NEWS: Scientists Clash About Mental Illness - Debate With American Psychiatric Association Continues.

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NEWS: Mind Your Freedom - 15 Dec. 2003

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Scientists Clash About " Mental Illness " :

Hunger Strike Leads to Ongoing Debate

with American Psychiatric Association.

Read the Latest Scientific Panel Reply to the

American Psychiatric Association BELOW.

It began as a hunger strike this summer when

about two dozen people refused to eat until

they had some answers from the American

Psychiatric Association about human rights.

The hunger strike won national media

including in the _Washington Post_ and

_LA Times Magazine_. It ended months ago.

But the strike led to an ongoing ping pong match

back and forth between the scientific panel

for the Fast for Freedom in Mental Health

and the American Psychiatric Association.

Today, the latest reply by the scientific panel

for the hunger strike has been sent to the

American Psychiatric Association saying,

" The hunger strikers asked the APA for the

'evidence base' that justifies the

biomedical model's stranglehold on the

mental health system. The APA has not

supplied any such evidence...

" We urge members of the public, journalists,

advocates, and officials reading this

exchange to ask for straightforward answers

to our questions from the APA. "

Civil e-mail questions & comments to the

APA medical director Dr. H. Scully

may be sent to MedicalDirector@....

In a sharp rebuke to the APA, the hunger strike

scientific panel concludes, " We also ask Congress

to investigate the mass deception that the 'diagnosis

and treatment of mental disorders,' as promoted by bodies

such as the APA and its powerful allies, represents

in America today. "

You may read the complete ongoing five-part

debate, including today's new response, here:

http://www.mindfreedom.org/mindfreedom/hungerstrike1.shtml

You may view the background media coverage of

the hunger strike, including photographs and

an ongoing open message board, here:

http://www.mindfreedom.org/mindfreedom/hungerstrike.shtml

BELOW is the text from today's letter by the

scientific panel, which is composed of

respected and experienced psychiatrists,

psychologists, researchers and clinicians.

At the BOTTOM is more information and

how to join. Please FORWARD this news release.

~~~~~~~

15 December 2003

FROM:

MindFreedom

Support Coalition International

454 Willamette, Suite 216

PO Box 11284

Eugene, OR 97440 USA

Phone: (541) 345-9106 Fax: (541) 345-3737

E-mail: office@...

http://www.MindFreedom.org

TO:

H. Scully, Jr., M.D., Medical Director

American Psychiatric Association

1000 Boulevard, Suite 1825

Arlington, VA 22209-3901 USA

e-mail: MedicalDirector@...

Re: American Psychiatric Association

Statement on Diagnosis and Treatment of

Mental Disorders, 25 September 2003, Release 03-39.

Dear Dr. Scully:

We believe that the above-mentioned APA

Statement was released in response to the

questions posed last summer to the American

Psychiatric Association, the National

Alliance for the Mentally Ill, and the

Surgeon General of the United States by the

Fast for Freedom in Mental Health based in

Pasadena, California.

The scientific panel convened by the hunger

strikers has written the present letter to

respond to this APA Statement. We have

paired the contents of the 11-paragraph APA

Statement to the strikers' original

questions and also added our own comments

about some issues the APA Statement raises.

The Fast for Freedom in Mental Health wrote

on 28 July 2003:

" WE ASK THAT YOU PRODUCE

scientifically-valid evidence for the

following, or that you publicly admit to

media, government officials and the general

public that you are unable to do so:

" 1. EVIDENCE THAT CLEARLY ESTABLISHES the

validity of 'schizophrenia,' 'depression' or

other 'major mental illnesses' as

biologically-based brain diseases.

" 2. EVIDENCE FOR A PHYSICAL DIAGNOSTIC EXAM

-- such as a scan or test of the brain,

blood, urine, genes, etc. -- that can

reliably distinguish individuals with these

diagnoses (prior to treatment with

psychiatric drugs), from individuals without

these diagnoses. "

The APA Statement's fourth paragraph states:

" Research has shown that neurobiological

disorders like schizophrenia reveal

reproducible abnormalities of brain

structure... " Without any citations, these

statements cannot be supported, qualified,

or rejected.

However, in the fifth, sixth, and eighth

paragraphs, the APA Statement admits to the

absence of " discernible pathological lesions

or genetic abnormalities " in mental

disorders. This admission contradicts the

previous assertion of " reproducible

abnormalities. "

Without evidence of brain pathology no basis

exists to call emotional distress, disturbing

behavior, or unusual thoughts or perceptions

" neurobiological disorders. " This and

similar terms negate the sufferer's distress

as reaction, protest, or adaptation to

his/her position in the personally relevant

social context. A person is understood in

terms of personal history and social

circumstances. A neurobiological disorder is

understood differently. The choice of labels

is of great consequence.

Moreover, finding reliable biological

markers would be only a first step toward

concluding that mental disorders are

essentially neurobiological. For example,

blushing, an obviously physical reaction, is

not biologically caused. Its effective cause

is acute embarrassment. Biological processes

make blushing possible but they do not cause

blushing.

Even total congruence between biological

processes and psychological events does not

show that the former cause the latter.

Psychiatric research is far from showing any

reliable connections between mental disorders

and biological measurements, much less

revealing anything definitive about the

nature of mental disorders.

Aware of this shortcoming, the APA cites

migraine headache and hypertension to

illustrate that the lack of biological

markers (and thus of physical diagnostic

tests) is not unique to mental and

behavioral disorders. It is true that

medicine has yet to find the biological

cause for these two disorders, though it has

developed a very reliable physical

measurement for blood pressure.

However, in other branches of medicine such

disorders are exceptions. In psychiatry they

are the norm. Psychiatry is the sole medical

specialty that treats only disorders with no

biological markers.

Moreover, hypertension is regarded as a

symptom of physical disease because

hypertension can degenerate into frank

physical disease, even death. No such

parallel exists in psychiatry. For example,

people diagnosed with schizophrenia or major

depressive disorder often are physically

healthy: unless their social circumstances

and neglect interfere negatively, they may

live long lives and die of the same physical

causes as other people.

The APA confirms in paragraph six that, in

the absence of biological markers, mental

disorders are defined by " a variety of

concepts " : " distress experienced and

reported, " " level of disability, " " patterns

of behavior, " and " statistical deviation

from population-based norms. " Precisely. The

APA should therefore explain how such

sociological concepts -- which easily define

conditions such as poverty, discrimination,

or war -- substantiate the existence of

" neurobiological disorders. "

Although it acknowledges the absence of

genetic abnormalities, the APA still claims

that " compelling evidence exists for a

strong genetic " component " for schizophrenia

and other conditions. This statement might

mislead people who have not read the

research into thinking that physical

evidence for a genetic condition has been

discovered. In fact, this research only

involves counting cases of schizophrenia

(diagnosed according to behavioral criteria

and clinical judgment) and testing the

probability that such cases would occur in

certain samples.

The twin and adoption studies of this nature

that the APA usually cites are plagued by

untenable theoretical assumptions (e.g.,

that identical and fraternal twins grow up

in identical environments) and serious

methodological problems (e.g., expanding the

diagnosis of schizophrenia to include

conditions no one thinks are schizophrenia).

Any results that remain after accounting for

these manipulations can be fully explained

on non- genetic grounds (ph, 2003;

Lewontin, Rose, and Kamin, 1984; Pam, 1995).

The Fast for Freedom in Mental Health also

requested:

" 3. EVIDENCE FOR A BASELINE STANDARD of a

neurochemically-balanced 'normal'

personality, against which a neurochemical

'imbalance' can be measured and corrected by

pharmaceutical means.

These issues were not addressed in the APA

Statement.

The APA Statement could have replied

accurately that neuroscientists have not

established any normal baseline quantity for

any known neurotransmitter (no measurements

even remotely parallel to blood pressure to

diagnose hypertension exist), nor have they

shown any chemical imbalance to correlate

with mental disorders diagnosed in un-

medicated individuals (Breggin, 1991; Healy,

1997; Valenstein, 1998).

The Fast for Freedom in Mental Health also

requested:

" 4. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can

correct a 'chemical imbalance' attributed to

a psychiatric diagnosis, and is anything more

than a non-specific alterer of brain

physiology. "

The APA Statement merely states what has

been known for at least 50 years, that

" medications clearly exert influence on

specific neurotransmitters... " This response

states the obvious: all mind and mood

altering drugs have effects on the brain.

This includes illegal mind and mood altering

drugs, though no one has suggested that they

correct chemical imbalances in the brain.

Given the Food and Drug Administration's

impotent exercise of its mandate to protect

consumers from false advertising,

pharmaceutical companies recklessly

advertise cartoons showing neurotransmitter

" imbalances " corrected by drugs. However, in

the absence of scientific proof to

substantiate such claims, it is ethically

and medically reprehensible for doctors to

convey such messages to justify prescribing

drugs, and for the APA's own journals to

publish such advertisements.

And finally, the Fast for Freedom in Mental

Health also requested:

" 5. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can

reliably decrease the likelihood of violence

or suicide. "

Not addressed in the APA statement.

" 6. EVIDENCE THAT PSYCHOTROPIC DRUGS do not

in fact increase the overall likelihood of

violence or suicide. "

Not addressed in the APA statement.

" 7. FINALLY, that you reveal publicly

evidence published in mainstream medical

journals, but unreported in mainstream

media, that links use of some psychiatric

drugs to structural brain changes. "

Not addressed in the APA statement.

Despite its use of terms such as " compelling

evidence " and " research shows, " the APA

Statement provides no citations to any

scientific literature. This was also the

case in the first letter that Dr. Scully

addressed to the scientific panel on 12

August 2003.

Associations devoted to research and

treatment of genuine diseases readily

provide consumers with scientific references

on the pathological basis of these diseases.

The APA is a 35,000-member organization,

with an annual budget exceeding $38 million.

With a handful of allies, it shapes mental

health practice and policy in this country

and has convinced taxpayers to spend

billions to support its claim that

psychiatrists treat " neurobiological

disorders. "

The APA should be able to provide a one-page

list of published scientific studies to

support this claim. Yet, the APA only

speculates on future findings: " Mental

disorders will likely be proven to represent

disorders of intercellular communication; or

of disrupted neural circuitry. " (This

sentence is yet another de facto

acknowledgement that neuropathology cannot

be shown in mental disorders.)

The APA uses terms like " complex, " " emergent

properties, " and " subtle " when describing

people's overwhelming mental and emotional

crises. It states: " the human brain is the

most complex ... object of study in the

history of human science. " Yet this language

about complexity is completely at odds with

the biological model that reduces the human

mind to a machine. Since the discovery of

the infectious cause of neurosyphilis nearly

a century ago, this model has failed to

explain the cause of a single mental

disorder. Yet this model dominates the

mental health system.

Aware of this utter failure to find causes,

the APA claims that money spent by the

public and private sector " has greatly

improved our ability to treat severe,

frequently disabling mental and behavioral

disorders effectively. " However, relevant

indicators show the exact opposite.

For schizophrenia, worsened relapse rates

and increased numbers of people on

disability status characterize outcomes over

the last 50 years (Hegarty, Baldessarini,

Tohen, Waternaux, and Oepen, 1994; Whitaker,

2002). For depression, increased incidence

and prevalence are reported. Indeed, the APA

Statement cites that mental disorders " rank

second in societal burden, behind only

cardiovascular conditions " in modern

societies.

Perhaps the treatment is worsening the

disorder. At best, the treatment is not

helping: researchers now recognize that the

most popular psychiatric drugs, the SSRI

antidepressants, rate only slightly better

than inert placebos (Kirsch, Scoboria, and

, 2002; Kirsch, , Scoboria, and

Nicholls, 2002). In addition, negative

research findings (sponsored by industry)

are commonly suppressed, and adverse drug

effects are massively under-reported in

psychiatric journals and to the Food and

Drug Administration. These dubious but

tolerated practices create an enormously

misleading view of the actual impact of drug

treatments.

Rather than acknowledge the lack of progress

despite the huge expenditure of public and

private funds, the APA dismisses its critics

as denying the reality of suffering and

impatient with the " pace of science. " A

genuine science states hypotheses in ways

that allow them to be proven true or false.

For a century now psychiatry has put forth

hypothesis after hypothesis that is not

falsifiable.

Today, despite no biological causes, no

discernible biological markers or

abnormalities, no diagnostic tests, no

accurate predictions of treatment response

and outcome, the APA still continues to

claim that emotional disorders are genuine

neurobiological disorders ... with causes

too subtle to detect at present! This is

hardly an advance over earlier unfalsifiable

ideas such as the Oedipal complex.

In sum, the APA's statements reflect less

the " pace of science " than the pace of

commerce: they blur with the pharmaceutical

advertising themes saturating our media.

This is because the APA is not an

independent organization. One third of its

operating budget comes from the drug

industry. Drug companies dominate its

professional meetings to advertise drugs. In

addition, the drug industry funds, directs,

and analyzes many drug studies (Healy,

2003), and psychiatric journals publish

so-called scientific reports of these drug

studies that are ghost-written by industry

employees or marketing firms. Psychiatric

drug experts with no significant ties to

industry can hardly be found. Industry

largesse binds many psychiatric

practitioners to the industry (Editorial,

2002).

The hunger strikers asked the APA for the

" evidence base " that justifies the

biomedical model's stranglehold on the

mental health system. The APA has not

supplied any such evidence, which compels

the scientific panel to ask one final

question: on what basis does society justify

the authority granted psychiatrists, as

medical doctors, to force psychoactive drugs

or electroconvulsive treatment upon unwilling

individuals, or to incarcerate persons who

may or may not have committed criminal acts?

For, clearly, it is solely on the basis of

trust in the claim that their professional

acts and advice are founded on medical

science that society grants psychiatrists

such extraordinary authority.

We urge members of the public, journalists,

advocates, and officials reading this

exchange to ask for straightforward answers

to our questions from the APA. We also ask

Congress to investigate the mass deception

that the " diagnosis and treatment of mental

disorders, " as promoted by bodies such as

the APA and its powerful allies, represents

in America today.

Signed:

Scientific Panel for the Fast for Freedom in

Mental Health

Fred Baughman, MD; Boyle, PhD;

Breggin, MD; Cohen, PhD; Ty Colbert,

PhD; Pat Deegan, PhD; Al Galves, PhD;

Greening, PhD; s, PhD; Jay ph,

PsyD; Leo, PhD; Bruce Levine, PhD;

Loren Mosher, MD; Stuart Shipko, MD.

The hunger strikers endorse the scientific

panel's statement. The Fast for Freedom in

Mental Health is a project of MindFreedom

Support Coalition International.

http://www.MindFreedom.org

References:

Breggin, P. (1991). Toxic psychiatry. New

York: St. 's Press.

Editorial. (2002). Just how tainted has

medicine become? Lancet, 359, 1167.

Healy, D. (1997). The antidepressant era.

Cambridge: Harvard University Press.

Healy, D. (2003). Let them eat Prozac.

Toronto: Lorimer & Company.

Hegarty, J., Baldessarini, R., Tohen, M.,

Waternaux, C., and Oepen, G. (1994). One

hundred years of schizophrenia: A

meta-analysis of the outcome literature.

American Journal of Psychiatry, 151,

1409-1416.

ph, J. (2003). The gene illusion:

Genetic research in psychiatry and

psychology under the microscope.

Ross-on-Wye: PCCS Books.

Kirsch, I., , T. J., Scoboria, A., and

Nicholls, S. S. (2002a). The emperor's new

drugs: An analysis of antidepressant

medication data submitted to the US Food and

Drug Administration. Prevention and

Treatment. Available:

http://journals.apa.org/prevention/volume5/pre0050023a.html

Kirsch, I., Scoboria, A., and , T. J.

(2002b). Antidepressants and placebos:

Secrets, revelations, and unanswered

questions. Prevention and Treatment.

Available:

http://journals.apa.org/prevention/volume5/pre0050033r.html.

Lewontin, R. C., Rose, S., and Kamin, L. J.

(1984). Not in our genes. New York: Pantheon.

Pam, A. (1995). Biological psychiatry. In A.

Pam and C. Ross (Eds.), Pseudoscience in

biological psychiatry: Blaming the body (pp.

7-84). New York: Wiley and Sons.

Valenstein, E. (1998). Blaming the brain:

The truth about drugs and mental health. New

York: The Free Press.

Whitaker, R. (2002). Mad in America: Bad

science, bad medicine and the enduring

mistreatment of the mentally ill. Cambridge:

Perseus Publishing.

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