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“Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems… Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.” Dr. Peter Breggin

May 26, 2011

What is a Practice Parameter For?

Quack Master Jack
Jon McClellan
A practice parameter appears to be 
a justification to continue a
"standard practice"
 no matter
 This is my analysis and commentary on portions of the 
American Academy of Child and Adolescent Psychiatry's 
Practice Parameters
written by Quack Master Jack, Jon McClellan 

"Psychological and Social Factors There is no evidence that psychological or social factors cause schizophrenia.  Rather, environmental factors may potentially interact with biologic risk factors to mediate the timing of onset, course and severity of the disorder." Page 10

What is the source of this for pseudo-factoid?  Not one study is cited to support these statements. There is no citation because it is made up, not derived from analysis of data.  Only a reference that the voting body of the APA determined this is to be a considered fact, based on WHAT exactly is a mystery...It is true that there is no discovered cause and effect link, but this is determining without any valid data that schizophrenia is biological in nature---without any facts cited to make such an assertion!  The assumption that there is a biological predisposition for schizophrenia or any psychiatric diagnosis, without citing any definitive empirical evidence is not ethical, scientific or honest.  I find it frightening reading with a critical eye what passes for science among the psychiatristic researchers in a "work group" that developed this parameter to validate drugging children with teratogenic drugs.  This fact remains: There is has been no defiinitive evidence found that schizophrenia is a caused by a biological defect, or genetic abnormality; nor is there any evidence symptoms are caused by an underlying  disease process. Indeed, there is no definitive empirical evidence that any psychiatric diagnosis is the result of a disease process or a chemical imbalance.  In effect, determining by 'consensus,' which is not a scientific process, but a quasi-democratic process; psychiatry stakes it's claim to medically treat 'diseases' which are not even identified.  Psychiatry treats sypmtoms which are supposedly manifestations of diseases, which have yet to be identified, much less understood. 

Do NOT misunderstand what I am saying--the distress, social difficulties, emotional, behavioral and cognitive symptoms are real; However, none of them have been scientifically validated as being caused by a disease, biological dysfunction or genetic defect.  This is something that the APA has repeatedly  acknowledged; as has the NIMH.  At the same time however, through NAMI, the TAC, CABF, and in  'professional journals' members of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, tell the world diagnoses are diseases that can be treated "safely and effectively." This is no harmless exaggeration, taking indecent liberties with the truth, it is a fraudulent claim.  Bio-psychiatry purports to "treat" diseases with no known etiology or pathology identified, defined or understood. All of the diagnoses in the APA's Diagnostic and Statistical Manual were created by consensus, relyin upon the most unreliable data, subjective opinion. The disease hypothesis for the etiology of schizophrenia, was derived from the mechanisim of action of the neuroleptic drugs.

This is backwards. In medicine, a disease or defect is discovered, and defined, THEN drugs and somatic treatments are developed to reverse, prevent or inhibit the progression of the disease process.  All of the psychiatric drugs have the potential to disrupt and alter the function of various organs and physiological processes, causing iatrogenic illnesses, disabilities and incresed mortality. Psychiatry as a profession, seems to have an affinity for the  bio-disease paradigm, yet does not seem to understand basic scientific principles, or simply applies them 'as needed;' which appears to be rarely, if ever. The worst psychiatrists are willfully ignorant, lack ethical integrity, and wonder what's all the fuss about? 

The strategy seems to be this: Claim psychiatric diagnoses are diseases that are treatable--since psychiatrists are "doctors" who diagnose these diseases, what they are doing is "treatment."  What the patient or parents want; i.e. give consent to, is not important.  Psychiatry does not treat individuals so much as apply a label and institute a drug treatment protocol.  Once Practice Parameters are instituted, outcomes or overall improvement in those treated is not as important as not ever questioning the bio-psychiatric paradigm. Fatalities and disability caused by the drugs do not have to be  reported to the adverse events database, it is not a requirement for psychiatrists or other prescribers; so the disabled and dead are simply "justifiable risks."  Once you realize this, it is obvious why Informed Consent is not part of "standard practice."  

The fact is, psychiatry has no interest in keeping track of how many die, or develop obesity, diabetes, akasthisia, tardive dyskinisia, tachycardia, or any iatrogenic illness as a direct result of getting psychiatric treatment. This failure to collect relevant data makes it impossible to assess risk vs. benefit in real world practice. Bio-psychiatry insists on the absolute utility of the teratogenic drugs, without these drugs, how would psychiatry practice medicine?  It would have to return to the "effective" treatments used prior to the develpoment of the drugs: lobotomy and insulin shock.  Another option would be to learn to respect, have compassion for, and relate on a human level with their patients. Apparently, it's easier to continue to willfully force pills down patient's throats, and tell everyone through direct to consumer marketing,"advocacy" and "education" that "mental illness" is a disease---which must be drugged to be "effectively treated" no matter what until the death of the patient...

"The interactions between psychological, social  and illness related factors are complex and bidirectional.  For example, the presence of difficult family interactions may not be “causal”, but rather a reaction to the collection of difficulties the patient brings to the family setting." Page 10

Ok, I am not a psychiatrist, but I could play one on TV.  I agree the interactions are bidirectional; however, it would be much more likely that the influence of family interactions would precede and/or exacerbate any difficulties a child in the family would experience!  Symptoms which would lead to a diagnosis of  schizophrenia do not develop in a biological vacuum!  The above sentence example seems to blame the diagnosed child, while the parents and other family members are cast as victims of the child who has "the collection of difficulties." It is more plausible that "the collection of difficulties" are the behaviors a child develops in response to inter- and/or intra-personal conflicts, as well as other environmental influences.  Regardless of the cause/s of a child's "collection of difficulties," no a child develops behavioral and/or emotional difficulties within a biological vacuum!  

The statement effectively demonstrates that the stigma is the diagnosis itself; and offers insight into how psychiatrists intentionally or not, teach parents and others to stigmatize their loved ones with a psychiatric diagnosis.  It effectively shuts the door on considering how family dynamics, interactions, and other social/economic/educational/political experiences cause, or exacerbate the distress experienced!  Once this perspective is accepted, no examination or analysis of the environmental stressors, the interpersonal and/or intrapersonal conflicts which may play cause or an exacerbate symptoms of  distress.  How can the subjective experiences of the patient be given so little consideration?  Surely even a young child may have an idea why they are distressed, in trouble, or having problems??? Environmental stressors and interpersonal and intrapersonal conflict have the potential to cause physical illness, and exacerbate symptoms of pre-existing physical illnesses.  

"Treatment strategies should focus on alleviating symptoms, reducing long-term morbidity, and  relapse prevention."

Treatment provided by psychiatry must focus on symptoms, because that is the only thing that is defined; but clearly not understood. Psychiatric drugs sometimes, for some people, provide relief.  So, all the neuroleptics can do is alleviate some of the symptoms for some of those diagnosed with schizophrenia, and for some they prevent further psychotic episodes---for a significant percentage, they do neither.  Psychiatrists do not like to talk about this fact AT ALL.  People who take these drugs long term have increased chances of becoming chronically ill, developing iatrogenic illnesses and dying decades early, so the goal of reducing morbidity--the outcome data for those 'treated' does not support this goal as even being possible, people who stay on neuroleptics become chronically ill.   Neuroleptics cause withdrawal psychosis and many patients never achieve full remission; regardless of how many drugs are prescribed.  The majority of individuals who take neuroleptics long term develop health problems, and experience cognitive and intellectual decline.  These last two risks is directly correlated with length of treatment and dosage of drugs.  For some who experience psychosis, the neuroleptics do NOT have an ANTI-PSYCHOTIC effect!   Even these people, (like my son) it is recommended that he take them regardless of lack of efficacy or risk of harm. Psychiatry does not know why the drugs are helpful for some people, or why the drugs are tolerated by some without causing intolerable negative effects. I am at a total loss as to why psychiatrists would recommend continued use of drugs even when the patient protests and/or has adverse health effects due to continued use.  Equally as troubling is why in the hell did psychiatrists start giving these drugs to children for any condition other than psychosis?  

Psychiatry teaches family members to stigmatize the patient; so the family members can be enlisted to coerce "treatment compliance."  Knowing the deleterious effects of the drugs and how compliance has always been an issue with most people, psychiatry has used them on, coercion and subterfuge are necessary to have "compliant" patients.  It seems to me the claim that schizophrenia is a biological condition which must be treated with drugs is told to parents to gain parental compliance.  It is a gross misstatement of what is known about schizophrenia to authoritatively state it is caused by a pathology when there is no evidence which demonstrates that this is so.  It is nothing more than a belief, based on an unsubstantiated hypothesis.  I believe this is a ploy to gain the parent's support to continue the drugs even if the patient protests the horrifying "side effects" which in reality, are the effects, the altered functioning of neurological, cognitive, and metabolic processes.  These alterations are in fact evidence of the damage that is being done to previously normally functioning biological processes. "Side effects" is a term that refers to the "extra effects" of a medical treatment, that is, as a medication brings about a return to health, it may produce effects, unrelated to the ameliorating effect of the medication.  Since neuroleptics are not correcting an identified dysfunction; they are not in any ethical medical sense treatment. 

"Some clinicians are hesitant to make a diagnosis of schizophrenia, even when there is sufficient evidence to do so, because of its ominous prognosis and social stigma.  This potentially denies the child or adolescent and  the family access to appropriate treatment, knowledge about the disorder, and support services."

How it can be claimed that neuroleptics are appropriate treatment in all cases with a certainty?  What about the significant percentage of those treated who never experience remission?  Yet the American Academy of Child and Adolescent Psychiatry claims that early identification and treatment (which means neuroleptics) is absolutely critical.   Neuroleptics are not at all like antibiotics, or insulin.  Given the Ethics Guidelines of the American Medical Association for Informed Consent and the Scientific Standards which are supposedly used to develop Treatment Protocols, begs the question, from what scientific data were these particular Practice Parameters developed?  Diagnoses that are arrived at based on subjective opinion treated with drugs where the data is purposely not being collected about safety and efficacy in Real World Practice and research is frequently flawed and or fraudulent.  The drugs psychiatry uses can and do kill and disable regularly; why are are Legislatures granting them special powers over our children and vulnerable citizens?  The majority of the States have Civil Commitment laws which violate Individual and Parental Constitutional Rights.  

"Laboratory and neuroimaging procedures are not helpful for making a diagnosis of schizophrenia, but instead are used to rule out other neurological or medical problems. Tests and procedures should be justified based on the clinical presentation, and significant findings in either the history or physical examination."

These tests and procedures are how psychiatry learned about what the drugs were actually doing to the people's brain functions and structures who took them.  It is also how it was determined the drugs cause the impairments we see in people who are diagnosed with schizophrenia, and drugged long term.  For some, even brief use can disable or kill.  The effects of neuroleptics are noted to be much more profound in children.and for some, damage is done rapidly.

In spite of my son having a neurological condition, detected at 7 by EEG, which also can have the same symptoms as schizophrenia, Jon McClellan, the writer of these "Practice Parameter" said it was not necessary to rule it out by a followup EEG at 12 almost 13 years of age, before definitively diagnosing schizophrenia.  It was also not necessary to address the environmental factors which may have also explained my son's symptoms: specifically, the severe trauma my son had experienced as a victim of violent assault, and the repeated trauma of being sent to the hospital and never getting the recommended treatment for for his severe PTSD.  The effects of severe early childhood trauma, also can cause the symptoms he had. 

"Informed consent.  Informed consent (which addresses the rationale for treatment and potential risks and benefits of the therapy)  should be obtained from both the youth and the parents/guardians.  If the psychotic state or developmental level of the patient precludes this, or if therapy is refused, invoking the relevant statutory mechanisms for involuntary treatment may become necessary.  For patients under the legal age of consent, basic information regarding treatment should be provided in a developmentally appropriate manner."

Informed Consent does not happen in the real world practice of psychiatry, or if it does, I have had some down right aberrant experiences with every single psychiatrist who has ever treated my son.  Imagine my surprise when reading this document, to find that the APA and AACAP believe:

"As many as 50 percent of youth on neuroleptics may experience some form of tardive or withdrawal dyskinesia (Ernst et al., 1998, Kumra et al., 1998)." and "tardive dyskinesia may persist even if the antipsychotic agent is discontinued." 

Not a single one of them has ever told me this,
including Quack Master Jack who wrote these parameters.

"Tardive Dyskinesia:  Tardive dyskinesia  (TD) is an involuntary movement disorder usually consisting of athetoid or choreic movements in the oro-facial region, but may affect any part of the body (Ernst et al., 1998). TD is a major public health concern in the treatment of schizophrenia, with both clinical and medicolegal implications. TD is typically associated with the long-term  use of neuroleptics (Ernst et al., 1998).  Withdrawal dyskinesia may occur with  either gradual or sudden cessation of neuroleptic agents.  As many as 50 percent of youth on neuroleptics may experience some form of tardive or withdrawal dyskinesia (Ernst et al., 1998, Kumra et al., 1998).  Withdrawal dyskinesias almost always resolve over time, whereas tardive dyskinesia may persist even if the antipsychotic agent is discontinued."

"Because there is no specific treatment for tardive dyskinesia other than discontinuing the medication, strategies for prevention and early detection need to be followed (APA, 1997)."

"The concern over tardive dyskinesia should not outweigh the potential benefits provided by antipsychotics for patients with schizophrenia."  

Informed Consent can not be considered all that important, or every child and their parents would be told the above information prior to the prescribing of any antipsychotic; in addition to other serious risks. The TRUTH is "mental illnesses" are in reality, NOT like any other illness; if they were,  subjective opinions would not be the only evidence used when making a diagnosis.  In the study of Medicine and every other field of scientific research, subjective opinion is the weakest, most unreliable data; it is therefore used to support more reliable empirical data. In psychiatry, it is used as a substitute for empirical data. The fact that subjective opinion is considered reliable "evidence" when diagnosing and treating mental illnesses, is stunning. The fact that the drugs used to treat mental ilnesses can cause dependence, chronic dysfunction of physiological processes, disability and death; is sadly sobering.  

My son is almost 23 and he was first given an antipsychotic briefly, when he was 7.  He was not prescribed any regularly until after the above studies citing the the statistic that 50% of children are expected to "experience" Tardive Dyskenisia were completed. This statistic alone is reason to SERIOUSLY question this "Practice Parameter" and the medical ethics of those involved in it's development and it's adoption as a standard of care. How can a Tardive Dyskenisia, and brain damage be "acceptable risks?!"  And why were we, never told of this risk?  It is obviously "relevant information" that a parent would need to consider in makng an Informed Consent decision in thier  child's best interest.  That this practice parameter was written by Jon McClellan is most disturbing to me. I have first hand knowledge about how he practices medicine; that he fails to adhere to the Ethical Guidelines for Informed Consent of the Medical profession.  

I am continuing to learn how little psychiatrists who treated my son told us; and how little value the Hioppocratic Oath has.  I am learning what it feels like to know without a doubt that I was misled,  and outright lied to by psychiatrists.  The fact of the matter is Jon McClellan, a lead researcher for childhood schizophrenia, told me repeatedly I had not say in the treatment he forced upon my son. Who was provideng consent for the massive amounts of neuroleptic drugs Quack Master Jack prescribed?  It couldn't have been my seriously ill child; his attention span may have been 5 minutes on a very good day.    

"...if therapy is refused, invoking the relevant statutory mechanisms for involuntary treatment may become necessary."  

Please believe me when I tell you, the refusal being spoken of above is not only in reference to a child who does not want to "take his medicine" as prescribed; it also means parents who consider both the potential risks and benefits, then determine not to give their child an antipsychotic---Such parents would conceivably be defending their parental rights in a Court of Law where Judges usually rely on the opinion of a psychiatris; in spite of the fact that a psychiatrist does not offer evidence which complies with the Rules of Evidence used in standard Court Procedures. Opinions are considered a sufficient substitute for factual testimony in civil commitment proceedings...

The Law has lowered the standards used in the Courts for psychiatry so that psychiatry has the Courts and the Police to ensure "medication compliance" is forced upon those who resist. Psychiatry is "treating" distress and maladaptive behaviors with drugs that can cause disability and death; drugs that are expected to cause half of the children who take them to develop Tardive Dykinisia. 

It is criminal that children are prescribed drugs that 
This cannot be good for anyone; and should rarely, if ever,b e done by force. Why would prescribing drugs that can cause brain damage, diabetes, tardive dyskinesia, and death be considered therapeutic?  With such serious risk for deleterious effects, how could using such drugs off label at all ever be  ethically justified?  Using teratogenic drugs to treat undesirable behaviors in children, without substantive evidence validating the prescription, is criminal. Without empiriacal evidence of safety and  effectiveness, how in the hell did using neuroleptics for behavior problems become standard  practice? 

Many drugs, including neuroleptics, were prescribed to my son to treat his behavior problems. He had been the victim of violent crime, and had severe PTSD, and was aggressive. All of the drugs prescribed were prescribed off-label, the FDA calls it experimental use. The drugs caused a great deal of harm. 

Neuroleptic drugs are not FDA approved for PTSD with aggression. 
My precious child's psychiatric treatment was human experimentation, 
not ethical medical treatment. 



"Whenever a doctor can not do good, he must be kept from doing harm." 

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