MARCIA ANGELL M.D.'THE ILLUSION OF PSYCHIATRY' - COURTESY OF THE NEW YORK REVIEW OF BOOKS

BIOGRAPHY

Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She stepped down as Editor-in-Chief of the New England Journal of Medicine on June 30, 2000. A graduate of Boston University School of Medicine, she trained in both internal medicine and anatomic pathology and is a board-certified pathologist. She joined the editorial staff of the New England Journal of Medicine in 1979, became Executive Editor in 1988, and Editor-in-Chief in 1999.

Dr. Angell writes frequently in professional journals and the popular media on a wide range of topics, particularly medical ethics, health policy, the nature of medical evidence, the interface of medicine and the law, care at the end of life, and the relations between industry and academic medicine. Her critically acclaimed book, Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case, was published in June, 1996, by W. W. Norton & Company. Her most recent book is The Truth About the Drug Companies: How They Deceive Us and What to Do About It, published in August, 2004, by Random House. In addition, Dr. Angell is co-author, with Dr. Stanley Robbins and, later, Dr. Vinay Kumar, of the first three editions of the textbook, Basic Pathology. She also has written chapters in several books dealing with ethical issues.

Dr. Angell is a member of the Association of American Physicians, the Institute of Medicine of the National Academy of the Sciences, the Alpha Omega Alpha National Honor Medical Society, and is a Master of the American College of Physicians and a Fellow of the American Association for the Advancement of Science. In 1997, Time magazine named Marcia Angell one of the 25 most influential Americans.

NEW YORK LITERARY REVIEW ARTICLE

In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it.1 Here I discuss the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—often referred to as the bible of psychiatry, and now heading for its fifth edition—and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider’s view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.”2 By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.



But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry

When psychoactive drugs were first introduced, there was a brief period of optimism in the psychiatric profession, but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent, and an antipsychiatry movement had taken root, as exemplified by the writings of Thomas Szasz and the movie One Flew Over the Cuckoo’s Nest.

There was also growing competition for patients from psychologists and social workers. In addition, psychiatrists were plagued by internal divisions: some embraced the new biological model, some still clung to the Freudian model, and a few saw mental illness as an essentially sane response to an insane world. Moreover, within the larger medical profession, psychiatrists were regarded as something like poor relations; even with their new drugs, they were seen as less scientific than other specialists, and their income was generally lower.

In the late 1970s, the psychiatric profession struck back—hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible.

These efforts to enhance the status of psychiatry were undertaken deliberately. The APA was then working on the third edition of the DSM, which provides diagnostic criteria for all mental disorders. The president of the APA had appointed Robert Spitzer, a much-admired professor of psychiatry at Columbia University, to head the task force overseeing the project. The first two editions, published in 1952 and 1968, reflected the Freudian view of mental illness and were little known outside the profession. Spitzer set out to make the DSM-III something quite different. He promised that it would be “a defense of the medical model as applied to psychiatric problems,” and the president of the APA in 1977, Jack Weinberg, said it would “clarify to anyone who may be in doubt that we regard psychiatry as a specialty of medicine.”

When Spitzer’s DSM-III was published in 1980, it contained 265 diagnoses (up from 182 in the previous edition), and it came into nearly universal use, not only by psychiatrists, but by insurance companies, hospitals, courts, prisons, schools, researchers, government agencies, and the rest of the medical profession. Its main goal was to bring consistency (usually referred to as “reliability”) to psychiatric diagnosis, that is, to ensure that psychiatrists who saw the same patient would agree on the diagnosis. To do that, each diagnosis was defined by a list of symptoms, with numerical thresholds. For example, having at least five of nine particular symptoms got you a full-fledged diagnosis of a major depressive episode within the broad category of “mood disorders.” But there was another goal—to justify the use of psychoactive drugs. The president of the APA last year, Carol Bernstein, in effect acknowledged that. “It became necessary in the 1970s,” she wrote, “to facilitate diagnostic agreement among clinicians, scientists, and regulatory authorities given the need to match patients with newly emerging pharmacologic treatments.”3

The DSM-III was almost certainly more “reliable” than the earlier versions, but reliability is not the same thing as validity. Reliability, as I have noted, is used to mean consistency; validity refers to correctness or soundness. If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be “reliable,” but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers, and in the case of the DSM-III mainly of Spitzer himself, who has been justly called one of the most influential psychiatrists of the twentieth century.4 In his words, he “picked everybody that [he] was comfortable with” to serve with him on the fifteen-member task force, and there were complaints that he called too few meetings and generally ran the process in a haphazard but high-handed manner. Spitzer said in a 1989 interview, “I could just get my way by sweet talking and whatnot.” In a 1984 article entitled “The Disadvantages of DSM-III Outweigh Its Advantages,” George Vaillant, a professor of psychiatry at Harvard Medical School, wrote that the DSM-III represented “a bold series of choices based on guess, taste, prejudice, and hope,” which seems to be a fair description.

Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies. (There are four separate “sourcebooks” for the current edition of the DSM that present the rationale for some decisions, along with references, but that is not the same thing as specific references.) It may be of much interest for a group of experts to get together and offer their opinions, but unless these opinions can be buttressed by evidence, they do not warrant the extraordinary deference shown to the DSM. The DSM-III was supplanted by the DSM-III-R in 1987, the DSM-IV in 1994, and the current version, the DSM-IV-TR (text revised) in 2000, which contains 365 diagnoses. “With each subsequent edition,” writes Daniel Carlat in his absorbing book, “the number of diagnostic categories multiplied, and the books became larger and more expensive. Each became a best seller for the APA, and DSM is now one of the major sources of income for the organization.” The DSM-IV sold over a million copies.

As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession. Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly. They showered gifts and free samples on practicing psychiatrists, hired them as consultants and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials. When Minnesota and Vermont implemented “sunshine laws” that require drug companies to report all payments to doctors, psychiatrists were found to receive more money than physicians in any other specialty. The pharmaceutical industry also subsidizes meetings of the APA and other psychiatric conferences. About a fifth of APA funding now comes from drug companies.

Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.5

The drug industry, of course, supports other specialists and professional societies, too, but Carlat asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that.

In addition to the money spent on the psychiatric profession directly, drug companies heavily support many related patient advocacy groups and educational organizations. Whitaker writes that in the first quarter of 2009 alone,

Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.

And that’s just one company in three months; one can imagine what the yearly total would be from all companies that make psychoactive drugs. These groups ostensibly exist to raise public awareness of psychiatric disorders, but they also have the effect of promoting the use of psychoactive drugs and influencing insurers to cover them. Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:

In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.


1

See Marcia Angell, " The Epidemic of Mental Illness: Why? ," The New York Review , June 23, 2011. ↩

2

Eisenberg wrote about this transition in "Mindlessness and Brainlessness," British Journal of Psychiatry , No. 148 (1986). His last paper, completed by his stepson, was published after his death in 2009. See Eisenberg and L.B. Guttmacher, "Were We All Asleep at the Switch? A Personal Reminiscence of Psychiatry from 1940 to 2010," Acta Psychiatrica Scand. , No. 122 (2010). ↩

3

Carol A. Bernstein, "Meta-Structure in DSM-5 Process," Psychiatric News , March 4, 2011, p. 7.

4

The history of the DSM is recounted in Christopher Lane's informative book Shyness: How Normal Behavior Became a Sickness " (Yale University Press, 2007). Lane was given access to the American Psychiatric Association's archive of unpublished letters, transcripts, and memoranda, and he also interviewed Robert Spitzer. His book was reviewed by Frederick Crews in The New York Review , December 6, 2007 , and by me, January 15, 2009 . ↩

5

See L. Cosgrove et al., "Financial Ties Between DSM-IV Panel Members and the Pharmaceutical Industry," Psychotherapy and Psychosomatics , Vol. 75 (2006). ↩

BIPOLAR DISORDER FOR KIDS IS THE NEXT 'BIG THING.' - from article in the Daily Tribune by Jeremy Olsen

Someday, Jenna Beckman's daughter might be diagnosed with bipolar disorder, an incurable swaying between manic rage and depression. But it won't be now, at age 8.

The brown-haired spitfire can be calm one minute, screaming and biting the next. In her most anxious moments at school, Jade Boyce runs out of her classroom and hides.

Yet while her behavior resembles the symptoms of bipolar disorder, Beckman recoils from the diagnosis.

"Once you put that in a child's file, you can't remove it," said the mother from Little Falls, Minn. "It sticks there."

Beckman's resistance is part of a national backlash against one of psychiatry's fastest-growing -- and most feared -- diagnoses.

The number of American children diagnosed with bipolar disorder increased 40-fold in a recent 10-year span, one study found. In Minnesota, spending on powerful antipsychotic drugs to treat bipolar and other disorders in children has risen 17-fold since 2000 and exceeds $6 million annually -- just in one state-funded health program.

Now, in a medical reversal with few parallels, psychiatrists are backing away from the diagnosis. While some feel bipolar was once under-diagnosed in children, they worry that thousands of kids have since received the diagnosis in error, due to overzealous doctors, desperate parents, quirks in the health insurance system and aggressive marketing by drug companies.




This summer, in a sign of the profession's second thoughts, the manual that psychiatrists use to make diagnoses is being rewritten and field-tested with a new disorder that would replace bipolar in many cases.




The profession's about-face could help the next generation of troubled children, but it also raises questions about the harm done to children who shouldn't have received either the diagnosis or the potent drugs used to treat it.




"Some of the doctors that got going with that early on, they sort of drank their own Kool-Aid," said Dr. Stephen Setterberg, a child psychiatrist with Maple Grove-based PrairieCare. "They talked themselves into believing that many kids were bipolar. It essentially was a diagnostic fad."

The damage done

The trouble is that fads have consequences.




While antipsychotics can be lifesavers for patients who truly are bipolar, they come with increased risks of obesity, diabetes, muscle spasms and other serious side effects.




Primary care doctors often try these and other drugs in combinations and different dosages as their patients' struggles persist and new symptoms emerge. By the time children with bipolar diagnoses reach specialists such as Dr. Carrie Borchardt, it can be tough to sort out the symptoms caused by disorders and the problems triggered by medications.




"A substantial number of those kids, if you take them off the problem medication, those symptoms go away," said Borchardt, a child psychiatrist with Children's Hospitals and Clinics of Minnesota. "And then they don't have bipolar, they just had a medication-induced problem."




In addition, the wrong diagnosis can prevent children from getting the right treatment. A bipolar diagnosis implies that children need medications, and steers them away from therapy or alternative treatments that psychiatrists are "notorious for ignoring,'' Setterberg said.

Had they not been diagnosed as bipolar, some children might have received the same drugs anyway. For others, however, the bipolar label keeps them from getting what they need, said Dr. David Shaffer, a child psychiatrist at Columbia University in New York. Antidepressants and stimulants, for example, might help -- but misdiagnosed children don't receive them because they can aggravate manic symptoms in bipolar patients.

"In some ways," he said, "the worst result of the misdiagnosis of these kids is there are useful treatments that they are not offered because of the mistaken view that they can actually make things worse."




Finally, the label itself carries a life-altering stigma. "For kids, it can limit their opportunities. It can change parental or academic expectations,'' said Dr. Mark Olfson, also a Columbia U child psychiatrist. "So I think that the words matter."




'I get very worried'




In a cramped townhouse on the edge of Little Falls, Beckman raises Jade and her two brothers. Both boys have ADHD, or Attention-Deficit-Hyperactivity Disorder. Six-year-old Trevor strains to sit still, even with a cast on a broken foot. Nine-year-old Brandon moves from room to room, reading and explaining nutritional textbooks -- textbooks Beckman is studying to earn a degree in nursing.




The boys are creative playmates for Jade, but also her tormenters, as when they cut the manes from her My Little Pony dolls.




Jade's angry reaction at moments like that is understandable. What surprises her mother is the anger that explodes out of otherwise sunny days -- in school, at a store, anywhere.




A request to comb her hair one day drew a harsh reply -- "You hate me! You don't think I'm pretty" -- and anger that lingered until she finaly slept.




Watching Jade giggle and show off ballet moves in the living room one evening, Beckman was nervous.




"When she gets this happy," she said, "I get very worried."




Bipolar disorder is a possible explanation for Jade's tendencies. The disorder has genetic traits, and it runs in her father's side of the family.




On the other hand, Jade's behaviors emerged after her parents' separation -- the type of traumatic event known to trigger mood swings in children.




Jade was 5 when a psychologist suggested bipolar disorder.




"Are you positive?" Beckman replied. "Unless you're positive, I don't want that in her file."

The puzzle of bipolar

There is no brain scan or test to confirm bipolar disorder, so doctors base a diagnosis on symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM.




Trouble is, children with the diagnosis often don't match the DSM profile, which was written for adults. Bipolar adults often suffer long bouts of depression and mania, with such symptoms as delusions, grandiose self-images and risk-taking behavior that damage their work and social lives. Children with the diagnosis can swing in and out of rage in minutes.




As a result, children get the bipolar diagnosis even in the absence of classic symptoms.




Psychiatrists say the label often comes when children are admitted to hospitals, which can't gain insurance coverage for even a short stay unless a patient has a major diagnosis.




"A lot of clinicians have the belief that, 'Gosh, if I don't get this kid a label, he'll never get the services he needs,'" said Dr. Steven Sutherland, who oversees an inpatient child psychiatric unit in Duluth.




At one point, a quarter of all children discharged from psychiatric hospitals had bipolar diagnoses, said Olfson, the Columbia child psychiatrist.

Often, it appears, the diagnosis is wrong. One 2001 study examined 120 children in a New York psychiatric hospital; only half who entered with a bipolar diagnosis met criteria for the disorder.

Part of the problem is the pressure parents place on doctors to define their children's frightening behaviors, said Dr. Kathryn Cullen, a University of Minnesota child psychiatrist.




"They're just looking for answers,'' she said. "If there is a diagnosis, there must be a treatment for it. And then you can just follow that path."




A diagnosis takes off




Twenty years ago, psychiatrists faced professional ridicule for even suggesting bipolar disorder in kids, because there was no evidence or plausible theories that it existed.




That changed in the mid-1990s with studies by Dr. Joseph Biederman, a top Harvard University child psychiatrist. He reasoned that chronic irritability in children, often those already diagnosed with ADHD, represented a child version of bipolar mania.

Then came "The Bipolar Child," a 1999 book by Dr. Demitri Papolos, who reviewed trend data from Yale University and concluded that bipolar disorder was legitimately on the rise among children. Suggested causes ranged from the increasing stress and media exposure of childhood, to "genetic anticipation,'' the idea that diseases appear at younger ages as they are passed down the generations.

In an ill-timed coincidence, the U.S. Food and Drug Administration issued a "black box" warning in 2004 on antidepressants, noting that they carried a heightened risk of child suicide. That had a chilling effect on antidepressant use and pushed doctors toward other treatments -- especially the so-called "big gun" antipsychotics such as Seroquel and Risperdal.

A review of data from Minnesota's fee-for-service Medical Assistance program confirms this sequence. Antidepressant prescriptions for children leveled off, while spending on antipsychotics surged from $402,000 in 2000 to $6.8 million in 2006. Spending on antiseizure drugs for kids, also used to treat bipolar mania, rose seven-fold to $2.3 million.




Olfson's research shows a rise in bipolar diagnoses that matches these drug trends. His studies showed a 4,000 percent increase in the clinical diagnosis of children with bipolar disorder between 1994 and 2003, and a doubling of preschool children with the diagnosis from 2000 to 2007.




"We're always responsible in the medical field for altering our prescription patterns based upon the evidence," said Sutherland, the Duluth psychiatrist. "The problem is ... there's a lot of things that may look like evidence but really aren't -- for instance, how to interpret the black box warning."




A money-maker




The trend soon got a powerful tailwind from pharmaceutical companies eager to market expensive antipsychotics.




While federal regulations bar drugmakers from promoting medications for unapproved uses -- such as bipolar in children -- the companies could sponsor doctors to travel and speak with other doctors about their results using the drugs for such "off-label" purposes.




The practice came under scrutiny, though, as consumer advocates questioned whether the money not only paid for doctors to share their expertise, but also bent their opinions in favor of the drug industry.




Just this March, AstraZeneca paid $68.5 million to settle claims that it improperly marketed Seroquel for children and for other unapproved uses beyond the treatment of adult schizophrenia and bipolar disorder.




Biederman, the father of the child bipolar movement, came under scrutiny as well. An investigation by U.S. Sen. Chuck Grassley, R-Iowa, alleged that he hadn't disclosed more than $1 million in drug company lecture fees and grants he received from 2000 to 2007.




Documents produced in state lawsuits against drug companies also suggested that he promised a positive study -- before doing research -- to Johnson & Johnson regarding the use of its antipsychotic, Risperdal, in preschool kids.




Biederman did not comment for this article but has contested Grassley's conclusions and reaffirmed his finding that frequent irritability can suggest bipolar disorder in children.




Even as the number of bipolar cases swelled, some specialists were skeptical.




Dr. Ellen Leibenluft at the National Institute of Mental Health has followed children years after their diagnoses. Bipolar is supposed to be a permanent, biological brain disease. Yet Leibenluft found that, by their teen and adult years, these supposedly bipolar children had no manic symptoms that are characteristic of the disease. Instead, many were anxious or depressed.




Another anomaly is that two-thirds of the child bipolar cases involve boys, whereas only half of adult cases involve men.




"People often ask, 'Where were these kids when we were younger?'" Leibenluft said. "I can think back, and there were definitely kids who were struggling. People viewed them as problem kids, not kids with problems."

Doing better for kids

Nobody believes that children mislabeled with bipolar disorder are OK. Their extreme tantrums -- even violence and self-harm -- suggest something beyond the throes of childhood and adolescence.




But many psychiatrists believe the answer isn't contained in the current DSM. This summer they're promoting a new disorder for the book's soon-to-be published fifth edition. Named Disruptive Mood Dysregulation Disorder, the diagnosis would apply to grade-school children who suffer frequent outbursts in more than one location and remain irritable between outbursts.




Shaffer, the Columbia psychiatrist who is taking part in this effort, said the condition is more likely to lead to the use of other treatments before doctors resort to antipsychotic or antiseizure drugs.




One critic doubts the new diagnosis will help, because, like bipolar, it will be classified as "affective," meaning it has biological origins and requires drug treatment.




Dr. Stuart Kaplan, author of "Your Child Does Not Have Bipolar Disorder," believes children with bipolar diagnoses have behavior problems that require therapy, not just drugs.




Others worry that the pendulum is swinging too quickly, threatening the children who benefit from the diagnosis.




"Parents are desperate by the time they get to me," said Mimi Sa, a psychologist who assesses and treats bipolar kids at an Allina clinic in Cambridge, Minn. "They say they fear for their own safety ... It's a frightening, dramatic type of rage -- not a tantrum, I-didn't-get-my-way kind of a thing."




'My anger'





The debate is personal for Beckman, who admits her defiance to a bipolar diagnosis weakens as the intensity of her daughter's outbursts grows.




"It would be one thing if I could just say it's bad behavior," she said, "but it's not."




Still, it seems to her that too many options remain unexplored, and the underlying cause of what Jade calls "my anger" hasn't been examined. The only time Jade took medication, a non-stimulant for ADHD, it left her sleepy and depressed all day. Beckman hopes to find a better way.




Jeremy Olson • 612-673-7744

ITV TONIGHT PROGRAMME WITH JULIE ETCHINGHAM THURSDAY 28TH JULY 2011 - "THE CHEMICAL COSH FOR KIDS."Watch this excellent programme which demonstrates a multi-agency way of working to reduce the prescribing of psychotropic drugs.



JULIE ETCHINGHAM PRESENTER



http://www.itv.com/itvplayer/video/?Filter=259926&module=whatson&title=chemical-cosh-for-kids-tonight&day=yesterday&channel=itv1 

Watch this excellent programme which demonstrates a multi-agency way of working to reduce the prescribing of psychotropic drugs by clicking on the title above or the underlined link and you will instantly start the programme.

PROGRAMME INFORMATION 

The number of hyperactive children being given controversial drugs to control their behaviour has almost doubled in the last five years. Julie Etchingham investigates what is behind the increase and asks whether parents and doctors are too keen to use medication to sedate children as young as four years old.

 

BARNADOS' DIRECTOR- "CHILDREN NEED SUPPORT NOT LABELS."

Troublesome children need support, not labelling

By Martin Narey, Director of Barnados, 2008.

I don’t think I’m a soft touch when it comes to children. Twenty three years working with offenders before coming to Barnardo’s, four of them in a Borstal, revealed to me the damage which can be caused by a minority of children and young people. But, the key word here is minority.

And yet, somehow, we have arrived at a point where children; all children; your children and my children, are routinely traduced. Dismissed as worthless they are referred to as 'vermin', 'animals' or 'feral'. If these words were used to describe people who are black, who are gay or those of a particular religious persuasion, there would be uproar. Yet this language is now casually used by people when talking about the youngest and most vulnerable in society.


Today Barnardo’s will be releasing an online film which highlights some of the extreme language that far too many of us use when talking about children. Phrases like ‘shoot a few and if that doesn’t work, shoot a few more’ or ‘let’s sort these parasites out’ are all comments which have been left by members of the public on UK newspaper websites. And these are comments which have not been removed even after the entries have been “moderated” by newspaper editors.


Are these people simply cranks who we should ignore or does this language capture a wider view about children? Sadly, the latter appears to be the case. In a survey, conducted for Barnardo’s by YouGov, over half of the population agreed with the view that British children are beginning to behave like animals with just under half thinking that people are right to describe children as feral because children behave in that way.

When did it become acceptable to condemn all children in this way? When did we stop noticing the sign on the doors of thousands of shops in every type of neighbourhood and across the UK which restrict entry to two children at any one time.

 

Reflect for a moment if one of those notices referred to a different minority. Yet the overwhelming majority of children in our society lead decent, constructive, generous lives – they attend school, take part in activities and a significant number are volunteers. Nine out of ten 16-year-olds are in some form of further learning and 275,000 young people take part in the Duke of Edinburgh Award Scheme. Half of all 16-19 year-olds help in their communities and a third of them formally volunteer.


At Barnardo’s we struggle to cope with the rising number of children and young people who want to give their time freely to help our work. There are of course a few children who are troublesome and who do make life difficult for their neighbours and communities. Those children, and their families need to be made to face up to their actions and some children, I’m afraid, need to be locked up.


But does anyone genuinely believe that a fivefold increase in the numbers of children aged twelve to fourteen whom we lock up is a sensible development. What has happened to us as a society in the last decade or so which means that last year we locked up almost 600 children aged fourteen and under when their incarceration, as recently as 1995, would have been illegal?


It’s certainly not the case that offending by children has increased (the public overestimate by a factor of four, the amount of crime committed by young people) and serious offending by children has, indisputably, fallen during this period. In twenty three years working with offenders I only ever met two child offenders who I did not think were redeemable.


And I always knew – because I did it frequently – that if I took the most vehement advocate for imprisonment to meet children in custody they would leave wondering whether there wasn’t a better way. The reality is that, overwhelmingly, the children we lock up, mostly for futilely short periods, are from the poorest families, have been excluded from school or have been in care.


Our society faces a clear choice - we can either support troublesome children to grow into responsible citizens and valued members of the community or we can reinforce their disadvantage by labelling them, expelling them from school and locking them up – pushing them further to the margins, when they most need our guidance and support.

PETER BREGGIN M.D.-EXPOSES THE RISKS TO BRAIN FUNCTION IN CHILDREN OF PSYCHOTROPIC DRUGS

Psychiatric Drug Adverse Reactions (Side Effects) and Medication Spellbinding

Dr. Peter Breggin’s new concept of medication spellbinding provides insights into why so many people take psychiatric drugs when the drugs are doing more harm than good. Psychiatric drugs, and all other drugs that affect the mind, spellbind the individual by masking their adverse mental effects from the individual taking the drugs. If the person experiences a mental side effect, such as anger or sadness, he or she is likely to attribute it to something other than drug, perhaps blaming it on a loved one or on their own “mental illness.” Often people taking psychiatric drugs claim to feel better than ever when in reality their mental life and behavior is impaired. In the extreme, medication spellbinding leads otherwise well-functioning and ethical individuals to commit criminal acts, violence or suicide.

The concept of medication spellbinding is a unifying theme in Dr. Breggin’s newest book, Medication Madness (2008), which describes dozens of cases of otherwise self-controlled people who became spellbound by psychiatric drugs, leading them to perpetrate bizarre acts, including mayhem, murder and suicide. Dr. Breggin’s other recent book, Brain-Disabling Treatments in Psychiatry (2008), presents the science beyond the concept of medication spellbinding in great depth.

The majority of Dr. Breggin's books focus on harmful medication effects on the brain, mind and behavior. Brain-Disabling Treatments in Psychiatry (2008) is the most up-to-date and thorough presentation of his overall views on the dangers associated with psychiatric medication. It describes how the supposed therapeutic effects of psychiatric drugs are in fact the result of drug-induced mental disabilities. The following very abbreviated summary should not substitute for the more thorough explanations in Brain Disabling Treatments in Psychiatry (2008):

• Antidepressants - cause emotional anesthesia and numbing or sometimes euphoria, providing a fleeting, artificial relief from emotional suffering.

• Neuroleptic or antipsychotic drugs - disrupt frontal lobe function, causing a chemical lobotomy with apathy and indifference, making emotionally distressed people more submissive and less able to feel.


• Mood stabilizers - slow down overall brain function, dampening emotions and vitality.


• Benzodiazepines - suppress overall brain function, sedating the individual, with temporary relief of tension or anxiety at the cost of reduced mental function.


• Stimulants - blunt spontaneity and enforce obsessive behaviors in children, making them less energetic, less social, less creative and more obedient.

CAN WE AFFORD THESE SIDE-EFFECTS FOR OUR CHILDREN IN A 'PROGRESSIVE SOCIETY?'



The individual taking the drugs or the doctor, family and classroom teacher can mistakenly interpret these effects as an improvement when they reflect dysfunction of the brain and mind. As an egregious example, millions of school children are prescribed these drugs because schools find them easer to deal with when their spontaneity is impaired and when they become more compulsively obedient.


CHOICES AS A SOCIETY?



In the long run, all psychiatric drugs tend to disrupt the normal processes of feeling and thinking, rendering the individual less able to deal effectively with personal problems and with life’s challenges. They worsen the individual’s overall mental condition and produce potentially irreversible harm to the brain.






Most recent books by Dr. Breggin:


Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex (2008)

Medication Madness: A Psychiatrist Exposes the Dangers of Mood-Altering Medications (2008)





Ethics - Study Shows Discussion of Ethical Practice re: Prescribing Psychotropic Drugs to Children is Still Rare which Should not be the Case in an Era of Safeguarding Children.

The Ethics and Science of Medicating Children

Authors: Sparks, Jacqueline A.1; Duncan, Barry L.2

Source: Ethical Human Sciences and Services, Volume 6, Number 1, 2004 , pp. 25-39(15)

Abstract:

Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable a critical examination of research addressing the drugging of children. The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how to distinguish science from science fiction. The authors argue that an ethical path requires the challenge of the automatic medical response to medicate children, with an accompanying demand for untainted science and balanced information to inform critical decisions by child caretakers.

DSM5 - ANOTHER CRACKING EXAMPLE OF 'SUBJECTIVITY' -"CALLOUS AND UNEMOTIONAL SPECIFIER FOR CONDUCT DISORDER"

 
"Callous and Unemotional Specifier for Conduct Disorder." 

FRESH OFF THE DSM5 REVIEW GROUP PRESSES.

WHAT CAN THIS LITTLE GEM BE?
LET'S TRY AND FIND OUT.
 
1.   Meets full criteria for Conduct Disorder.
INTERESTINGLY NO REVISED CRITERIA AVAILABLE FOR THIS AS YET BUT  C.U.S.C.D. IS READY.

2.   Shows 2 or more of the following characteristics persistently over at least 1 or 2 months and in more than one relationship or settings. 

The clinician should consider multiple sources of information to determine the presence of these traits, such as whether the person self-reports them as being characteristic of him or herself and if they are reported by others (e.g., parents, other family members, teachers, peers) who have known the person for significant periods of time.

    Lack of Remorse or Guilt: Does not feel bad or guilty when he/she does something wrong (except if expressing remorse when caught and/or facing punishment).
  
  Callous-Lack of Empathy: Disregards and is unconcerned about the feelings of others.
    
  Unconcerned about Performance: Does not show concern about poor/problematic performance at school, work, or in other important activities.
    
   Shallow or Deficient Affect:  Does not express feelings or show emotions to others, except in ways that seem shallow or superficial (e.g., emotions are not consistent with actions; can turn emotions “on” or “off” quickly) or when they are used for gain (e.g., to manipulate or intimidate others).

'DOES NOT SHOW CONCERN ABOUT POOR PERFORMANCE' - 
WOULD INCLUDE A LOT OF BOYS 
ESPECIALLY DISAFFECTED ONES
in my thirty years of experience.

-'SHALLOW OR SUPERFICIAL'-
WHO DETERMINES THAT? 
WHAT DOES IT ACTUALLY MEAN?
WHAT MEASURES OF INTENSITY AND SEVERITY ARE APPLIED?

THIS IS UNBRIDLED SUBJECTIVITY- AS THE BPS POINTS OUT.