Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Three)

Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he discusses the delusions of psychiatry. Each Monday, a new section of the book is published, and all chapters are archived here.

More issues with unreliable diagnoses and poor drugs

A textbook called it a psychopharmacological revolution that we can alleviate or cure 80-90% of people with severe depression, and it claimed that patients with schizophrenia can get their symptoms so much under control or even become cured that they do not need to be hospitalised.^18:232 These claims go directly against the evidence. Drugs cannot cure depression or schizophrenia, and if we wait long enough, most patients, also those with severe depression or schizophrenia, will improve, which is not a drug effect.

This textbook claimed, with no references, that studies from the London School of Economics show that it is a really good business for society to offer treatment of psychiatric disorders.^18:288 Since treatment always means drug treatment—when psychiatrists don’t say otherwise—the claim is false. It is the other way around. The less we use psychiatric drugs, the greater the savings for society, and the more people will be able to work and contribute to society.^5:8,119:24

Apart from this, the textbooks did not mention economic aspects of their recommended treatments. Prices of drugs change, but there wasn’t a single remark that off-patent drugs should be preferred because they are vastly cheaper than patented drugs and not any worse than these. The psychiatric narrative was the opposite of what it should have been. We are told about new drugs that are “modern” or second-generation or third-generation drugs. Some of the drugs that have been most widely used are also some of the worst ones in terms of the harms they cause, e.g. olanzapine, paroxetine, and alprazolam.

This has nothing to do with evidence-based medicine but everything to do with corruption of the science and of the psychiatric leaders.^7,8,533 Psychiatry has sold out to the drug industry. Psychiatrists collect more money from drug makers than doctors in any other specialty,^209,639 and those who take the most tend to prescribe psychosis drugs to children most often.⁶³⁹ Psychiatrists are also “educated” with industry’s hospitality more often than any other specialty.^209,640

Lundbeck patented the active half of citalopram (Celexa or Cipramil) before the patent ran out and called the rejuvenated drug escitalopram (Cipralex or Lexapro), which it launched in 2002. When I checked the Danish prices in 2009, the rejuvenated drug cost 19 times as much for a daily dose as the original drug.^6:224 This enormous price difference should have deterred the doctors from using escitalopram, but it didn’t. Its sales were six times higher in monetary terms than the sales of citalopram. I calculated that if all patients had received the cheapest citalopram instead of escitalopram or other SSRIs, Danish taxpayers could have saved around €30 million a year, or 87% of the total amount spent on SSRIs.

Corruption, both of the science (see Chapter 8, Part Thirteen) and of the doctors, was behind this disregard for the public purse. A psychiatrist described vividly that when Lundbeck launched escitalopram in 2002, most Danish psychiatrists (there are more than a thousand psychiatrists in Denmark) were invited to an enjoyable meeting in Paris: “With expensive lecturers—of course from Lundbeck’s own ‘stable’—luxurious hotel and gourmet food. A so-called whore trip. Under influence? No, of course not, a doctor doesn’t get influenced, right?”⁶⁴¹

The textbooks claimed, without any reliable evidence, that early detection and intervention with drugs are very important for the prognosis, e.g. for psychosis, depression and ADHD. This is not correct.

A chapter on psychopharmacology written by three professors of psychiatry, Anders Fink-Jensen, Poul Videbech and Erik Simonsen, glorified the drugs.^17:645 They claimed that knowledge of brain functions has increased dramatically over the last half century; that our understanding of the mechanisms of the drugs’ effects has been strengthened; that new drugs with fewer harms and better effects have been developed; and that there is no doubt that this has decisively contributed to better psychiatric treatment for the benefit of the patients and their relatives.

All of this was wrong. Psychiatrists turn the evidence on its head to suit their own interests, which align with those of the drug industry.

A 2007 paper surveying US department chairs of medicine and psychiatry reported that 67% of them had received “discretionary funds” from industry within the last year.^7,642 This is likely an underestimate, as the survey was not anonymous. The donations to department chairs and other decision-makers are sometimes called unrestricted educational grants, which is a euphemism for corruption, as the industry doesn’t just give its money away. They are restricted uneducational grants, as their purpose is to buy doctors.⁶⁴³

The three professors’ praise of the drugs continued.^17:650 They wrote that the lack of compliance is worst for psychoses, which leads to lack of recovery, relapse and readmissions, and that the patients must understand that the diseases will have health and social consequences if the treatment is not being followed.

It is the other way around. It is very rational when some patients refuse to take toxic drugs that have no meaningful beneficial effects; that will likely harm them irreversibly; and that might even kill them. But in the psychiatrists’ delusional world, these patients are the problem, not the drugs they use.

One book was different to the others in terms of what it admitted. Right from the start, in the first chapter of the 1,065-page textbook, a psychologist and a psychiatrist noted that it is important to counteract the one-sided reductionism that neuropsychiatry has led to.^17:58 They said that diagnoses do not have much validity and have no direct consequence for the treatment and for the patients; that there is an epidemic of diagnoses, which have a life of their own; and that psychiatry has not been sufficiently cautious about the consequences of the many false positive diagnoses.

They quoted an interesting paper by Jerome Wakefield.⁶⁴⁴ His major point is that the shift to symptom-based, operationalised diagnostic criteria in DSM-III and subsequent editions of the manual missed the context in which the symptoms appear, which has led to colossal overdiagnosis—false positive diagnoses—of psychiatric disorders because the symptoms are often a normal reaction to a stressful situation.

Wakefield noted, with examples, that physicians used context for about 2,500 years to distinguish conditions like depression from normal sadness, but that this was now gone. He mentioned that the DSM-IV criteria for primary insomnia do not consider one of the commonest non-medical reasons for difficulty sleeping, a noisy environment.

Wakefield considered that this problem had urgency because the DSM’s symptom-based criteria are often applied in studies and screening instruments outside the clinical context and by nonprofessionals.

He noted, with examples, that flaws in the diagnostic criteria, which lay people can recognise immediately, remain unaddressed, and that the use of symptom checklists gives a diagnosis to many people who do not self-identify as disordered and are often not disordered. Wakefield mentioned a colleague who was seeing a depressed unemployed person and suggested medication, at which point the patient said indignantly, “I don’t need medication; I need a job.”

Wakefield noted that symptomatic criteria cannot diagnose an underlying dysfunction. For example, adjustment disorder is evaluated in part by whether there is “marked distress that is in excess of what would be expected from exposure to the stressor,” but if “what would be expected” is construed in a statistical sense, then this criterion potentially pathologises the upper range of normal variation.

Wakefield wondered why the psychiatric experts behind the DSM revisions had not looked systematically for counterexamples to the proposed criteria that could lead to false positive diagnoses.

I did exactly that in my two books about psychiatry.^7,8 I mentioned earlier that one of my colleagues, Danish filmmaker Anahi Testa Pedersen, got the erroneous diagnosis schizotypy when she became stressed over a difficult divorce.⁸ She should never have had a psychiatric diagnosis or been treated with drugs.

Since I suspected it was a dubious concept, I looked it up on the Internet and found a test for schizotypal personality disorder.^8:145,645 It is defined in various ways in different sources but the test reflects quite well the criteria on the Mayo Clinic website that notes that the symptoms are those in the DSM.⁶⁴⁶ You should reply true or false, or yes or no, to nine questions.

1. “Incorrect interpretations of events, such as a feeling that something which is actually harmless or inoffensive has a direct personal meaning.” This is a vague question, and many people interpret events incorrectly, particularly psychiatrists, or take them personally.
2. “Odd beliefs or magical thinking that’s inconsistent with cultural norms.” When a psychiatrist disagrees with the “cultural norms” about preventative treatment of schizotypy, as recommended in a textbook,^18:106 is he then abnormal? And what about monstrous overdoses, which is also a “cultural norm” in some places? It seems that those in the staff who protest are normal but would be considered abnormal according to this question.
3. “Unusual perceptions, including illusions.” I have provided evidence in my books including this one that most psychiatrists would need to say yes to this question. Just think about the illusion called the chemical imbalance.
4. “Odd thinking and speech patterns.” Most psychiatrists display odd thinking, about the chemical imbalance and many other issues, and they deny totally what other people see clearly, including their own patients, e.g. that psychiatric drugs do more harm than good.
5. “Suspicious or paranoid thoughts, such as the belief that someone’s out to get you.” If you are detained in a psychiatric department, such a reaction is normal and understandable. The staff is surely out to “get you,” namely to treat you forcefully with psychosis pills against your will. When psychiatric leaders use terms about their critics such as “anti-psychiatry” and “conspiracy,” is it then a “yes” to this question?
6. “Flat emotions, appearing aloof and isolated.” This is what psychiatric drugs do to people. If they were normal to begin with, the psychiatrists will ensure that this won’t last.
7. “Odd, eccentric or peculiar behaviour or appearance.” One definition of madness is doing the same thing again and again expecting a different result, which is what psychiatrists do all the time with their drugs. I would call that an odd, eccentric, and peculiar behaviour.
8. “Lack of close friends or confidants other than relatives.” This is what psychiatric drugs do to people, particularly psychosis pills; isolate people and make zombies out of them.
9. “Excessive social anxiety that doesn’t diminish with familiarity.” If you are detained in a psychiatric department, such a reaction is normal and understandable.

Many, perhaps even most, psychiatrists would test positive. What is less amusing is that the test provides circular evidence because patients who are normal might test positive after they have been treated inhumanely by psychiatrists.

When I discuss the state of psychiatry with critical psychiatrists, psychologists and pharmacists I collaborate with, they sometimes ask: “Who are most mad, the psychiatrists or their patients?” An Oxford dictionary defines delusion as “An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument, typically as a symptom of mental disorder.” According to this, the most vocal leading psychiatrists suffer from delusions.

I was once invited to follow the chief psychiatrist’s round at a closed ward.^8:68 We talked with several patients, and one of them appeared normal and reasonable to me, but to my big surprise, the psychiatrist asked me if I could see that he was delusional. As I couldn’t, he explained that the patient was delusional because he had been on the Internet and had found out that psychosis pills are dangerous. I replied that they are indeed dangerous and that there is nothing delusional in believing this. I was so stunned that I said no more. This psychiatrist was not just anybody. He had a high position at the Danish Psychiatric Association.

On another occasion, I phoned a psychiatric department that has a bad reputation because of the patients the psychiatrists have killed there with their drugs, including Luise.²³⁴ A desperate patient in great distress had rung me, but I couldn’t get through to a psychiatrist, even though I was a colleague and it was within normal working hours. I was transferred to a head nurse who told me not to become involved because the patient was delusional. When I asked her in what way, she said he had found out that psychosis pills were dangerous. I asked her if she knew whom she was talking to. Oh yes, she knew about me.

Psychiatry is characterized by such insanity. The psychiatrists’ delusions are not shared by people considered sane, e.g. the general public, but they forcefully maintain them, even when the most reliable science has clearly shown that their beliefs are wrong. When I point this out to them, they have no shame or regrets.

If psychiatry had been a business, with competition, it would have gone bankrupt long ago.

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To see the list of all references cited, click here.