Welcome to From Insults to Respect.
A while ago, as I began to think about what topic to write about for my next post, I received an email from Mindfreedom International (MI). It brought attention to a demonstration it was planning. As MI expressed it in part:
A mock funeral mourning those lost to psychiatry or who have had their spirits broken and struggle to survive is to be held as protesters deliver a public message to psychiatrists at the annual meeting of the American Psychiatric Association on Sunday, May 6, 2018. “First, Do No Harm” is the message that protesters hope will go viral and get people to think twice before getting involved with psychiatry.
Our coalition brings attention to the harm that psychiatry has caused for many people in the mental health system, psychiatric survivors, people of color, people with psychiatric histories, and people experiencing other forms of structural oppression. Uninformed or court-ordered psychiatric drugging; chemical and mechanical restraints, solitary confinement; forced and uninformed shock treatments….have caused irreversible damage to the minds, bodies, souls, and lives of people who voluntarily trusted their doctors or were brought to court to comply with their prescriptions over their objection….We will mourn the deaths and the ongoing forced treatment of our brothers and sisters.
Is there a way to move MI’s various conflicts with the psychiatric organization forward in a manner that leads to a more respectful relationship between the two?
My Views About Psychiatric Drugs
I became interested in the conflict about the use of psychiatric drugs very early in my career as a psychologist. I began to discuss the issues with psychiatrists as well as those who objected to this form of treatment. A broad outline of what I heard follows:
Advocates for the use of these drugs make the following claims: These drugs reduce emotional pain, correct abnormal brain patterns, and restore normal mental function. When used judiciously, they reduce hospitalization and may quickly alleviate symptoms of serious mental disorders such as depression and bipolar illness. Going off medication results in disruptive lives and devastating personal loss. Careers, relationships, financial troubles, and even life itself are all placed at grave risks without proper psychiatric medication management.
In contrast, critics of psychiatric drugs have made the following counter claims: The use of psychiatric drugs has unleashed the worst medically induced disaster in history. They have caused millions of people to become addicted to them, suffering debilitating, life threatening side effects. Rather than promoting mental health, these drugs are being used to promote social control and conformity. Reduction in hospitalization, moreover, occurred not because of the use of these drugs, but because of a deinstitutionalization policy that became known as “dumping.” Problems now being handled with psychiatric drugs can be more effectively, safely, and humanely handled with a variety of social support systems, counseling, mindfulness, healthy diet, and physical exercise techniques.
As I heard these conflicting claims, I initially thought that psychiatrists had principles of science on their side. With my graduate training in research methods and statistics, I thought that by doing a thorough job finding out the scientific research that backs up the psychiatric drug supporters I could explain in an easy to understand language why psychiatric drugs are necessary. With such an explanation, perhaps the conflict would be resolved.
My Ritalin Research Analysis
I began with researching Ritalin because I was working in Rochester, NY’s school system. This was from 1974 to 1979. It was a time when drugs were just beginning to be prescribed more and more to treat students who had teachers dissatisfied with their activity level or ability to pay attention. I had witnessed a time when schools managed to deal with such problems without the use of this drug and life went on reasonably well. With the rise in its use, some thought it was a wonderful advancement, while others were expressing great discomfort at this new trend.
So, off I went to a medical library to learn the scientific merits of this new approach. A brief summary of what I found follows.
Supporting the use of Ritalin were short-term randomized controlled studies lasting less than 12 weeks. Both inattentiveness-impulsivity and activity level were reduced, as assessed by parent and teacher rating scales, direct observations in natural settings, and various laboratory tests.
Not all of the findings were supportive. At the time I initially did my research, there was only one study that looked at the long-term results of Ritalin use. It compared children placed on methylphenidate, the generic version of Ritalin, with those who received no treatment. The children in the two groups were matched with respect to age, IQ, socioeconomic class and sex. After 3 to 5 years, no statistically significant differences were found between the two groups on the following outcome measures: emotion maladjustment, delinquency, Wechsler Intelligence Scale for Children, Bender gestalt visual-motor test, and academic performance.
In addition to this, I found many studies documenting a number of common adverse effects of treatment, such as headaches, insomnia, anorexia, stomach pain, irritability, and weight loss. Suppression of the normal rate of growth was just beginning to be reported. The sudden development of a tic disorder that sometimes did not go away when treatment stopped was viewed as a rare occurrence, but troubling nevertheless. Other serious rare adverse events had been observed including some involving heart functioning such as angina and cardiac arrhythmias. 
Perhaps most troubling of all was the recognition that the safety of long term use of Ritalin had not been established despite many students being treated for years.
To make sure that my analysis of the available scientific evidence was complete, I sent a Freedom of Information Request to the Food and Drug Administration for the documents that it used to approve the use of Ritalin with children as a treatment for attention and activity problems. I soon received a fairly large packet of information, and upon reviewing its contents I became convinced that I had not overlooked anything of scientific merit.
In the end, I discovered that although the approval process of the FDA had in its documents the available scientific evidence in making its decision to approve Ritalin, the reviewers’ decision nevertheless relied more on their personal values. It seemed to me, and it still does, that different people looking over the same scientific evidence could, depending on their values, come to completely different conclusions about whether or not the drug should be approved.
For me, personally, with the full awareness of the scientific evidence, I would have voted against approval of the drug. Relevant to me was that after thousands of dollars had been spent by the parents of the child or their insurance company, there was no lasting positive effects, while treated children were suffering side effects. The additional facts, especially the one that indicated long term safety had not been established, seemed to me to make non-approval the obvious choice. And yet, according to the value judgments of those who sat on the FDA approval board, they ended up supporting approval.
What I Found Afterwards
Since then, more research has come out regarding the drugs used to deal with ADHD. It further supports the conclusion that there are no long term benefits from using these types of drugs. Moreover, additional harm from their use has been identified.
After what I learned about the ADHD drug treatments, my efforts to find out about psychiatric drugs expanded.
As time went on, I took a psychopharmacology course taught by Harvard professor Dr. Ross J. Baldessarini; did additional research to get the latest updates, not only on Ritalin, but on other psychiatric drug treatments; and participated in six debates on this subject.
I’ve come to the conclusion that as with Ritalin, when highly intelligent people become familiar with the scientific evidence, they still draw completely different conclusions from one another about whether or not it is morally okay to use the approved drugs as a treatment. The decision is not solely made on scientific evidence. Moreover, I’ve seen evidence that there are far safer non-drug alternatives.
Since I did my original research on Ritalin, I also learned something crucial about the reliability of the relevant research findings. Initially, I assumed the scientific studies were carried out in a manner that I could have confidence in. Since then, I’ve begun to seriously question this.
Many experts have written about the reliability of the research. 
For example, Marcia Angell, M.D., is a former editor in chief of The New England Journal of Medicine, and now is a member of Harvard’s Medical School. In her insightful book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, she writes, “Is there some way companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time” (p. 95).
Conclusion
And so, even if we believe that the available research is accurate, it just so happens that an examination of it leads to very different moral conclusions by very intelligent people about the wisdom of using these drugs. The pharmaceutical industry’s influences on the body of research about the safety and effectiveness of these drugs make these types of conclusions ever more questionable.
For those interested in following the peer reviewed scientific research about the effectiveness and safety of these drugs, I highly recommend the Mad In America website. It describes the latest research in non-technical language while providing the links to all of the actual research articles so readers, if they so choose, can read them for themselves.
Members of MI have seen first hand people who have died and who have suffered terribly as a result of their involvement with the psychiatric profession. At the same time, psychiatrists also well know that there are many incidences of tragic outcomes due to their treatments, but they have come to believe that overall the benefits of their treatments far outweigh all of those tragedies. And the enormous financial benefits that come with being a psychiatrist are very likely to influence their views.
Civil rights activists worked for generations to make some progress in achieving their goals. Among the most successful of these advocates was Martin Luther King, Jr. When advocating for civil rights, he avoided throwing insults at those who resisted the changes he was after. Instead, he focussed on painting his dream in beautiful, hopeful phrases and demonstrating in nonviolent, but impossible to ignore, peaceful resistance.
In a country where many of our current politicians have taken to insulting anyone who disagrees with them, King’s approach may seem out of style. As for me, I personally think King’s approach is as timeless as stars twinkling in the heavens.
First of all, I should note that I am a member of the American Psychological Association, and have been so for over forty years. Nevertheless, there is one particular aspect of the association that is deeply troubling to me.
As part of the psychological organization’s strong interest in science, pretty much anyone entering its approved doctoral psychology program is required to study the ideas of Thomas Kuhn’s thesis on The Structure of Scientific Revolutions. Such revolutions, we learned, come about after a period of time when a field presupposes a conceptual and instrumental framework accepted without question. Then, more and more, members of the community begin to see a buildup of anomalies in the framework until a “crisis” which can no longer be resolved within the pre-established framework.
It just so happens that the psychiatrist’s stigmatizing diagnostic system, which is described in its Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), has huge anomalies that have been recognized for years, and despite this, psychologists continue to utilize it without taking substantive steps to create a more scientific alternative. Let’s take a quick look at these anomalies. Afterwards, we’ll look at the benefits to psychologists that may be motivating it to continue to go along with the DSM-5 approach despite its major scientific weaknesses.
The process described in the DSM-5 for assessing the subjective notions of “disturbance” in the individual is left to the clinician who decides if these are “clinically significant.” Thus, it provides clinicians an opportunity to include anything that benefits their set of values.
All psychologists are taught that if a hypothetical construct, such as a mental disorder, is to have any validity, it must first demonstrate that it can be reliably identified. Upon reading the DSM-5, we find that there is no documentation that people, whether they are clinicians or not, can reliably distinguish between those who have mental disorders and those who do not have mental disorders. Thus, the lack of this documentation is analogous to a classification system of birds that has no documentation that people can reliably distinguish birds from non-birds.
The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century, as we have understood that symptoms alone rarely indicate the best choice of treatment.
In addition to the DSM’s shortcomings with regards to its classification system’s reliability and validity, there are also serious shortcomings with regards to its claim of being a diagnostic system. A diagnostic system speaks to etiology, that is, the cause, set of causes, or manner of causation of a disease or condition. But the DSM-5 specifically states that it is not designed to identify the cause of the various “disorders” it classifies. Then why use the term “diagnosis” rather than the more scientifically defensible term, “classification?” As we will see, this gets us back to our larger question, why does the psychologist organization accept the use of the DSM-5 given its problematic record of reliability and validity, as well as its use of the word “diagnosis” in a misleading, imprecise manner?
Moreover, symposium proposals on this issue are oftentimes accepted for presentations at its national convention. (See 
A well recognized usefulness of the DSM-5 is that by using its medical sounding terms to refer to all of the experiences that this approach classifies as “mental disorders” it legitimizes in the minds of many the prescribing of drugs for these experiences.
Now keep in mind that the psychiatric association membership consists largely of psychiatrists who make their living by prescribing these drugs. Moreover, there are several reports indicating that the majority of the major players who developed the DSM-5 were on the payroll of the pharmaceutical industry. So, it makes sense to theorize that the psychiatric organization may very well be influenced by all of this wealth. But what about the psychological association?