Involuntary Transformation: I have MadPride Harry A. Nasrallah claims it's, "irritating, Antipsychiatry"

via Current Psychiatry Online:

Vol. 10, No. 12 / December 2011

The antipsychiatry movement: Who and why

"Although irritating, antipsychiatry helps keep us honest and rigorous about what we do"
(when is this going to start?)

Henry A. Nasrallah, MD

Editor-in-Chief

excerpts:

"Finally, the antipsychiatry movement aggressively criticizes the pharmaceutical industry’s research, tactics, and influence on psychiatry. Also included in the attacks are academic psychiatrists who conduct FDA clinical trials for new drugs and educate practitioners about the efficacy/safety and indications of new FDA-approved drugs. Although industry research grants are deposited at the investigators’ universities, critics mistakenly assume these psychiatrists personally benefit. The content of all educational programs about psychiatric drugs is strictly restricted to the FDA-approved product label, but critics assume that expert speakers, who are compensated for their time and effort, are promoting the drug rather than educating practitioners about the efficacy, safety, tolerability, and proper use of new medications. Part of the motive for attacking this collaboration is the tenet held by many in the antipsychiatry movement that medications are ineffective, unnecessary, or even dangerous. I wish antipsychiatrists would spend a week on an acute psychiatric unit to witness the need for and benefit from psychotropic medications for psychotic, manic, or depressed patients. Although psychiatric patients experience side effects, they are no worse than those experienced by cancer, arthritis, or diabetes patients."

"The antipsychiatry movement is regarded by some as “intellectual halitosis” and by others as a thorn in the side of mainstream psychiatry; most believe that many of its claims are unfair exaggerations based on events and primitive conditions of more than a century ago. However, although irritating and often unfair, antipsychiatry helps keep us honest and rigorous about what we do, motivating us to relentlessly seek better diagnostic models and treatment paradigms. Psychiatry is far more scientific today than it was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past. The best antidote for antipsychiatry allegations is a combination of personal integrity, scientific progress, and sound evidence-based clinical care."

His final paragraph begins with a couple of insults followed by a claim; the veracity of which is questionable to say the least...I see no evidence of honesty resulting from criticisms leveled by "antipsychiatry" in this editorial. It is inaccurate for Nazrallah to state that people who are critical of psychiatry, keeps psychiatrists honest, Following this statement by characterizing critics who speak out against "the pharmaceutical industry’s research, tactics, and influence on psychiatry" as members of a conspiratorial, "antipsychiatry movement," a biased negative judgement proffered as if there is no pretense to disguise the lack of basic human regard for those critics of psychiatry that Nazrallah claims help keep psychiatrists honest? Nazrallah discounts valid criticisms by attributing it to an ancient medieval illusory history of psychiatry that no one alive ever witnessed or experienced. No error of attribution, casually proffered to manipulate emotions fears and innate biases can invalidate the humanity of the person or their history of being tortured in psychiatric treatment facilities. Attributing valid complaints of criminal mistreatment to the past as a justification for failing to perform an ethical medicial duty owed any patient--it does not diminish the truth inherent in the testimony. This can no longer be used as an excuse that relieves any medical professional who hears it, from an ethical duty to act. The public is not as easily coerced as frightened people in emotional crisis...

Some people cling to a belief that emotional, social and behavioral difficulties are caused by a "brain disease." It seems to me that believing one has a brain disease encourages people to abdicate responsibility for their own health and for their own behaviour. I fail to see how a belief that people's difficulties are caused by a neurobiological condition, without definitive evidence this is in fact the case, is helpful. Those who believe in a disease model of mental illness, seem to invalidate themselves and discount their ability to learn new skills, enhance their innate abilities and correct deficits they have identified as being barriers. A belief mental illness is caused by a neurobiological disease with no cure causes dispair and can prevents some people from making any effort to learn how to more effectively cope with life on life's terms. I fail to see how encouraging such a belief is ethical, and it certainly is not at all therapeutic.

I have no doubt that some people with a psychiatric diagnosis remain invested in the belief they have a brain disease as an excuse to avoid being accountable for their behavior or responsible for their personal recovery. As long there's no attempt to infect or indoctrinate me into this flawed belief system; it's all good...Compliant psychiatric patients who remain invested in biological based fallacies, render themselves powerless---That is my own experience...As long as I believed I had a brain disease, I was powerless to aid in my own recovery, or even believe recovery was a possibility; or that it should be expected...

I was given a bipolar diagnosis; I am grateful that with appropriate help provided by a professional, I managed to find real recovery. I am no longer bound by a false belief or the negative self-esteem which accompanied it. I know that I do not have a defective brain or a neuro-biological disease. I know I do not need to take dangerous, minimally effective drugs on a daily basis for the rest of my life. I do not miss the negative impact the drugs had on my vision, my moods, my ability to function, or my digestive tract. I also do not miss the regular blood tests required.

I have found that there are many tools to support recovery from mental, emotional, and psychic pain----I am extremely grateful I know I am worth the effort. I have taken psychiatric drugs for brief periods of 2-3 days, a handful of times in the last 8+ years. I know that I am not diseased, disordered or chemically imbalanced. I know I am not powerless over my moods, my emotions, my behaviors or my recovery.

It is shameful for any psychiatrist to invalidate survivors. The term "anti-psychiatry" is used by Nasrallah in an attmpt to disparage, and invalidate people who have been harmed by his profession. Similarly, the false claim that psychiatric diagnoses are caused by a brain disease or defect is used to justify claiming the disease causes a lack of insight. This claim is used to justify minimizing, invalidating, disrespecting and ridiculing patients who complain when they are mistreated, even those who have experienced grave harm. Since none of us were alive over a hundred years ago, it appears that Harry A. Nasrallah seems to lack insight into the valid issues he is attempting to address with his editorial. I question his ethical integrity since he fails to explain how the real world outcomes of patients who have been harmed, traumatized and even disabled by psychiatric treatment is justifiable; indeed, he fails to even mention psychiatry's victims, as if they do not even exist. My perception is that Nasrallah is unwilling to validate the lived experiences of psychiatric survivors or even acknowledge complaints of real and lasting harm, because he knows they are an "adverse effect" of current standard practices used by psychiatry. Naszrallah's claim that psychiatric survivor's complaints are based on historical events which were not actually experienced is not credible.

If Nasrallah's statement that most psychiatrists believe survivor's complaints are "unfair exaggerations based on events and primitive conditions of more than a century ago" is true; this could explain the current failure to effectively treat the majority of people who receive psychiatric treatment. It also suggests that the psychiatric profession as a whole, is seriously lacking any real insight into the very people it hopes to serve.

FYI Henry A. Nasrallah----the complaints which you claim are, "unfair exaggerations based on events and primitive conditions of more than a century ago," are not. Every survivor I know has complaints that are based on their own lived experience. Most have spent more than "a week on an acute psychiatric unit" which is why they know the truth of the safety and efficacy of the drugs; they have experienced the traumatic nature of the coercion, the medical neglect, and the abuse of power and authority that occurs in Standard Practice, and these are not uncommon experiences. That some psychiatric patients are "helped" and remain compliant, does not mean the harm done to other patients is justifiable or acceptable.

I have experienced how harmful and how disrespectful some professionals who provide "psychiatric treatment" using techniques which are called Standard Clinical Practices. I see the evidence of the utter failure of modern psychiatric treatment every day when I help my beloved son. My son is struggling to overcome the traumatic iatrogenic injuries inflicted upon him by neuroleptic and other psychotropic drugs, mdical neglect and lack of compassion, his injuries that are compounded by the manner in which he was treated by mental health professionals, specifically, the abuse of power and authority upon which bio-psychiatric treatment relies. Psychiatric treatment robbed him of his autonomy, deprived him of his human dignity which obviously, badly damaged his sense of self-worth. The "treatment" was experimental, and it was forced upon him by a "lead researcher" and "Nationally renown expert" who ignored ethical medical principles, State, Federal and International Laws governing individual and parental Civil Rights, and tortured my precious son into a state of profound disability with impunity.

George Santayana said, "Those who cannot remember the past are condemned to repeat it." Psychiatry as a profession, does not seem to value the history from whence the standards of care and standard clinical practices are derived. This begs the question, "Why do psychiatrists continue to use these standards while disavowing any connection to how, when, and by whom the standards were first used and developed? The patriarchal mental health and social service system of the eugenics era is evident in the publicly funded biologically biased community mental health clinic model. Diagnoses and treatment protocols become standardized by consensus, not "evidence based." Consensus is a quasi-democratic, i.e. political, process; not a scientific method. Consensus is evidence of agreement, it is not evidence of diagnostic or treament validity or reliability. Substituting consensus for analysis of existing statistical data, or in the absence of objective research data to assess a treatment's efficacy, safety, and actual effectiveness for the symptom and the patient it's being prescribed is medical fraud--it's now "standard practice" thanks to consensus and hubris.

Harry A. Nasrallah do you question how ethical or moral is it to minimize, or dismiss altogether the valid complaints of psychiatric survivors as you do in this editorial? Addressing these valid complaints that you and your colleages pretend are irreleveant, would earn psychiatry, as a profession, some sorely needed trust. Who knows, it may even help restore some of the ethical integrity the psychiatric profession seems to believe is still has, despite the unethical conduct being ignored; and worse, being rewarded.

I am a MadMother.

I have Mad Pride.

Harry A. Nazrallah, you can dismiss me as "antipsychiatry."

No psychiatrist can minimize me, or invalidate my experience.

Trust, and respect are earned; they are not awarded with a diploma from a medical school, or issued with a medical license. Trust and respect are not ephemeral, they cannot be maintained when unethical behavior and dishonesty are "standard practice" No profession can claim to be trustworthy or respectable if unethical behavior, dishonesty and fraud are acceptable standard practices. Having the trust and respect of others is based upon the actual effects of one's conduct; not one's intent to be benificent, or helpful.

After I posted this rebuttal to Harry Nasrallah's editorial, the links were disabled-so here is the text of Nazarallah's Op-Ed:

Henry A. Nasrallah, MD

Psychiatry is the only medical specialty with a longtime nemesis; it’s called “antipsychiatry,” and it has been active for almost 2 centuries. Although psychiatry has evolved into a major scientific and medical discipline, the century-old primitive stage of psychiatric treatments instigated an antagonism toward psychiatry that persists to the present day.

A recent flurry of books critical of psychiatry is evidence of how the antipsychiatry movement is being propagated by journalists and critics whose views of psychiatry are unflattering despite the abundance of scientific advances that are gradually elucidating the causes and treatments of serious mental disorders.

What are the “wrongdoings” of psychiatry that generate the long-standing protests and assaults? The original “sin” of psychiatry appears to be locking up and “abusing” mentally ill patients in asylums, which 2 centuries ago was considered a humane advance to save seriously disabled patients from homelessness, persecution, neglect, victimization, or imprisonment. The deteriorating conditions of “lunatic” asylums in the 19^th and 20^th centuries were blamed on psychiatry, not the poor funding of such institutions in an era of almost complete ignorance about the medical basis of mental illness. Other perceived misdeeds of psychiatry include:

Medicalizing madness (contradicting the archaic notion that psychosis is a type of behavior, not an illness)
Drastic measures to control severe mental illness in the pre-pharmacotherapy era, including excessive use of electroconvulsive therapy (ECT), performing lobotomies, or resecting various body parts
Use of physical and/or chemical restraints for violent or actively suicidal patients
Serious or intolerable side effects of some antipsychotic medications
Labeling slaves’ healthy desire to escape from their masters in the 19^thcentury as an illness (“drapetomania”)
Regarding psychoanalysis as unscientific and even harmful
Labeling homosexuality as a mental disorder until American Psychiatric Association members voted it out of DSM-II in 1973
The arbitrariness of psychiatric diagnoses based on committee-consensus criteria rather than valid and objective scientific evidence and the lack of biomarkers (this is a legitimate complaint but many physiological tests are being developed)
Psychoactive drugs allegedly are used to control children (antipsychiatry tends to minimize the existence of serious mental illness among children, although childhood physical diseases are readily accepted)
Psychiatry is a pseudoscience that pathologizes normal variations of human behaviors, thoughts, or emotions
Psychiatrists are complicit with drug companies and employ drugs of dubious efficacy (eg, antidepressants) or safety (eg, antipsychotics).

Most of the above reasons are exaggerations or attributed to psychiatry during an era of primitive understanding of psychiatric brain disorders. Harmful interventions such as frontal lobotomy—for which its neurosurgeon inventor received the 1949 Nobel Prize in Medicine—were a product of a desperate time when no effective and safe treatments were available. Although regarded as an effective treatment for mood disorders, ECT certainly was abused many decades ago when it was used (without anesthesia) in patients who were unlikely to benefit from it.

David Cooper¹ coined the term “antipsychiatry” in 1967. Years before him, Michel Foucault propagated a paradigm shift that regarded delusions not as madness or illness, but as a behavioral variant or an “anomaly of judgment.”²That antimedicalization movement was supported by the First Church of Christ, Scientist, the legal system, and even the then-new specialty of neurology, plus social workers and “reformers” who criticized mental hospitals for failing to conduct scientific investigations.³

Formerly institutionalized patients such as Clifford Beers⁴ demanded improvements in shabby state hospital conditions more than a century ago and generated antipsychiatry sentiments in other formerly institutionalized persons. Such antipathy was exacerbated by bizarre psychiatrists such as Henry Cotton at Trenton State Hospital in New Jersey, who advocated that removing various body parts (killing or disfiguring patients) improved mental health.⁵

Other ardent antipsychiatrists included French playwright and former asylum patient Antonin Artaud in the 1920s and psychoanalysts Jacques Lacan and Erich Fromm, who authored antipsychiatry writings from a “secular-humanistic” viewpoint. ECT use in the 1930s and frontal leucotomy in the 1940s understandably intensified fear toward psychiatric therapies. When antipsychotic medications were discovered in the 1950s (eventually helping to shut down most asylums), these medications’ neurologic side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) prompted another outcry by antipsychiatry groups, although there was no better alternative to control psychosis.

In the 1950s, a right-wing antipsychiatry movement regarded psychiatry as “subversive, left-wing, anti-American, and communist” because it deprived individuals of their rights. Psychologist Hans Eysenck rejected psychiatric medical approaches in favor of errors in learning as a cause of mental illness (as if learning is not a neurobiologic event).

The 1960s witnessed a surge of antipsychiatry activities by various groups, including prominent psychiatrists such as R.D. Laing, Theodore Lidz, and Silvano Arieti, all of whom argued that psychosis is “understandable” as a method of coping with a “sick society” or due to “schizophrenogenic parents” who inflict damage on their offspring. Thomas Szasz is a prominent psychiatrist who proclaimed mental illness is a myth.⁶ I recall shuddering when he spoke at the University of Rochester during my residency, declaring schizophrenia a myth when I had admitted 3 patients with severe, disabling psychosis earlier that day. I summoned the chutzpah to tell him that in my experience haloperidol surely reduced the symptoms of the so-called “myth”! Szasz collaborated with the Church of Scientology to form the Citizens Commission on Human Rights. Interestingly, Christian Scientists and some fundamental Protestants³ agreed with Szasz’s contention that insanity is a moral, not a medical, issue.

A major impact of the antipsychiatry movement is evident in Italy due to the efforts of Franco Basaglia, an influential “psychiatrist-reformer.” Basaglia was so outraged with the dilapidated and prison-like conditions of mental institutions that he convinced the Italian Parliament to pass a law in 1978⁷ that abruptly dismantled and closed all mental hospitals in Italy. Because of uncontrolled psychosis or mania, many patients who were released ended up in prisons, which had similar or worse repressive conditions as the dismantled asylums. Many chronically hospitalized patients died because of self-neglect or victimization within a few months of their abrupt discharge.

Finally, the antipsychiatry movement aggressively criticizes the pharmaceutical industry’s research, tactics, and influence on psychiatry. Also included in the attacks are academic psychiatrists who conduct FDA clinical trials for new drugs and educate practitioners about the efficacy/safety and indications of new FDA-approved drugs.

Although industry research grants are deposited at the investigators’ universities, critics mistakenly assume these psychiatrists personally benefit. The content of all educational programs about psychiatric drugs is strictly restricted to the FDA-approved product label, but critics assume that expert speakers, who are compensated for their time and effort, are promoting the drug rather than educating practitioners about the efficacy, safety, tolerability, and proper use of new medications. Part of the motive for attacking this collaboration is the tenet held by many in the antipsychiatry movement that medications are ineffective, unnecessary, or even dangerous. I wish antipsychiatrists would spend a week on an acute psychiatric unit to witness the need for and benefit from psychotropic medications for psychotic, manic, or depressed patients. Although psychiatric patients experience side effects, they are no worse than those experienced by cancer, arthritis, or diabetes patients.

The antipsychiatry movement is regarded by some as “intellectual halitosis” and by others as a thorn in the side of mainstream psychiatry; most believe that many of its claims are unfair exaggerations based on events and primitive conditions of more than a century ago. However, although irritating and often unfair, antipsychiatry helps keep us honest and rigorous about what we do, motivating us to relentlessly seek better diagnostic models and treatment paradigms. Psychiatry is far more scientific today than it was a century ago, but misperceptions about psychiatry continue to be driven by abuses of the past. The best antidote for antipsychiatry allegations is a combination of personal integrity, scientific progress, and sound evidence-based clinical care.