Dubious Drug Therapy – Keith Koeller / Bread and Shelter, Yes. Psychiatrists, No – Sally Satel

Dubious Drug Therapy – Keith Koeller / Bread and Shelter, Yes. Psychiatrists, No – Sally Satel

Wed, 30 Mar 2005

Two OpEd columns deserve special attention because they provide insight and evidence of the harm done by current psychiatric / psychological practices. Sally Satel, MD is a psychiatrist and resident scholar at the (conservative) American Enterprise Institute, and a co-author of a new book, “One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance.” In her OpEd in the New York Times, Dr. Satel gives psychological debriefing therapy–whose practitioners descended upon the survivors of Columbine and 9/11 like a pack of scavengers–the a final kick into oblivion (we hope).

In his OpEd (appearing in The Washington Times and the San Francisco Chronicle), Keith Hoeler, the editor of the Review of Existential Psychology & Psychiatry reminds readers that Jeffe Weise is not the first troubled teenager who was prescribed an SSRI antidepressant–in his case, Prozac at high dose–who went on a school shooting rampage. In fact there have been at least 8 such incidents linked to these drugs.

If there had been no scientific evidence that the drugs pose a very serious risk of violent and suicidal behavior, then the attribution of a causal link between such violent rampages to the drugs would fall into the category of an “ecological fallacy.”

But scientific evidence does exist linking SSRI drugs to violent acts– Indeed, after years of denial, when the unpublished evidence from company controlled clinical trials was laid out for independent analyses, the FDA was convinced that Black Box warnings about the hazards posed by these drugs especially for adolescents, was necessary.

Those who argue that the FDA warnings refer to suicidal behavior only, are disingenous. First, because suicide is self-inflicted violence. Second, the FDA approved antidepressant drug label (since March 2004) warns not only about suicidal symptoms, but about “the emergence of anxiety, agitation, panic attacks, irritability, hostility (aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania, and mania.” The FDA warning further indicates that “pediatric patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality.” See: http://www.fda.gov/cder/drug/antidepressants/default.htm

What, if not drug-induced violence is described by such terms as: “the emergence of anxiety, agitation, panic attacks, irritability, hostility (aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania, and mania…” ?

Health Canada requires SSRI drug manufacturers to issue explicit warnings about violence: “There are clinical trial and post-marketing reports with SSRIs and other newer anti-depressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others.” See: http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/prozac_e.html

Whose interests are served by FDA’s obfuscating language?
Hint: Follow the money.

Contact: Vera Hassner Sharav
212-595-8974

The Washington Times
Dubious drug therapy
By Keith Hoeller
Published March 29, 2005

Another teenager has shot and murdered schoolchildren and mental health movement proponents have offered us the standard explanation and the usual solution. This child was mentally ill, we are told, and if only someone had seen the symptoms and notified mental health authorities, the child would have been accurately diagnosed, given the proper medication, and this tragedy could have been prevented.

If only the child had been placed on antidepressant medications, psychiatrists say, this murder/suicide would never have happened. The story is usually followed by calls for more mental health screening and treatment of schoolchildren.

However, in most cases of school shootings, the signs had been noticed, the child had been reported to mental health authorities, he had received a psychiatric diagnosis, he been put on psychiatric medications and was taking the medications when he pulled the trigger.

Eric Harris of Columbine was on the antidepressant Luvox and Kip Kinkel in Oregon was on Prozac. And the same was true in perhaps a dozen cases in all. And this may be the tip of the iceberg, since this information is often kept confidential and out of the papers, even when a murder occurs.

Now news reports indicate Jeff Weise, the murderer of 10 in Red Lake, Minn., had been suicidal and committed to a mental hospital. He began taking an antidepressant last summer, and his dosage had been increased a week before the shootings.

In 2003, Britain banned giving antidepressants to children and adolescents, and last year Health Canada issued a stern warning about these drugs: “There are clinical trial and post-marketing reports with SSRIs and other newer anti-depressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others.”

This year the Food and Drug Administration has mandated a black box on antidepressants labels, warning of the potential for increasing suicidal thoughts and behavior in children and adolescents. Yet, as Vera Sharav of the Alliance for Human Research Protection, has said:

“Journalists continue to be beguiled by speculative scientific hypotheticals which psychiatrists discuss as though they have been proven. Misinformation is transmitted to the public about unproven ‘chemical imbalances’ in the brain of depressed people — when, in fact, no evidence exists demonstrating any chemical or structural brain abnormality in people diagnosed with a mental illness.”

Indeed, the papers are full of quotes of psychiatrists claiming depression is a serious medical disease caused by a serotonin imbalance in the brain. But there is no conclusive scientific in support of this theory. Not surprisingly, psychiatrists have never developed any physical test to detect depression or any mental illness, and all diagnosis is done based solely on symptoms. In other words, antidepressants and all other psychiatric medications are medically unnecessary.

Yet whenever anyone criticizes the drugs, psychiatrists shout about the increased risk of suicide if patients stop taking their antidepressants, though no antidepressant has ever been tested on suicidal patients and therefore never approved by the FDA as safe and effective in preventing suicide.

President Bush included an unprecedented call for mandatory mental health screening of schoolchildren in his recently passed budget bill. Violating the rights of parents to just say no to psychiatric diagnosis and treatment of their children, this idea originated in the President’s New Freedom Commission.

With 8 million children on psychiatric drugs, all signs indicate this method of dealing with our children is not working.

It is time both parents and schools find a different way to deal with troubled children. To paraphrase Shakespeare’s “Julius Caesar,” the fault is not in our children’s brains or genes, but in ourselves, and it is to our own treatment of children we must look to find an answer to their problems — and ours.

Keith Hoeller is editor of the Review of Existential Psychology & Psychiatry, Seattle, Wash.

The NEW YORK TIMES
March 29, 2005
ESSAY
Bread and Shelter, Yes. Psychiatrists, No.
By SALLY SATEL, M.D.

Days after the tsunami struck South Asia, American mental health workers flew to Sri Lanka to offer counseling services to grief-stricken victims. “Psychological scarring needs to be dealt with as quickly as possible,” one psychologist told The Washington Post in January. “The longer we wait, the more danger.”

Sri Lankan health officials saw things slightly differently. They discouraged aid agencies that offered to send counselors to their country. “We believe the most important thing is to strengthen local coping mechanisms rather than imposing counseling,” Dr. Athula Sumathipala, chief of the psychosocial desk at the Sri Lankan government’s Center for National Operations, told The New York Times the same month.

I found the contrast between the two men particularly striking because I had recently gone to Rome to attend an international conference on trauma. The conference, titled “Project One Billion,” was organized by Dr. Richard Mollica, a psychiatrist at Harvard, under the auspices of the World Bank, the World Health Organization, and humanitarian nonprofit organizations. The United States also provided support.

“One billion” signified the number of people worldwide, roughly one in six, suffering the psychological consequences of war, torture and terrorism. And though these people suffered human-caused horror rather than natural disaster, the question still applies: can outsiders bearing therapy provide meaningful help in times of crisis?

One thing is clear. Even before strife ripped these societies apart, many of them had pitiful mental health systems. According to the W.H.O., most developing countries have fewer than 1 psychiatrist per 100,000 people; in rural areas, the gap is even larger. The entire country of Rwanda has only one psychiatrist. (The United States has about 14 psychiatrists per every 100,000 people; England has about 4 per 100,000.)

Experts at the conference emphasized four undertreated mental conditions: psychoses (mainly schizophrenia), major depression, drug and alcohol abuse, and epilepsy (a neurological disorder often treated by psychiatrists). They noted that depression and drug and alcohol abuse increased in the aftermath of violence and destabilization. When they spoke of post-traumatic stress disorder, on the other hand, it was more as a nod to the organizing theme of the meeting.

True, suffering was abundant – “We cannot dry our tears,” said one African representative – but psychiatry was not the obvious answer.

It would not be the first time that psychological aid was regarded by non-Western recipients as a kind gesture but a bad fit. For the last 15 years or so, humanitarian workers have been exporting the concept of post-traumatic stress disorder and trauma counseling around the globe.

They have rushed in to impose Western “debriefing” – a group therapy technique intended to get victims to express their feelings about a horrific event and to relive it as vividly as they can – without regard to the needs of the victims, their natural healing systems or their very conception of what mental illness might be.

Indeed, as literature from CARE International put it during the Balkan conflict: “Almost everyone in Kosovo will consider her- or himself traumatized.”

But is this true?

Several years ago, a resettlement project run by the United States government for Albanian Kosovars at Fort Dix, N.J., was staffed with mental health specialists prepared to treat high rates of post-traumatic stress disorder among the refugees.

Those expectations were not met, observed Elzbieta Gozdziak, an anthropologist at Georgetown University who was part of the team. “Only 7 of the 3,000 refugees were found to need psychiatric care,” Dr. Gozdziak said.

Indeed, many program evaluations reveal that actual use of specialized psychological help is typically low.

Kenneth Miller, a psychologist in the Bosnian Mental Health Program in Chicago, saw much suffering among his clients – they had been placed in concentration camps before migrating to the United States – yet the most successful feature of his program was not therapy, which most clients rejected anyway. It was practical help like education and job training.

Dr. Elie Karam, a psychiatrist at the Institute for Development, Research and Applied Care in Beirut, who attended Project One Billion, similarly concluded that post-traumatic stress disorder was not a major issue. “What we found was that the violence served as a catalyst for the destabilizing effects of pre-existing problems in people’s lives such as poverty, marital discord, physical illness,” Dr. Karam said.

Project One Billion reflected this philosophy. Debriefing, Dr. Mollica stated, has been discredited in clinical trials. In its place, he strongly urged that Western mental health workers collaborate with indigenous healers. The W.H.O. now instructs aid workers to “listen, convey compassion, assure basic physical needs, not force talking, and provide or mobilize company preferably from family or significant others.”

Notably, mental health advisers acknowledge that local economic and social recovery is a prerequisite for improved psychology, not a consequence of it. As Dr. Mollica put it, “the best antidepressant is a job.”

The very same week that Project One Billion took place, a “Dare to Act” conference was held in Baltimore. Supported by federal tax dollars, the conference promoted an inward-looking “trauma paradigm,” holding that childhood and adult traumatic experiences lie at the root of most psychopathology.

A colleague of mine who works with Bosnians, Hmong and Somali refugees told me he was asked by organizers of the conference to provide a refugee woman to talk about “her trauma” at the conference. He asked around but couldn’t find one. “They don’t want to think of themselves as victims,” he said.

Sally Satel is a psychiatrist and resident scholar at the American Enterprise Institute and a co-author of a new book, “One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance.”

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