorial disease. It can predispose towards epilepsy, chronic fatigue, and even autism, but it doesn’t do it alone. It does it in combination with other factors, which is why in a family with a single mutation going through the family, everyone in the family is affected in a different way. Because it predisposes for disease throughout the entire system.” (from http://www.hormonesmatter.com/cyclic-vomiting-syndrome-mitochondrial-dysfunction/) BUT, interestingly, mitochondria can take a punch. They can withstand multiple insults before a person who has damaged mitochondria feels ill (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895369/) So, dosages of up to a person’s individual threshold of statins, or other mitochondrial damaging drugs (like fluoroquinolones – which messed me up) can have little or no adverse effects. However, after the person’s threshold for mitochondrial damage is reached – game over. EVERYTHING goes haywire in a person’s body. Especially if he or she goes into the peroxynitrite cycle described here – http://www.thetenthparadigm.org/index.html Basically, my point is, LOOK AT THE MITOCHONDRIA YOU FOOLS! Cells don’t lie. But pharmaceutical shills do.”

      Random note – I told my boyfriend that mitochondria were able to take multiple insults before going hay-wire and we decided to think up mitochondrial insults. We came up with:
      You’re leftover bacteria
      Your DNA is round and fat
      You get damaged by everything

      Yeah, the mitochondria were totally insulted.

  28. http://www.theguardian.com/society/2014/mar/13/statin-side-effects-minimal-study-finds

    Back to this debate, 360 comments now, Neil.

    It seems that the public are not buying in….

  29. On Dx Revision Watch

    Update on proposal to add DSM-5 Somatic symptom disorder to ICD-10-CM http://wp.me/pKrrB-3PE

  30. Richard, you see some bloke who tells you to take a pill.

    Why you do this I have no idea.

    Would I swallow weed killer, if I had a gardener who told me so?

    You cannot talk to a pill.

    End of story.

    You cannot talk to Sir Andrew Witty because he will not engage.
    If Sir Andrew Witty does not know about Paroxetine and billions of damages in the USA about Seroxat, then he has no business to be a CEO.

    Someone like me at the end of his rainbow, is amazed that Sir Andrew Witty can go to his office, do the figures, be Mr Nice Guy, go home to his wife and kids and sleep at night.

    Hey, Mister Witty, what about the 1:10,000 1:100,000 whatever, who just happened to have a reaction to Paroxetine.

    You really don’t give a shit do you?

    • What about the people who are not informed about that? Not mentioning the people who are forced to take psych drugs against their will…

  31. If I may introduce another thread, the following is long but very worth reading. “My Son is Mentally Ill, so Listen Up!”

    This article illustrates in highly graphic terms, that severe emotional and mental distress are not simply a problem for the individual who experiences them, but also for people around them. Families are stressed and sometimes fractured by what we call mental illness. Some patients are explosively violent and disruptive toward others. And while some patients can safely withdraw from a sedating medication regime, it is not at all clear that everyone can.

    See http://www.cnn.com/interactive/2013/12/health/mentally-ill-son/

    • Since when the doctor has a responsibility put family’s or society’s wishes first before patient’s well-being? That’s the main problem with psychiatry, especially its coercive part (and not only psychiatry, this attitude is also rampant in geriatric institutions and in some cases in hospice care). If someone is violent (disruptive or annoying does not fall into this category) and dangerous that may be a valid reason for coercion however there are 5 problems with that:
      1. There is no reliable way to determine if someone mentally ill will really hurt other people and that is true even if this person may be threatening that – treating them as if they already did that. That’s a clear example of pre-crime and it would be illegal but for crazy people it’s open season. One should not be punished before they commit a crime. Well, apparently that does not apply to psychiatric patients.
      2. There are no defined criteria by which a psychiatrist determines if someone is a potential danger. Therefore it’s basically “you speak up to me or shout at me or refuse to take drugs: you’re dangerous and will be forcibly restrained and drugged”. That’s common practice.
      3. Some of these drugs actually produce symptoms of mental illness – how are you supposed to determine if a person is experiencing symptom worsening from the disease or just got worse on the drug.
      4. Many of the coercive psychiatric interventions are considered torture by UN. How is it that if you strap someone “normal” in 4-points and leave them like that for hours or drug them into oblivion it’s torture and crime against humanity but if you do that to a crazy person it’s therapeutic? Not buying it.
      5. The coercive drugging will be usually the first thing to try. Who is going to bother with costly and time consuming therapies when they just can write a prescription? There is evidence that anti-psychotics actually can hinder recovery in the long-term (including the WHO study on schizophrenia recovery in Western world and 3rd World) but I guess just drugging someone is easier.
      In my mind one can have a discussion about coercive treatment for convicted criminals (when the crime was violent and connected to the illness). but that’s not the same: you’re labelled mental you lose you human rights.

    • One more thing, more directly related to the facts in the article. They estimate that 20% of teenagers suffer from mental illness. That’s one in 5 kids. That’s insane and it’s a clear indication that the way mental illness is defined and diagnose is bulls**. No one will tell me that a kid that gets bullied and tries to commit suicide is mentally ill. Or a kid who goes through puberty and gets angry one day and smashes a plate on the floor and then euphoric the other is mentally ill. I’m not even mentioning the overdiagnosis of ADHD. Tell me that any of these cases are not an automatic depression, bipolar etc. Maybe we should stop pathologising being human, especially a crucial aspect of it: growing up. It’s not only a problem because of stigma that can last a lifetime, because of effects or side effects of drugging on an individual etc. but it’s also a problem because it takes the responsibility from the society to care for its members well-being and puts it onto a person: if you’re not happy, you’re not strong enough to endure the sh** of domestic abuse, bullying, whatever it may be: there is something wrong with you, you have a sick brain so take your pills and move along or we will lock you up. I’ve heard people who say that modern day societies have a mental disorder themselves, that is they’re psychopathic. The more I see the more I’m starting to believe it.

  32. B: I realize you hold strong opinions on the illegitimacy of ever confining people or forcing them to take drugs. But I sense that if you take an “all or nothing” approach to changing psychiatric practice, then you’re programming yourself and others to lose the argument. To expect families and communities to tolerate people whose every day behavior includes raving against or being in public dialog with their voices, is simply asking too much. It’s not going to happen in the real world we all live in. And responsible and thoughtful people aren’t going to sign up to a movement that demands that it does happen.

    What realistic alternatives would you propose to the present system of forced medication, that average people confronted with a raving mad person can sign onto? I realize quite well that we cannot and should not characterize all people who are in distress by this standard. But if we are unwilling to meaningfully address betterment of the worst cases, then the whole edifice fails.

    Respectfully,
    Red

    • How about the approaches like Open Dialogue in Finland? I thought psychotic people are the posterboys for the dangerously crazy and they should be isolated and drugged or they will kill their family members but seems like in Lapland they take a more relaxed approach and it seems to be working.

      I do understand that if someone is smashing stuff around on a regular basis or trying to stab you that may be a reason to use some coercion and I’m not an “all or nothing” on that one. I think that if someone has committed a violent crime then maybe you have a right to do something about it if they don’t cooperate at all.

      That being said: using violence against distressed people (or any people at all), even if they are unbearable is likely to make them only more oppositional, violent etc. Trying to treat these people with respect, understanding and using empathy may not be the way to go in 100% of the cases but probably in most of them. Plus how can you establish a patient-doctor relationship later on if the patient doesn’t trust you because you first treated them with physical violence and then you use threats to make him do what you want? The first thing that person will want to do is to get even, cheat you or do anything to make you stop controlling them. In other words if you assume the path of coercion you’re likely to end up with a chronic patient who either doesn’t want to take drugs, fights with you, shouts and spits and does everything in his power to disobey the system or if the person’s more timid with someone who will pretend everything’s ok and lie to you.

      I’ll give an example of myself as a kid: when I did something wrong my parents first tried to punish me. Once they made me sit by myself in a room. Of course I didn’t like it and I only got angry at them and started literally destroying things. What do you do with a kid like that? Well, you can grab the kid, hold it to the floor and then take to a psych ward and drug them for the rest of her life. Or you can do what my parents did: calm down, go talk to the kid about how they feel bad about the whole thing and make the kid think it over. They only really tried to punish me a few times when I was small and then they saw it only made me more unbearable so they switched to “you made me so sad by doing this” and “I think what you’re doing is a bad idea but it’s your life and you have to remember that you will have to face consequences for this later on”. Worked like a dream.

      I know being an unruly kid and being mentally ill is not the same (though it seems to become more so with the ADHD epidemic) but I think in most cases you can do better without making the person hate you. But that requires time and effort and restraining and drugging someone is easy. Just take them away and throw them somewhere when nobody can see them or hear them. Sanitize it. Especially for the family that drops the person in the hospital and they assume the doctors know what they’re doing.

      You also miss the point which is: it is often the family or other people around the crazy guy who are at the root of the problem. I had a friend who was forcibly put in a psychiatric hospital because she tried to commit suicide because of her abusive parents. She gets punished because someone hurt her and she had a bad psychological reaction to it. another one was in a similar situation because she was sexually abused by her grandfather. There was a study recently showing that victims of domestic abuse are far more likely to “go mad”. But in the current system what happens is that the victim gets drugged and restrained for acting out and the abuser (who usually plays it cool in front of others) gets away with it and can even get sympathy from other people about having so much trouble with the crazy spouse/kid. Often the people who complain most about the horrible mad person are the very ones who are the most guilty of the situation whether they recognise it or not. I think that may be a reason why Open Dialogue is so successful: it takes these factors into account and it tries to fix the life of this person and the relationships around and not just drug someone into oblivion.

      That all comes down to the “biological” basis of mental illness. While I think it is biological because we are biological creatures and not some magical souls (I’m not particularly religious) I also think that biology gives you a predisposition to react one way or the other to stress. Some people can take a lot, some get depressed, some get psychotic. How you are more likely to react is biological but what triggers the reaction is most often environmental.

      So yeah, I think that the system should be non-coercive in principle and only in extreme cases should it use force and only for a short time necessary. But this requires time, resources, training and actually giving a shit about these people. It requires the system to take care of that person and his or her surroundings and not just: admission, restraint, drugging, release into hostile environment of scared strangers and frustrated family or no family at all (plus unemployment, homelessness etc.), admission, drugging, release… and repeat ad infinitum.

    • May I just add: you asked what is my answer and I think that the Open Dialogue-like approaches are the way to go. But like all actual answers to complex problems, rather than simple pseudo-answers, it requires a holistic approach. It’s not only about the psychiatric system (which I think would do better if it was disassembled and we started from scratch but I know that will never be a viable option), it’s about society as a whole. Look at the prison system in Norway: they have one of the most lenient systems in the world and they get one of the best results. But that, just as approaches to psychiatric care in Finland requires a certain kind of society: the one that is willing to take its time (and money although in the long term it may end up being cheaper) to deal with the person. You can probably calm almost anyone down if you take an hour or more time to calmly talk with them and sometimes it’s all they need but you can’t accomplish that if you have 15 minutes at most to tackle the problem. You also have to have a society that understands the concept of responsibility towards others and not only for yourself. In an individualistic society your mental problem is your problem only and if you make it others’ problem by acting out you are going to get punished. In a society when people get it that they are responsible to some extend not only for themselves but for people around them they are more likely to react with sympathy and patience. I’ve been living in a few different countries in Europe so far and the way people react to someone in distress is really a factor of that societal attitude. You have to build this culture just as you’re building institutions who channel the new forms of help. In the long run it will not only help the psychiatric patients, it will help society as whole.

    • I know I got very long now but I’ve just found a short article which kind of sums op what is a big problem with the medicine nowadays (which is multiplied by a huge factor in case of psychiatry):

      “The New York Times did a piece on it and the commentary contained a great deal of doctor-bashing. So of course I opened my big mouth and pointed this doctor hatred out. The comment I got back was this: ”It’s not hatred, it’s fear.”

      Wow. If people are starting to fear physicians then we’ve got a real problem. Trust has always been the basis of the doctor-patient relationship. (…) If you can’t trust us then we’re done. If you can’t trust us then our relationship becomes adversarial: you against me. If you can’t trust us, you won’t tell us things, you won’t do what we say, you will constantly be doubting our motives. And vice versa. (…) That old-fashioned trust of the physician resulted in a paternalistic approach to medicine with the resulting backlash by the autonomy movement. The basic function of the doctor, to diagnose and treat, has been called into question by the Mayo Clinic article as well as a number of other stories such as over-prescribing, doctors taking money from drug companies, the guy who performed illegal and unsanitary abortions, doctors turning down medicaid patients, etc. Doctors trust patients less too. Part of the reason doctors don’t follow the latest recommendations is fear of litigation, especially if they don’t do something.”
      from http://www.kevinmd.com/blog/2013/08/doctors-patients-regain-trust.html
      Add to that the fear of coercion and stigma for psychiatry and you’re in a hot mess. If you want to make sure mentally ill people get the help they need before their condition deteriorates to the point of no return you have to take coercion out of the picture.

    • http://www.prnewswire.com/news-releases/mental-health-advocates-decry-forced-treatment-provision-in-doc-fix-bill-252969621.html
      “Force and coercion drive people away from treatment,” said Jean Campbell, Ph.D., one of the nation’s leading mental health researchers. “In 1989, 47% of Californians with mental illnesses who participated in a consumer research project reported that they avoided treatment for fear of involuntary treatment; that increased to 55% for those who had been committed in the past.”
      Just to re-enforce my point. After seeing how the mental hospitals look like and the “treatment” people receive there I’d never ever tell a person to seek “professional help” as I simply don’t want to betray this person’s trust and potentially put them through torture. The way it is currently done is not only inhumane but counterproductive.

  33. B: so what would you do? What realistic, concrete, actionable alternatives would you propose in public policy, law, and psychiatric practice to bring patients and physicians together in a cooperative and constructive relationship? What are the steps?

    • Maie Liiv says:

      In Canada we have http://www.patientscanada.ca – started by a medical insider who went through healthcare hell. The last monthly meeting had representatives from several hospitals – included management, and ER doctor, two ER nurses. Doctors and patients listened to each other.

      I think this would not work for the inhumane profession of psychiatry – both hated and feared.

      • Thanks for the link, I didn’t know about this initiative. You’re probably right about psychiatry – so much wrong was done for so long that I have serious doubts that this system can be fixed without any drastic measures. If you try to talk about these things with psychiatrists they immediately go on the defensive, which is understandable when someone calls everything you did for the last 20yrs inhumane, counterproductive, torture etc. They are essentially not qualified (with rare exceptions) to do anything else than drug people and they’re also afraid of their patients. I think most people who work in closed wards have already completely dehumanised their patients, I don’t know how else could they continue doing this. This has to be done by on one hand building alternatives to psychiatric institutions and on the other hand by pushing the laws which protect human rights.

        • B., you mention “funding”. That generally implies either governments (NHS in the UK or Medicare in the US), or third-party insurance arrangements. Based on such recent atrocities as the Murphy Bill in the US — which makes it easier for a psychiatric professional to commit patients based on their opposition to being committed — one may reasonably surmise that Big Pharma now has a hammer lock on legislators who control such funding.

          Thus a third dimension may be suggested: it may be necessary to sue insurance companies for willful or negligent harms to patients, in their funding of reimbursement for psychiatric confinement, and their subsidies to doctors who prescribe harmful medications. Do any of us in this forum know of a law firm that handles a lot of malpractice cases? It seems to me that some consultations with the legal folks (aka “shyster lawyers”) may be in order.

          Regards, Red

          • On the funding: where I currently live, psychiatric institutions are funded publicly so it really just requires setting your objectives straight. In this case getting a number of professionals to back up the non-coercive approach, get a movement for the pilot program to build and sustain some of the alternative models, hopefully show it works and then expand the model at the expense of the old model. Which in the current climate of cutting funds for everything is even harder to imagine, especially with mentally ill being conveniently scapegoated for everything evil. Unfortunately, statistics almost always lose with one good mass shooting.

            Another way is to try to push the change in law by courts (in Europe we have the European court of human rights – unfortunately it’s still bound by the law of the country but it can also issue statements about the relation of the law to the human rights). I think UN here is also a bit more respected than in US (I don’t think US even ratified the relevant convention). On the other hand I think you have much better constitutional protections so there is some hope there. The idea would be to undermine the old system based on human rights protections to force the legislature to offer alternatives. The only problem with that is if the legislature decided it does not give a shit and they let things go wrong (like they pretty much did in US) we run the risk of losing the general public who are likely to blame the lack of coercion rather than the lack of any sensible alternative policy.

            On more practical approach: I’ve recently heard that in US people are forced to cover medical expenses even though their treatment is involuntary and that’s against the protection of the free contract that theoretically could be challenged in a class action lawsuit. I’ve also heard about these guys: http://psychrights.org/ but I have no idea what can they really do (there is an interesting talk though from one of the lawyers on strategies one can use to challenge involuntary treatment in court system but as I say – I’m not a lawyer and I’m not from US so I can’t judge the content).

        • B, your comment about “most people who work in closed wards have already completely dehumanised their patients, I don’t know how else could they continue doing this” my first question to you is when was the last time you spent a day on a closed unit. Or for that matter on an emergent unit?

          Yes, forced medications and forced restraints are sometimes used appropriately and discontinued appropriately. It’s very nice to think that “someday when someone has a crisis, we will get 8-man teams to hug them and keep them safe till they calm down” (my ideal – perhaps not yours) and I totally support that. But that ideal situation/day is not yet here.

          I am working with a patient today, that I had to help put into restraints yesterday. We are talking, he is getting better, and he understands why I did what I did. He understands that his reactions are more than what is needed and appropriate and he can see that he is getting better. (Note: my use of “he” being a generic term in no way attempting an accurate portrayal of actual or implied gender or chosen gender identification).

          You are right in that I would love to build an alternative to what we have. I’m finishing my NP (hope to be done next spring) and in a few years I’ll be moving to Oregon (better practice climate for NPs) and starting up a severely alternative clinic. In a few years I hope to be able to invite you (large collective ‘you’) to come see, tour and possibly work with me.

          Diane

          • Well, then you’re one of the few exceptions and yes I do speak from experience. You don’t have to be a strong man who’s running around trying to hurt people or destroy equipment to be forcibly restraint and drugged. Sometimes it’s enough to refuse a physical exam (in the middle of a panic attack – one would think that a half-brain should understand that if a person is panicking and telling you to leave them alone maybe you should keep your distance and take some time to call them down). Sometimes it’s enough that a doctor has no time (“I don’t have time for you, I have other patients” – an actual quote before putting a non-violent person in restraints for not complying with whatever the person wanted immediately). Sometimes it’s enough someone screams. Or swears. Or refuses to take a drug. Or do anything you don’t like or hesitate to do something you order.
            So sorry if that offends you but claiming that doctors use restraint and other means of force only after careful deliberation in most dire circumstances and then they discuss it with the patient in an empathic way is bullshit. They do it because they don’t have time or knowledge to do anything else, or they don’t care, or they’re scared of their patients to the point that they restrain them just in case, or they are afraid of potential responsibility etc. etc. Maybe you’re a rare example of a person who actually uses force only if there is no other way but I hope that you don’t assume that about all the other doctors. And you don’t tell a patient who complains to you about being traumatised by another doctor that their wrong and it must have been justified without knowing anything. Because I’ve seen also guys like that and I can tell you that this erodes trust and yes in many cases makes the so called therapeutic relationship impossible.

          • B commented:

            “So sorry if that offends you but claiming that doctors use restraint and other means of force only after careful deliberation in most dire circumstances and then they discuss it with the patient in an empathic way is bullshit. They do it because they don’t have time or knowledge to do anything else, or they don’t care, or they’re scared of their patients to the point that they restrain them just in case, or they are afraid of potential responsibility etc. etc.”

            I’m glad that you brought up so many possibilities because there is no one reason.

            “Don’t have time or knowledge to do anything else”

            Time being key here. If a patient is acting in a way such that staff present believe there is danger to the patient or someone else, there is not a whole lot of time to … well to dink around. To delay for deliberation IF there appears to be danger would invite every relative of every other patient to sue (and probably rightfully so).

            “They don’t care”

            I have worked in health care since 1988 and so far I have only met 3 people that I could really say I thought truly didn’t care. The problem is, between staffing, legalities and obligations – caring is unfortunately very regimented and limited. As an example, I will get in trouble if I hugged my patients because they are considered “vulnerable adults” and it could be misinterpreted.

            “They’re scared of their patients”

            This is one reason why I love teaching clinicals to nursing students. After the first shift, they pretty much all tend to say something like “well, I was worried about coming to psych, but these folks are just people like anyone else” – and if the average nursing student can pick this up in a few hours, most people who are actually employed there lose that “OMG/fear” reaction. That being said, when a 6’6” well-muscled guy leaps OVER a 3 foot-wide table to attempt to tackle the housekeeper because he is misperceiving a mop as an assault rifle (not kidding) you would be an idiot NOT to be scared. Yes, when patients are severely misperceiving and severely dangerous; appropriate fear informs the need to take steps.

            “Afraid of potential responsibility”

            I’m always honest with my patients on this one. If they are (for instance) on a 72 hour hold, or going to court, I tell them that the physicians will prefer to err on the side of paranoia, because if “the doc” says all is well, then the patient goes out and something bad happens – it’s the doc’s behind on the line. As an example I know of a patient who was homeless, did not want to apply for disability (too much work), did not want to stay in a shelter (didn’t like the people, didn’t like the food, didn’t like being kicked out every morning), had restraining orders from local relatives, and basically I think in this particular case – wanted a safe place to stay. Yes, he “heard voices” and he reported they told him to do bad things, and this had been going on for a decade (more, actually) and he was not admitted because the staff didn’t think he needed to be admitted. Then he badly badly hurt somebody. Who do you think is in trouble now? Because “the doc” somehow magically “should have known”.

            So yes, I agree that the present system is crap. I intend to pilot a better one. I think it should include therapy dogs (think of a giant mastiff laying on someone instead of restraints), and massage, and possibly even interpretive dance. And I’ll probably get my behind sued a lot. Or maybe not. We’ll see.

            Diane

          • Thanks for the thoughtful answer Diane.

            I think that all these things cannot really be addressed in the current system. I know that probably having more stuff would help to allow for them to have time to actually talk it through with someone or at least sit around until they calm down on their own and not having to deal with it in the next 10minutes because you have 10 other people to deal with. It’d help if psych wards really only dealt with people who cannot be served differently (in many places finding a comprehensive outpatient treatment is really difficult – either you go to the hospital full time or you have an hour every now and then, there should be something in between). There is also little to know alternatives to drugs and they tend to be the first line of treatment.

            In my view there are two key problems: 1) the coercion often mixed with arrogance 2) the drugs as the first and last line of tackling the problem.

            1) You can’t expect people to like you and cooperate with you when you treat them like a cross between a 5yr old and a criminal and you also can’t treat them effectively because they are not only going to resist you or lie to you but you’re also less likely to take them seriously when they tell you what’s really wrong (you may not realise it but I have not seen many doctors who actually listen to what you say – they may claim so but then they brush it off and do what they wanted anyway).

            I know from some really good doctors in other areas of medicine: listening to what your patients say is key. Psychiatrists have a tendency (and I’m generous with wording here) to ignore or disrespect things that are being sad. They also have a tendency to misinterpret certain emotions and behaviours as signs of mental illness. If you’d come to my house with police, drug me out against my will, restrain me, forced drug me etc. – I don’t have to be crazy to get really fearful or angry or depressed or aggressive. But since these kinds of interventions happen to people (either from you or from their previous experience) they are likely to be aggressive, uncooperative etc. You’re going to see it as a sign of illness not the justified reaction (well, maybe not you, but I’ve seen enough of it).

            Same goes with lack of insight. I don’t know if they are people who really don’t realise what is really going on in their brains but it’s certainly not the majority. Yet almost every time you try to discuss your diagnosis or the relation of your particular emotional state it is viewed as you have no insight into yourself. Like the psychiatrist knows you and your mind better than you do. It’s arrogant and it’s stupid and yet it happens all the time.

            Even the sheer threat of violence from the staff (not even verbalised – it’s often enough I know what you can do – again it’s the system’s fault) may suffice for people to be treating you like their mortal enemy. How can you help someone like that? They don’t even want to be helped because they want to prove you wrong. A person’s strive for independence may be stronger than they will to be helped.

            You’re telling me that you have met very few people who didn’t care. Well, it may be true in some sense but it looks a bit different from the perspective of a patient. If you don’t have time or patience to listen to someone, don’t take the side effects of drugs seriously, don’t allow people’s autonomy…that can’t work well. It may work for some people in some circumstances but it can’t be a default. What looks like a justified reaction to a threat from your side does not look like that from theirs. Really, you tend to tell the stories about how huge, strong guys hallucinate and mistake things for guns etc. to justify what you’re doing. Then how is it that I’ve seen psychiatrists restrain little women who did nothing else than refused to be touched in the middle of a panic attack? Or did not take their meds? Or shouted at you and called you names without even laying a finger on you? And all of it was named “danger for self and others” and all of it was fixed in the documents later on to make it legit, often with straight lies. I’m sorry but if someone is so scared of a person who’s unarmed, smaller than him, and not at all violent and whose only crime is shouting “don’t touch me” then this someone should look for another job. I’ve heard gardening is less stressful. And btw, none of it would ever be the issue if psychiatrists did not have the power to inflict violence in the first place: that women would no reason to shout in fear.

            2) There is plenty of evidence around about pretty much any class of psych drugs showing they are mostly if not totally ineffective in dealing with what they are supposed to deal, that even if they deal with it is mostly by unspecific sedation rather that any meaningful help, that they have plenty of side effects and that they are likely to impair and prevent cases of spontaneous recovery. So why the hell the first (and usually the last) thing you’ll ever get from a mental health professional is drugs? I understand the argument that if nothing helps and someone is in a mess then maybe you should try drugs. But you just hand out drugs without trying anything else, worse you force them on people, even though they are harmful and ineffective more often than they do any good. Also teh psychiatrists’ definition of getting better has nothing to do with reality. The fact I’m too drug to care (or even to eat or walk or engage with anyone) does not make me better. Yet that’s called “the patient’s been stabilised” and followed by a prescription for at least 3 different drugs to keep this wonderful effect. I wonder why people don’t want to take their pills and claim not to benefit from them? Must be the lack of insight…

    • I’ve already given you some examples like Open Dialogue and Soteria. One could start with funding and supporting alternatives like that as well as with creating legal frameworks which are in accordance with UN convention on the rights of persons with disabilities. Train professional people in non-coercive approaches. Train police and emergency workers on how to react to people with mental illness or distress. Start a public awareness campaign about how they should react. Allocate funds so that there is higher number of professionals resulting in more time they can spend on a single person. Fight the root causes of mental illness including unemployment, domestic abuse etc. There are a lot of things to do and it won’t happen overnight but it’s important to start somewhere.

  34. Richard, said:

    *But if we are unwilling to meaningfully address betterment of the worst cases, then the whole edifice fails.*

    Annie, says:

    It is when a normal person is grouped into the worst cases, that the whole edifice fails, Richard.

    When I arrived at the mental hospital, six weeks off Paroxetine, psychotic and deranged, it was assumed, that somehow, between being given Seroxat 18 months earlier and arriving at the hospital, I had somehow turned into a very severe mental case. When nobody could be bothered to check on my medication, and nobody could be bothered to actually talk to me, and nobody asked what my doctor had done, then assumptions turned into a further living nightmare of more drug abuse than any normal person could possibly withstand.

    Assumptions are very dangerous and I totally agree with B, from the bottom up, each and every mental case needs a proper analysis and review of all medication and, I think, we mostly agree that most psychiatrists are half-baked, badly trained, psychopathic idiots who don’t realise that most ‘crazies’ would have done much better without their divine intervention.

    Drugged into stupor is no way to treat anybody, forcefully or with gentle persuasion, and there is a subtle difference between grouping whole swathes of the world with enticing drugs and psychiatrists drugging violent people.

    If a psychiatrist cannot see the difference between dealing with a violent schizophrenic and a middle aged housewife with withdrawal problems, then we have a very serious problem with psychiatry……..but, we all know that.

    and shredding Prozac data is monstrous abuse to Prozac casualties by the MHRA and I will continue to put the Hood in Hud son who would not recognise Iatrogenic suicide from Seroxat, Prozac, ++++++++, even when it is staring him in the face….put, the Mitty in Witty…………….and put Gotzsche in front of Cameron and put sticky tape over my keyboard?

    Carry on Richard and B, just thought I would interrupt momentarily…………..

    The law is not up to much and is not a real reason for anything in particular.
    No one is going to say sorry.
    And it all costs too much.

    I can do lawyers, they can do me, but, at the end of the day, I would just like Sir Andrew Witty to say, sorry, our company made a mistake……………..but, he is not going to do that. He is going to hope that he is not dragged through the courts……

    Carry on……Richard and B…..nice to finally see a dialogue going on…..and don’t think for one moment that I do not find it all quite fascinating……..as a murdered patient….it is important to ruminate on the abuse that is going on…………

    And, what is the result of Alltrials dancing with GSK and what is the result of the vote on Clinical Trial Transparency by the European Diktats?

    • Annie, believe me I get your frustration. My story is not as horrific as yours, mainly because my family pooled me out of there quickly but the trauma is still there… I’ve tried everything: I went through so called patients advocates (it’s such a joke that I don’t even feel like ranting about it right now), I’ve looked for patients rights organizations (non-existent where I live). What I have not tried yet is the press but even if I did that: I’ve seen quite a lot of surprisingly good coverage on the issue and even the UN recently took the stand against some of the practices they use (I live in Austria) but policy wise nothing’s changing. And even if there are good policies on paper you can’t really prove anything – I know they broke several laws and regulations in dealing with me but in their documents it’s all legit – no wonder, when they lied and fixed them after I went to the lawyer.
      I must say, I’m at loss what to do, because where I am now I’m at even more disadvantage as an immigrant with relatively poor language skills (I can communicate just fine in daily life but that’s not enough for being an advocate and having a voice: you need to have good communication skills).

      I’m still planning on doing something and I’m trying to figure out what ideas are out there. I think that also has to come from people in the outside coming together with the patients. Not everyone in this system is completely lost for humanity, especially the younger people but it’s really hard to break through…

      One more note on the meds: I think there may be value in them for some people in some cases. They have a tranqulizing activity which can be sometimes helpful, I actually took Prozac for a month and it surprisingly cured me from chronic fatigue syndrome-like symptoms. The point is: taking them should be voluntary and people should have knowledge about the side effects. I personally don’t believe that they treat any particular “mental illness” – they have a limited value as tranqualizers, Prozac can have some use in treating viral and immune system-related dysfunctions (I’ve seen some evidence that it can help in treatment of EBV-related lymphoma) but that really need good scientific studies (truth is serotonin signalling is not only restricted to the brain: it affects digestive and immune systems as well – claiming that these drugs are in anyway selective flies in the face of basic scientific knowledge). What is being done right now with these drugs is what one would expect when the profit motive gets in the way of medical ethics.

    • On the positive note: if you’re from US you have a relatively well organised patients movement compared to Europe. Maybe you should just locate some group close to you and do your part. To be honest it’s like with any other civil rights issue: you have to build it bottom up by small steps, nobody is going to do it for you unfortunately…
      Another thing: dialogue and bitching around in a calmest and most rational way possible on the internet has its value. there are people out there who have just been through the experience and they need to know they’re not alone. And they are people there who have no experience themselves and they need to hear there is a problem and why the crazy schizophrenic next door does not want to take his meds. Otherwise they’re left with the official narrative.

  35. Annie, I never intended this thread to be just a “dialog”. I’d hoped for something larger — like a concrete action plan to improve on the sorry performance you highlight. We can vent all we want to, and perhaps that’s also needed. I’m sure it feels good. But it ultimately doesn’t change anything for patients abused by psychiatrists, or bring Sir Andrew to the dock for his crimes.

    So please try to focus: what would you have a NAMED “somebody” do differently? Would you empty the asylums and burn pharmacies to the ground? WHAT?

  36. OK, point taken.
    Bringing Sir Andrew Witty to the dock, in this first place, will show up the anti-depressant charade, up for what it is. If this happens, it should be high profile, in the media every day, the courtroom on tv, and it should be a masterpiece of media engineering.
    If this happened, and I see no reason, why it shouldn’t, Sir Andrew Witty will be toppled from his post and the whole realisation, by the public and the doctors and the psychiatrists might learn that, even if Seroxat, is defective, then why should not all other anti-depressants be defective, too.

    We have waited twelve years for litigation against GSK. We are patient. We are not ‘crazies’ making up stories about horrific withdrawal and suicide and murder.

    The GSK legal action will be the first step into the long road of getting anti-depressants, not exactly, abolished, but, reigned in. Not to be dished out like smarties.

    I have my own action plan. GSK litigation giving me proof to hammer in my own case of abuse.

    I am totally focused and this is what I am going to do.

    There is no NAMED “somebody” to do anything differently.
    When we bring down Sir Andrew, we will bring down the MHRA, at the same time.

    I am quite confident of that.

    Emptying the asylums is a rather strange thing to say. I have walked up and down my high street when the ‘crazies’ are allowed to go walkabout. They are not shunned or not allowed into the coffee shops. They are just people who came from the local hospital and people have more compassion than you think. (Just never thought I would be one of them), in a million years……..oops sorry, no more me…….

    Burn pharmacies to the ground is a rather strange thing to say. I have got more sense out of pharmacies than from hospital who ignored me. It was a hospital pharmacist who suggested Paroxetine liquid…..and for that, I shall always love pharmacies….Not the bloody doctor, not the bloody psychiatrist, a pharmacist said drop my mls. *gradually*, thank you, god, for this pharmacist…….

    WHAT?
    You might say, WHAT, but you are a doctor. You have not been through torture and relentlessly abused until you almost lost the will to live….or have you?

    WHAT?
    And, I will also disabuse you of the notion that it feels good to vent. It does not feel good. I don’t vent because I want to vent. I am always logical, always thoughtful, always calm and the only reason I have commented about my particular horrific venture into the world of anti-depressants is because I support Professor Healy and I trust him. I actually trust him and believe, me, I do not trust anyone who dares to confront me in a medical situation, now.

    A concrete action plan is not possible. You cannot put anti-depressants and benzodiazepines away for good.
    They are a last resort……for people who are in their last gasp of going totally off the rails…..

    And, I will tell you what I have done with myself after four years of unedifying abuse. I have compartmentalised it. I have treated it, almost, like a project, which I did as Marketing Director, UK, and Vice-President, USA and Canada in my previous life before I had a child, and took to the good life…….ha ha ha…..and before I met an Indian Doctor who I happened to tell about my airline pilot losing his driving licence and sleeping in the hanger and me taking the calls for the air ambulance…..and me getting hold of him to save a life….and him doing it…..and so, yeh, I will vent my spleen at the atrocities I have been dealt by stupid people in surgeries and hospitals who have no idea as to what idiots they are.
    I just sat and took it. I sat and listened to all the drivel and the manipulation and I just thought to myself, one day you will pay for this………..

    WHAT?
    We will start with Sir Andrew and we will go from there………………..

    I have experienced the Mail on Sunday knocking on my door, when someone ratted on my partner, I have a girlfriend, a solicitor with ME, who had Swiss Life videoing her movements hiding in the bushes, to disabuse the courts of her case of ME, I have sat in boardrooms in meetings with people who will do anything to get rid of the competition…..I am quite aware…….and Sir Andrew Witty will go before I reach death from normal and aged circumstances……………….

    You have to tip toe with this one……..and not get all excited…..

    • “They are just people who came from the local hospital and people have more compassion than you think. (Just never thought I would be one of them), in a million years……..”
      That’s so true. I have had so much empathy and help from everyone around me: my family, friends, co-workers, my boss, even random policewoman who had to deal with me in the midst of total panic and she took her time to talk to me and calm me instead of just dumping me into the system. Only not from the so called “professionals”. They were the only ones who listened to what I said with a disregarding smirk, laughed about me in front of me, treated me like I was a 5yr old, used force, lied in their documents to cover up the abuse. I have no respect for this profession, I’ve had never had much, even before this experience but now I only know that my opinions were true and justified, even more than I expected. There are maybe some individuals who are not completely lost yet (usually the freshmen straight from the university who are just starting) but that’s a minority and usually a silent one and they quickly learn to fit into the system.

  37. Re whether a somatic diagnosis is unfair to people with fibromyalgia, it is interesting that Dr. Frederick Wolfe, an early proponent of fibromyalgia as clinical entity, and one of the leaders in developing the original diagnostic criteria, seems to have reversed course and now considers it a group of somatic symptoms with a psychological cause (assuming I am doing justice to his opinion).

    http://www.arthritis-research.org/files/Wolfe%20(2012)%20Culture,%20science%20and%20the%20changing%20nature%20of%20fibromyalgia%20-%20NRR%20submission%20version.pdf

  38. If Dr Wolfe has “reversed course”, then his new conclusions are simply wrong. The historical term “neurasthenia” is just as much a mythology as the more modern and equally unsupported and fallacious nonsense called “somatic symptom disorder”. Both are quite thoroughly demolished in Angela Kennedy’s book “Authors of Our Own Misfortune — Problems with Psychogenic Explanations for Physical Illnesses”, which I have recently reviewed on Amazon.

  39. Peter S. says:

    I don’t pretend to know enough about this to debate it myself, but if you were to debate, say, Dr. John Sarno, he would say with equal conviction that you and the book author were “simply wrong.” Or perhaps Dr. Arthur Barsky. At a minimum, on mindbody forums there are numerous self-reports of people “pathologized” with fibromyalgia and CFS who suffered for years until they addressed their psychological issues and learned to reduce their stress, at which point most or even all their symptoms resolved. I would recommend reading “The Great Pain Deception” by Steven Ozanich which mostly deals with chronic pain but also touches more broadly on fibromyalgia. Another point of view, anyhow.

    • Angela Kennedy (@AcademicAnge) says:

      Peter, you are free to think whatever you like of course. The one thing I will say about my book is that it makes no claims or evidence free assertions about others being ‘simply wrong’. I actually substantiate the problems of validity with psychogenic explanations that I have uncovered in my own work. I actually show key flaws in Sarno’s claims in the book itself. Sarno relies on authoritative, but unsubstantiated, assertions. To demand that someone is ‘simply wrong’ is not an adequate response at all. The other problems with the ‘mind-body’ forums is that they are similar to ‘God’s miracle’ forums. People may be invested to believe they can cure themselves with the power of thought, for just one example. However, belief is not an adequate defence of psychogenic explanations for physical illnesses at all! There are a lot of ‘testimonials’ for something called ‘the Lightening Process’ where claims to cure FM/CFS/ME are made, and people are blamed for having too much ‘negativity’ if they cannot be ‘cured! Phil Parker, the ‘inventor’, has the same style as John Sarno in the way he makes claims. There is a quasi-religiosity to both psychogenic explanations to illnesses, and claims to cure. But there comes a time when you have to approach the issue rationally. My book has done that, and I think it may be one of the first to do so.

      • Peter Spaeth says:

        I did not mean to suggest I wholeheartedly endorse Sarno or disagree with what I understood to be the premise of your book, which sounds like a worthwhile read. I don’t know enough to know the truth. I guess I was just reacting to the statement that Dr. Wolfe was “clearly wrong” when from my reading it seems there are intelligent points of view on both sides of the issue and perhaps the truth is not all or nothing. I do agree re the “quasi religiosity”of mindbody people to some extent; I have read some of the forums quite a bit and some of the views are pretty rigid and almost cult-like in their incantations of dogma. E.g., one should not stretch because that sends a bad message to the unconscious that there is a physical problem and thereby reinforces pain. Come on, really?? But I think at the same time it’s hard to deny that in general, a lot of people with chronic pain and diseases have gotten a lot of benefit out of various mind body practices, whether or not there is some underlying pathology or whether their problem was really a cascade of physiological responses to stress. Certainly those practices seem more productive and likely to yield benefit than the endless tweaking of supplement regimes and the misplaced faith in increasingly obscure tests and alternative practitioners that are a staple of the CFS/FM boards.

  40. I also should have mentioned this book which views fibromyalgia as a mindbody disorder.

    http://www.amazon.com/Freedom-Fibromyalgia-5-Week-Program-Conquer/dp/0812933753/ref=sr_1_1?ie=UTF8&s=books&qid=1276181067&sr=8-1

  41. David_Healy says:

    Red Lawhern’s review of Angela Kennedy’s book is here:

    http://www.amazon.com/gp/cdp/member-reviews/A3V3YJ82HPTK2M/ref=pdp_new_read_full_review_link?ie=UTF8&page=1&sort_by=MostRecentReview#RCENVOZ2C6YDK

    Angela Kennedy has assembled a major body of well-referenced research in “Authors of our own Misfortune? The Problems With Psychogenic Explanations for Physical Illnesses”. The book is difficult in two ways. Kennedy writes as a social scientist and researcher. Her intended audience is primarily medical doctors, psychiatrists and psychologists who assign diagnoses of psychosomatic disorder to patients seen in their practices. Non-professional readers may find her long paragraphs and 8-line sentences to be hard slogging. In language and style, the book is nearly inaccessible to any but the most persistent of college educated non-physician readers.

    This being said, a second and deeper sense of difficulty applies in this book. Kennedy directly challenges both medical doctors and mental health professionals to examine and revise their assumptions about a range of important issues pertaining to so-called “psychogenic” medical symptoms. These are by definition, symptoms of physical disorder or disease that are presumed to be “caused” by the mental state or thinking of the patient. The term “presumed” is highly central here. Kennedy is also challenging professional doctors who may be in emotional denial that what they practice in “psychosomatic” medicine is a dangerous and destructive mythology rather than a consistent or constructive healing art.

    Kennedy effectively demolishes an entire branch of current psychiatric practice as codified in the 5th and previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. She demonstrates compellingly that there is no basis in science for such diagnoses as “Somatic Symptom Disorder”, “Functional Neurological Symptom Disorder (Conversion Disorder)”, “Hypochondriasis,” or “Munchhausen Syndrome by Proxy”. She also sets forth evidence that several presently controversial medical disorders are far better explained as poorly understood medical illness, than they are treated as outgrowths of any emotional or psychogenic process. These medical disorders include Fibromyalgia, Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS), and Irritable Bowel Syndrome (IBS).

    Kennedy demonstrates predictable and unnecessary harms that grow from misdiagnosing medical disorders as mental disease entities. Chief among these is the denial of effective medical assessment and treatment to millions of people who are instead written off as “head cases” and then disregarded as reliable reporters of their own medical symptoms and conditions. The careless or frustrated discharge of “difficult” patients who have subtle or unusual medical problems can and already has led to patient deaths. Likewise, among mental health professionals charged with caring for psychosomatic patients, there are no truly effective modalities of treatment. None.

    If you are a mental health professional, then you should read this book and ask yourself how many of your patients have been harmed by the fallacies it reveals. If you are a patient who has been referred by a medical doctor for mental health evaluation, or who has been diagnosed with so-called psychogenic symptoms, then you should buy this book and give it to the practitioner who diagnosed you. You may even want to add a note on the flyleaf: “if you can’t do better than this, then it’s time you looked for an honest line of work!”

    Fair Disclosure: I approached this book with a predisposition to accept its premises. I read it to verify that sufficient research was quoted to support those premises. As a social networking site moderator for over 5,000 chronic face pain patients, I have met many who were written off as head cases because their medical doctors didn’t recognize what was causing their pain. I have separately published on the connections between psychogenic diagnoses and patient suicides. See “Psychogenic Pain and Iatrogenic Suicide”.

    Thus I may have a bias of my own: having seen the damage done to medical patients with rare disorders by psychosomatic medicine, I am convinced that this branch of psychiatry is a complete crock! Practitioners of this mythology should be confronted with the harms they do, and if necessary barred from treating patients until they have been reeducated.

  42. I have had chronic headaches, sensitivity to scents, chronic fatigue, intolerances to foods etc… I spent thousands on treatments which assumes these have an organic source, to no avail. The only thing that helped me was changing my associations, mindfulness, CBT, stress reduction and other psychotherapeutic techniques. I am certain that my condition is somatic in nature. It is all due to my brain sending me false messages. SSD is the correct diagnosis for me.

  43. And i am almost fully recovered now through psychotherapy

Leave a Comment

*