Fighting the Myth of Mental Illness ... Next Round

Below is an item from a recent issue of the Canadian Journal of Psychiatry. I've edited this slightly for clarity. A PDF file is available here. The author Dr. Joanna Moncrieff is arguing against the usual position of the shrinks although it surprises me that this debate even made it into any medical journal. Her straight forward response targets previous contributors in what appears to be an ongoing debate in the pages of CJP. Obviously things are changing. Reminds me of that time, about five years ago, when I sent a email to the author of the Quackbusters website ... another psychiatrist who seems to think "skepticism" only applies to more obvious nuts like chiropractors ... and asked him what was the scientific basis for that "other" scam Attention Deficit Hyperactivity Disorder or ADHD. I also pointed out that claiming everyone who opposes psychiatry is working for the Scientologists wasn't going to wash. I actually received a reply, believe it or not. In his attempt to excuse frying the brains of kids with Methylphenidate a Schedule II stimulant which is structurally and pharmacologically similar to the amphetamines. (Approximately 85 to 90 percent of all prescriptions for methylphenidate are written for young children and adolescents for the treatment of ADHD. Methylphenidate is available as the brand name product, Ritalin, manufactured by Ciba-Geigy, and as generic products manufactured by MD Pharmaceuticals) the good doctor said " It (ADHD) was a good place to start". Start? Holy shit, so where does it end? Also click the title link for an interesting take on the debilitating influence of money on otherwise educated people.

Rebuttal: Depression Is Not a Brain Disease
Joanna Moncrieff, MBBS, MRCPysch, MSc, MD1
(Can J Psychiatry 2007; 52:100–101)

Psychiatrists have been trying to construct a biological theory of depression for decades. Numerous candidates have been proposed, from noradrenalin and serotonin abnormalities to cortisol excess, hippocampal insufficiency, and neurotrophic factor. In all cases, results are inconsistent, and where abnormalities are found, they have not been shown to be specific or causal. For example, contrary to Dr Ravindran and Dr Kennedy’s suggestions, the evidence on hippocampal volume is weak. Numerous studies show no difference between subjects with depression and control subjects, and I could not find studies supporting their assertion that duration of untreated illness correlates with volume reduction. In contrast, studies show that duration of treated illness predicts volume reduction.This raises the possibility that drug treatments for depression reduce brain volume in the same fashion as antipsychotics have been shown to do in patients with psychosis. In addition, loss of hippocampal volume is also found in first-episode psychosis and post traumatic stress disorder (shagnote: what used to be called 'shell shock' in more honest times) and was recently shown in women diagnosed with dissociative identity disorder. (The DSM, Diagnostic and Statistical manual of Mental Disorders, grows bigger every year. There is even a " refusal to obey authority" and a " refusal to realize that your sick" syndrome now. Scary stuff.) Abnormalities sometimes found in depression are also not specific. For example, acute psychosis is also associated with increased hypothalamo–pituitary–adrenal axis function. Even if biochemical or structural abnormalities were found to be associated with depression, this would not imply that they were causal. If I experience an adverse event, I will feel sad, and if this emotion is strong enough, there are likely to be associated biochemical changes—but it is the event that has made me sad, not the chemical fluctuations. They are best viewed as an accompaniment, or a biological correlation, of the emotional state. In my first piece, I concentrated on placebo-controlled studies because it is difficult to show any real-world benefits from the use of antidepressants. In fact, their increased use is associated with increasing prevalence and duration of depressive episodes. The naturalistic Sequenced Treatment Alternatives to Relieve Depression trial found remission rates that are unimpressive in a naturally remitting condition, although the fact that this study did not include a placebo group means this valuable opportunity to evaluate the effectiveness of antidepressants was wasted. The study on absence due to sickness quoted by Ravindran and Kennedy actually found that individuals treated with antidepressants were less likely to return to work than those who were not treated with them.

Here are some sources for people fighting psychiatric bullying. The Coalition Against Psychiatric Assault has a page of links which I found, in turn, over at the Ontario Coalition Against Poverty (OCAP) site. Both references have been included in Shag's sidebar. These sites contain many links helping in the battle against psychiatry and in defence of the poor. Also see my posting derived from New Scientist on the roots of moral consciousness.