Blog des AK Psychiatriekritik der NFJ Berlin

Monat: Juli, 2012

It’s Not Just the Drugs; Misinformation Used to Push Drugs Can Also Make Mental Problems Worse

by MadinAmerica

I was recently talking with a young man about his anxiety, which he experiences as extreme.  When I asked him what the anxiety was about, he didn’t know.  When I suggested that we become curious about it and explore what it might be about, he told me that it was so extreme, it must be “biochemical.”  This meant to him that the anxiety could not be understood in a psychological way, but had to be dealt with as part of his “illness.”

I acknowledged to him that anxiety certainly involves biochemistry, but suggested that there are also experiences and interpretations of experience that trigger the biochemistry into action.  For example, if he experienced someone pointing a firearm in his direction, he would likely experience an intense biochemical process within his body, but the experience would not be “just biochemical.”

If people are going to understand themselves and work through emotional problems, it is essential that they get curious about their experiences and reflect on what might be triggering them.  Sometimes such curiosity or reflection results in getting valuable messages from those experiences, or at other times, it involves identifying a mistake that triggered the emotional experience, which then allows for resolution.  To use the simple example of the threat perceived from the firearm, one might either take quick action to avoid being shot, or in another situation perhaps observe more carefully and notice a movie is being filmed and that the firearm being pointed is just a prop.

Of course, experiences like anxiety and depression often have their sources in much more complex experiences, and so more complex reflection is necessary to sort out what actions to take or what interpretations to revise.  We live though in a society that does not like complexities or deep reflection, so we already have a bias toward thinking that disturbing emotions that don’t quickly make sense must just be something wrong with us.  This bias makes us think we “shouldn’t have” disturbing emotional states, so we tend to push them away or dissociate from them, which just makes it more difficult for us ever to understand their sources and decide what to do about them.

Those who market psychiatric drugs take advantage of this cultural bias to offer a seductive pseudo explanation, which is that unwanted emotional states that aren’t easily resolved must be the result of a “biochemical imbalance” or some other biological problem.   Our culture has become heavily influenced by this viewpoint, to the point where it seems the majority believe that seriously disturbing emotional states lacking easy explanations must be caused by a fault in biochemistry, rather than being something that can be potentially understood and resolved.

The sad result of this marketing effort has been to dramatically aggravate a cultural tendency to avoid deeply listening to each other, or even to ourselves.  Any mental or emotional problem which does not rapidly resolve must be “biochemical” and not worth even trying to understand; instead we should be trying to drug it away.

While many others have pointed out how this dishonest marketing pushes drugs that often cause damage or make mental health problems worse in the long term, I think it is worth reflecting on how the beliefs promoted by the marketers are themselves damaging to mental health.  In particular, I want to emphasize the way these beliefs aggravate splits within a person, typically splits between more conscious aspects of the person and the less conscious parts that are experienced as disturbing emotions and/or voices.

A certain amount of “division of labor” within a person is actually functional:  we are complex beings with multiple needs that must be attended to.  But when people are traumatized, or when they experience conflicts that exceed their ability to manage them, such divisions often become entrenched and deep and troublesome.  One word that has been used to describe such splits is “dissociation.”  Such splits can be seen as the basic dynamic behind all the common mental and emotional problems, as described in my (free) recorded webinar on Dissociation as a Common Factor in Many “Mental Disorders” Including Psychosis.  (You may also be interested in the paper “Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing” for which voice hearer Eleanor Longden was the lead author, and you may be interested in a new “transdiagnostic” approach to therapy which sees conflicting purposes within a person, and not pathological “symptoms” as the basic mental health problem:  for a great introductory video, see Introduction Vignette – Method of Levels.)

When dissociation is the problem, there is a need to work toward more understanding and integration.  Dialogue (such as in the Open Dialogue method) is needed, both within the person, and between people, to give voice to the various purposes that may need to be integrated.  But the effect of beliefs about a “biochemical imbalance” is to instead aggravate the dissociation.  Rather than wonder what the anxiety or depression is about, for example, the person convinced it is a biochemical imbalance seeks only to get rid of it, to wall it off even more, without attempting to understand its source within.

When people are convinced their problems are biochemical, they are also less likely to explore the problem with others or with a therapist.  And when a therapist is convinced that his or her client’s problem is “biochemical” then that therapist is likely to focus on sending the client in for a “medication check” rather than looking deeper into what may be going on.  (“Biochemcal imbalance” theories are also great for explaining away any failures of understanding on the part of therapists!)

The end result is that marketing misinformation may itself be hugely iatrogenic, and be one of the primary causes, along with negative long term effects of drugs, of the worsening of mental health outcomes.

This issue is one I hope to address in a seminar Pam Birrell and I will be teaching called “When Treatment Might Cause Harm: Exploring Ethical Dilemmas related to Diagnosis, Drugs, and other Possibly Iatrogenic Aspects of Mental Health Care.”   We will be presenting in Eugene OR and Portland OR in early September, but we hope to present it later in other locations, and also as a webinar, so that mental health professionals can earn their CEUs in ethics while also learning how to minimize iatrogenic harm, including harm that results from the unfortunate effects of believing drug marketing propaganda.

I encourage all of you who might be interested in taking this course at some point, perhaps as a webinar, to get on my email list.  Also, I hope some of you consider yourselves teaching a course like this in your own locality:  we need to spread the word widely about the importance of these considerations if we are ever going to create that necessary revolution in mental health care!  I will be happy to help you do that if I can.

J&J Appeals $1.2 Billion Arkansas Risperdal Ruling

by Bloomberg

Johnson & Johnson (JNJ) appealed an Arkansas judge’s decision to fine the drugmaker $1.2 billion over what state officials said was a misleading marketing campaign for the company’s antipsychotic drug Risperdal.

Lawyers for J&J, the world’s biggest health-products maker, asked the Arkansas Supreme Court today to throw out a ruling by Judge Tim Fox that the company misled doctors and patients about Risperdal’s risks and should pay fines for almost 240,000 violations of the state’s Medicaid laws, according to court filings.

Johnson & Johnson and its Janssen unit are seeking to have Arkansas’ highest court consider laws that prohibit “imposition of excessive fines,” the company’s attorneys said in the filing. Photographer: Daniel Acker/Bloomberg

J&J and its Janssen unit are seeking to have the state’s highest court consider laws that prohibit “imposition of excessive fines,” the company’s attorneys said in the filing.

The penalty is the largest of the three handed down so far against New Brunswick, New Jersey-based J&J in state cases alleging the company hid Risperdal’s risks and tricked Medicaid regulators into paying more than they should have for the medicine.

“We anticipated that the defendants would appeal this decision, but are confident that the verdict of an Arkansas jury will be upheld,” Aaron Sadler, a spokesman for Arkansas Attorney General Dustin McDaniel, said in an e-mailed statement.

Risperdal’s global sales peaked at $4.5 billion in 2007 and declined after the company lost patent protection. The drug generated $3.4 billion in sales in 2008, or 5.4 percent of J&J’s revenue, according to company filings. Sales of the drug fell to $527 million in 2010, according to earnings reports.

Risperdal Probe

Along with contending that J&J and Janssen defrauded the Medicaid program by failing to properly outline the medicine’s risks, Arkansas officials alleged J&J officials deceptively marketed the drug as safer and better than competing medicines.

The state’s lawyers also argued that J&J marketed the drug for “unapproved uses, including various symptoms in children and the elderly” after being warned by federal authorities to halt such sales.

The U.S. has been investigating Risperdal sales practices since 2004, including allegations that the company marketed the drug for unapproved uses, J&J executives said in a U.S. Securities and Exchange Commission filing last year.

The U.S. Justice Department is demanding that J&J pay $2.2 billion to resolve civil and criminal claims over Risperdal marketing pressed by federal regulators and some state attorneys general, people familiar with the settlement talks said in June.

Litigation History

J&J and Janssen face suits from at least seven other states seeking reimbursement for Medicaid or other public funds paid for Risperdal prescriptions.

In June 2010, a judge threw out Pennsylvania’s suit over the Risperdal marketing campaign in the middle of a trial. An appeals court is considering whether to reinstate the case.

Four months later, jurors in Louisiana ordered the drugmaker to pay almost $258 million to state officials for making misleading claims about the drug’s safety. J&J has appealed.

In June 2011 a South Carolina judge ordered J&J to pay $327 million in penalties for deceptively marketing the medicine. The company has appealed that ruling. J&J ended the most-recent trial in Texas with a $158 million settlement in January.

America – the antidepressant nation?

DSM-V To Rename Gender Identity Disorder ‚Gender Dysphoria‘


The newest edition of the psychiatric diagnostic manual will do away with labeling transgender people as „disordered.“

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, will replace the diagnostic term “Gender Identity Disorder” with the term “Gender Dysphoria,” according to the Associated Press.

For years advocates have lobbied the American Psychiatric Association to change or remove categories labeling transgender people in a psychiatric manual, arguing that terms like “Gender Identity Disorder” characterize all trans people as mentally ill. Based on the standards to be set by the DSM-V, individuals will be diagnosed with Gender Dysphoria for displaying “a marked incongruence between one’s experienced/expressed gender and assigned gender.”

“All psychiatric diagnoses occur within a cultural context,” said Jack Drescher, a member of the APA subcommittee working on the revision. “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”

Homosexuality was diagnosed in the DSM as an illness until 1973, and conditions pertaining to homosexuality were not entirely removed until 1987. According to Dana Beyer, who helped the Washington Psychiatric Society make recommendations on matters of gender and sexuality, the new term implies a temporary mental state rather than an all-encompassing disorder, a change that helps remove the stigma transgender people face by being labeled “disordered.”

“A right-winger can’t go out and say all trans people are mentally ill because if you are not dysphoric, that can’t be diagnosed from afar,” Beyer told the AP. “It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes.”

From a legal perspective, the classification of Gender Identity Disorder is extremely harmful to some trans people, but surprisingly beneficial to others.

In one legal case, says San Francisco psychiatrist Dan Karasic, a trans woman from Utah risks losing the children she fathered before her transition. Because she is trans, a lawyer has argued that her GID is a “severe, chronic mental illness that might be harmful to the child.”

But in other cases, a GID diagnosis justifies insurance coverage for gender reassignment surgery and other medical procedures that sometimes accompany a transition. Having a diagnosis is the difference between a necessary medical procedure and something that can be perceived as cosmetic surgery that insurance won’t cover, Drescher says.

Others argue that GID should stay in the DSM in some form because it provides a solid legal defense for transgender people who have experienced discrimination based on their gender identity.

“Having a diagnosis is extremely useful in legal advocacy,” said Shannon Minter, legal director of the National Center for Lesbian Rights. “We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice … that this is a very deep-seated condition recognized by the medical community.”

Mental health professionals who work with trans clients are also pushing for a revised list of symptoms, so that a diagnosis will not apply to people whose distress comes from external prejudice, adults who have transitioned, or children who simply do not meet gender stereotypes.

Peter Breggin, MD: Do You Have a Biochemical Imbalance? Simple Truths About Psychiatry

Trailblazing psychiatrist Peter R. Breggin, MD in his first of the series: Simple Truths About Psychiatry: Do You Have A Biochemical Imbalance? Dr. Breggin debunks the myth of biochemical imbalance and examines what is known about „mental illness.“