Fast for Freedom: A debate (of sorts) about scientific evidence

Sat, 23 Aug 2003

The Medical Director of the APA was unable to cite a single scientific study proving an underlying biochemical basis for any mental illness. An amazing exchange between Dr. James Scully and a panel of experts lays bare the fact that psychiatry’s claims about a biological basis ("chemical imbalance") for mental illness are faith-based–rather than supported by any scientific evidence.

Since last Saturday, a group of former patients organized by MindFreedom – an organization whose members have experienced first hand the abusive mental health system–are fasting in Pasadena, Cal. The purpose is to challenge the psychiatric establishment–the American Psychiatric Association (APA), the US Office of the Surgeon General, and the National Alliance for the Mentally Ill (NAMI), to provide scientific evidence to back up their claims that mental illnesses are biologically based brain diseases, much like diabetes and heart disease.

The problem with such claims–no matter how often they are recited– is that they are not backed by scientific evidence. Furthermore, the drugs being forced on psychiatric patients have severe adverse effects–including drug-induced diabetes and heart damage. At issue is the dominance of psychotropic drugs in the treatment of all mental /emotional problems which are designated as one or another “disorder” requiring a psychotropic drug or “cocktail” of drugs. At issue also is an increasingly coercive mental health system that gives psychiatric patients no choice of treatment. https://ahrp.org/infomail/1102/03.php

The entire mental health establishment–including NAMI a powerful family organization that has lent its unreserved faith-based support for psychiatry–is currently geared toward assisting industry to market the latest powerful psychotropic drug or “cocktail” of drugs. No wonder the pharmaceutical industry handomely rewards its “partners”–the APA and NAMI–with financial support.

Since there are no objective diagnostic tools in psychiatry to identify a specific illness, psychiatric diagnoses are arrived at by subjective conjecture. The damage caused by the drugs is physically demonstrable–too many patients have suffered debilitating, irreversible brain damage and early death from these drugs.

As the exchange of letters (below) demonstrates, the Medical Director of the APA was unable to cite a single scientific study proving an underlying biochemical basis for mental illness. Dr. Scully’s condescending put down, suggesting these former patients are ignorant amateurs, demonstrates the lack of respect shown by psychiatry toward its "clients." Furthermore, as the panel of expert’s reply (below) demonstrates, the documents cited by Dr. Scully as proving a biological basis for mental illness appear to prove the exact opposite of what he claims.

This leads us at the Alliance for Human Research Protection (AHRP) to wonder how officials of the National Institute of Mental Health might respond when called upon by a Congressional Committee to provide scientific evidence to justify its biological research agenda.

Taxpayers have a right to know if officials of the NIMH and the APA colluded in a vast conspiracy, falsely declaring “chemical imbalances” where none are proven. Were these claims made in order to expand the psychotropic drug market? Have U.S. taxpayers been deluded with false claims and defrauded of billions of dollars?

See also, the series "A Fast for Freedom in Mental Health" on RedFlagsWeekly: http://www.redflagsweekly.com/

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http://www.mindfreedom.org/mindfreedom/hungerstrike14.shtml

August 19th, 2003,
Day 4: the Hunger Strikers receive a response from the APA to their Fast for Freedom in Mental Health Statement:

Mr. David Oaks
c/o Stuart Shipko, M.D.
Pasadena, CA 91105

Dear Mr. Oaks:

I am acceding to your request that I send my response to your letter of July 28, 2003 to Dr. Stuart Shipko.

The mission of the American Psychiatric Association is to promote the highest quality care for individuals with mental illness and substance abuse disorders and their families. In recent years, there has been substantial progress in understanding the neuroscientific basis of many mental illnesses. Research offers hope and must continue.

The answers to your questions are widely available in the scientific literature, and have been for years. I suggest you begin your review with Surgeon General David Satcher’s report, “Mental Health: A Report of the Surgeon General.” In addition, I recommend the Introductory Textbook of Psychiatry (3rd edition), edited by Andreasen and Black. This is a “user-friendly” textbook for persons just being introduced to the field of psychiatry.

A more substantial and advanced series would include The American Psychiatric Publishing, Inc.’s “Textbook of Clinical Psychiatry (4th edition),” edited by Hales and Yodofsky. For the latest science, of course, there are the American Journal of Psychiatry and Archives of General Psychiatry, among many other journals which are available in both printed and on-line versions.

These are but a few of the extensive number of scientific publications that answer your questions.

I share the concern of Rick Berkel [sic] of NAMI that your proposed activities are ill-considered and invite you to join NAMI to help improve the care of our fellow citizens who suffer from serious mental illnesses.

Sincerely,

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

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http://www.cinemaniastigma.com/pages/13/index.htm
August 21st, 2003,
Day 6: the 14 member scientific panel and the six Fast for Freedom hunger strikers reply to Dr. Scully’s letter:

James H. Scully, Jr., M.D., Medical Director
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209-3901

Dear Dr. Scully:

David Oaks, Executive Director of MindFreedom, has forwarded to us your reply dated 12 August 2003 to the hunger strikers involved in a “Fast for Freedom in Mental Health.” We are a panel of 14 academics and clinicians who have agreed to review any such reply for scientific validity.

The hunger strikers asked your organization, as well as the Surgeon General of the United States, and the National Alliance for the Mentally Ill, to provide:

1. evidence that establishes the validity of “schizophrenia,” “depression” or other “major mental illnesses” as “biologically-based brain diseases”;

2. evidence for a physical diagnostic exam that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs) from individuals without these diagnoses;

3. evidence for a baseline standard of a neurochemically-balanced “normal” individual, against which a neurochemical “imbalance” can be measured;

4. evidence that any psychotropic drug can correct any “chemical imbalance” attributed to a psychiatric diagnosis;

5. evidence that any psychotropic drug can reliably decrease the likelihood of violence or suicide.

In your reply, no specific studies of any kind were cited with reference to any of the questions above. You cited three general sources, including the recent Surgeon General’s report on mental health and two textbooks of psychiatry.

In examining each of these sources, we found numerous statements that invalidate suggestions that behaviors referred to as “mental illnesses” have specific biological bases:

_Mental Health: A Report of the Surgeon General (1999) is explicit about the absence of any findings of specific pathophysiology:

p. 44: “The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify the illness.”

p. 48: “It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms.”

p. 49: “The precise causes (etiology) of mental disorders are not known.”

p. 51: “All too frequently a biological change in the brain (a lesion) is purported to be the ’cause’ of a mental disorder … [but] The fact is that any simple association — or correlation — cannot and does not, by itself, mean causation.”

p. 102: “Few lesions or physiologic abnormalities define the mental disorders, and for the most part their causes remain unknown.”

In the third edition of _Textbook of Clinical Psychiatry_ (1999), we find similar statements:

p. 43: “Although reliable criteria have been constructed for many psychiatric disorders, validation of the diagnostic categories as specific entities has not been established.”

p. 51: Most of these [genetic studies] examine candidate genes in the serotonergic pathways, and have not found convincing evidence of an association.”

In Andreasen and Black’s (2001) _Introductory Textbook of Psychiatry, we find, in the chapter on schizophrenia:

p. 23. “In the areas of pathophysiology and etiology, psychiatry has more uncharted territory than the rest of medicine…Much of the current investigative research in psychiatry is directed toward the goal of identifying the pathophysiology and etiology of major mental illnesses, but this goal has been achieved for only a few disorders (Alzheimer’s disease, multi-infarct dementia, Huntington’s disease, and substance-induced syndromes such as amphetamine-related psychosis or Wernicke-Korsakoff syndrome).”

p. 231: “In the absence of visible lesions and known pathogens, investigators have turned to the exploration of models that could explain the diversity of symptoms through a single cognitive mechanism.”

p. 450: “Many candidate regions [of the brain] have been explored [for schizophrenia] but none have been confirmed.”

As you are no doubt familiar with these textbooks you cited, you will agree that such statements invalidate claims for specific, reliable biological causes or signs of “mental illnesses.” In the judgment of the panel members, your reply fails to produce or cite any specific evidence of any specific pathophysiology underlying any “mental disorder.”

You have also referred us to 60 volumes of _Archives of General Psychiatry and 160 volumes of _The American Journal of Psychiatry. The 28 July 2003 cover letter from the hunger strikers and panelists that they sent to you by certified mail stated:

“We are aware that research studies can run to thousands of pages. Therefore, please respond only with those studies that you consider the best available in support of your claims and theories in a timely way. When responding with evidence, please send citations for the original publications or copies of the publications you are citing.”

Like you, we are familiar with the material found in these journals. It is understandable why you did not provide any citations. There is not a single study that provides valid and reliable evidence for the “biological basis of mental illness.”

The members of the panel wish to make some further observations which we hope will assist the American Psychiatric Association to present an honest scientific stance with respect to the hunger strikers’ questions.

In the panel’s view, the questions posed by the hunger strikers are serious and fair. These questions are legitimate questions that any patient or family member or interested person might ask of any psychiatrist, or a student might ask of a professor. The panel was therefore quite dismayed that you, as Medical Director of the world’s largest, wealthiest, and most resourceful psychiatric association, could not provide a more specific or substantial response than the equivalent of, “See our textbook.”

If, as you state in your letter, “the answers to [the above] questions are widely available in the scientific literature, and have been for years,” then it behooves your organization to make these answers and their specific sources — if they differ from the quotes we present in this letter — available promptly.

The panel members could not help but notice the contrast between the hunger strikers, who ask clear questions about the science of psychiatry and consciously take risks in the name of protecting the well-being of users of psychiatry, and the American Psychiatric Association, which evades revealing what actual scientific evidence justifies its authority. By not giving specific answers to the questions posed by the hunger strikers, you appear to be affirming the very reason for the hunger strike.

Sincerely,

Fred Baughman, MD
Mary Boyle, PhD
Peter Breggin, MD
David Cohen, PhD
Ty Colbert, PhD
Pat Deegan, PhD
Al Galves, PhD
Thomas Greening, PhD
David Jacobs, PhD
Jay Joseph, PhD
Jonathan Leo, PhD
Bruce Levine, PhD
Loren Mosher, MD
Stuart Shipko, MD

The hunger strikers endorse the scientific panel’s statement.

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NAMI response: http://www.mindfreedom.org/mindfreedom/hungerstrike6.shtml