Print

Print


http://www.alternet.org/story/153634/7_reasons_america%27s_mental_health_industry_is_a_threat_to_our_sanity

*7 Reasons America's Mental Health Industry Is a Threat to Our Sanity*

By Bruce E. Levine, AlterNet
Posted on January 6, 2012

Why do some of us become dissident mental health professionals?

The majority of psychiatrists, psychologists and other mental health
professionals “go along to get along” and maintain a status quo that
includes drug company corruption, pseudoscientific research and a “standard
of care” that is routinely damaging and occasionally kills young children.
If that sounds hyperbolic, then you probably have not heard of Rebecca
Riley, and how the highest levels of psychiatry described her treatment as
“appropriate and within responsible professional standards.”

When Rebecca Riley was 28 months old, based primarily on the complaints of
her mother that she was “hyper” and had difficulty sleeping, psychiatrist
Kayoko Kifuji, at the Tufts-New England Medical Center in Boston,
Massachusetts, diagnosed Rebecca with attention deficit hyperactivity
disorder (ADHD). Kifuji prescribed clonidine, a hypertensive drug with
significant sedating properties, a drug Kifuji also prescribed to Rebecca’s
older sister and brother. The goal of the Riley parents—obvious to many in
their community and later to juries—was to attain psychiatric diagnoses for
their children that would qualify them for disability payments and to
sedate their children making them easy to manage.

By the time Rebecca was three years old, again based mainly on parental
complaints, Kifuji had given Rebecca an additional diagnosis of bipolar
disorder and prescribed two additional heavily sedating drugs, the
antipsychotic Seroquel and the anticonvulsant Depakote.

At the age of four, Rebecca was dead.

At the time of her death, Rebecca had a life-threatening amount of
clonidine—enough to kill her—in her body, according to the former director
of the Massachusetts toxicology lab and the medical director of a regional
poison control center. The medical examiner who performed the autopsy
concluded that Rebecca died from intoxication of clonidine, Depakote and
two over-the-counter cold and cough medicines that led to heart failure,
lungs filled with bloody fluid, coma, and then death. Rebecca’s abusive
parents went to prison for the over-drugging that led to their daughter’s
death.

Kifuji’s fate? The psychiatric establishment rallied around Kifuji,
enabling her to return to Tufts Medical Center practicing child psychiatry
without any restrictions, penalties or supervision. After Rebecca’s death,
Tufts-New England Medical Center defended Kifuji. A Tufts spokesperson told
“60 Minutes” in 2009, “The care we provided was appropriate and within
responsible professional standards.”

Apparently, psychiatric care that is considered appropriate and within
responsible professional standards includes diagnoses of ADHD for a
two-year-old and bipolar disorder for a three-year-old when the symptoms of
those disorders are normal behaviors for those ages; prescribing three
heavily sedating drugs that have not been approved by the FDA for child
psychiatric treatment; ignoring the warnings from a school nurse about
over-dosages for Rebecca; and making diagnoses based almost entirely on the
reports of Rebecca’s mother, who herself was diagnosed with mental illness
and heavily medicated to the point of falling asleep in Kifuji’s office.

Long before the Rebecca Riley tragedy hit the headlines, I was embarrassed
by the mental health profession for seven major reasons:

*1. Corruption by Big Pharma*

How did it become within responsible professional standards for a
two-year-old to get an ADHD diagnosis, for a three-year-old to get a
bipolar diagnosis, and for toddlers to be prescribed multiple heavily
sedating drugs? The short answer is drug company corruption of the mental
health profession.

Congressional hearings in 2008 revealed that psychiatry’s “thought leaders”
and major institutions are on the take from drug companies.

On June 8, 2008, the *New York Times* reported about psychiatrist Joseph
Biederman: “A world-renowned Harvard child psychiatrist whose work has
helped fuel an explosion in the use of powerful antipsychotic medicines
in children earned at least $1.6 million in consulting fees from drug
makers from 2000 to 2007.”

Due in large part to Biederman’s influence, the number of American children
and adolescents treated for bipolar disorder increased 40-fold from 1994 to
2003. Pediatrician and author Lawrence Diller notes about Biederman, “He
single-handedly put pediatric bipolar disorder on the map.” In addition to
his popularization of bipolar disorder for children, Biederman is one of
the most significant forces behind the expanding numbers diagnosed with
ADHD; and congressional investigators also discovered that Biederman
conducted studies of Eli Lilly's ADHD drug Strattera that were funded by
National Institute of Health at the same time he was receiving money from
Lilly.

Not only does the drug industry have influential psychiatrists such as
Biederman in their pocket, virtually every major mental health institution
is financially interconnected with Big Pharma. Congressional hearings also
exposed the American Psychiatric Association psychiatry’s premier
professional organization, as being on the take from drug companies. In
2006, the drug industry accounted for about 30 percent of the APA’s $62.5
million in financing. Most relevant here, the APA is the publisher of the
psychiatric diagnostic bible, the Diagnostic and Statistical Manual of
Mental Disorders (DSM), and thus the APA is the institution responsible for
creating mental illnesses and disorders.

*2. Invalid Illnesses and Disorders*

Psychiatry’s first DSM (1952) and its DSM-II (1968) listed homosexuality as
a mental illness. Only because of a fierce political fight waged in the
1970s by gay activists did the APA abolish homosexuality as an illness and
eliminate it from its DSM-III (1980). Gay activists’ fight was not only a
victory for themselves but a service for everyone else, as it made public
the important scientific problem of psychiatric disorder invalidity.
Specifically, are psychiatric disorders scientifically valid illnesses, or
are they simply behaviors that create discomfort for some authorities at a
given moment in time?

While psychiatry lost homosexuality as a mental illness in the 1980
DSM-III, the APA found other groups it could pathologize, groups that could
not mobilize and resist, most notably children, who are now routinely given
psychiatric diagnoses for behaviors that many of us view as normal for
their ages.

Psychiatry sees it as within responsible professional standards to diagnose
three-year-olds such as Rebecca Riley with bipolar disorder. The symptoms
of bipolar disorder include irritable and rapidly changing moods, severe
temper tantrums, defiance of authority, agitation and distractibility,
sleeping too little or too much, poor judgment, impulsivity and grandiose
beliefs.

Psychiatry also sees it as within responsible professional standards for
Rebecca Riley to have been diagnosed at 28 months old with ADHD. The
symptoms of ADHD are inattention (easily distracted and bored, difficulty
organizing and completing tasks, losing things, not seeming to listen, not
following instructions); hyperactivity (fidgeting, talking nonstop, having
trouble sitting still, difficulty with quiet tasks), and impulsivity
(impatience, blurting out inappropriate comments, interrupting
conversations).

Today, children and teens are also diagnosed with oppositional defiant
disorder (ODD), the symptoms of which include “often actively defies or
refuses to comply with adult requests or rules,” and “often argues with
adults.”

The standard for a medical disorder should not be whether or not an
individual causes friction.

*3. Scientifically Unreliable Diagnoses*

Even if you believe that bipolar disorder for three-year-olds, ADHD for
two-year-olds, ODD for teenagers, and all the other DSM diagnoses are valid
disorders, there is still the scientific issue of diagnostic
unreliability—the lack of diagnostic agreement among professionals
examining the same person.

A generation ago, psychiatrists admitted that their diagnoses were
unreliable and agreed that this was a major scientific problem. So in 1980,
in an attempt to eliminate this embarrassment, they created the DSM-III
with concrete behavioral checklists and formal decision-making rules, but
they failed to correct the problem. Psychiatric diagnoses remain
unreliable, but now psychiatry no longer talks about the unreliability
problem.

If a measurement is a reliable one, then clinicians trained with it should
be in high agreement on the diagnosis. A major 1992 study, conducted at six
sites with 600 prospective patients, was done to examine the reliability of
psychiatric diagnoses. Experienced mental health professionals were given
extensive training in how to make accurate DSM diagnoses. Because of the
extensive training, one would expect that diagnostic agreement would be
much higher than in typical clinical settings. Herb Kutchins and Stuart
Kirk summarize the study in *Making Us Crazy* (1997):

What this study demonstrated was that even when experienced clinicians with
special training and supervision are asked to use DSM and make a diagnosis,
they frequently disagree, even though the standards for defining agreement
are very generous. . . . [For example,] if one of the two therapists made a
diagnosis of Schizoid Personality Disorder and the other therapist selected
Avoidant Personality Disorder, the therapists were judged to be in complete
agreement of the diagnosis because they both found a personality
disorder—even though they disagreed completely on which one! So even with
this liberal definition of agreement, reliability using DSM is not very
good.

Kutchins and Kirk conclude: “Mental health clinicians independently
interviewing the same person in the community are as likely to agree as
disagree that the person has a mental disorder and are as likely to agree
as disagree on which of the over 300 DSM disorders is present.”

*4. Biochemical Imbalance Mumbo Jumbo*

Just as nothing was more important in selling the Iraq war in 2003 than the
Bush administration’s certainty that Iraq possessed weapons of mass
destruction, nothing has been more important in selling psychiatric drugs
than psychiatry’s certainty of biochemical brain imbalances as the cause
for mental illnesses.

Prior to psychiatry’s proclamation that depression was caused by too little
of the neurotransmitter serotonin, few Americans were taking
antidepressants. But by declaring that depression was caused by a serotonin
imbalance analogous to diabetes and an insulin imbalance, depressed
Americans became far more receptive to serotonin-enhancing drugs such as
the “selective-serotonin-reuptake inhibitors” (SSRIs) Prozac, Paxil, and
Zoloft.

SSRIs can make some depressed people feel better; however, alcohol makes
some shy people less shy, but that’s not enough evidence to say that
shyness is caused by an alcohol imbalance. The truth is—and scientists have
known this for quite some time—that serotonin levels are not associated
with depression.

Researchers have used a variety of methods to test the serotonin imbalance
theory of depression, including comparing serotonin metabolites in
depressed and nondepressed people, and depleting serotonin levels through a
variety of means and then observing whether this resulted in depression.
Elliot Valenstein, professor emeritus of psychology and neuroscience at the
University of Michigan, reviewed the research in his book *Blaming the Brain
* (1998) and reported that it is just as likely for people with normal
serotonin levels to feel depressed as it is for people with abnormal
serotonin levels, and that it is just as likely for people with abnormally
high serotonin levels to feel depressed as it is for people with abnormally
low serotonin levels. Valenstein concluded, “Furthermore, there is no
convincing evidence that depressed people have a serotonin or
norepinephrine deficiency.”

In 2002, the *New York Times* reported: “Researchers knew that
antidepressants seemed to raise the brain’s levels of messenger chemicals
called neurotransmitters, so they theorized that depression must result
from a deficiency of these chemicals. Yet a multitude of studies failed to
prove this precept.”

Yet even now, many psychiatrists and other mental health professionals
continue to promulgate the serotonin imbalance theory of depression, and
polls show that the majority of Americans continue to believe it.

*5. Pseudoscientific Drug Effectiveness Research*

There are multiple tricks that psychiatric drug manufacturers and their
researcher psychiatrists and psychologists use to make their drugs look
more effective than they really are. One of the most common depression
measurements used by researchers paid by drug companies is the Hamilton
Rating Scale for Depression. In the HRSD, researchers rate subjects, and
the higher the point total, the more one is deemed to be suffering from
depression. On the HRSD, there are three separate items about insomnia
(early, middle and late) and one can receive up to six points for
difficulty either falling or remaining asleep; however, there is only one
suicide item, in which one is awarded only two points for wishing to be
dead. The HRSD is heavily loaded with items that are most affected by
drugs, and it is therefore especially damning for antidepressants that even
with such measurement dice-loading, these drugs routinely fail to
outperform placebos—even dice-loaded placebos.

Proper drug research requires that neither subject nor experimenter knows
who is getting the drug and who is getting the placebo (a true double-blind
control). Drug company antidepressant researchers use inactive placebos
such as sugar pills (which don’t create side effects). Independent research
on inactive placebos show that many subjects in antidepressant and other
studies can guess if they are getting the actual drug or not, which changes
their expectations and subverts the double-blind control. In order to make
it more difficult to guess correctly, an active placebo (which creates side
effects) should be used. In 2000, a *Psychiatric Times* article concluded:
“In fact, when antidepressants are compared with active placebos, there
appear to be no differences in clinical effectiveness.”

Dice-loading depression measurements and placebos are just two of many
techniques drug company researchers use to make antidepressants look more
effective than they really are. But even with such dice-loading,
antidepressants have not fared well, at least when one examines all the
studies.

Drug companies try to ensure that those studies showing antidepressants to
be no more effective than placebos are not published; however, all studies
must be submitted to the FDA. So independent researcher Irving Kirsch and
his research team at the University of Connecticut used the Freedom of
Information Act to gain access to all data, and analyzed 47 studies that
had been sponsored by drug companies on Prozac, Paxil, Zoloft, Effexor,
Celexa, and Serzone. Kirsch discovered that in the majority of the trials,
the antidepressant failed to outperform a sugar pill placebo (and in the
trials where the antidepressant did outperform the placebo, the advantage
was slight).

*6. Psychotropic Drug Hypocrisy*

Chemists consider psychiatric prescription drugs and illegal mood-altering
drugs all to be psychotropic or psychoactive drugs. Cocaine and ADHD drugs
such as Adderall and other amphetamines affect the neurotransmitters
dopamine, serotonin, and norepinephrine; and antidepressants used in
combination also affect the same neurotransmitters. Not only are
prescription psychotropics and illegal psychotropics chemically similar,
they are used by people for similar reasons, including taking the edge off
their discomfort so they can function. The hypocrisy surrounding illegal
and prescription psychotropic drugs is harmful to society in at least two
ways.

At one level, because people are being misinformed about the realities of
prescription psychotropic drugs, they are more likely to gulp them down and
to give them to their children. This has helped create a tragic phenomenon
detailed by investigative reporter Robert Whitaker in his book *Anatomy of
an Epidemic* (2010). Psychiatric drug use turning mild and episodic
conditions into severe and chronic ones has helped create a huge increase
of Americans with severe mental illness, especially among children.

At a second level, this psychiatric-illegal psychotropic drug hypocrisy
allows for unfair criminalizing and incarceration of people using illegal
psychotropics.

*7. Diversion from Societal, Cultural and Political Sources of Misery*

When we hear the words *disorder*, *disease* or *illness*, we think of an
individual in need of treatment, not of a troubled society in need of
transformation. Mental illness expansionism diverts us from examining a
dehumanizing society.

In addition to pathologizing normal behavior, the mental health profession
also diverts us from examining a society that creates the
ingredients—helplessness, hopelessness, passivity, boredom, fear, and
isolation—that cause emotional difficulties. We are diverted from the
reality that many emotional problems are natural human reactions to loss in
our society of autonomy and community. Thus, the mental health profession
not only has financial value for drug companies but it has political value
for those at the top of societal hierarchies who want to retain the status
quo.

Today, a handful of dissident mental health professionals do challenge and
resist their profession’s dehumanizing standard practicies. I know several
of these dissidents, and they are the only psychiatrists, psychologists and
mental health professionals that I have any respect for.

* Bruce E. Levine is a clinical psychologist and author of Get Up, Stand
Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate
Elite <http://www.amazon.com/Get-Stand-Populists-Energizing-Corporate/dp/1603582983/ref=ntt_at_ep_dpt_3>
(Chelsea
Green, 2011). His Web site is www.brucelevine.net. *