In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog. What’s remarkable about this blog is that it is highly critical of psychiatry. Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline.
The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes.
So far, she has written six posts. The central theme of three of these posts is antipsychotic (or as I prefer to say, neuroleptic) drugs.
Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics (Dec 20) Quote:
“It seems not to be interested in discussing the serious harm its drugs can do to both physical and mental health, and in taking the steps necessary to minimise this harm. The profession appears to believe that if it keeps quiet about these inconvenient findings, and discusses them as little as possible, the fuss will blow over and nothing need change.”
Antipsychotics and brain shrinkage: an update (Dec 13) Quote:
“People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labelled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes. This does not mean that taking antipsychotics is not sometimes useful and worthwhile, despite these effects, but it does mean we have to be very cautious indeed about using them.”
Long-term Antipsychotics – making sense of the evidence (Dec 9) Quote:
“This study [Wunderink et al] should fundamentally change the way antipsychotics are used. These are not innocuous drugs, and people should be given the opportunity to see if they can manage without them, both during an acute psychotic episode and after recovery from one. If psychiatrists had not forgotten the lessons of the past, and if they had been prepared to acknowledge what they saw the drugs doing with their own eyes, this would have come about long ago.”
Whilst all of Dr. Moncrieff’s writing is compelling, it was this last quote that particularly caught my attention, and caused me to articulate the following questions:
- Why have psychiatrists not acknowledged what they saw the drugs doing with their own eyes?
- How did it come to be that highly educated and intelligent people became so enamored of their professional dogma that they failed to recognize the damage that neuroleptic drugs were doing and continue to do?
- And, with particular reference to the last decade or so, how have they been able to participate, apparently with clear consciences, in the huge increase in the use of these products, even to children as young as 2 years?
In my view the answers to these questions fall into two general categories: self-interest and fear.
For the past fifty or sixty years, the prescribing of psychopharmaceutical products has brought considerable benefit to the psychiatric profession. Firstly, it has provided them a good living ($190,000 per annum in the US) for relatively non-taxing work (15- minute med checks). Secondly, it has boosted their perceived status in the eyes of other medical practitioners.
It’s largely forgotten now, but during the 60’s and even into the 70’s, psychiatrists were widely regarded by the medical community as a coterie of quacks who delved endlessly and pointlessly into such chimerical abstractions as unconscious impulses, Oedipus complexes, ids, etc… Today psychiatrists prescribe drugs, have their own medical journals which often have pictures of brain scans, and conduct randomized controlled trials. They’ve become “respectable,” or at least somewhat respectable, and they recognize that this respectability is intrinsically dependent on their symbiotic relationship with pharma.
The kind of fear that I’m talking about here might more correctly be termed peer pressure – the fear of being ostracized or marginalized by one’s professional colleagues. In my interactions with psychiatrists during my career, I gained the impression that in medical colleges there’s relatively little emphasis placed on discussion and opinions, and relatively high emphasis on absorbing the facts as passed down by the academics. Other disciplines stress discourse and debate, especially at doctoral level, but medicine leans towards a traditional didactic model and conformity to orthodoxy. I’m not saying that this is necessarily a bad thing. Four years of medical school passes quickly, and there’s a lot of factual material to be learned. But the inevitable result is that medical practitioners tend to be followers of orthodoxy rather than innovators. The rationale is that the academic researchers will pursue the innovations, and the toilers in the field will follow protocol.
In and of itself this isn’t a bad model. Similar dynamics occur in engineering. But – and this is crucial – for the past 40 years or so academic psychiatry has been hijacked by pharma! The only innovation that’s allowed to occur is: more drugs for more people.
In this kind of context it’s almost impossible for a junior psychiatrist in a hospital or a mental health center to challenge the standard philosophy. And as the years pass, it becomes even more difficult, because any challenge of this sort inevitably involves a critical review of one’s own career.
It’s almost as if there’s a macabre conspiracy of silence among psychiatrists concerning the spuriousness of their concepts and the damage they inflict on their clients. In their “hearts” they all know that it’s there, and that it’s enormous, but no one is allowed to talk about it. No one is allowed to wake the monster, because they intuitively know that the monster will devour them all.