bmj.com Rapid Responses for Szasz, 327 (7429) 1449-1451

Rapid Responses to:

WARD ROUND:
Thomas Szasz
The psychiatric protection order for the "battered mental patient"
BMJ 2003; 327: 1449-1451 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The "Battered Mental Paitient"- a different perspective: Jayne Sercombe (19 December 2003)

Tired Cliches: Dr Daniel M Beales (20 December 2003)

Where is the humanity?: David M Bowker (21 December 2003)

In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill: Ronald Pies MD (21 December 2003)

Enough of anti-psychiatric rhetorics: Sudip Sikdar (22 December 2003)

A Mad World Doesn't Need Headshrinkers: Dr Lynne Wrennall (22 December 2003)

Psychiatric Protection Orders Would Protect Human Rights: Darby J. Penney (22 December 2003)

No competing interest?: Nestor J. Presas (22 December 2003)

Great article: LostBoyinNC (Eric Rucker) (23 December 2003)

Dr Thomas Szasz is a Member of the Church of Scientology: Dr P V F Cosgrove (23 December 2003)

There are no scientologists at the BMJ: Richard Smith (23 December 2003)

Rights imply responsibilities: Angela F Harte (24 December 2003)

Should endocrinologists assume responsibility for psychotic patients?: Richard G Fiddian-Green (24 December 2003)

psychiatry should be formally merged into Neurology: Eric Rucker (24 December 2003)

Dr Szaz's BMJ article cannot have been peer reviewed: Dr P V F Cosgrove (27 December 2003)

Re: Dr Thomas Szasz is a Member of the Church of Scientology: Nelson Borelli, MD (28 December 2003)

Re: Great article: Nelson Borelli, MD (28 December 2003)

Dr. Szasz's Insightful Analysis of Freedom of Choice: Thomas K. Zander (28 December 2003)

Szasz � the same old tune!: Richard L O'Reilly, John E. Gray (28 December 2003)

Your own worst enemy: Gurli Bagnall (28 December 2003)

Protecting the Vulnerable from Zealots: Richard J Winkel (28 December 2003)

re: Enough of anti-psychiatric rhetorics: Annie E Scotney (28 December 2003)

Re: Dr Szaz's BMJ article cannot have been peer reviewed: Nicolas S. Martin (29 December 2003)

You need to compartmentalize your emotions on this one: Eric Rucker (29 December 2003)

"Battered mental patients": Christmas article: M E Jan Wise (29 December 2003)

Civil rights and Mental Illness: Christopher J O'Loughlin (29 December 2003)

re: your own worst enemy: Angela Kennedy (29 December 2003)

Re: The "Battered Mental Paitient"- a different perspective: Melanie Seaman (30 December 2003)

Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?: Richard G Fiddian-Green (30 December 2003)

Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?: Eric Rucker (31 December 2003)

Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?: Eric Rucker (31 December 2003)

Your own worst enemy: E.Ann Robertson (31 December 2003)

Re: Your own worst enemy: Eric Rucker (1 January 2004)

In reply to E. Ann Robertson.: Gurli Bagnall (1 January 2004)

Reform Psychiatry or Abolish Psychiatry!: Dr P V F Cosgrove (2 January 2004)

Re: In reply to E. Ann Robertson.: Eric Rucker (2 January 2004)

Re: Reform Psychiatry or Abolish Psychiatry!: Eric Rucker (3 January 2004)

Crazy talk: John Hopkins (3 January 2004)

Re: Crazy talk: Richard G Fiddian-Green (3 January 2004)

Re: Crazy talk: Nelson Borelli, MD (4 January 2004)

Flat World, Round World: Dan Beales (4 January 2004)

Can I take this back a step?: Kim Gregory (5 January 2004)

"Global Emergency": David W. Oaks (6 January 2004)

(Non)coercive pscyhotherapy and "care": Jacqueline R Roig (7 January 2004)

psychology is a pseudoscience: Ted Huntington (7 January 2004)

The "value neutral science": William K Smith (7 January 2004)

Survivor of Post Partum Psychosis: Jenny Hatch (7 January 2004)

Labeling Dissidents: David W. Oaks (7 January 2004)

Voluntarily Coercion? Coerced "Choice"? A Contradiction? NO! Not Now!: Roger D. Carlson, Ph.D., McMinnville, Oregon 97128 (7 January 2004)

Family of Lobotomy Victims Speak: Christine L. Johnson (7 January 2004)

Mad? Or afraid?: Patricia Robinett (7 January 2004)

Involuntary treatment gives profession a bad reputation: Ron J Unger (7 January 2004)

"No" is absolutely essential to ethical relationship: John C. Napier (7 January 2004)

Compelling Emotions But Not Practical: Edward D. Campbell (7 January 2004)

Stop coerced psychiatry: Fred A. Tenzer (7 January 2004)

Response to Dr.Szasz's Ideas on "Psychiatric Wills": John C. Hammell (7 January 2004)

Anti-abuse not Anti-psychiatry: David N. Gonzalez (7 January 2004)

Bothersome issues: Kim C. Maynard (7 January 2004)

Re: Flat World, Round World: Eric Rucker (7 January 2004)

recognize the future: Gregory D. Bowyer (7 January 2004)

Alternatives to hospitalization: Jay Fickling (7 January 2004)

Crazy talk: Advocating coercion?: Jacqueline R Roig, PsyD (7 January 2004)

protection orders are not enough: Nathaniel .S. Lehrman (7 January 2004)

Don't forget the learning disabled: Alan Challoner (7 January 2004)

Worldwide need for this open discussion: Mary S. Pearce (7 January 2004)

advanced psychiatry: joerg b. dao (7 January 2004)

Re: Family of Lobotomy Victims Speak: Eric Rucker (7 January 2004)

Enough is enough: Joni M Gallo (7 January 2004)

WHEN DO WE DRAFT THE DOCUMENT?: Carol Hebald (7 January 2004)

Well Done Tom: John Malone (7 January 2004)

The need to bypass the chain of command: Eric Rucker (8 January 2004)

Congratulations to the BMJ Chief Editor: Volker Kubillus (8 January 2004)

Re: Re: Family of Lobotomy Victims Speak: Christine L. Johnson (8 January 2004)

Coercion: Roderick J Harvey (8 January 2004)

Well Done BMJ Editors: Joseph .C. Obi (8 January 2004)

"Forced" psychiatric treatment: Irene Mazis (8 January 2004)

Psychiatry is always dodging the issues.: Cal Grandy (9 January 2004)

good article!: Roelof A. Bijkerk (9 January 2004)

Gratitude for Szazs's Article: John O. E. Laue (9 January 2004)

Re: In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill: Roelof A. Bijkerk (9 January 2004)

Stunning correspondance and the medicalization of childhood: Sami Timimi (9 January 2004)

Re: "Forced" psychiatric treatment: David Gonzalez (9 January 2004)

Re: "Forced" psychiatric treatment: Eric Rucker (9 January 2004)

Re: Re: Re: Family of Lobotomy Victims Speak: Eric Rucker (10 January 2004)

Addressing various comments: Kim Gregory (10 January 2004)

Prophilaxis for psych drug harm: Daniel Q Burdick (10 January 2004)

First improve the mental health system: Phil Thompson (10 January 2004)

People who want change must deal directly with the high command: Eric Rucker (10 January 2004)

We need to understand evolution of the mind and "normal" human irrationality: Mario Heilmann (11 January 2004)

Re: Tired Cliches: Roelof A. Bijkerk (11 January 2004)

Re: Enough of anti-psychiatric rhetorics: Roelof A. Bijkerk (11 January 2004)

Re: Where is the humanity?: Roelof A. Bijkerk (11 January 2004)

Re: The "Battered Mental Paitient"- a different perspective: Roelof A. Bijkerk (11 January 2004)

,It will be more interesting to know the opinon of Prof.Szasz on other issues,Insane people can be executed&lethal injection of prisoners in US.: AK Al-Sheikhli (11 January 2004)

Re: Szasz � the same old tune!: Roelof A. Bijkerk (11 January 2004)

Re: psychiatry should be formally merged into Neurology: Roelof A Bijkerk (11 January 2004)

Re: Rights imply responsibilities: Roelof A. Bijkerk (11 January 2004)

Re: Civil rights and Mental Illness: Roelof A. Bijkerk (11 January 2004)

Re: Re: "Forced" psychiatric treatment: Irene Mazis (12 January 2004)

Denial of the hard cold truth condemns millions to a lifetime of misery: Eric Rucker (12 January 2004)

Thomas Szasz, the Critical Psychiatry Network and the psychiatric protection order: D B Double (12 January 2004)

Psychopharmacology versus actual biochemical medicine.: Daniel Q Burdick (13 January 2004)

Who then would treat patients as responsible moral agents??: Thomas M. Fraser (13 January 2004)

Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Roelof A. Bijkerk (13 January 2004)

Re: Re: Re: "Forced" psychiatric treatment: David Gonzalez (13 January 2004)

Re: Can I take this back a step?: Glynis Meloy (13 January 2004)

Strong Support for Patients' Rights: Ann Fonfa (13 January 2004)

Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Thomas M Fraser (13 January 2004)

Psychiatric wards misdiagnose epilepsy and force treatment on psychiatric ward while withholding appropriate epilepsy treatment: Vonne N. Worth (13 January 2004)

Re: Psychopharmacology versus actual biochemical medicine.: Eric Rucker (14 January 2004)

Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: David Gonzalez (14 January 2004)

Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Eric Rucker (14 January 2004)

Are psychiatrists suffering from NERDS?: Sami Timimi (14 January 2004)

Best practice from various perspectives: Mary S. Pearce (15 January 2004)

Re: Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Eric Rucker (15 January 2004)

Time to abolish forceful restraint and detention?: Richard G Fiddian-Green (15 January 2004)

Re: Tired Cliches: David Gonzalez (15 January 2004)

Dr Szasz Is Right on Target: Harold Mandel (15 January 2004)

Re: Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Thomas M. Fraser (16 January 2004)

The bottom line is...: Eric Rucker (16 January 2004)

"Battered patient Syndrome": Harold A. Maio (16 January 2004)

Re: "Battered patient Syndrome": Thomas M Fraser (16 January 2004)

Re: Re: Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Roelof A. Bijkerk (18 January 2004)

Re: Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Roelof A. Bijkerk (18 January 2004)

Re: Re: Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery: Richard J Winkel (18 January 2004)

Re: Re: "Battered patient Syndrome": David Gonzalez (18 January 2004)

An interesting discussion.: Lloyd W Achtymichuk (18 January 2004)

Re: Re: "Battered patient Syndrome": Eric Rucker (18 January 2004)

"Battered mental patient as institutional problem: J�zsef Gerevich (18 January 2004)

Re: Re: Re: "Battered patient Syndrome": Thomas M. Fraser (18 January 2004)

Re: "Battered mental patient as institutional problem: Eric Rucker (18 January 2004)

Re: Re: Re: Re: "Battered patient Syndrome": David Gonzalez (20 January 2004)

Psychiatry is a pseudoscience and an Inquisition: C�sar Tort (20 January 2004)

Re: Re: Re: Re: "Battered patient Syndrome": Eric Rucker (20 January 2004)

Re: Psychiatry is a pseudoscience and an Inquisition: Eric Rucker (21 January 2004)

Re: Psychiatry is a pseudoscience and an Inquisition: Cesar Tort (21 January 2004)

Therapeutic Jurisprudence: Thomas M. Fraser (22 January 2004)

Re: Therapeutic Jurisprudence: Kathleen (Katie) M. Hill (23 January 2004)

Re: Therapeutic Jurisprudence: Kathleen (Katie) M. Hill (24 January 2004)

Context is important: Martin Briscoe (24 January 2004)

"In Strong Society": Roelof A Bijkerk (24 January 2004)

Doesn't the depth of needed improvement demand our minds be open?: james m nordlund, 901 s.w. Tyler, apt. 111, Topeka, KS 66612 (25 January 2004)

Re: Context is important: Roelof A. Bijkerk (25 January 2004)

Long Overdue Idea: Thomas J. Scheff, Santa Barbara, Ca. 93106 (27 January 2004)

Re: Doesn't the depth of needed improvement demand our minds be open?: Kathleen (Katie) M. Hill (28 January 2004)

Re: Long Overdue Idea: Kathleen (Katie) M. Hill (28 January 2004)

Re: Long Overdue Idea: Thomas M. Fraser (30 January 2004)

Re: Re: Psychiatry is a pseudoscience and an Inquisition: Kathleen (Katie) M. Hill (30 January 2004)

Mental Health or Is It Mental Death !: Dennis F. Nester (1 February 2004)

Re: Mental Health or Is It Mental Death !: Roelof A. Bijkerk (5 February 2004)

If it's any different is it worse here or there?: Roelof A. Bijkerk (5 February 2004)

Psychiatry is a Criminal Fraud: George Wynns (6 February 2004)

Re: Re: Re: Re: Psychiatry is a Criminal Fraud: Kathleen (Katie) M. Hill (8 February 2004)

Re: Psychiatry is a Criminal Fraud: Kathleen (Katie) M. Hill (9 February 2004)

Re: Re: Doesn't the depth of needed improvement demand our minds be open?: james m nordlund (9 February 2004)

Re: Re: Re: Doesn't the depth of needed improvement demand our minds be open?: Kathleen (Katie) M. Hill (10 February 2004)

Re: Re: Psychiatry is a Criminal Fraud: Roelof A. Bijkerk (10 February 2004)

Re: Re: Re: Psychiatry is a Criminal Fraud: Kathleen (Katie) M. Hill (11 February 2004)

Abuse in Therapy: Kathleen (Katie) M. Hill (11 February 2004)

Re: The "Battered Mental Paitient"- a different perspective: Kathleen (Katie) M. Hill (11 February 2004)

Retraumatizing the Victim: Kathleen (Katie) M. Hill (12 February 2004)

Re: Re: The "Battered Mental Paitient"- a different perspective: Roelof A. Bijkerk (13 February 2004)

Re: Re: Re: The "Battered Mental Paitient"- a different perspective: Kathleen (Katie) M. Hill (15 February 2004)

Re: Psychiatry is a Criminal Fraud: Kathleen (Katie) M. Hill (15 February 2004)

Re: Re: Re: Re: The "Battered Mental Paitient"- a different perspective: Roelof A. Bijkerk (16 February 2004)

suicide is not always preventable!: Stephen F Hayes (16 February 2004)

Re: suicide is not always preventable!: Roelof A. Bijkerk (17 February 2004)

one step further: Roelof A. Bijkerk (17 February 2004)

Re: Abuse in Therapy: Roelof A. Bijkerk (18 February 2004)

Creating Health vs Destroying Disease: Kathleen (Katie) M. Hill (19 February 2004)

Re: Re: suicide is not always preventable!: Stephen F Hayes (20 February 2004)

"Mercy Killing of the Psyche" (Freeman): Kathleen (Katie) M. Hill (20 February 2004)

RE: The Tools Have Changed But The Weaponry Remains The Same: Kathleen (Katie) M. Hill (22 February 2004)

Re: Re: Re: suicide is not always preventable!: Roelof A. Bijkerk (22 February 2004)

Re: Re: Re: suicide is not always preventable!: Roelof A. Bijkerk (22 February 2004)

Re: Re: Re: suicide is not always preventable!: Kathleen (Katie) M. Hill (23 February 2004)

Re: "Forced" psychiatric treatment: Roelof A. Bijkerk (23 February 2004)

Psychiatry: regression to pharmaceutical catastrophe since 1927?: Richard G Fiddian-Green (23 February 2004)

Re: Psychiatry: regression to pharmaceutical catastrophe since 1927?: Roelof A. Bijkerk (24 February 2004)

Re: Re: Re: suicide is not always preventable!: Roelof A. Bijkerk (24 February 2004)

Re: Re: Re: Re: suicide is not always preventable!: Stephen F Hayes (24 February 2004)

Re: Re: Re: Re: suicide is not always preventable!: Stephen F Hayes (24 February 2004)

Re: Re: Re: Re: Re: suicide is not always preventable!: Roelof A. Bijkerk (25 February 2004)

Re: Re: Psychiatry: regression to pharmaceutical catastrophe since 1927?: Roelof A. Bijkerk (25 February 2004)

Re: Reform Psychiatry or Abolish Psychiatry!: Roelof A. Bijkerk (25 February 2004)

Re: Re: Reform Psychiatry or Abolish Psychiatry!: Roelof A. Bijkerk (26 February 2004)

Re: Re: Re: Reform Psychiatry or Abolish Psychiatry!: Kathleen (Katie) M. Hill (28 February 2004)

Re: Re: Re: Re: Reform Psychiatry or Abolish Psychiatry!: Roelof A Bijkerk (29 February 2004)

Ecological vs Corporatist Cultural Logic: Kathleen (Katie) M. Hill (6 March 2004)

Bleed and Purge all Kensington!: Peter Morrell (3 April 2004)

Re: "Battered mental patient as institutional problem: Harold A Maio (20 October 2004)

The Pros and Cons of Psychiatric Living Wills (From Someone Who's Been Through It All): Lori E. Wiest (7 November 2004)

The "Battered Mental Paitient"- a different perspective 19 December 2003

Jayne Sercombe,
SpR Learning Disability Psychiatry
Bristol
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Re: The "Battered Mental Paitient"- a different perspective

As someone who has been troubled with major mental illness episodically for some years and who has seen psychiatry from both ends of the couch, I would like to make a few points.
I have an unfortunate, real and at times life threatening illness, which I have been successfully treated for by kind, compassionate psychiatrists and other mental health staff.
Though I would clearly never welcome detention under the Mental Health Act for myself were it unavoidable, I am aware that there may be times for myself when this could be potentially lifesaving. It would concern me to think that when my thoughts become so changed as to put me at risk there would be no safeguard for me to allow for help.
Were it not for the interventions of psychiatrists, alongside my GP, in the past I wonder whether I would be here to write this now.
It is well enough to philosophise about these things, injustices have surely been done in the name of psychiatry, however what is important for me and my family is that I am alive and well. I am certain that this is so for the majority of patients that we see.
Competing interests: Mental Health Service user and Psychiatrist

Tired Cliches 20 December 2003

Dr Daniel M Beales,
Specialist Registrar in Forensic Psychotherapy
Mersey Care NHS Trust, North Administration, Ashworth Hospital, Maghull, Merseyside, L31 1BD
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Re: Tired Cliches

Sir
As someone who has experienced mental illness that did not require compulsory treatment, and a relative of someone with a mental illness that did, as well as a psychiatrist and trainee psychotherapist, it is sad to see Szasz being given yet another platform from which to present his clich�d and increasingly out of date views unchallenged. Szasz�s denial that �mental illnesses are real diseases and that psychiatrists are regular doctors� illustrates the degree to which his argument has grown in sophistication since his �Myth of Mental Illness� in 1961. In other words, it hasn�t. Consent and compulsion are difficult issues in psychiatry: is it evident that Szasz�s article considers their complexity fully?
What an excellent Christmas present from the BMJ, the most widely read medical journal amongst British doctors. Perhaps one New Year�s resolution for you to consider would be to question your own indulgence of the further stigmatisation of psychiatry, which you perpetuate by allowing Szasz to go on suggesting that psychiatrists do not work to the same ethical considerations as all doctors should.
Competing interests: None declared

Where is the humanity? 21 December 2003

David M Bowker,
Retired
Retired: Home address Stockport SK7
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Re: Where is the humanity?

If one wished to study the psychopathology of the overvalued idea then one is naturally drawn to the writings of Szasz, but where is the humanity in his views? Popularly (but medical practitioners should know better) early treatments in psychiatry are derided, but cold baths and spinning among other similar techniques were arguably, although crude, relatively benign and thoughtful attempts to disrupt intrusive thoughts which were perceived as frightening, dangerous or senseless in cases of severe mental disorder. One could probably rate them as more rational than blood letting and cupping!
I am certain that if I had authored a similar piece to that submitted by Szasz, it would not have been published - the editor could not have missed a generalised, rambling, unsubstantiated content which also failed to address the practical consequences and management of the proposals described.
D M Bowker.
Competing interests: Retired consultant psychatrist

In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill 21 December 2003

Ronald Pies MD,
Clinical Prof. of Psychiatry
Tufts University 02111
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Re: In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill

� The notion that psychiatrists (and only psychiatrists) �commit� patients against their will represents a distortion of the relationship between psychiatry and the law in the U.S. It also ignores the role of other professionals, paraprofessionals, and even �ordinary citizens� in the commitment process. As Dr. Robert Simon points out in his book, Psychiatry and Law for Clinicians, ��mental health professionals must understand that it is not they who make commitment decisions about patients. Commitment is a judicial decision that is made by the court or by a mental health commission. The clinician files a petition or medical certification that initiates the process of involuntary hospitalization.� (Simon, 1998, p. 127, italics mine). This is not a trivial or semantic distinction. True: most states provide for brief, emergency hospitalizations (e.g., 48-72 hours) before a judicial hearing is held, at which time it is a judge�not a psychiatrist�who determines whether sufficient grounds exist for continuing the hospitalization. But the initial petition for involuntary civil commitment, in many states, may be initiated by ��police officers, next of kin, psychiatrists, other physicians, psychologists, social workers, or even �interested parties�� (Simon, 1998, p. 128). Of course, one might argue that in so far as these other parties �behave� like psychiatrists, the whole motley crew constitute agents of �state-sponsored social control�� (Szasz manifesto, op. cit.). This argument turns the concept of �agency� on its head. In fact, when a court authorizes a commitment, it is acting as the agent of the doctor, the social worker, or, in many cases, the parent of the sick individual. This is as it should be in a democracy, where the �state� (state and national government) exists to carry out the will of the people. To be sure, there are countries in which�at various times in their history�psychiatrists and other physicians truly have acted as agents of the state. This was clearly the case in Nazi Germany, the old Soviet Union, and arguably, in present-day China. I would submit that such �political� uses of psychiatry are very rare in the United States, and certainly not part of every day clinical practice. (I am aware that a few very high-profile cases, such as the confinement of Ezra Pound in the 1940s, may be exceptions to this general conclusion). The persistent failure of some critics of psychiatry to distinguish the system of civil commitment in this country from involuntary confinement in totalitarian countries greatly undermines the credibility of their moral claims.
Another myth: Non-psychiatrist medical specialists�those who deal with �real� diseases�do not involuntarily hospitalize patients. In part, this is a corollary of the previous myth. In reality, other medical specialists in the U.S. do hospitalize patients involuntarily, and the diseases these patients have, or are reasonably believed to have, are not necessarily those traditionally considered �mental illnesses�. It is only contingently true that psychiatrists are much more often involved in involuntary commitment procedures. In New York State, where the consent of any two physicians can initiate the commitment process, non-psychiatric physicians often do so, particularly in counties with few psychiatrists (M. Dewan MD, personal communication, April 2001). Emergency detention of dehydrated, demented patients with admission to the general medical ward�not the psychiatric unit�has been carried out in some states (Schneidermayer et al, 1982). In rare cases, neurologists may initiate the commitment process for demented patients with severe behavioral disturbance (J. Cummings MD, personal communication, April 2001).
Consider the following vignette:
An 84-year-old man with no previous �psychiatric� history falls and hits his head. He feels alright at first, but over the ensuing week, he notices some difficulty walking and urinating. He sees a neurologist who performs a CT scan of the brain, and determines that the man is developing normal pressure hydrocephalus, which often develops after a head trauma. The neurologist urges the man to undergo surgical treatment, and cautions him that his condition will probably worsen without the installation of a �shunt�. The man refuses and goes home. Three weeks later, he becomes confused, irritable, and verbally threatening to his wife and next-door neighbor. In the middle of January, the man runs outside in the snow, wearing only his pajamas. He absolutely refuses to see the neurologist or any other doctor. The man�s wife phones the neurologist and begs for help. The neurologist says that the patient�s behavior is �likely due� to the untreated hydrocephalus, though he �can�t be certain.� He recommends an emergency hospital admission, against the patient�s will.
Now: what is the Szaszian position with respect to the neurologist�s recommendation? If it is one of assent, then we must acknowledge that under certain circumstances, we do deprive some individuals of their liberty on the basis of �disapproved behaviors�, even when there are no criminal offenses involved, and even when we can�t be certain the behaviors are due to brain disease. Indeed, in Israel, involuntary hospitalization of senile and arteriosclerotic dementia patients is permitted under the 1991 Israeli Mental Health Act (Heinik & Kimhi, 1995). If the Szaszian position is to disagree with the neurologist, even when the patient�s behavior is likely due to clearly documented brain dysfunction, then the Szaszian quarrel is not with psychiatry or psychiatric diagnosis per se, but with the police power of the state and the doctrine of parens patriae (which asserts that the state may act on behalf of those citizens who are unable to take care of themselves; Simon, 1998, p. 121). [Reference citations available upon request]
Competing interests: None declared

Enough of anti-psychiatric rhetorics 22 December 2003

Sudip Sikdar,
Consultant Psychogeriatrician
Mersey Care NHS Trust, Waterloo day Hospital, Liverpool, L22 3 XR
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Re: Enough of anti-psychiatric rhetorics

Dear Editor,
I was truely amazed that even today Prof Szasz's articles still find their way into esteemed journals like BMJ.His views about psychiatrists and mental illness only adds to the terrible stigma that mentally ill patients already face in society.
The fundamental point that he misses is that no competent mentally ill patient can be sectioned. The sad truth about many serious mental illnesses is that it deems a person incapable of understanding the nature and impact of his/her illness and hence on occasion makes them a danger to themselves or to the society at large, which in turn occasionally necessiates a sectioning. A capacitated mentally ill person still has the rights to refuse treatment.
This particular issue will take a centre stage in British Law via the Mental Incapacity Bill which is going through the parliament as I write. Psychiatric patients further have access to independent advocacy services to uphold their rights.
I hope my colleagues all over the world join me in this column to give a robust rebuttal to Thomas Szasz.
Competing interests: None declared

A Mad World Doesn't Need Headshrinkers 22 December 2003

Dr Lynne Wrennall,
Honorary Fellow
University of Liverpool, L69 3BX
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Re: A Mad World Doesn't Need Headshrinkers

When a person chooses his or her own actions in life and takes responsibility for those choices, they present us with the single most impressive sight on earth. The truly powerful and provocative act of personal choice is what energises life, gives life it�s meaning and is ultimately what makes life worthwhile. When people who are autonomous partner, it is better and not worse, in health and not sickness and they are richer, not poorer for it. And when a people is formed on the interests of each of them they fight with the kind of strength that wins a battle of Stalingrad or stops a war in Vietnam.
To steal choices from people is one of the most pitiable actions a being can undertake. There is no more humiliated posture than a pretentious professionalism bloated by theft of choice. Relationships based on asymmetrical symbiosis are parasitical relationships and deserve no place or quarter. We should have none of them. However degraded the human condition may appear, it got that way by some people denying other people, the right to be themselves. The truth of who we are, is in the choices we make, even if is our choice to give up choice to the people around us, to the person who calls himself a professional.
If Sercombe and Beales (Rapid Responses to Szasz) want to wear coats with very long sleeves, tied around their waists, or take drugs with very psychotropic actions, taking their minds to zero on the Richter scale, I support their right, so long as it comes with informed consent, to do so. I trust them to understand in their own precious moments, the larger rationale for the choices they make. I support the right of Sercombe and Beales to make their own advance directives, mandating whatever compulsions they choose, but I insist that with their claiming of their rights is a mutual obligation to support the rights of others to make different choices. I would expect those who present themselves as experts on people to have the maturity to accept the diversity that dignifies and glorifies what it is to be human.
Further, I applaud the call for orders to restrain abuse. Inducement to psychiatrists to move beyond pill pushing and brain frying to understanding that people are more than their physiology and matter more than the value judgments inflicted upon them, are required. Szatz understands this.
Szazs knows things. He knows, along with Jean Paul Satre that people live by their choices and that if they choose to give up responsibility for the choices that they make, they live under a kind of Nazism. Szazs knows, along with Friedrich Neitsche that greatness follows to those who take their choices all the way down the line, to wherever they may lead. And Szazs knows along with Dosteovsky that it is better to be honestly wrong than dishonestly right. Szazs knows things. He has done more than all the flunkies and other followers of orders could ever do to inspire his contemporaries to reject the roles of patient and punisher. Szazs has inspired sufferers of mental anguish to be more than patients. He has inspired psychiatrists not to shrink heads, but to expand minds, nay, to expand lives.
It is Szazs� responsibility as a psychiatrist to make a people wiser He lives with the conundrum that to so, they must be able to hear him. Sercombe and Beales have that responsibility and that priviledge also. If they can lift humanity for one moment as Szazs has done, they will deserve their positions in society, they will deserve the rewards conferred upon the professions and they will deserve to be called healers of the human soul.
Competing interests: I am committed to Human Rghts and and this influences the research I undertake.

Psychiatric Protection Orders Would Protect Human Rights 22 December 2003

Darby J. Penney,
private consultant
Cambridge, NY 12816 USA
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Re: Psychiatric Protection Orders Would Protect Human Rights

Dr. Szasz�s proposal for the creation of �psychiatric protection orders� is a logical, reasonable, even ingenious response to the serious human rights issues that are inherent in forced psychiatric intervention.
In response to Dr. Szasz�s article, Dr. Daniel Beales calls Dr. Szasz�s views �increasingly out of date.� Over the last four years, I oversaw a project that collected oral histories from over 200 current and former psychiatric inpatients. Most of these people told stories of being traumatized by forced psychiatric treatment - I doubt that they would find the idea of psychiatric protection orders �out of date.� New York State, among others, frequently seeks court orders to deliver multiple electroshock treatments to objecting patients. These patients would benefit from psychiatric protection orders.
A colleague and I are presently curating an exhibit at the New York State Museum entitled �Lost Cases, Recovered Lives: Suitcases from a State Hospital Attic.� Based on the contents of their abandoned suitcases and their case files, we have attempted to reconstruct the life stories of a dozen deceased individuals both before and after their institutionalization. All of these people spent decades in a state mental hospital; as a direct result of forced treatment, their lives were essentially taken from them.
If Dr Beales and Jayne Sercombe, who also wrote a negative response to Dr. Szasz�s article, believe they have mental illnesses and wish to voluntarily seek help from psychiatrists, that is obviously their right. If they even wish to pre-authorize involuntary treatment for themselves, that is also their right. But people who don�t share that view and have found forced psychiatric treatment harmful should have the right to make their own choices, too. A �psychiatric protection order� should be legally available to people who want this protection.
Competing interests: None declared

No competing interest? 22 December 2003

Nestor J. Presas,
former P&A Specialist
Beverly Hills, CA
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Re: No competing interest?

I loved that most psychiatrists declared �no competing interest� while submitting a response to Dr Thomas Szasz article. Apparently they also have the same perceptive omission while interpreting their last paycheck.
The same omission they have when they characterize primitive torturous treatments as �benign.� While conveniently forgetting that such treatments took place in the context of an institution; a closed, insular, prison-like structure where people had been cut off from the rest of society.
The same omission they have when characterizing the legal protections afforded to the �mentally ill� while failing to mention that such protections only came into life as a societal response to the abuses and human rights violations of institutionalized psychiatry, or how corporate psychiatry fought and fights against each step of their implementation. By the way, anyone who has ever attended a commitment hearing knows that 98% of testimony is prosecutorial and offered by a state paid psychiatrist.
As long as psychiatry is part medicine, part law enforcement, its power must be curved by public scrutiny. Specially; since the �provision of mental health care by the government,� has introduced the element of �the state sovereign immunity� to further limit the relief available to a person victimized or, abused, by the system.
The maintenance of a free society demands an active response to assure the balance of power. The proposal by Doctor Thomas Szasz seems as a logical progression in this continuum.
Competing interests: None declared

Great article 23 December 2003

LostBoyinNC (Eric Rucker),
Disabled due to psychiatric abuse
Scotland Neck, North Carolina, USA
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Re: Great article

While I dont agree with Szasz on most issues, I found this article interesting. And its an idea that I would like to hear more about. While I totally disagree with Szasz on the idea that severe mental illness is not biologically based (brain based), I still find this particular idea a good one.
Due to the inherent subjectivity and lack of scientific rigor in psychiatry, many psychiatric abuses do indeed occur. Oftentimes from misdiagnosis or from overzealous "headcase" psychiatrists who like to label their patients with personality disorders and try to pharmacologically treat these personality disorders. Or try to use drugs strictly for behavioral control. From my experiences, which are extensive, "bad vibes" occur between psychiatrist and patient for these three primary reasons:
1) the patient is grossly misdiagnosed and placed on the wrong class of psychiatric medication altogether, which creates a further deterioration in the patient's health. Oftentimes the psychiatrist will refuse to acknowledge they made a misdiagnosis, despite the patient's complaints that they are feeling worse, not better. And will insist a patient continue to take medications despite the complaints of the patient that they are "feeling worse, not better." Usually, the patient has to switch psychiatrists and get a second opinion before their diagnosis/medication is changed to something more realistic and appropriate.
2) when the psychiatrist is a big believer in "personality disorders" and tries to pharmacologically treat these so called personality disorders. Pharmaceutical treatment of personality disorders should be severely curtailed in psychiatry. Psychiatrists who try to focus on a patients negative personality characteristics, rather than focusing on the core underlying Axis One disorder(s) (major psychiatric problems) oftentimes create extremely bad feelings between themselves and their patients.
3) When the psychiatrist tries to use drugs for behavioral control, rather than to treat an actual Axis One disorder. An example of this would be when a psychiatrist uses low dose neuroloeptics to treat agitation or irritability in a mood disordered patient or tries to use neuroleptics to calm down an upset patient who just needs to vent and decompress.
I believe it is time for individuals who have mental illness to take matters into their own hands. Sometimes, this may mean cutting themselves off from the so called "profession" set up to help them...psychiatry. Oftentimes psychiatry takes already unwell individuals...and makes them profoundly worse. While I realize this is hard for some to believe....particularly psychiatrists...its a true statement and many psychiatric patients would agree with me.
Until severe mental illness is formally recognized for what it truly is and formally removed from the psychiatric category and recategorized as Neurological illness...and we begin to see some real high tech improvements in diagnosis and treatment, there will continue to be friction between psychiatrist and patient. As long as psychiatry remains low tech and subjective, in an era when the rest of medicine is high tech and objective in diagnosis, there will continue to be friction between psychiatrist and patient. Until that day occurs, when psychiatry is able to bring itself up to par technologically and science-wise, an idea like Szasz presents here isnt a bad idea.
Additionally, one of the problems in psychiatry is that many psychiatrists have "control" issues. That is, some psychiatrists seem to have an internal need to control some of their patients...some psychiatrists are megalomaniacs.
Sometimes, a person can just be broken totally. Sometimes, a severely mentally ill individual who is already very unwell can be "finished off" by an emotional, violent involuntary or even voluntary hospitalisation. Due to the condescending nature of psychiatric hospitals and dissmissive attitudes of many psychiatrists towards their patients, psychiatric hospitals are more like minimum security prisons than real "hospitals."
I for one would like to see more work on this particular idea Szasz presents here. I believe there are many psychiarists who deserve criminal prosecution for some of the things they have done to some patients. Making it a criminal offense for involuntary committing individuals who want nothing to do with the mental health profession isnt a bad idea.
Competing interests: I hate psychiatry

Dr Thomas Szasz is a Member of the Church of Scientology 23 December 2003

Dr P V F Cosgrove,
Consultant All-Age Psychiatrist
The Bristol Priority Clinic. Bath BA2 5JJ
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Re: Dr Thomas Szasz is a Member of the Church of Scientology

Dr Szasz has completed his article with "Competing Interests: None Declared". Well now, Dr Szasz and the Church of Scientology founded the Citizens Commission on Human Rights in 1969.
Dr Szasz is famous for being the Grand Old Man of Anti-Psychiatry, and he is writing true to form in this BMJ article, which he has called "The Psychiatric Protection Order for the battered mental patient". He proposes a new legal safeguard against psychiatry, which would make it a criminal offence to impose involuntary psychiatric interventions on people protected by the order.
On the website of the Citizens Commission on Human Rights (www.cchr.org)under "What is CCHR?" is a photograph of none other than Dr Szasz himself. And looking dapper and far from emeritus in age.
The answer to "What is CCHR?" is: "CCHR was formed to combat psychiatry's oppression".
It continues: "CCHR members see it as their duty to expose and help abolish any and all physically damaging practices in the field of mental healing".
CCHR claims on its website: "CCHR has documented many thousands of individual cases that demonstrate that psychiatric drugs and other brutal psychiatric practices actually create insanity and cause violence".
And then, consistent with Szasz's 'psychiatric protection order' proposed on the pages of the BMJ, is the following on the CCHR's website: "In fact, a major cause of the drug problem worldwide is the psychiatrist who, for decades, has used his influence as a medical doctor to push extremely dangerous and addictive mind-altering drugs on persons of all ages".
What Szasz would not have dared to mention in his BMJ article, especially since he has declared no competing interests, is that the Church of Scientology is on trial in Florida for the manslaughter of a 36 year old woman, who died of dehydration whilst acutely psychotic over a seventeen day period. They are also charged with unlawfully practising medicine.
In an article in the New York Times, Douglas Frantz reported that this woman, Lisa McPherson, a member of the Church of Scientology, had had a minor traffic accident in the autumn of 1995. She, then, stripped off her clothes and began to mumble.
She was taken to a local hospital where a doctor wanted to provide psychiatric treatment for her. However, several members of the Church of Scientology went to the hospital and removed her, and took her to a Scientology owned hotel. The article in the New York Times (14 November 1998) stated that "The Church of Scientology prohibits psychiatric treatment for its members".
According to the affidavit of the state's medical examiner, Lisa McPherson had been hyperactive, delusional and hallucinating over the 17 days following the accident. During this time, she had tried to harm herself and others.
She was restrained repeatedly and prevented from leaving the room. Perhaps, Dr Szasz, we need a Scientologist Protection Order as well!
She urinated and defaecated on herself repeatedly; she rarely slept; she had conversations with people who were not there; she claimed to be people she was not; she sang and she danced around the room as if giving a performance; she crawled around the floor; she stood on the toilet; she got into the shower fully clothed; she drank her own urine on more than one occasion.
The Scientologists gave her magnesium chloride injections to get her to sleep; they gave her numerous doses of vitamins, herbal sleep remedies and, also, believe it or not, prescription drugs.
On the evening of her death, a Scientologist, working as an Accident & Emergency doctor at a hospital forty-five minutes away, was phoned by the Scientologists. They were advised to take her to the NEAREST hospital but, instead, they took her to this particular Scientologist doctor, who was three-quarters of an hour distant from them.
She was dead on arrival.
The pathologist stated that she had been deprived of water for 5-10 days, and that she had died from a blood clot brought on by dehydration.
All these allegations contained in this newspaper article are being tested in a Florida court at the moment, and a verdict is expected in January 2004.
How, then, did this anti-psychiatry article by Dr Szasz get into the BMJ, when psychiatry is a bone fide part of the medical profession?
How did this virulently anti-psychiatry article get past the Editors' desk, when many psychiatrists are members of the BMA?
The explanation I favour is that there are Scientologists employed in the production of the BMJ.
Sir John Foster QC, MP was commissioned in 1969 by Richard Crossman, Secretary of State for Social Services, to produce a report for the UK Parliament. The Enquiry into the Practice and Effects of Scientology was published in 1971.
Foster says that he was told by Scientologists that there were Scientologists actively involved in the BMA (Section 67). Since that was more than thirty years ago now, I would expect there are more members of this cult employed at the BMA and undertaking work at the BMJ.
There is now evidence indicating and suggesting that there are Scientologists working in the Fitness to Practise Directorate of the General Medical Council of the UK. So be careful all you British psychiatrists especially if Szasz's proposed 'Psychiatric Protection Order' comes into being.
Foster reported to the UK Parliament in December 1971 that, at that time, Scientology organisations had $75 million worth of law suits so far filed against psychiatric organisations and others over the world in the international conspiracy against Scientology. They had been filed for psychiatric efforts to destroy the Church of Scientology, and also for libel, slander and conspiracy (Section 184).
Competing interests: Specialist in clinical psychopharmacology of children, adolescents and adults

There are no scientologists at the BMJ 23 December 2003

Richard Smith,
Editor
BMJ
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Re: There are no scientologists at the BMJ

I can assure Dr Cosgrove that there are no scientologists at the BMJ, and I must confess that his rapid response seems to me to be full of chopped logic.
His argument seems to be:
1.Thomas Szasz had some link with the scientologists�albeit in 1969. ( I don�t know what Dr Cosgrove was doing in 1969, but many people have over 30 years had some strange links. I, for example, copresented some television programmes with Esther Rantzen, but she and I do not share a philosophy.)
2.Scientologists are anti-psychiatry.
3.Some scientologists have done some terrible things.
4.Therefore Szasz�s article is worthless, and the only reason the article can have got into the BMJ is because some of the staff must be scientologists. (Interestingly some of our younger editors have never heard of scientologists.)
The argument is very unconvincing. We published the article because it is well written and raises important ideas. We debated whether we had heard it all before and decided we hadn�t. The idea of a legally enforceable psychiatric protection order is new and interesting. Plus, although some older readers will be familiar with the writings of Szasz, many younger readers will not.
We bother not a hoot that the article criticises some psychiatric practices. Most of what is published in the BMJ criticises some part of medicine. That�s how a discipline advances, and I�m confident that psychiatrists can respond critically to Szasz�s ideas. Indeed, Dr Cosgrove�s response would be more convincing if it were to tackle Szasz�s arguments head on.
Richard Smith, editor, BMJ
Competing interests: I'm the editor of the BMJ and accountable for all it contains.

Rights imply responsibilities 24 December 2003

Angela F Harte,
Consultant Psychiatrist
Maroondah Hospital, East Ringwood, Australia 3135
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Re: Rights imply responsibilities

It is easy to speak of the right of the person to refuse treatment, however all rights are meaningless and their exercise may be damaging if the corresponding responsibilities are not identified and respected.
The right to drive a car relies on the responsibility to learn to drive, to remain alert and unimpaired by substances. The right to make one's own decisions depends on the responsibility that these decisions will not significantly harm one's self or others.
Where a person has accepted the right and responsiblity of driving, and then drives incompetently, whether due to anger, drinking, excessive fatigue or other cause, and causes harm, they are held to be legally responsible. It follows that the hypothetical person who has made a competent advance directive refusing coercive treatment will be legally responsible for all the consequences of their actions when unwell.
Although this contravenes principles of natural justice and reason, this is the reductio ad absurdum of Szasz' arguments. I find this a pity as I have enjoyed many of Szasz' pithy comments in the past.
Competing interests: Psychiatrist

Should endocrinologists assume responsibility for psychotic patients? 24 December 2003

Richard G Fiddian-Green,
None
None
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Re: Should endocrinologists assume responsibility for psychotic patients?

"Anyone who sees a psychiatrist needs his head read": Sam Goldwyn.
My interest in this subject extends beyond my academic interests in the neuropsychiatric effects of an intracerebral energy deficit(1), the body-mind split (2), and metaphysics (3).
The worst decision I made in my life was to agree to see a psychiatrist some ten years ago to reassure someone close to me that some of the observations I had made were not a figment of my imagination. What I discovered very quickly was that psychiatrists are like Brear Rabbit tar babies, once seen by one one is for ever stuck to them. After my initial encounters in which I was admitted and forcefully medicated against my will I refused to have anything to do with the psychiatrists other than to ask when I was to be released from my incarceration. The worst of my cummulative exposure has been the repeated efforts to modify my behaviour with a combination of carrots and the most noxious of sticks and intrusive monitoring of my behavioural responses.
I met some surprisingly normal and worldly psychiatrists, some that were undoubtedly very good at what they called "phenomenology" (ostentatious way of saying taking a good history), some that were the sterotype and on occasion scruffy weirdos, and none that appeared to have any knowledge of intermediary metabolism. I met a number of people who were not medically qualified but had some degree of understanding of psychology. All were incredibly naive relative to those with medical qualifications and appeared to follow printed protocols in their efforts to modify behaviour.
The patients were surprisingly normal. I met a number who had simply pretended to be psychotic with the intention of getting free board and lodging. Some called me the "doctor's spy". I cannot remember ever having met one that was overtly psychotic, although all were medicated. I did, however, see a few who were subnormal and were in the wrong institution. A lot of patients were drug abusers and those who had to be tied to their beds were usually suffering from withdrawal symptoms. The side effects of the medications were ubiquitous, so ubiquitous that those pretending to be psychotic became skilled in faking the motor side-effects.
I was forcefully administered Haldol in full doses under court order. The effects were not apparent for awhile. The most restricting were the interference with my facial musculature, and my ability to speak fluently and to shave. The latter was of the greatest interest for I lost almost all knowledge of what too do when I shaved, from the descriptions I have since read almost as though I had a split-brain. The net effect it took me infintely longer than usual. It was in short a completely dehumanising effect. What is more it took almost six months for the effects to wear off after I was able to discontinue them and refuse to see a psychiatist ever again.
The most destructive aspect of my "battering" has been the destruction of my relationships with those who were once close to me. I, for example, have never been told what was supposedly wrong with me but I believe my family have. If they have they have never disclosed the details to me and that in itself has destroyed our relationship and my credibility in their eyes. On one occasion when I agreed to meet with the psyciatists and my family I was told, "there are two hypotheses, the one is that you are ill and the other is that you ar not". That this psychiatrist was an effeminate sterotype did not help matters. I have never seen him or any other psychiatrist again.
As all legal rights to managing my own affairs were taken from me in court, again for reasons unknown to me, it would not surprise me if the US psychiatrists were holding this right with the intention of forcing m to return to them for follow-up or possibly to make sure that my family remained rsponsible for my financial affairs such as they might exist.
During my first forceful incarceration I agreed to speak to residents and even students as I was supportive of the teaching of students and confident that my medical colleagues would declre me completely well and discharge me. The first psychiatrist I met and who declared me ill and in need of treatment after just a ten minute interview, from which I walked out in disgust, did just that and put it in writing, but his colleagues would not accept his opinion! The ball he had started rolling has yet to stop rolling ten years later. What is more I have yet to be told what is supposed to be wrong with me. I am quite sure there has never been anything wrong with me except when I was medicated.
What has been very revealing to me has been the inability of most professionals I have met with in this regard to even accept the possibility that some of my allegations might have been true. Indeed it has been clear to me from early on that I would be declared insane if I were ever to disclose them during the course of a professional consultation. But the legal position in which I find myself is not directly their fault. It is the fault of the lawyers, and their decisons are based upon the opinions of "expert witnssess" and a very rudimentary understanding of the relevant medical issues. No jury was ever involved in my cases. There was no examining of the evidence I had accumulated. I was, however, given five minutes in which to make a statement.
The bottom line is that there are no objective means of establishing or rejecting a psychiatric diagnosis with any certainly especially in criminal cases especially as most would seem to be the products of an intracerebral energy deficit. Hence my suggestion that the recent supreme court decision had in effect put the psychiatrists and even psychiatry on trial (4)
Giving patients legal rights to refuse treatment will not resolve the issues because of the stigma associated with psychiatic treatment. A more radical solution is needed. Removing all legal rights from psychiatrists would seem to me to be mandatory. The question is whether psychiatry as a discipline should be abolished. There are good grounds for doing so, not the least of which is their apparent ignorance of the relevant metabolic and endocrinological issues.
If then psychiatry is abolished who will take care of this supposed explosion of psychiatic disorders? Is there an explosion or is it an exploson of billable diagnoses based upon an ever expanding glossary of new "psychiatric disorders" most oif not all of which are normal variants? Who then should be responsible for evaluating supposedly overtly psychotic patients? Any doctor who is sufficiently well versed in intermediary metabolism and its consequences and can tell whether there is organic inracerebral disease, and that may have very little if anything to do with neurotransmitters and fMRI scans. Who then should the make judgements on mental health in criminal cases? The clergy, therapists, GPs, consultant physicians or surgeons, or the courts?
I submit that forceful incarceration has no place whatsoever in our profession for it presents an unacceptable conflict of interest. What is more most psychotropic drugs violate the principle of "first doing no harm". The real issue is whether psychiatry should be abolished as a subspecialty. I think it should for the simple reason that has such a bad history and has completely discredited itself. Perhaps the solution is to shift the care of these patients to another subspecialty. The most logical would seem to be endocrinology and metabolism provided the mistake of giving psychiatrists the legal right to detain against their will patients who do not have an energy deficit is not repeated.
1. Debbie A Lawlor, George Davey Smith, and Shah Ebrahim Association of insulin resistance with depression: cross sectional findings from the British women's heart and health study BMJ 2003; 327: 1383-1384 (electronic responses).
2. Patrick Bracken and Philip Thomas Time to move beyond the mind-body split BMJ, Dec 2002; 325: 1433 - 1434. (electronic correspondence).
3. Brian Olshansky and Larry Dossey Retroactive prayer: a preposterous hypothesis? BMJ 2003; 327: 1465-1468 (electronic responses)
4. Scott Gottlieb Murderer can be forced to take medication to become sane enough to be executed BMJ, Oct 2003; 327: 889-c. (electronic responses)
Competing interests: None declared

psychiatry should be formally merged into Neurology 24 December 2003

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: psychiatry should be formally merged into Neurology

Richard Fiddian wrote: "If then psychiatry is abolished who will take care of this supposed explosion of psychiatic disorders?"
The answer to that one is easy. Neurology should take over the diagnosis and treatment of severe mental illness. Neurology could provide the high tech neuropsychiatry answers we need to successfully and PROFESSIONALLY deal with severe mental illness. Neurologists should be the ones taking care of individuals with schizophrenia, bipolar disorder and severe forms of depression. Neurology is the branch of medicine concerned with the study of, diagnosis and treatment of diseases of the nervous system. As severe forms of mental illness are increasingly being recognized as being brain based illness, ie; physically based, its only logical that Neurology take over.
Why have two separate branches of medicine treating brain disorders? Thats stupid. Especially when one of them is more technologically advanced and more scientific minded (Neurology).
As far as the "lesser" forms of mental illness such as mild to moderate depression and most anxiety disorders, Internal medicine and family doctors could take over there. With the modern class psychiatry mediciations available now, its extremely safe and easy for a family doctor to prescribe antidepressants and anxti-anxiety medications. There is no need to go to a "psychiatrist" for the cumbersome and sometimes dangerous prescription of old line psychiatry drugs such as Tricyclics and MAOIs anymore.
Between Family medicine and Neurology taking over, there would be no need for psychiatry at all. It could be dissolved, its "behavioral control" aspects done away with forever and remembered with as some form of quasi-fascist aberration.
Another thing Richard, Id suggest you read some of the things by maverick Neuropsychiatrist Dr. E. Torrey Fuller, MD. Here in the USA, Dr. Fuller is a full advocate of formally merging psychiatry into Neurology.
To summarize, it comes down to this in the "real world."
1) Internal/family medicine could (and already does) successfully diagnose and treat most forms of depression and anxiety. At least here in the USA this is the situation. Psychiatrists here in the states are losing A LOT of patients to internal medicine doctors.
2) Psychiatry is mostly for behavioral control, not to figure out, diagnose and treat complicated, brain based Neuropsychiatric illnesses such as schizophrenia and severe depression. Psychiatry is distastful, unAmerican and should be dissolved as a separate branch of medicine.
3) Neurology is the branch of medicine that deals with diseases and illnesses of the nervous system or the neuroendocrine system. There is a growing minority in the USA that advocates the Neurological takeover of the so called "mental health" profession.
If Neurology was running the show instead of psychiatry, there wouldnt be all these abuses to begin with. We wou
Competing interests: I hate psychiatry

Dr Szaz's BMJ article cannot have been peer reviewed 27 December 2003

Dr P V F Cosgrove,
Consultant All-Age Psychiatrist
The Bristol Priority Clinic BA2 5YD
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Re: Dr Szaz's BMJ article cannot have been peer reviewed

The Editor of the BMJ, Dr Richard Smith, discussed Dr Szasz's article with his colleagues and decided to publish it because it is well written and raises important ideas; and because the idea of a legally enforceable psychiatrist protection order is new and interesting.
He also decided to publish it because many younger readers are not familiar with Szasz's writings and, therefore, need to be educated.
In his desire to educate younger readers, Dr Smith has focused on one single idea of Szasz, namely the enforceable psychiatrist protection order. In doing so, he has, in my opinion, failed to educate anyone about Szasz but, instead, he has succeeded in using the pages of the BMJ to broadcast the anti-psychiatrist position of the Church of Scientology, to which Dr Szasz belongs.
I will endeavour to tackle Szasz's BMJ article "head on" as the Editor has requested but, first, I would like to deal with Dr Smith's statement that "Szasz HAD some links with Scientology - albeit in 1969".
I appreciate that the Editor was in a hurry to get his Rapid Response published as soon after mine as he could, but it would have been wiser, I believe, if he had looked at the Church of Scientology's website of www.cchr.org. If he had done this, he would have seen that Dr Szasz's links with Scientology are NOT in the past but are very much in the present.
He would have seen that, on 25 December 2003, Szasz had allowed his photograph to be placed adjacent to a flashing advertisement entitled "There is no science to psychiatry only: Graft; Misappropriation; Pretended Authority; Betrayal; Abuse; Greed"
If our Editor or one his staff had done a Google search for "Dr Thomas Szasz", they would have found that the Church of Scientology honoured Dr Szasz in 2000 (and not "albeit in 1969") for founding the Citizens Commission on Human Rights (CCHR).
Part of the honour was to give a lecture in which Dr Szasz stated: "Psychiatry is probably the single most destructive force that has affected American society within the last fifty years".
The co-founder of CCHR with Szasz in 1969, Jan Eastgate, described Szasz as being "An outspoken critic of his profession...."
Then she goes on to say, "Szasz has unflinchingly lambasted his fellow psychiatrists for their abuse of power, (for their) unconstitutional, involuntary commitment laws and their use of insanity defence".
So, "our dear colleague", Szasz, has lambasted those of us who are his "fellow psychiatrists" for our abuse of power. And now, in the pages of the BMJ, he continues to lambast his "fellow psychiatrists" by recommending a psychiatrist protection order.
As part of his unflinching lambasting, Dr Szasz went on during his great day of being honoured by Anti-Psychiatry in April 2000, to say, "My urgings that psychiatrists confront the legitimacy of their power have forced them to chew on a bone that got stuck in their throat".
"They can neither...acknowledge that they are the only medical specialists whose practice rests on coercion, nor can they...repudiate the use of psychiatric coercion".
Our Editor has allowed the BMJ article to be printed with the following comment and without any debate on the matter in the same edition of the journal, for which he is fully responsible in terms of content.
He has allowed Szasz to say unopposed, "The psychiatrist has no other legitimate duties or roles; only the job of the coercive psychiatrist is legitimate and proper". This is simply not true, and our Editor should have recognised this.
Patients are treated by psychiatrists WITHOUT coercion and WITHOUT being inpatients. Patients are caused to be relieved of their suffering by their voluntary partnership with a psychiatrist. And such treatment and such relief of suffering ARE legitimate roles and duties of the psychiatrist.
It is, therefore, sheer nonsense for Szasz to state that "the psychiatrist has no other legitimate duties or roles" except the job of being coercive to patients. And for our Editor to have allowed this into publication makes me wonder seriously whether he has had this article by Szasz peer reviewed.
Szasz's paranoia extends beyond psychiatrists for, in his last paragraph in the BMJ article, he complains that "Doctors, politicians and journalists assert that mental illnesses are real diseases and that psychiatrists are real doctors".
Well, well! Dr Szasz expands his professional range of targets to include doctors who are not psychiatrists, but who frequently call upon the help of the psychiatrist when they are faced with acutely suffering patients in the community.
He includes politicians who have the democratic responsiblity to ensure a system of care and treatment for those who suffer psychotic illnesses.
Politicians do not want young people like the Church of Scientology member, Lisa McPherson, to die of dehydration because they have failed to recruit, train and enable psychiatrists to treat such psychotic people properly, without resorting to magnesium injections, herbal potions and a random assortment of prescription drugs.
Like doctors, politicians are all intelligent people with a wisdom far superior to that of Dr Szasz.
Our Editor asserts that this article he has published by Szasz is well written. Well, is that so? There are so many important words which he has allowed Szasz to lace with inverted commas, thus indicating a double meaning but without adequate explanation, that we are justified in asking once again: "Was this BMJ article ever peer reviewed?"
Was it peer reviewed by some of Szasz's "fellow" psychiatrists, by those he has "unflinchingly lambasted" throughout his long life? The answer must be no since peer reviewers would have insisted on this article being re-written to reduce, if not to remove, these words enshrouded in inverted commas.
This BMJ article should never have appeared without psychiatrists being given a right to reply to it in the same edition. To have done so would have enhanced the educational value for younger readers.
Dr Smith has done a great disservice to honest, caring psychiatrists and to fair and balanced education.
And finally, Dr Smith says that some of his younger editors had never heard of scientologists. Why should he record the responses of the younger members of staff only?
For, after all, the Church of Scientology has been around long enough for staff members of his own age, not only to have heard of scientologists, but also to be members of the Church of Scientology as well - or older, like Dr Thomas Szasz.
Competing interests: A caring, non-coercive psychiatrist who works in partnership with patients and parents who voluntarily choose him to heal them of their suffering.

Re: Dr Thomas Szasz is a Member of the Church of Scientology 28 December 2003

Nelson Borelli, MD,
Assist. Prof. Dept. Psychiatry
Chicago, IL 60611
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Re: Re: Dr Thomas Szasz is a Member of the Church of Scientology

Prof. Thomas S.Szasz, MD, is not and has never been a member of the Church of Scientology. Dr P V F Cosgrove not may be defamatory. Nelson Borelli, MD n-borelli@northwestern.edu
Competing interests: None declared

Re: Great article 28 December 2003

Nelson Borelli, MD,
Assist. Prof. Dept. Psychiatry
Chicago,IL 60611
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Re: Re: Great article

When Eric Rucker quotes Professor Thomas S. Szasz as: "...severe mental illness is not biologically based (brain based)", he is missrepresenting the author twice. First: Dr. Szasz has said many times, that there is no "mental illness". Second: Dr. Szasz has said, also many times, that if the so called "mental illnesses" are brain illnesses they should be called and treated as such, medically and upon the patient's consent. Nelson Borelli,MD n-borelli@northwestern.edu
Competing interests: The truth

Dr. Szasz's Insightful Analysis of Freedom of Choice 28 December 2003

Thomas K. Zander,
Adjunct Professor of Law
Marquette University Law School
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Re: Dr. Szasz's Insightful Analysis of Freedom of Choice

Dr. Szasz has once again pointed out the inconsistency inherent in freedom of choice when it comes to psychiatric treatment. In my years of providing legal representation to person facing civil commitment, it was always interesting for me to observe that most psychiatrists considered all decisions to accept psychiatric treatment to be "rational" and "competent," whereas any decision to refuse it was "irrational" and "incompetent." As Dr. Szasz notes, the same inconsistency exists with respect to psychiatric advance directives: they only apply to decisions to accept psychiatric treatment, and are not valid to prevent it. It is the classic "Catch-22." Dr. Szasz's proposal for psychiatric protection orders would end this inconsistency. Thank you, Dr. Szasz, for reminding us that freedom of choice is never a one-way street!
Competing interests: None declared

Szasz � the same old tune! 28 December 2003

Richard L O'Reilly,
Associate Professor of Psychiatry, The University of Western Ontario
Regional Mental Health Care, 850, Highbury Avenue, London, Ontario, Canada, N6A 4H1,
John E. Gray
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Re: Szasz � the same old tune!

Like many people who work closely with individuals who suffer from serious mental illness I was disappointed to find that Thomas Szasz continues to be given a prominent platform for his views. This is after all the scholar who told us that mental illness was a myth. The assertion, that mental illness was manufactured by society and especially by psychiatrists, coupled with the writings of prominent sociologists in the late 1950s convinced policy makers that negative symptoms of schizophrenia (such as blunted affect, decreased motivation and inability to plan for the future) were the results of institutionalization. They went on to na�vely suggest that by simply throwing open the doors of psychiatric hospitals these people would be free from being labeled as ill and would regain the abilities lost in the institution. In large part because of the erroneous pronouncements of Szasz and others, people with serious metal illness continue to suffer, untreated, on our streets and in our jails.
Regrettably Szasz continues to ignore important facts in his recent article in the BMJ. His persistent opposition to civil commitment requires that he doggedly ignores the many studies that confirm Stone�s �Thank you Theory,� which suggests that civil commitment should be viewed positively if committed patients later concur with the decision that they be involuntarily hospitalized.
Among several factual errors in his article is Szasz�s assertion that courts do not recognize advance directives when the directives reject psychiatric help. In fact, jurisdictions vary in how they approach this issue. In Ontario a previously expressed wish to forego a specific treatment, expressed while competent and applicable to the current circumstances, will be honored. The difficulties with this model were highlighted by the case of Mr. Sevels who expressed a wish to permanently avoid antipsychotic medication. When he was subsequently admitted to a forensic unit, following a serious offence, the inability to provide standard effective treatment resulted in Mr. Sevels spending 404 days in solitary confinement. Hardly a humanitarian way to treat an individual who is ill.
Szasz ignores both the needs of people with mental illness and the complexity of trying to make binding decisions for future scenarios. Of course, if you simply disavow the existence of mental illness you don�t need to address these needs or complexities.
Competing interests: None declared

Your own worst enemy 28 December 2003

Gurli Bagnall,
Independent Patients' Rights Campaigner
Marlborough Sounds 7372, New Zealand
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Re: Your own worst enemy

Like so much in medical science, if conditions are not understood, patients are referred to psychiatrists who need no scientific basis or even knowledge, upon which to make a diagnosis. There is no need for the doctor to touch the patient nor to take samples of blood or tissue for with �x-ray eyes� issued, apparently, along with a licence to practice, the psychiatrist is able to determine that there is a chemical imbalance in the brain. This means that if he has his way, the patient will be enslaved to him and the pharmaceutical industry for life.
This approach has been routine in at least the English speaking countries for about four decades. Unfortunately, as your correspondent, Richard G Fiddian-Green pointed out: � most psychotropic drugs violate the principle of �first doing no harm�".
Examine the history of psychiatry and we find that such �methods� have always been routine. Before asthma, epilepsy, tetanus, gastric ulcers, asbestosis and many more were understood, they were deemed to be hysteria. We have seen the same diagnosis under different names applied to military personnel who suffered the effects of agent orange and exposure to radiation. We have seen the collusion between diagnosticians and politicians who seek to deny responsibility and the subsequent paying of compensation.
We currently see the same political expedience in the diagnosing of conditions such as Myalgic Encephalomyelitis (also known by the misleading title, the chronic fatigue syndrome) and the Gulf War Syndrome. Further, the evidence of conflicts of interest in this pursuit have been confirmed. Professor of Psychiatry, Simon Wessely, is influential in ME and GWS and he has recently made his position on conflicts of interest clear in a letter to the BMJ. He stated: �It is time we all grew up. Everyone has conflicts. Everyone has agendas.� According to his letter, his conflicts of interest currently stand at 53. (1)
Similarly his colleague, Dr. Michael Sharpe�s influence in the insurance field has denied many sufferers of conditions such as ME their legitimate benefits. (2)
We have seen medical �experts� in court argue that defendants are competent to stand trial, while their colleagues testifying for the other side, are equally passionate in claiming they are not.
By way of further examples, we know that psychiatrists are engaged in torture under certain regimes by using psychotropic substances (3) - the same substances referred to by Fiddian-Green; and we know that people like Dr. Donald Ewen Cameron betrayed his patients in a Canadian institution by destroying their brains with experimental brain washing techniques on behalf of the CIA. (4)
What it boils down to is this: It is not what people like Thomas Szasz (5) are doing to his profession, it is what the profession is doing to itself.
References:
1. �Enough Already� Simon Wessely http://bmj.bmjjournals.com/cgi/eletters/326/7400/1155#32821
2.�Functional Symptoms and Syndromes: Recent Developments� Michael Sharpe. Trends in Health and Disability 2002 (UNUM Provident)
3. �History of medical involvement in torture � then and now� Giovanni Maio. Lancet, Vol. 357, May 19 2001
4.�Journey into Madness� by Gordon Thomas
5. The psychiatric protection order for the "battered mental patient" Thomas Tsasz. BMJ 2003;327:1449-1451 (20 December, 2003) http://bmj.bmjjournals.com/cgi/content/full/327/7429/1449
Competing interests: None declared

Protecting the Vulnerable from Zealots 28 December 2003

Richard J Winkel,
no medical credentials
University of Missouri Mathematics Dept, 65211
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Re: Protecting the Vulnerable from Zealots

The need for psychiatric protection orders is evidenced by psychiatry's longstanding and unscientific denial of the following facts:
1) despite decades of psychiatric PR claiming an organic basis for most mental illness and promising future scientific breakthroughs that will bear out their optimism, even the APA has been forced to admit that: ""Brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group." (http://www.mindfreedom.org/mindfreedom/hungerstrike1.shtml#september) Scientific prudence would dictate that treatment should be motivated by scientific understanding. Instead the psychiatric research agenda appears to be motivated by an increasingly desperate drive to justify existing treatment paradigms. The fact that some people are helped by these treatments appears to be more a matter of luck than science.
2) in the absence of a scientific justification for the "brain disease" model, and the abundant evidence that powerlessness, social oppression and domestic abuse are major factors in the creation of mental illness, psychiatry's self-assumed role in the social control and non-criminal "policing" arena may well be in conflict with their duty to serve patients' interests. Such conflicts of interest are especially toxic in domestic abuse contexts, where psychiatrists are often hired and paid by the abusers themselves. Professional ethics seems to be in short supply in psychiatry.
3) the well-documented decades of unscientific, faddish, irreversible and often devastating surgical, electrical and chemical assaults on the brains of mental patients, and the resultant trail of broken lives and families, has not resulted in a single public acknowledgement or apology for the harm inflicted by psychiatry. Indeed, institutional psychiatry exhibits the very behaviors (profound denial and lack of insight) which they frequently attribute to psychiatric patients as a justification for involuntary treatments. Perhaps psychiatry itself is in need of some involuntary interventions.
As a survivor and observer of grievous psychiatric assault and injury on my person, my mother and my family, resulting in suicides, brain damage, life long PTS and social, psychological and intellectual devastation, I applaud professor Szaz and hope that his legal strategy might some day be used to protect children from treatments that no sane adult would consent to for themselves.
Richard Winkel
Competing interests: None declared

re: Enough of anti-psychiatric rhetorics 28 December 2003

Annie E Scotney,
counsellor
voluntary sector projects
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Re: re: Enough of anti-psychiatric rhetorics

Dear sir
Whilst, legally, a capacitated mentally ill person has the right to refuse treatment in practice the threat of sectioning is used as a form of coercion to get people to do what ever medical personel want them to do. I've been threatened with sectioning because I declined to watch day time TV, prefering to read a book insted.
Competent mentally ill people can be, and are, sectioned. Talk to user groups and you will find many examples of people who have been abused by a system that is designed to protect them and others. I do not agree with everything Prof Szasz has to say but he is worth listening to with an open mind.
Competing interests: Mental health service user and psychotherapist

Re: Dr Szaz's BMJ article cannot have been peer reviewed 29 December 2003

Nicolas S. Martin,
Executive Director
American Iatrogenic Assoc., Indiana, USA 46240
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Re: Re: Dr Szaz's BMJ article cannot have been peer reviewed

Dr. Cosgrove has issued forth over 1000 words, but nowhere does he address "head on" Dr. Szasz's proposal for a psychiatric protection order.
Cosgrove is very upset that Szasz works with Scientologists in opposing psychiatric coercion. Then, without apparent irony, he declares himself to be a "non-coercive" psychiatrist. Is Dr. Cosgrove, too, a Scientology collaborator? If Szasz is wrong to oppose psychiatric coercion, and wrong to propose a method of preventing coercion, why does Cosgrove make a point of declaring his own disavowal of coercion?
Of course, he doesn't really oppose coercion. Cosgrove notes that he "works in partnership with patients and parents who voluntary choose him to heal them of their suffering." The parents are mentioned, but the children are implicit. It is they who are brought to him involuntarily, and who he, no doubt, "treats" without their freely given permission. Parents authorize psychiatric coercion against their children, just as psychiatrists are given authority by the state to force treatments on adults who are reduced to the legal status of children.
Cosgrove is apparently livid that Szasz's article was published. He says it should have been peer reviewed, as if Szasz were propounding a cure for SARS rather than a moral-legal case against the abuse of individuals. Would Cosgrove have demanded peer review of claims about the treatment of Jews before they were liberated from the Nazi death camps? His inability to distinguish morality from science is emblematic of his profession. It points to the core of Szasz's critique.
It is revealing that Cosgrove knows pre hoc what the result of a peer review of the Szasz article would have accomplished. It would have stripped it of meaning. The reviewers "would have insisted on this article being re-written to reduce, if not to remove, these words enshrouded in inverted commas" which have a "double meaning but without adequate explanation." But Szasz's meaning is clear enough for those who are not anxious to deflect his moral scrutiny. For Cosgrove, peer reviewers are the Thought Police who censor unauthorized ideas.
How far have we traveled down the road to what Szasz long ago labeled the "therapeutic state"? Very far, as Cosgrove illustrates when he says, "Like doctors, politicians are all intelligent people with a wisdom far superior to that of Dr Szasz." In his medical paternalism, Cosgrove echoes Plato, who was an early advocate of coercive medicine administered by wise politicians and doctors."(1) Cosgrove is more modern than Plato, so he would like this tyranny applied in a "democratic" way.
Cosgrove can't help but use psychiatry to label Szasz, who he says suffers from "paranoia," which is not mere hyperbole to a psychiatrist. It is one reason why people are stripped of their freedom, restrained, and medicated. Why does he diagnose Szasz as suffering from mental illness? Because, says Cosgrove, Szasz writes that "Doctors, politicians and journalists assert that mental illnesses are real diseases and that psychiatrists are real doctors." It is amazing how little evidence is required for a "caring" psychiatrist to develop a diagnosis of mental illness. (And do those people not make that assertion?) Szasz has the authority to counter this sort of psychiatric smear, but what about the rest of us?
I don't have a DSM nearby to consult, but I fear for Cosgrove's liberty if careless accusations have been declared a personality disorder. He says that Szasz "belongs" to the Church of Scientology, but, as Szasz has said repeatedly, he has never been a Scientologist. He has chosen to work with them in their opposition to psychiatric violence.(2) Anyway, what is it about Scientology that so scares Cosgrove? If it had a history of brutality and quackery comparable to psychiatry's, I might worry. But nothing like lobotomy has entered the practice of Scientology. I guess I'm obligated to add that I've never been a member.
1. T. S. Szasz, "The Moral Physician," http://www.iatrogenic.org/library/ moralphysician.html
2. J. A. Schaler, "Statement by the Owner and Producer of the Site," http:/ /szasz.com/enemies.html
Competing interests: None declared

You need to compartmentalize your emotions on this one 29 December 2003

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: You need to compartmentalize your emotions on this one

I sit back and read the many responses to Szasz's great idea here. Some are very very emotionally anti-Szasz and against his idea. Others think he is right on.
I will be the first one to say I strongly disagree with a large part of what Szasz has to say about mental illness. His claim that mental illness is a creation of psychiatry and that basically it doesnt exist is laughable to me. I know for a hard fact that mental illness does exist and I know its biologically based. I know for a hard fact that severe forms of mental illness destroys lives and families and there is no hope in being in denial about it as Szasz and similar "anti-psychiatrists" are.
However at the exact same time, I also realize that the present state of psychiatry is a sorry state. A malpractice attorney once told me that "there are more complaints about psychiatry than any other branch of medicine." I realize that psychiatry has a bad name and has a bad name for very good reasons, that its extremely subjective, its unscientific compared to other branches of medicine and that it has a long history rife with all kinds of abuses. Basically...psychiatry is a joke.
I realize that while serious mental illness is biologically based, the present technological state of psychiatry is so primitive as to be absolutely ridiculous. Research spending into the three severe forms of mental illness is pathetic compared to what is spent for cardiovascular disease, cancer research, AIDS and infectious diseases, sports medicine, etc. Psychiatry is fifty years behind that of general medicine scientifically and technologically. Its just something to be ashamed of. If I was a psychiatrist, I would be ashamed of myself and would feel guilty all the time for claiming that I was a "Medical Doctor." Psychiatrists are Medical Doctors in name only...the general public thinks they are mostly quacks and is intuitively distrustful of psychiatry.
Personally, I think of psychiatrists as being in the same category as chiropractors and podiatrists. You might call them "doctor" to their face in their office out of politeness, but what you are really thinking is "this guy is a quack."
I have been encouraged by many people, including my own family, to cut off my ties with psychiatry. But I keep going to one, to get my drugs. The drugs only work halfassed, they are better than nothing but they keep me alive. But thats all the drugs do. They dont restore me to a fully functioning person, to anything like I was before. And there are tens of thousands of others...probably hundreds of thousands...who are on longterm disability despite psychiatric treatment.
I personally have never been involuntarily committed or "sectioned" as its obviously called in the UK. Ive been treated outpatient for about six years for severe depression and my only hospital experience was a nine day voluntary hospitalisation in a private hospital that involved MAOIs. That was ENOUGH for me. I came out of that place feeling twenty times worse than when I checked in. It was the single worst experience of my entire life. And my experience didnt even begin to compare to others, who have been involuntarily committed. I didnt have a high opinion of psychiatry before that hospitalisation, but that experience finalized my opinion of psychiatry. It made me a lifelong enemy of psychiatry.
I did indeed come out of the hospital feeling "battered" emotionally and psychologically. Basically, I came out feeling like I had been in a minimum security prison for nine days. You are treated like a kindergartner in there, not like a grown man or an adult. It was insulting and ridiculous and had an extremely negative effect on my "mental health." You get no respect. Anybody who claims a psychiatric hospital experience builds you up as a person has got rocks for brains.
You are supposed to come out of a hospital feeling better than when you went in...but with psychiatric hospitals many patients oftentimes complain they feel worse afterwards. Why is that?
It was in my hospital experience that I finally decided that psychiatry was a big pile of shit. It simply does not work a large percentage of time, particularly for the more severe cases of mental illness. Nobody really likes it except the psychiatrists themselves, psychiatry has a bad name and always will have a bad name. There is nothing psychiatry can do that will ever truly change its reputation. Because their reputation is rooted in decades of charlatan, quackery type "medicine."
As I said before, psychiatrists deal sometimes with complicated brain illnesses that really should be dealt with by Neurology. What we really need is NASA space technology applied to the human brain. But what we get in the real world is a bunch of psychobabblers who prescribe crude psycho-tropic drugs and diagnose by outward behavioral checklists and who have no medical tests to administer to their patients to confirm diagnosis. And know jack diddly about the brain and little about the true pathology of severe mental illness.
So therefore, until we as a society someday reach that hypothetical era when severe mental illness is diagnosed much more objectively and treated more professionally, an idea like Szasz presents isnt a bad idea at all. To legally protect individuals who want nothing to do with the subjective, scientifically inept, so called branch of medicine known as "psychiatry."
Its important to try to forget for this particular article that Szasz is one of the all time greatest anti-psychiatry psychiatrists. Compartmentalize your feelings and emotions regarding Szasz himself and just focus on this one particular idea. Its a long overdue idea and its desperately needed for the no telling how many individuals who have been abused by inpatient psychiatry. Abuse comes in many forms in psychiatry...both straightforward physical abuse as well as more subtle forms of abuse. I realize for many of the individuals posting on this board it is extremely difficult to take anything Szasz says seriously. But you must have the strong minded mental discipline to separate your negative feelings for Szasz himself from this idea.
Psychiatry is a joke, always has been a joke, always will be a joke and this idea Szasz presents is an excellent way to protect individuals from the big joke known as psychiatry.
There wouldnt even be a need for a discussion like this if Neurology was running the show. Neurology wouldnt tolerate the CRAP that goes on in psychiatric hospitals.
Competing interests: I know the truth. That psychiatry is quack medicine

"Battered mental patients": Christmas article 29 December 2003

M E Jan Wise,
Consultant Psychiatrist
Brent East CMHT NW2 6BX
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Re: "Battered mental patients": Christmas article

Dear Editor,
Professor Szasz writes entertainingly (1). I am sorry to report that he has misunderstood the scale of the problem. It is not merely one of patients wishing to divorve their doctors, but of those who have fallen in love with another being coerced into an unwanted relationshio by domineering parents(2)! Health care profesionals can find themselves battling not with patients clamouring to remove a diagnostic label, but who battle to obtain one - for social or economic reasons (3). Many staff would wish to divorce than stay together in an unproductive union. In today's climate of risk reduction, may I suggest that, it is the staff who have the greater need of a protection order.
1 Szasz T. The psychiatric protection order for the "battered mental patient". BMJ 327; 1449-51, 2003.
2 Managing dangerous people with severe personality disorder. Home Office, HSO, 1999.
3 Littlewood R & Lipsedge M. Aliens & Alienists. Routledge, London, 1989.
Competing interests: Consultant psychiatrist for a deprived community

Civil rights and Mental Illness 29 December 2003

Christopher J O'Loughlin,
Psychiatry SpR
Bury St Edmunds, UK, IP33 2QZ
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Re: Civil rights and Mental Illness

Dear Sir,
As a practicing psychiatrist in the NHS and "Section 12 approved" under the 1983 Mental Health Act I am interested in the balance between civil liberty and appropriate treatment for mental illness. I have found in my career, in fact, that psychiatrists in general have a far greater understanding of this tension than their general hospital colleagues, and have often been asked to see patients on medical and surgical wards who are choosing to take a course of action other than that recommended by their doctors.
There is a particular difficulty in England and Wales as the 1983 Mental Health Act is not a "capacity-based" Act, and despite substantial recommendations from many quarters the current government has been more inclined to revise and extend a Mental Health Act than reconnect the artificial splitting of the "organic" and "functional" with Incapacity legislation. It is therefore quite possible (despite the Rapid Response of Dr Sikdar) for a compentent but mentally ill patient to be detained and treated under the current Mental Health Act if it is to a "nature or degree" that makes hospital treatment appropriate and it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment. Indeed mental illness is undefined in the Act, whereas the other types of mental disorder allowing detention (mental impairment, severe mental impairment and psychopathic disorder) are defined, and incapacity is not part of the criteria for detention at all.
It is also the case that a large proportion of patients without capacity (often due to acute confusional states or dementia) are treated under Common Law on medical or psychiatric wards without any of the safeguards that the Mental Health Act would provide (though perhaps also without the stigma) and, as long as the patient is not actively trying to leave, this has been supported by the House of Lords in the Bournewood ruling.
Szasz article, however, remains unsatisfactory for several reasons:
1) While Szasz quite rightly points out the rights a competent medical patient has, and does not address what should happen with patients without capacity, the arguments he uses would equally apply to all patients with or without capacity. I remain unconvinced that Szasz really believes that only consenting patients should receive treatment (considering, for example, unconscious patients, acutely confused patients and patients with advanced demetia).
2) Szasz gives the example of a patient with schizophrenia deciding whether or not to receive treatment, but does not address the difficulties of "insight", with "loss of insight" reported to be the most common symptom in schizophernia. This has profound implications for capacity to accept or refuse treatment and while I acknowledge that many believe "insight" simply to be a measure of the degree of agreement with the psychiatrist, feel that this fundamental point needs to be addressed in any discussion of this sort.
3) The suggestion Szasz makes of a "psychiatric protection order" and "divorce" does not draw any distinction between a number of different relationships someone may have with mental health services, eg patient- psychiatrist, patient-hospital or patient-"the whole system", or how far the "protection order" is to be extended.
4) Szasz makes no comment about how to predict future eventualities, and does not allow for unforeseen happenings (such as new illness or incapacity) to overcome the formal "protection order". Other medical wills are specific to foreseen events rather than all-encompassing on a relationship between doctor and patient.
I look forward to Szasz' future challenging writings and hope he will keep this issue alive for a long time to come.
Yours sincerely,
Dr Chris O'Loughlin MRCP MRCPsych
Competing interests: None declared

re: your own worst enemy 29 December 2003

Angela Kennedy,
Social Science Lecturer
Open University
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Re: re: your own worst enemy

Dear Sir,
This correspondence does not intend to adhere to the implied claim that �all psychiatry is bad�. However, I suspect that psychiatry, as a discipline, if it is not careful, will eventually become most ridiculed over its adherence to one theme: that of �somatization�. Presently, sufferers of Myalgic Encephalitis (also called Chronic Fatigue Syndrome) are increasingly subject to medical negligence or even abuse because the huge body of international bio-medical evidence is ignored, especially in Britain, in favour of an unfortunately incomprehensible, incoherent and empirically inadequate theory. �Somatization� and its companion terms (�Hysteria�, �Psychosomatic�, �Psychogenic� even �Neurasthenia�) appear to be part of a �Gothic Revival� (1) in psychiatry, in which words such as �hysteria� are used by certain psychiatrists without irony, as if the tide of academic critiques of that branch of psycho-analysis had never happened.
What is worse, the idea that an illness is �all in the mind� is often based on what can only be described as �sexist� notions, as the term �hysteria� and its companions are most often applied to women, (2) and also, in the case of ME/CFS, to children and their carers, again, mostly women. The empirical inadequacies around the Munchausen�s Syndrome By Proxy diagnosis of mothers of Sudden Infant Death Syndrome victims (in the news recently), for example, apply also to many young ME/CFS sufferers and their carers. (3). Even worse, the categorisation of an illness as being psychosomatic also means a further categorisation of an individual as �deviant� rather than �ill�, so that they are denied sympathy, support, and even benefits they are entitled to (and this happens to many other sufferers of illness classified as 'mental'). Categorised as �deviant�, the ill then suffer increasing social exclusion and material inequalities. As far as I can see, medicine�s role in this categorisation of deviance and its effects has not yet been adequately explored or critically reviewed within its own field, and this is a serious problem that needs to be addressed.
The main problems with somatization theories is that they cannot be either proven or disproven, (a la Popper), and therefore are not very �scientific� at all. Whereas most theories in the �social� sciences or humanities have to abide by this disclaimer, some practitioners of psychiatry, amnesiac as to the origins of their discipline, seeing it as a �medical� or �natural� science, usually never bother. But they REALLY should. Instead, in relation to ME/CFS at least, flawed, unsubstantiated theories have been uncritically adopted and treated as �fact�, even against the already substantial (and substantiated) body of bio-medical evidence which continues to grow. In this respect, psychiatrists are not alone:some paediatricians and even General Practitioners have been guilty of this.
The material effects of such sloppy �science� has had two main (though not the only) consequences for ME/CFS sufferers: Firstly, the medical impairments of the illness have often been ignored and left untreated, and many sufferers therefore become severely disabled, their physical health absolutely devastated and their chances of a restoration to good health uncertain at best. (4) Secondly, children in particular end up victims of institutional abuse (though this can happen to adults too). In the case of children, they may be forcibly removed from their concerned parents and subjected to draconian �treatments� (5) that could also, quite easily, be termed abuse, and for which the need for legal protection from psychiatry as described by Szasz would apply. The capacity for abuse of institutional power appears to have increased enormously, and this is becoming most evident in the fields of health care and particularly psychiatry. How such problems are addressed will determine the future of such disciplines, as far-reaching demands for justice from those who are faced with or survive such institutional abuse are inevitable, and this will lead to a critical review of medical practice, both from other disciplines, and society at large.
FOOTNOTES
1. This term was first suggested to me by a colleague whose interest lies in the historical cultural constructions of women�s illnesses.
2. One exception to this is the categorisation of psychosomatic to Gulf War Syndrome Sufferers, in which male soldiers form the majority. However, I have seen their suffering categorised as being similar to �shell shock�, or post-traumatic stress disorder, for which many men were executed in World War 1, yet another example of how any form of suffering can be categorised as �deviant�.
3. Here I part company with Szasz somewhat as his analysis of the family as a source of abuse is rather generalised in the above article and does not take into account dynamics of power within the family itself, for example.
4. Hooper, M. Marshall, E.P. Williams, M. �What is ME? What is CFS? Information for Clinicians and Lawyers, 2001 (Document available on www.meactionuk.org.uk)
5. See, for example, accounts of these in the following: Michell, L. �Shattered: Life with ME� (Thorsons, London, 2003), and Walker, M. �Skewed: Psychiatric Hegemony and the Manufacture of Mental Illness in Multiple Chemical Sensitivity, Gulf War Syndrome, Myalgic Encephalitis and Chronic Fatigue Syndrome� Slingshot Publications, London, 2003.
Competing interests: Carer and Social Scientist studying the cultural myth of 'mind over matter'

Re: The "Battered Mental Paitient"- a different perspective 30 December 2003

Melanie Seaman,
Medical Student & psychologist
University of Liverpool, L69 3GA
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Re: Re: The "Battered Mental Paitient"- a different perspective

An excellent article by Szasz, well done to the BMJ for being openminded enough to publish it. As a former recipient of psychiatric treatment, a psychologist and a current medical student I would agree with Szasz that much of psychiatry is in need of reform and feel that introducing psychiatric protection orders would be an important part of achieving this. While Sercombe and Beales make interesting points I do not believe their positive opinions of psychiatry are shared by the majority of current and former service users. For example, Rufus May, a clinical psychologist and former psychiatric patient describes his experiences of compulsory treatment being cruel and 'like rape' (1). I am involved with various networks of current and former service users and find such views very common.
However I do not see psychiatrists as deliberately out to harm people, far from it. I believe the problems arise due to the narrow- mindedness of the profession, how the medical model is seen as the only way of understanding severe mental health difficulties. Many service users reject the medical model of understanding their problems so understandably are not going to be happy if they are only offered interventions that follow this model. Medical students and psychiatric trainees are taught for example that hearing voices or experiencing unusual beliefs are due to biological illness, which must to be treated with medication. There is no mention of the numerous people such as myself who have recovered from psychosis without medication, or those who find it worse than the original problem. The numerous non-biological frameworks for understanding 'mental illness' barely get a mention, the varied and often highly patient approved psychological and other non-drug interventions have a similar fate. Until psychiatry becomes more accepting to other models of understanding and intervening with mental health problems, and starts taking seriously the opinions and values of those it aims to help then it will not stop being viewed and experienced as abusive.
(1) The Guardian, September 20, 2000
Competing interests: None declared

Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians? 30 December 2003

Richard G Fiddian-Green,
None
None
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Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?

In his rapid response Eric Rucker suggested that it might be more appropriate for neurologists to investigate and manage patients with "mental disorders". Neurologists are very good at detecting subtle evidence of neurological dysfunction, usually ireversible neurological damage. In their ability to detect subtle "phenomenological" changes psychiatrists might, however, be better able to detect early and therefore reversible neurological disorders or diseases. In other words a neurologist's diagnostic skills might be much less sensitive but much more specific than a psychiatrist's.
Phenomenology, or taking a good psychiatric history, would seem to be a clinical skill that should not be lost. It is, however, one that needs to be complemented by metabolic measurements. These would seem likely to improve the specificity and accuracy of a psychiatrist's or for that matter any doctor's ability to detect and manage psychiatric disorders and diseases. A good physician or better yet an endocrinologist would seem far better qualified in this respect, hence my suggestion that psychotic patients be referred to endocrinologists rather than to psychiatrists.
Since it is symptoms, in this case mood or behavioural changes, that leads patients to seek professional advice in the first place what would seem to be needed is a doctor skilled in phenomenology, neurology, endocrinology and metabolism. If, however, thought and executive decison making are entirely bosonic [waves of energy] as opposed to fermionic [ordinary matter] events an intimate knowledge of theoretical physics including quantum theory would also be desirable.
Upon re-reading Steven Hawking's book, "The universe in a nutshell", I was struck by an illustration of an old "His Master's Voice" gramaphone (1). The caption read, "The area formula for entropy---or number of internal states---of a black hole suggests that information about what falls into a black hole may be stored like that on a record [hence the illustration], and played back as the black hole evaporates". The illustration showed information entering the speaker and presumably being stored on a record. That is precisely what has been suggested might be one of the practical implications of the Alice hypothesis which has become increasingly credible to my thinking(2,3,4).
If the Cartesian body-mind split is real, as proposed in the Alice hypothesis, then neuropsychiatric diagnoses and indeed all diagnoses could become computer diagnoses. What is more the theoretical potential to "cut and paste" information whilst it is stored on a computer might even provide the means to cure neuropsychiatric disorders and perform operations and even transplants. In which case diagnosis and treatment could become the exclusive domain of radiologists, physicists or even mathematicians.
I might have been much closer to the truth than I realised when I suggested that Steven Hawking might be a miraculous product of this kind of technology and even a back-up copy of a former self(4). The starting point of my exploration of theoretical physics was, however, observations of snails, cats, rabbits, people physical and meteorological events as unreal as this and that I was unable to explain from my understanding of Newtonian physics. [I completed the first year of a mechanical engineering degree before reading medicine].
1. Steven Hawking. The universe in a nutshell Bantam Press, London, 2001, pp 62.
2. Patrick Bracken and Philip Thomas Time to move beyond the mind-body split BMJ, Dec 2002; 325: 1433 - 1434 (Electronic correspondence).
3. Brian Olshansky and Larry Dossey Retroactive prayer: a preposterous hypothesis? BMJ, Dec 2003; 327: 1465 - 1468. (Electronic responses).
4. Anthony Campbell Why are miraculous cures mainly of cancer? BMJ 2003; 326: 106b (Electronic correspondence).
5. Brian Olshansky and Larry Dossey Retroactive prayer: a preposterous hypothesis? BMJ, Dec 2003; 327: 1465 - 1468. (Electronic correspondence).
Competing interests: None declared

Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians? 31 December 2003

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?

>In his rapid response Eric Rucker suggested that it might be more appropriate for neurologists to investigate and manage patients with "mental disorders". Neurologists are very good at detecting subtle evidence of neurological dysfunction, usually ireversible neurological damage. In their ability to detect subtle "phenomenological" changes psychiatrists might, however, be better able to detect early and therefore reversible neurological disorders or diseases. In other words a neurologist's diagnostic skills might be much less sensitive but much more specific than a psychiatrist's. >
What I was saying is that there is now enough scientific evidence available to formally remove schizophrenia, manic depression and major depression from the "inorganic" categories and formally recategorize them as having "organic" causes. In other words, there is no longer reason to let psychiatrists treat these individuals. If it is indeed true that the severe forms of mental illness are brain based illnesses, then Neurology would be a more appropriate branch of medicine for these problems.
Psychiatry is for treatment of "diseases" which have no organic (physical) underlying cause, ie; "your just crazy or hysterical, there is nothing wrong with you." Whereas Neurology is the opposite...it is the branch of medicine that deals with organic disease and illness of the brain and CNS. As I have repeated many times so far, the severe forms of mental illness are increasingly being rooted to organic (brain based) dysfunction and disease. As well as to genetic links.
Its time for fundamental reform of the way severe mental illness is thought of and treated. In my opinion, only Neurology could provide this approach.
By letting Neurology handle schizophrenia, manic depression and severe forms of depression society would truly be liberating the severely mentally ill. By admitting openly that these are real physically based diseases, that its not "all in your mind." It would remove stigma, it would improve scientific research into these severe disorders as Neurologists are better researchers than psychiatrists or psychologists. Neurology as I stated before is more high tech, more technologically advanced than psychiatry or psychology. That is exactly what the severely mentally ill need. High tech, innovative, creative solutions to their brain diseases.
If Neurology ruled the roost of severe mental illness, its higly likely that abuse would gradually cease to exist due to a more professional approach. The emphasis would be less on "behavioral control" and more on treating actual illness.
Most of the handful of good researchers in the mental health field are board certified in both Neurology and psychiatry. A few are also certified in Radiology...the ones who are involved in functional neuroimaging. By contrast, most of the mainstream practicing psychiatrists are only board certified in exactly that...psychiatry. Their perception of mental illness is narrow and sometimes distorted because of their training as psychiatrists only.
To summarize:
1) its time for patients, their families and responsible members of the medical community to demand that schizophrenia, manic depression and major depression be formally removed from the psychiatric category (inorganic) entirely and placed into the Neurological category (organic category).
2) once severe mental illness is formally redefined as having an organic basis, subsequently dissolve psychiatry as a branch of medicine and have its duties absorbed by Neurology. New Neurologists in training would have severe mental illness added to their Neurology education in medical school. The study of insanity should be a subdivision of Neurology, not psychiatry.
3) Neurologists should be placed in charge of psychiatric hospitals.
Doing the three above things would have a gradual effect on the elimination of "psychiatric abuse."
Obstacles to the above would include:
1) psychiatrists protecting their turf and their lucrative financial private practice. There have always been turf battles between psychiatry and Neurology, at least in the USA.
2) excessively conservative "old line" Neurologists who do not want to deal with the so called "behavioral" components of severe mental illness.
3) Backward, primitive perceptions of severe mental illness, such as the idea that severe mental illness has no organic underlying cause to it. This perception of severe mental illness stymies efforts to study it and provide adequate research funds for severe mental illness. Afterall, if there isnt anything wrong with you, why bother to research it?
Id also like to say that I believe Neurologists should only deal with "severe" forms of mental illness. Most people with mild to moderate "mental illness" can be successfuly treated by internal medicine doctors and talk therapy spedialists. This saves money as well.
According to Dr. E. Fuller Torrey, MD only about 5% of people currently seeing psychiatrists should really be seeing a specialist. He claims that those 5% should really be seeing Neurologists and not psychiatrists, for they have mental illness so severe that only a brain savvy Neurology type approach can have any chance to fix them. The remaining 95% need social support and training in "life skills"...talk therapy, moderate psychopharmacology such as SSRIs, benzos, etc.
Competing interests: I hate psychiatry

Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians? 31 December 2003

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Will neuropsychiatric disorders become the exclusive domain of radiologists, physicists or even mathematicians?

Richard Fiddian wrote: >If the Cartesian body-mind split is real, as proposed in the Alice hypothesis, then neuropsychiatric diagnoses and indeed all diagnoses could become computer diagnoses. What is more the theoretical potential to "cut and paste" information whilst it is stored on a computer might even provide the means to cure neuropsychiatric disorders and perform operations and even transplants. In which case diagnosis and treatment could become the exclusive domain of radiologists, physicists or even mathematicians. >
I dont know what you mean by the "Cartesian body-mind split" but I personally dont believe there is a split between mind and body after experiencing severe mental illness. Basically, everything starts with the brain and the nervous system and goes from there. Sleep, cognition, autonomous functions you dont even think about like breathing and your sex drive...its all ultimately CNS controlled. With severe mental illness, things go screwy in the brain and basic bodily functions like sleep cycles, sex drive and function, appetite, cognition, energy levels all fall apart. I view the brain as just another organ of the body, although much more complicated and poorly understood.
As far as being able to diagnose by computer, this is a bit far off. However functional neuroimaging (SPECT, PET and functional MRI) are all made possible by the computer. Additionally, a psychologist recently informed me of the SCID-One diagnostic test being available on the computer now. SCID-One is a very thorough checklist type test psychiatrists use here in the USA to diagnose major psychiatric illness. It stands for "Structured Clinical Interview for Axis One Disorders."
Being given on a computer, it might be more objective than the other way where you are interviewed face to face by a psychiatrist or psychologist. Afterall a computer doesnt care if a patient looks like crap from being sick, a computer doesnt care if the patient is irritable or agitated, in a bad mood or doesnt want to be there. A computer also eliminates the need for there to be "good chemistry" between patient and psychiatrist. Thats particularly useful in government sponsored mental health clinics where time on with a psychiatrist is extremely limited and a patient oftentimes isnt able to choose who they get as their psychiatrist.
As far as radiologists, physicists and mathematicians being used to diagnose severe mental illness this is not at all conventional or clinically applied. However at the Medical University of South Carolina, the functional neuroimaging research department headed by Dr. Mark George has a full time physicist on hand to help with high tech brain imaging equipment. The research department there also hires at least one mathematician I know of and Dr. George himself is a radiologist in addition to being board certified in both Neurology and Psychiatry. However, the research department there at MUSC-Charleston is NOT AT ALL typical of psychiatry research departments across the USA.
Neurology is already at this moment clinically using functional neuroimaging to help diagnose certain neuropsychiatric conditions like dementia, alzheimers disease, ADD as well as conventional neurological disorders like parkinsons disease. Why psychiatry is so far behind Neurology with functional neuroimaging is beyond me. Psychiatry is behind the times on a whole bunch of things.
An awful lot of the "research" in psychiatry is redundant and stupid. Such as trying to figure out which antidepressant is more effective, which atypical anti-psychotic is better, which psychotherapy is more effective (none are effective for severe mental illness), etc. etc. etc. A lot of the drug research is biased and skewed from the drug companies perspective. And most psychiatrists just go along with it...too many of them are weak minded in the sense that they believe anything the drug companies tell them.
Here in the USA, the NIMH has been criticized for not aggressively studying severe mental illness. NIMH has been criticized for squandering money on silly psycho-social type research. Whereas the money should have been funneled directly into neuro-type research which would have a direct impact on the quality of life for individuals with severe mental illness.
Competing interests: I hate psychiatry

Your own worst enemy 31 December 2003

E.Ann Robertson,
Parent and supporter
RH2 9NR
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Re: Your own worst enemy

Dr.Szaz seems to have opened up a hornet�s nest. Dr. Szaz is from the USA where, from what I have read, psychiatric patients may not be afforded the same compassion that they might be in the UK. If Dr.Szaz does, as suggested, have connections with the Church of Scientology there is a certain amount of hypocrisy at work here. Was it not this very Cult that was outlawed in the UK due to its highly undesirable methods of recruitment and indoctrination � in itself, a form of psychiatric abuse?
Having had first hand experience of Psychiatry, as a patient many years ago, I have found the input into my life very positive. If I had suffered with my inherited tendency to chronic anxiety and periods of depression a hundred years ago I may well have been condemned by a bearded, bespectacled man with a mid-European accent to somewhere where I wouldn�t be an embarrassment to my family, to be treated with cold baths and �the ducking stool.� But this is the 21st century and Psychiatrists are considerably more enlightened. The brain is the most intricate and highly complex organ in the body and, also, the most fascinating so, when things go wrong, it should be treated with the same respect and care as any other bodily organ.
Sadly, when things do go wrong with one�s brain chemistry it can affect our behaviour. My late cousin suffered from schizophrenia. Initial depression descended into psychosis where she was keeping her parents awake all night and every night. She refused to acknowledge that there was anything wrong and eventually, in sheer desperation, her parents asked for her to be sectioned. Had they not done so all three of them would have ended up extremely ill. After six weeks, she was back home, stabilized, and ready to get on with an, albeit limited, life. After her parents died she had great difficulty looking after herself and this is where her local Christian church family were a Godsend. They included her in all their activities, transported her and supported her in her numerous hospital appointments with the Psychiatrist and Oncologist, when she developed terminal cancer. Thanks to good Psychiatric care she said she�d had �a good life� � in her eyes.
I also have a son who developed ME/CFS at the age of eight. Thanks to a psychiatric approach he is now one hundred per cent well. He did not imagine his illness and neither did we, his parents. Like many other people, I don�t like the outdated term �mental illness� as it is suggestive of, and misconstrued as an imagined or psychosomatic condition. ME/CFS is believed to be a brain cell disfunction caused by prolonged stress and triggered by a virus or trauma. A Psychiatrist specializes in the finer workings of the brain and the effect on one�s behaviour, mood, or ability to function and, therefore, is best qualified to choose an appropriate medication. A small dose of sedating antidepressant helped my son improve his sleep quality and low dose Prozac restored his lost brain function. In combination with a graduated activity programme this formula was the recipe for complete recovery. Prozac is restoring cognitive brain function to ME sufferers who have been ill for years. Sadly, not every ME sufferer can tolerate antidepressants.
With advancing knowledge it is ever more important that Psychiatrists, Neurologists and Endocrinologists work closer together and co-operate fully with each other, for the benefit of the patient. Psychiatric care should be seen as a safety net not a long long-term sentence. In the meantime, Psychiatrists should not be given such a hard time. They are trying their best to do a difficult job in the midst of narrow minded, outdated prejudice and ignorance. A good Psychiatrist will work in partnership with his patient, not against him, help him to deal with his problems and, if medication is the only course, then to achieve a decent quality of life. The latter, I have certainly been blessed with and I have no complaints at all!!
Competing interests: None declared

Re: Your own worst enemy 1 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Your own worst enemy

Anne Robertson wrote: <A Psychiatrist specializes in the finer workings of the brain and the effect on one�s behaviour, mood, or ability to function and, therefore, is best qualified to choose an appropriate medication.>
This is not true. Most psychiatrists actually know very little about the brain. Most have a rather rudimentary knowledge of Neurology and the Central Nervous System. Psychiatrists do know drugs, that is true. However the overall emphasis is on behavior.
Furthermore, despite aggressive pharmacology efforts, an awfully large percentage of patients with severe mental illness DO NOT achieve remission. Or anything close to it. Many remain disabled or partially disabled despite aggressive use of psychiatric services. I personally view this as due to psychiatry's lack of technological sophistication...in other words their poor understanding of the brain.
Neurologists are the medical experts of the brain, not psychiatrists.
Anne Robertson also wrote: <In the meantime, Psychiatrists should not be given such a hard time. They are trying their best to do a difficult job in the midst of narrow minded, outdated prejudice and ignorance. A good Psychiatrist will work in partnership with his patient, not against him, help him to deal with his problems and, if medication is the only course, then to achieve a decent quality of life.>
I totally disagree. Psychiatrists should be given a hard time because all too often they do a poor job of diagnosing patients and get poor results, particularly with the more severe forms of mental illness. Diagnosing and drugging psychiatric patients has been compared to throwing darts at a dartboard in a dark room...its not very scientific and is subjective. Psychiatry should be criticized from all quarters, because they deserve to be criticized.
I dont agree with you that all psychiatrists are trying to do a good job...my personal experiences with many of them is that many are dismissive, sardonic, lazy, tired and burned out. Many are just in it primarily for the money, at least here in the USA where private practice psychiatry can be very lucrative financially. And many in private practice psychiatry are mostly interested in working with the "worried well." People who do not have severe forms of mental illness. In fact, many psychiatrists actually dislike to work with patients who have severe mental illness because they know that results are oftentimes poor. Like I said before, when dealing with the severe cases they are oftentimes trying to do a job which should be done by a Neurologist
Competing interests: I hate psychiatry

In reply to E. Ann Robertson. 1 January 2004

Gurli Bagnall,
Indepedent Patients' Rights Campaigner
Marlborough Sounds 7372, New Zealand
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Re: In reply to E. Ann Robertson.

Ms. Robertson brought to mind a letter written by consultant psychiatrist, PT Huppert of New South Wales and published in The Medical Journal of Australia, Vol. 145, Oct. 6, 1986. On the death of his wife, he found himself under treatment �from reactive depression at a well regarded psychiatric nursing home and on the receiving end of most of the medication and treatment to which I had been subjecting my own patients for year.� He went on to describe the horror of the addiction that developed along with other adverse reactions including suicidal tendencies. He was angry that these symptoms were not recognized as adverse events, and he did not recover from his iatrogenic condition until he was discharged and had returned home.
While one sympathizes with Huppert�s experience, one must also recognize that he had been just as blind as his colleagues, to the harm he had done to his own patients.
While it is always heartening to hear of success stories such as Ms. Robertson tells, they are no excuse for ignoring the iatrogenic statistics as far as they are known. Preventable medical error is an umbrella term that covers anything from genuine error to malpractice. It is not easy to obtain the full statistics (particularly as they relate to GP treatment), therefore the statistics that DO exist, relate mostly to preventable errors occurring in hospitals.
Studies carried out in the USA and Australia have been described as representative of most western countries. When we read that in the USA, preventable medical error is the third leading cause of death after heart disease and cancer, and that the estimated cost of dealing with iatrogenic injuries/disabilities/diseases is estimated to be $US76.6 billion, we can work out the cost to our own countries. (1) Australia, with a population of 18,400,000, reports that there are 18,000 known unnecessary deaths per annum, and more than 50,000 patients are disabled each year. (2) The cost is estimated to be in the vicinity of $AU400 million.
Psychiatry contributes greatly to these figures for psychotropic drugs are highly toxic and addictive.
On the other hand, it has been known for many years that at least a third of all pharmaceuticals have no value whatsoever and in the last four weeks this has been drawn to our attention in a dramatic manner. Quote: ��.it has been an open secret within the drug industry that most drugs do not work for most patients, a secret that has now been publicly aired for the first time by Allen Roses, the head of genetics at GlaxoSmithKline, Britain�s biggest drugs company. (3) There is no shortage of similar authoritative information.
It is disappointing that so many people with poorly and unsubstantiated arguments are relying upon an association between Dr. Szasz and the Church of Scientology to discredit him and his views. His views are shared in part or in full by millions world wide irrespective of religion. Included are other members of the medical profession, families and friends who have witnessed the appalling suffering and of course, those who have been personally injured.
Ms. Robertson states: �Sadly, when things do go wrong with one�s brain chemistry it can affect our behaviour.� What she does not tell us is how this state of affairs was determined since no tests are ever carried out. Too often it has been discovered - sometimes years later - that the �psychiatric� illness was in fact an undiagnosed physical condition; a condition which usually pales to insignificance by comparison to the disease inflicted by the incompetent diagnostician.
�A Psychiatrist specializes in the finer workings of the brain and the effect on one�s behaviour, mood, or ability to function and, therefore, is best qualified to choose an appropriate medication.� This quote is an indication that Ms. Robertson has been badly misled. Challenge any psychiatrist to produce the science behind his diagnoses and he will be unable to do so. Psychiatric diagnoses are based purely on opinion.
It is pleasing that Ms. Robertson�s son recovered from ME/CFS by psychiatric methods, but if she spoke to other parents of afflicted children, she might find there are differences in the conditions. Since the name change to CFS, and the broadening of the diagnostic criteria to include a wide range of conditions, a great deal of confusion has arisen. This is why many victims and carers are insisting that the condition continues to be known as ME rather than CFS.
I refer Ms. Robertson to the reference material listed in Angela Kennedy�s rapid response for more information about ME.
References:
1. �Is US health really the best in the world?� JAMA vol.284 No.4. July 26 2000
2. �Epidemiology of Medical Error� BMJ Vol. 320. 774-777. 18 March, 2000
3. The Independent 8 December, 2003.
Competing interests: None declared

Reform Psychiatry or Abolish Psychiatry! 2 January 2004

Dr P V F Cosgrove,
Consultant All-Age Psychiatrist
The Bristol Priority Clinic BA2 5YD
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Re: Reform Psychiatry or Abolish Psychiatry!

The publication of Dr Szasz's article in the BMJ has resulted in, firstly, a clearer and better understanding of Dr Szasz himself and, secondly, a considerable amount of anti-psychiatry feeling. However, for the freedom and opportunity to discuss these important matters, our thanks go to the Editor of the BMJ, Dr Richard Smith.
Two positions vis-a-vis psychiatry have developed in our discussion, and I shall call them the Abolish Psychiatry and the Reform Psychiatry positions.
Whilst I have been defending psychiatry from Anti-Psychiatry, I am not complacent about contemporary psychiatry, about how it treats and relates to men, women and children these days. It is not good!
For those who have had bad experiences of psychiatry, and for those who perceive that they have had bad experiences, the solution to what we might call "the problem of psychiatry" is to Abolish Psychiatry.
Replace it with neurology,as Dr Szasz recommends, or with endocrinology, as one of the Rapid Response correspondents has suggested.
Many people are, without doubt, so disillusioned with contemporary psychiatrists that the only practical answer to "the problem of psychiatry" is to Abolish Psychiatry.
There is another solution to "the problem of psychiatry", however, and that is to Reform Psychiatry.
This, I fear, will not satisfy the abolitionists who, in their hatred of psychiatry, are out for 'professional blood'. Nevertheless, the calmer, wiser and maturer minds of the majority of people will, I am convinced, support the Reform Psychiatry position.
The reformation of psychiatry presupposes that psychiatry is in a bad way. It is! And the complacency amongst psychiatrists, especially amongst UK professors of psychiatry, is, in my opinion, shocking and shameful.
FIRSTLY, it is absurd that adult psychiatrists are given only six months or so in child & adolescent psychiatry in their training years.
As a result, they know little or nothing about the psychiatric conditions of childhood which, of course, can and do underlie the psychiatric problems of adulthood.
They cannot interpret academic, behavioural and emotional problems occurring in childhood. They cannot make use of information from parents, relatives or from school reports in assessing how to treat their adult patient. They haven't got a clue!
The reformation of psychiatry necessarily requires that psychiatrists -in-training spend 50% of their time in the psychiatry of childhood & adolescence and 50% in adult & old-age psychiatry.
All psychiatrists on reaching a consultant position must be All-Age Psychiatrists in one or two diagnostic categories, as well as being either child & adolescent psychiatrists or adult psychiatrists more generally.
SECONDLY, because adult psychiatrists have very little experience of childhood psychiatry, they have no experience of the medications used in childhood. They refuse, therefore, to use them in adults even though the condition is the same.
And, in order to justify their refusal to use a "childhood" medication in adult patients, they deny the existence of an ubiquitous disorder of childhood as ever occurring in adulthood. I refer, of course, to AD/HD. Maybe some patients or parents would like to comment on this.
THIRDLY, psychiatrists do not work characteristically in partnership with patients and parents.
Instead, they look for environmental reasons for the suffering of the patient in order to conclude that the patient or parents have brought this suffering down upon themselves. Therefore, the patient does not deserve to receive any professional help - just blame and criticism, implied or explicit.
Maybe some patients and parents would like to tell us about their experience of this.
The UK Prison Service informs its employees that 90% of prisoners have some form of psychiatric problem. Therefore, FOURTHLY, psychiatrists have failed individually and institutionally to treat the psychiatric problems, so that repeat offending and offending for the first time do not occur.
All prisoners have been pre-school children at some time; all prisoners have been primary school children; all prisoners have been teenagers; and all of them can be recognised and given medicinal treatment in order to prevent their conduct disorder from driving them relentlessly into prison.
Maybe some parents and prisoners would like to comment on this and on their childhood before prison.
FIFTHLY, the suicide rate should be seen by society as being the direct responsibility of psychiatrists, whether child psychiatrists and/or adult psychiatrists.
In a civilised and economically developed country, suicide is preventable and its antecedents are treatable by psychiatric medicinal treatment. It is better to be on medication than to die by your own hand. Maybe some parents and some people who have attempted suicide would like to comment on this.
SIXTHLY, no person should undergo psychosurgery (ie any form of modified leucotomy) for depression and/or anxiety without first being given treatment with the dopamine enhancing medications, which are so helpful and beneficial in childhood and adolescent psychiatric suffering.
SEVENTHLY, psychiatrists should stop using anti-depressants as if they were clinically effective. There is no researched evidence that any of the anti-depressants are clinically effective, ie. there is no scientific proof that they get human beings better from depression.
All there is is that anti-depressants have a little more efficacy than placebo, but that neither have much efficacy anyhow.
There are good alternatives to "antidepressants", which have been marketed so incorrectly by the pharmaceutical industry. Maybe some patients who have found antidepressants useless but alternative psychiatric medications beneficial, would like to write in and tell us.
These comments are, perhaps, the beginning of a conversation. They do, however, illustrate two things. Firstly, that psychiatry is not in good health and deserves much of the current criticism it receives. And, secondly, that there is much improvement in treatment that can, should and must take place.
Reform Psychiatry is to be preferred greatly to Abolish Psychiatry.
Competing interests: I love psychiatry!

Re: In reply to E. Ann Robertson. 2 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: In reply to E. Ann Robertson.

Gurli Bagnall wrote: <Psychiatry contributes greatly to these figures for psychotropic drugs are highly toxic and addictive. >
This is a very generalized and overall an inaccurate statement. Most psychiatry drugs are NOT addictive and are in fact very safe. I cant think of one antidepressant, mood stabilizer or anti-psychotic which is addictive. Here in the USA, none of the antidepressants, mood stabilizers or anti-psychotics are controlled substances and regulated by the DEA. Ive taken antidepressants at extremely high doses for long periods of time and never become "addicted." That is pure bs.
As far as psychiatry drugs being "toxic" overall thats an inaccurate statement as well. While some of the psychiatry drugs are toxic, the ones that are toxic are in the minority rather than the majority. The only psychiatry drugs that are truly "toxic" and have truly serious potential to do harm to the body are the older MAOI antidepressants and the anti-psychotic drugs. Anti-psychotics do have some toxic side effects, they can cause movement disorders and the newer ones can elevate blood sugar and cause diabetes.
The REAL problem with psychiatry drugs is that they simply DO NOT WORK effectively a large enough percentage of the time. The drugs do not achieve full remission in enough patients.
The claim that antidepressants are "addictive" is classic anti-psychiatry type diatribe, which is hardly based in hard fact. If these drugs were "additive" they would be controlled substances and regulated by the DEA.
Competing interests: I hate psychiatry

Re: Reform Psychiatry or Abolish Psychiatry! 3 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Reform Psychiatry or Abolish Psychiatry!

Dr. Cosgrove wrote: <The publication of Dr Szasz's article in the BMJ has resulted in, firstly, a clearer and better understanding of Dr Szasz himself and, secondly, a considerable amount of anti-psychiatry feeling. However, for the freedom and opportunity to discuss these important matters, our thanks go to the Editor of the BMJ, Dr Richard Smith. Two positions vis-a-vis psychiatry have developed in our discussion, and I shall call them the Abolish Psychiatry and the Reform Psychiatry positions. Whilst I have been defending psychiatry from Anti-Psychiatry, I am not complacent about contemporary psychiatry, about how it treats and relates to men, women and children these days. It is not good!>
Nah...really? Psychiatry has major problems? Its not good? No kidding? Wow...GREAT insight for a psychiatrist!
<For those who have had bad experiences of psychiatry, and for those who perceive that they have had bad experiences, the solution to what we might call "the problem of psychiatry" is to Abolish Psychiatry. Replace it with neurology,as Dr Szasz recommends, or with endocrinology, as one of the Rapid Response correspondents has suggested. >
Ive not read Szasz works and Im not a fan of his. Im only obliquely familiar with his ideas and dont bother with most of his stuff because he is considered a classic "anti-psychiatrist." None of these hardcore anti-psychiatry types such as Szasz advocate replacing psychiatry with Neurology, so far as I know. Real anti-psychiatry types totally reject the entire concept that mental illness exists and they most of all reject that mental illness has any biological (brain) basis to it. In other words, you couldnt talk a hardcore anti-psychiatry type into the idea of "merging psychiatry into Neurology" with a crowbar.
The central tenet of the anti-psychiatry movement is the scientology-like belief that mental illness has no biological basis whatsoever. Anyone who knows anything about mental illness knows thats a bunch of bunk.
If Dr. Szasz has indeed recommended that psychiatry be replaced by Neurology, then he would be strangely in agreement with the MOST pro-biological psychiatrist in the USA. Dr. E. Fuller Torrey, MD is the most prolific advocate of formally merging psychiatry into Neurology and letting Neurology deal with the serious cases.
Replacing it with endocrinology will never work, replacing it with Neurology probably would work if Neurology had the will and the leadership to do the job.
<Many people are, without doubt, so disillusioned with contemporary psychiatrists that the only practical answer to "the problem of psychiatry" is to Abolish Psychiatry. There is another solution to "the problem of psychiatry", however, and that is to Reform Psychiatry. >
The only way to truly reform psychiatry would be to make it more Neurology-like in approach, more high tech and scientifically adept. If you did that, basically what youd be doing is creating two versions of Neurology within medicine, which would be redundant and silly. It would make much more sense to just get rid of psychiatry as a separate branch of medicine, with its emphasis on behavioral control and merge it into Neurology.
<This, I fear, will not satisfy the abolitionists who, in their hatred of psychiatry, are out for 'professional blood'. Nevertheless, the calmer, wiser and maturer minds of the majority of people will, I am convinced, support the Reform Psychiatry position. > <The reformation of psychiatry presupposes that psychiatry is in a bad way. It is! And the complacency amongst psychiatrists, especially amongst UK professors of psychiatry, is, in my opinion, shocking and shameful. FIRSTLY, it is absurd that adult psychiatrists are given only six months or so in child & adolescent psychiatry in their training years.>
<As a result, they know little or nothing about the psychiatric conditions of childhood which, of course, can and do underlie the psychiatric problems of adulthood. They cannot interpret academic, behavioural and emotional problems occurring in childhood. They cannot make use of information from parents, relatives or from school reports in assessing how to treat their adult patient. They haven't got a clue! >
How about forgetting what happened in childhood (you cant change the past) and doing away with these Freudian delusions that are still lingering in so many mental health professionals minds? And just get in the science lab and figure out the brain pathology of severe mental illness? Figure out the genetics of it? And figure out a way...scientifically...to fix it. Wouldnt that make a WHOLE LOT MORE SENSE?
<The reformation of psychiatry necessarily requires that psychiatrists -in-training spend 50% of their time in the psychiatry of childhood & adolescence and 50% in adult & old-age psychiatry. All psychiatrists on reaching a consultant position must be All-Age Psychiatrists in one or two diagnostic categories, as well as being either child & adolescent psychiatrists or adult psychiatrists more generally. SECONDLY, because adult psychiatrists have very little experience of childhood psychiatry, they have no experience of the medications used in childhood. They refuse, therefore, to use them in adults even though the condition is the same. And, in order to justify their refusal to use a "childhood" medication in adult patients, they deny the existence of an ubiquitous disorder of childhood as ever occurring in adulthood. I refer, of course, to AD/HD. Maybe some patients or parents would like to comment on this. THIRDLY, psychiatrists do not work characteristically in partnership with patients and parents. Instead, they look for environmental reasons for the suffering of the patient in order to conclude that the patient or parents have brought this suffering down upon themselves. Therefore, the patient does not deserve to receive any professional help - just blame and criticism, implied or explicit. >
Wow, Im glad I dont live in the UK. You sound like a Freudian living in the year 2004. Over here in the states, we dropped Freud and the "environment" thirty years ago.
<Maybe some patients and parents would like to tell us about their experience of this. The UK Prison Service informs its employees that 90% of prisoners have some form of psychiatric problem.>
90%? Wow, thats AWFULLY high. I do believe a high percentage of convicts have mental illness have mental illness of some sort, but 90% is pushing it a bit high. I can only assume you are including personality disorders such as "anti-social personality disorder" as a mental disorder there. Or substance abuse. Its obvious a lot of convicts are anti-social..thats why they are criminals and in prison (unless falsely convicted). Psychiatrists wanting to treat anti-social personnality traits as a mental disorder and treating it with drugs is CRIMINAL.
Psychiatrists should stay focused on the Axis one major psychiatric disorders and leave personality disorders alone. Stop trying to be the police. Let the law enforcement people handle criminals and individuals with anti-social personality traits.
Of course, criminals with major Neuropsychiatric problems such as major depression, bipolar disorder, schizophrenia, etc. SHOULD be given every opportunity to get it treated while in prison!!! I find it hard to believe that 90% of criminals in prison have major depression, bipolar disorder, schizophrenia or some variation thereof or an anxiety disorder. But I bet if you let the shrinks factor personality disorders or substance abuse into their profiles, almost all of them would be "mentally ill."
<SIXTHLY, no person should undergo psychosurgery (ie any form of modified leucotomy) for depression and/or anxiety without first being given treatment with the dopamine enhancing medications, which are so helpful and beneficial in childhood and adolescent psychiatric suffering. >
<SEVENTHLY, psychiatrists should stop using anti-depressants as if they were clinically effective. There is no researched evidence that any of the anti-depressants are clinically effective, ie. there is no scientific proof that they get human beings better from depression. >
<All there is is that anti-depressants have a little more efficacy than placebo, but that neither have much efficacy anyhow. There are good alternatives to "antidepressants", which have been marketed so incorrectly by the pharmaceutical industry. Maybe some patients who have found antidepressants useless but alternative psychiatric medications beneficial, would like to write in and tell us. >
I dont know of many off label drugs that really work. The only one I know of is the anabolic steroid testosterone. After six years of severe refractory depression, I was diagnosed by my internal medicine doctor as being hypogonadal and was subsequently put on testosterone therapy (Androgel). The effect is far more than "placebo" I can assure you. It doesnt get rid of all my depression by any means but its WAY more effective than an SSRI or similar medication. But of course you cant prescribe unless a male depressive has low or maybe borderline low testosterone levels...not exactly the most practical antidepressant. And for women its off limits
As far as improving antidepressants, I personally believe more attention should be placed on developing dopaminergic antidepressants. Here in the USA Somerset pharmaceuticals is trying to get a selegiline transdermal MAOI patch FDA approved. Whether it will be FDA approved is another story, with the powerful SSRI drug company lobby looking out for its lucrative SSRI market. Another dopaminergic antidepressant that used to be available here in the USA that was supposed to work really well was nomifensine. But the FDA took it off the market.
Noted ECT "shock doc" Max Fink, MD strongly advocates developing pharmaceuticals which work more on the "neuroendocrine" system. As he claims thats the mechanism that ECT works by. He claims that ECT seizures normalizes and "recalibrates" the major glands deep in the brain such as the pituitary and hypothalmus glands. Which normalizes the stress response, which combats depression and anxiety.
All of this is complicated, high tech neuro stuff, not psychology or "psychobabble" stuff and certainly not behavioral control. In other words, beyond the scope of psychiatry.
<These comments are, perhaps, the beginning of a conversation. They do, however, illustrate two things. Firstly, that psychiatry is not in good health and deserves much of the current criticism it receives. And, secondly, that there is much improvement in treatment that can, should and must take place.>
Admitting things are not right and unwell is the first step towards changing and improving things. To get from point A to point B, you must first know where your present location is located.
<Reform Psychiatry is to be preferred greatly to Abolish Psychiatry. >
Just train new Neurologists to deal with severe mental illness and begin applying the high technology mindset the neurology community embraces to severe mental illness. Things would gradually improve.
Competing interests: I hate psychiatry

Crazy talk 3 January 2004

John Hopkins,
GP
Newton Aycliffe Durham
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Re: Crazy talk

Dear Dr Smith,
'Psychiatric patients are routinely treated against their will. Legally enforceable psychiatric protection orders would protect patients from coercive psychiatric interventions '
Szasz opens his article by blurring the distinction between fact and opinion.
Whilst it is certainly true that psychiatric patients are routinely treated against their will, there is no logical justification for moving from that statement to the assertion that they are subjected to coercive interventions which, by implication, are against their best interests.
In the absence of a logical link one might look for some observations to support Szasz�s case. Again these are conspicuous by their absence. A Medline search under his name reveals not a single piece of structured evidence based research. All we get is essays about the myth of mental illness.
Those who come up with original ideas that are workable and practical such as anaesthesia, antibiotics or keyhole surgery make real progress in medicine.
Until Szasz and those who follow him can provide a viable alternative to current clinical practice it is likely that psychiatrists and their colleagues in general practice will continue to make do with what they have.
Yours sincerely,
John Hopkins
Competing interests: None declared

Re: Crazy talk 3 January 2004

Richard G Fiddian-Green,
None
None
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Re: Re: Crazy talk

John Hopkins writes, "Until Szasz and those who follow him can provide a viable alternative to current clinical practice it is likely that psychiatrists and their colleagues in general practice will continue to make do with what they have". This is a rational and pragmatic decision in the face of uncertainty. It is also potentially harmful and even lethal for patients.
The problem as I see it is not so much whether psychiatry should be reformed or abolished but an apparent lack of insight on the part of most doctors into the full spectrum of clinical circumstancs in which metabolic disturbances can cause incapacitating mood and behavioural changes. Added to this is a lack of appreciation that, like anaesthetic agents and indeed alcohol and probably other recreational drugs, psychotropic drugs may achieve their therapeutic benefits [in the eyes of the doctor] by increasing the severity of the metabolic disturbances rather than decreasing them.
Upon imbibing alcohol, for example, stimulation together with mood and behavioural changes occur in lower doses than somulescence and unconsciousness. In order to reverse these effects it is desirable to stop imbibing and allow the liver to metabolise the alcohol. Increasing the intake of alcohol might quieten and even put to sleep someone who has become argumentative and disorderly but this increases the liklihood of pathological consequences such as coma and irreversible neurological damage.
Another important point is that the development of depression, for example, may be the earliest clinical evidence of a systemic metabolic derangement that may cause organ dysfunction and increase the risk of surgical interventions such as cardiac surgery. In other words the development of mood and/or behavioural changes are an indication for a comprehensive metabolic workup. Furthermore if abnormalities are found they need to be reversed before treating a patient empirically be the patient young or old.
Competing interests: None declared

Re: Crazy talk 4 January 2004

Nelson Borelli, MD,
Assist. Prof. Dept. Psychiatry Northewestern Un.
Chicago, IL, USA
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Re: Re: Crazy talk

"Crazy talk"...whose? What about this: "Whilst it is certainly true that psychiatric patients are routinely treated against their will, there is no logical justification for moving from that statement to the assertion that they are subjected to coercive interventions which, by implication, are against their best interests". As for case studies, Mr. John Hopkins will find plenty of them in Professor Szasz's books. One of my favorits cases is that of Erza Pound. Nelson Borelli, MD
Competing interests: Rationality in Medical thinking and practice

Flat World, Round World 4 January 2004

Dan Beales,
Specialist Registrar in Forensic Psychotherapy
Mersey Care NHS Trust, North Administration, Ashworth Hospital, Maghull, Merseyside, L31 1BD
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Re: Flat World, Round World

Sir
Szasz�s article (1) and the debate it has engendered illustrates the extent to which thinking about psychiatry can become polarised. This polarisation allows the needs of one of the most vulnerable groups in any society to remain marginalised. The splitting of the debate into �I hate psychiatry: I love psychiatry� means energy is directed at attacking or defending psychiatry rather than reforming it or attempting to address the paradoxes it involves.
The floridly psychotic have few freedoms to enjoy, despite those who wish to romanticise severe mental illness, or those who seek to deny its existence. Coercive treatment can restore freedoms, but clearly undermines traditional concepts of autonomy. I imagine Szasz continues to be very happy at the responses he gets: they illustrate the extent to which his clich�s continue to hold the imagination, and it is clear that they still chime with the experiences of many.
In the same issue of the BMJ Smith (2) engages in a creative dialogue about leadership in the NHS. We need to remember that being the libertarian that Szasz is (his website proudly proclaiming itself the �Free-Market.net Freedom Homepage of the Week� in the week of the publication of his article(3)) it is unlikely that he would support any concept of comprehensive public health provision at all. His advocates often seem to miss this connection, but the political context from which his views on psychiatry arise needs to be acknowledged.
Smith (4) reports that the BMJ published the article because it was �well written� and raised �important ideas�. He isn�t fully clear if the article was peer reviewed beyond this. I would never advocate not publishing Szasz. But would the BMJ accept an editorial by Tabo Mbeki on the relationship between the HIV virus and AIDS? Would it currently publish an article by Andrew Wakefield about possible links between MMR and autism without at least some comment?
Despite progress in this area, it is still acceptable for many doctors to be proud of their ignorance of the complexities of psychiatry, and this reflects the stigmatisation of those with mental disorders and those involved in their care (5). The University of Manchester recently reduced the core psychiatry component in its undergraduate medical curriculum to sixteen days.
We still have a lot to learn from Szasz and he should be required reading for all psychiatrists. My point about publishing him unchallenged is that it must have meaning that he still finds favour when we are spending over 14% of the NHS budget on mental health and over �1 billion annually on the treatment of schizophrenia (6). Despite this 12% of Consultant Psychiatrist posts in the United Kingdom remain vacant and funding has fallen in real terms despite government promises (7). Primary Care Trusts are presently diverting increased funding meant for psychiatry into other services.
The psychiatric world is round, not flat, as one might surmise from Szasz�s continued caricatures.
If Szasz�s article really reflects practise in modern psychiatry then this is indeed an absolute scandal. I expect to see many more articles in the BMJ, and a flood of referrals of psychiatrists to the General Medical Council. Surely the British Medical Association Ethics Committee should consider Szasz�s assertions and the British Medical Association be seriously concerned about psychiatrists belonging to it?
References
1. Szasz T. The psychiatric protection order for the "battered mental patient" BMJ 2003;327:1449 -1451 (20 December), and Rapid Responses, http://bmj.bmjjournals.com/cgi/content/full/327/7429/1449#responses 2. Berwick D Ham C Smith R. Would the NHS benefit from a single, identifiable leader? An email conversation. BMJ 2003; 327:1421-4 (20-27 December), http://bmj.bmjjournals.com/cgi/content/full/327/7429/1421 3. Szasz T, The Thomas Szasz MD Cybercentre for Liberty and Responsibility. 2003, www.szasz.com 4. Smith R. There are no scientologists at the BMJ. Rapid Response, 23 December 2003,http://bmj.bmjjournals.com/cgi/eletters/327/7429/1449#44571 5. Royal College of Psychiatrists. Mental illness: stigmatisation and discrimination within the medical profession, Council Report CR91 (with the Royal College of Physicians of London and British Medical Association), 2001, www.rcpsych.ac.uk 6. Rethink, 2003. www.rethink.org 7. Royal College of Psychiatrists Research Unit Workforce Planning Research Team. Workload and Working Patterns in Consultant Psychiatrists: An investigation into occupational pressures and burdens, 2003, www.rcpsych.ac.uk
Competing interests: None declared

Can I take this back a step? 5 January 2004

Kim Gregory,
Mum!
RH12 3LW
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Re: Can I take this back a step?

Having read all your responses - my mind is boggling and I confess that I couldn't even begin to embark on trying to equally baffle you with technical arguements! Anyway I have none - I enter this arguement purely from 1 aspect, a mum. So here's what I have to say!
1st point I'd like to make is that Dr Szaz may or may not be a scientologist BUT Dr. cosgrove is right that he's intrinsically connected with them and to point out that this is relevent when considering the validity and objectivity of his arguements. I say this as someone who's just been send a whole heap of scientology literature (which I've taken the trouble to annotate with lenghty notes from personal experience and which I intend to send back to them!) - and Dr. Szaz was in nearly all of them! So from a layman's point of view whether he 'IS' one or just works with them makes very little real difference!
My 2nd point is the various snipes I've seen litering the arguments about parents! >parents who voluntary choose him to heal them of their suffering." The parents are mentioned, but the children are implicit. It is they who are brought to him involuntarily, and who he, no doubt, "treats" without their freely given permission. Parents authorize psychiatric coercion against their children, just as psychiatrists are given authority by the state to force treatments on adults who are reduced to the legal status of children.<
Whoever truely believes that parents are forcing and allowing such treatment obviously knows very little about kids!!! Can you imagine a parent holding down a 15 year old and stuffing tablets down their throat? Beleive me kids are more than capable of making their own decisions. In suggesting that the children themselves have no say and/or are treated against their will you do terrible injustice to children that simply *reeks* of stereotypical medical establishemt attitude to children that I despise. The fact is that MOST intervention that kids experince could be argued to be against their will e.g. you could argue that Kids are *forced* to go to school where they are force-fed learning and info. that adults deem suitable! The reality is that parents make choices about their kids health and welface all the time! We've all been in the situation where as parents we've had to bribe/co-erce/sneakily administer medicines prescribed by a doctor to a sick child - does this mean we are bad parents - or responsible ones knowing that this medication will help them? What you all seem to be forgetting is that parents are the one's who know their kids best - not you not some *expert*. Sometimes it is the case that we must make hard decisions i.e. *We* choose to subject them to an anti- biotic if they are unwell, we may have to choose a medical intervention that we know will not cure them (medical science isn't so advanced as you'd like to believe either!) and that may have long-term side effects I see no difference here for conditions like ADHD. I have 2 boys with ADHD, in truth I've never had to force - my children are able to understand and are aware of how the medication helps them. The point is that that is what parenthood is all about WE are their parents and we do have to decide.
Finally can I say to the person who said that we should ignore children and childhood mental difficulties - again from a parents perspective - here is where the biggest mistake lies! Damage done to children by IGNORUNG and denying their difficulties are what exacerbate and further damage young people! IF they are treated and treated properly as young children then this can be the thing that turns their lives around and which avoids the emotional trauma of failure/frustration/insecurity which if they dont get proper recognition of their difficulties as children, merely gets added to their existing problems when they reach adulthood making them tenfold and harder to treat. Treatement of childhood problems can be the deciding factor that will prevent the child being written off and worse still in writing themselves off! IMHO treating adults with the drugs that are similar to those which help children would significantly decrease the need for more dangerous and perhaps less effective drugs. Can I also just say - quit blaming parents!
Competing interests: Mum?

"Global Emergency" 6 January 2004

David W. Oaks,
Diirector
MindFreedom; POB 11284; Eugene, OR 97440-3484 USA
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Re: "Global Emergency"

As director of MindFreedom Support Coalition International, which unites 100 groups to take action for human rights in mental health, I congratulate the _British Medical Journal_ for publishing Prof. Szasz's clarion call for a response to the overwhelming tragedy of human rights violations involving psychiatric procedures.
We are not alone in raising a warning about the nightmare of human rights violations in the mental health system.
Dr Benedetto Saraceno, director of the World Health Organization's department of mental health and substance dependence, was quoted in The Independent on 14 Dec. 2003 as declaring, "There is a global emergency in terms of human rights violations in terms of all countries. There is not enough attention paid to the human rights of people suffering from mental health problems."
We cannot wait for those with a personal financial stake in the current mental health industry to lead the way.
Truly, democracy must meet the mental health establishment, the public must take direct responsibility for the horrendous abuse, brain damage, addiction and death inherent in the coerced psychiatric system. This psychiatric establishment is poised to globalize to developing nations in the very near future.
We encourage all readers -- wherever they personally stand on these controversial and complex issues -- to become familiar with the social change movement for human rights in the mental health system. You may start by going to our own web site at http://www.MindFreedom.org, the web site for MindFreedom Support Coalition International.
While we are open to the public, the majority of our members identify themselves as having personally experienced human rights violations in the mental health system. There are literally millions of individuals who have experienced the forced drugging, restraint, labeling, solitary confinement, humiliation, and incarceration in the mental health system. It is to the credit of many of these survivors that, like Gandhi, they have not given up on trying to reach the perpetrators of human rights violations, and convince them that real human suffering is the result.
We encourage everyone, everywhere to fill out a psychiatric will, and to take a stand against the rise of corporate forced psychiatry.
This is about real human lives.
In the last few weeks, I have communicated with members in three US states where they are living peaceably in the community, but are court ordered to take super-powerful psychiatric drugs against their will, for years and years and years. Recent medical studies have shown that the drugs typically used, neuroleptics, can cause structural brain damage when used long term at high dosages. This brain damage can include actual measurable brain shrinkage of the frontal lobes so extreme it is visible under CT scans, and in autopsy. This brain damage is confirmed in animal studies, and in countless other studies.
The public, clients and family members have not been informed of the risk of these powerful neuroleptics. Yes, many of our members choose to take psychiatric drugs in any case. But the medical establishment has failed in informing the public about what they know from their own studies: That long term high dosage forced neuroleptics amounts to the mass chemical lobotomy of countless people.
The combination of brain damaging procedures with the use of coercion in the psychiatric system has created an unimaginable nightmarish catastrophe, a Chernobyl of the mind, that future generations will be mourning for a long time.
Thank you, Prof. Szasz, for being one of the few professionals willing to speak out. I also commend the organizatation of dissident professionals, the Internatioanal Center for the Study of Psychiatry and Psychology, for their own independent work in breaking the silence about these human rights violations.
The BMJ is to be deeply thanked for airing these points of view. May other medical professionals, their journals and organizations also inform the public, and allow democracy to be involved in these difficult ethical issues.
Sincerely,
David Oaks, Director, MindFreedom Support Coalition International
e-mail: oaks@mindfreedom.org
web: http://www.MindFreedom.org
Competing interests: None declared

(Non)coercive pscyhotherapy and "care" 7 January 2004

Jacqueline R Roig,
Psychologist
Private Practice, Chicago 60611
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Re: (Non)coercive pscyhotherapy and "care"

Dr. Szasz continues to make excellent and relevant points about disguising coercion of individuals as care and treatment. Professionals, family members, and society in general adopt an attitude that punishing an individual's choices with forced treatment is benign and, worse, helpful. This is despite the potential for an individual to feel and act like a failure, helpless, demeaned and hopeless.
This attitude is prevalent and chronically misused by the professionals who remain true to an agenda, one that is so slick that vicitmiization and participation issues become blurred. Often, it is the "patient" who adopts the helpless and hopeless demeanor that mirrors societal and professional views of them. And so the perpetuation of coercion as assistance, as those who are being "treated" become worse symptomatically, dependent yet resentful, and disabled by the very "cure" that they sought as endorsed by the professionals, media, and the like. It is the quinessential vicious circle.
I am grateful that Dr. Szasz presents a voice to enlighten and protest coercion of humans under the false auspices of caring and treating. Children and adults do not benefit from being set up by professionals (and the media, and caregivers) while being told that their thoughts, feelings and behaviors are subject to interpretation, with potential for dire consequences.
Competing interests: None declared

psychology is a pseudoscience 7 January 2004

Ted Huntington,
University of California, Irvine
92623
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Re: psychology is a pseudoscience

I am glad to see an article by Thomas Szasz critical of psychiatric hospitals. The history of the brutal unconsentual assaults and tortures inflicted in the name of psychology in psychiatric hospitals is initiated for the first time to my knowledge in a book "Mad in America" by Robert Whittiker. Like the brutal history of religious atrocities, humans in psychology appear to be not proud, and very secretive in terms of their history.
I think use of the word "intervention" is confusing, and I think that the basics are that a nonviolent human should never be restrained (fastened to a table, or wall, or in restrictive clothing), injected with drugs, or even held in a room without clear consent, and certainly not with clear verbal or gestural objection.
One important point is that psychology has captured the popular focus, unlike biology, evolution, robots, chemistry, health, anatomy, etc.. other legitimate sciences. We never see specials documenting the most popular doctors, only of people in acting and sports. Terms like "crazy", "weird", "insane", "psycho" permeate common vocabulary, but never do put-downs involve words like "stupid", "violent", "antiscience", "antisexual", because these traits are acceptible for the religious majority. Better to stop the violent, not the different, and only offer treatments, not force treatments on people that clearly object. There have been hundreds of nonviolent people shocked, lobotomized, and drugged that verbally objected and I think that those are assaults and should be prosecuted.
So, in conclusion, excellent to read from Szasz, and I think that BMJ is leading the way for better health care for the humans of this tiny planet. The trajedy is that if more people cared for science, we might have artificial lungs, hearts, etc... be more advanced that we are now.
Thanks!
Ted Huntington
Competing interests: None declared

The "value neutral science" 7 January 2004

William K Smith,
Northwestern University Medical School
Center for International Rehabilitation 351 E Huron Chicago Illinois 60611
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Re: The "value neutral science"

Perhaps, more than any other branch of medicine psychiatry reflects social values. In some societies talking to God might peg you as a saint, in others you get medicated if God talks back. A young man who dreams of shooting school children and has bought a gun may very well be committed but a bomber pilot who dreams of children dying in flames beneath his plane will be counseled or medicated and sent back up. The first man has killed no one, the second may have killed hundreds. If the varying approaches to "treatment" do not reflect social values than surely nothing in medicine does.
In medicine, as in western culture, we espouse the values human rights and the autonomy of the individual. In psychiatry these values are too often lightly or wrongly subjegated to the theraputic imperative. This is a shame since we so often lack a fundemental understanding and agreement as to what the term "sick" means in the psychiatric context. It should cause us to be doubally outraged when the need for "therapy" negates the checks and balances that underpin our most fundemental human rights.
Any efforts that can be made to further safeguard human rights and the values of autonomy are worthwhile. This article makes a valued contribution toward that end.
Competing interests: Founder International Disability Rights Monitor

Survivor of Post Partum Psychosis 7 January 2004

Jenny Hatch,
Homemaker
80027
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Re: Survivor of Post Partum Psychosis

I am thrilled by the recent article advocating legal protections for the mentally ill. I experienced a psychosis after the birth of my first child, brought on I believe, mostly, by sleep deprivation and a major move when my daughter was six weeks old. The nightmare that followed my exodus from reality is almost unbelievable, even now.
I was taken to a regular hospital for "treatment" by my family. Upon refusing to sign myself into the hospital, I was sent on a medical certificate to a Michigan State facility. On my first night in I was violently raped by four orderlies and thrown naked into seclusion, where I stayed for a few days and the nurses almost killed me with an overdose of Haldol. After a few days, I was able to realize where I was and what had happened (I remember walking outside with a fellow patient who was the first to inform me of where I was, I thought I had died and gone to hell). Once I realized that I was in a mental hospital, I started to refuse the medications and continued to refuse for the next few weeks. I was shuffled between a private and public facility, always refusing meds because I had been breastfeeding my daughter, and wanted to continue once we were reunited.
After a twenty-eight day fight I was sent to court where I landed in front of a judge who upon hearing my case declared that I should receive ninety days of incarceration and forced meds. I could not believe this judge had that much power over my mind and body. But I had nothing left to fight with and so caved to the treatments. I took all the antipsychotic drugs for fourteen months and by the grace of God was able to get off every single one. Once I was feeling better, I ran as fast as I could from the psyche profession, and never looked back. We have been able to welcome four additional children into our home, and by focusing on me getting proper sleep, and with the loving support of my sweet husband, have fully healed from the trauma of being treated by the mental health profession.
Recently I have been in contact with a woman who was told that should she decide to become pregnant she will be forced to take antipsychotic medications upon the birth of her next baby for TWO years. She had a psychosis after the birth of her first baby as well.
Does anyone else have a problem with this? I do.
We are all at risk of becoming psychotic from sleep deprivation, the military and the airline industry know this. Terrorists understand that sleep deprivation is a powerful way to break a person's spirit. New parents are particularly at risk for mental breakdown brought on by fatigue. Is the medical profession the only one that believes unreality is always a chemical imbalance in need of more chemicals?
Jenny Hatch
Colorado Mother of five
www.naturalfamilyco.com
Competing interests: None declared

Labeling Dissidents 7 January 2004

David W. Oaks,
Director
MindFreedom; PO Box 11284; Eugene, OR 97440 USA
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Re: Labeling Dissidents

I have already recently posted a note, but this is a brief postscript.
I have reviewed the comments already posted on the BMJ web site about the Szasz article.
It is interesting to me that several comments are about the Church of Scientolgy and their organization Citizens Commission on Human Rights (CCHR), and the extent of Dr. Szasz's connections to those entities.
Disclaimer:
Neither I nor the organization I direct, MindFreedom Support Coalition International, have any link to Scientology or their organization CCHR.
That said, I am concerned that individuals would seek to discredit Dr. Szasz by pointing out that he has worked with CCHR (though he is not himself a Scientologist).
Again, we have no connection to those groups, but we have also seen them do some excellent humn rights work.
There are severe legitimate criticisms of the Catholic Church, but if the Catholic Church sponsored a group working on human rights I would applaud that effort. (Unfortunately, the Catholic Church and any number of other larger churches, actually sposor psychiatric facilities that engage in human rights violations such as involuntary psychiatric drugging and electroshock.)
If this were 500 years ago, critics of the establishment faith would be said to be in league with the devil.
in the 1950's many people who was concerned about labor rights would be labeled as a Communist who had ties to Moscow.
Today, many people who criticize the psychiatric system are told they must be Scientologists.
However, the fact is there are a number of independent organizations that have legitimate critcisms of the psychiatric system and its coercion.
MindFreedom is 100 percent independent. We receive no funding from the mental health system, government or drug industry. Now stop for a moment and think: How many organizations in the field of mental health can say that? Nearly every advocacy organization, special interest group, trade association, etc. in the mental health field has major funding from the mental health system, government and/or the drug industry.
If we are to talk about who is linked to whom, the overwhelming issue is that many of those involved in this field have direct financial links to the psychiatric establishment, including the richest corporations in the history of the planet (when measured by return on investment for example) -- the psychiatric drug industry.
Please note that we at MindFreedom are pro choice. Many of our members choose to take prescribed psychiatric drugs. But the utter domination of the mental health system by the psychiatric drug industry, and other highly-profitable corporations, is the real issue.
I know Dr. Szasz, who is also a member of MindFreedom. He has spoken out for decades about liberty. I encourage individuals on this forum to directly address is arguments and concerns.
Too often the psychiatric system has indulged in unscientific labeling of those with whom they disagree. I have seen that same labeling process apply to dissidents such as Dr. Szasz. Unfortunately, this is an illustration of exactly what we are up against.
For those interested in the issue of the domination of the medical model, I encourage you to check out an historic five-part debate that our organization has had with the American Psychiatric Assocation as a result of a five-week hunger strike. You can read this debate on our web site at http://www.MindFreedom.org.
Thank you, David Oaks, Director, MindFreedom e-mail: oaks@mindfreedom.org
P.P.S. Those interested in what we are doing are encouraged to e-mail me, and we will try to keep you in touch with the occasional human rights alert and news on these issues.
Competing interests: None declared

Voluntarily Coercion? Coerced "Choice"? A Contradiction? NO! Not Now! 7 January 2004

Roger D. Carlson, Ph.D.,
Licensed Psychologist; Adjunct Professor
Linfield College,
McMinnville, Oregon 97128
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Re: Voluntarily Coercion? Coerced "Choice"? A Contradiction? NO! Not Now!

Not only is Prof. Szasz's article timely in terms of involuntary mental hospitalization, but it raises an important issue of whether or not one, if "mentally ill" as determined by the psychiatric/psychological establishment, is capable, because of that "mental illness" to "voluntarily" relinquish his/her rights to psychiatric examination/treatment. I submit that the ethos of modern psychiatry's pathologization of so many aspects of conduct of which society disapproves, that if "mental illness" is a "disease" by which one's capacity to reason and make "good" judgment is impaired, then ipso facto one's ability to "voluntarily" surrender to psychiatric/psychological examination/treatment is similarly compromised.
One who "voluntarily" surrenders one's right not to be examined or treated in the name of e.g. occupational screening, as a requirement for a job, or keep a job, if found to be in some way "mentally ill," have themselves caught in an irrevocable loop. In short, one has become voluntarily coerced or has made a "coerced choice."
When one submits to such examination/treatment, one needs to be guaranteed that one will suffer NO vocational repercussions as a result of that event--thus taking the third party out of the loop. (One's surrender to evaluation/treatment, itself would be considered "involuntary" if found to be under the influence of a "mental illness.") Only then can such evaluations be truly between professional and client, and the evaluation would continue to be for the client's own interests. Similarly any such evaluation/treatment by the courts, even if submitted to "voluntarily," must be rendered irrelevant and inadmissible to the determination of guilt or innocence, or sentencing proceedings.
Might there be many persons who ostracize themselves by such surrender? They are those who "buy into" the psychopathologizing of their own behavior with self-inflicted moral indictments (e.g. participants in "twelve step" programs by many names). Such indictments are only further reinforced by professionals who inclined to support such fictions. We live in an era of psychiatrically and socially-propogated self-fear. There is a difference between one who calls oneself "sick" as nurtured through popular and professional media, and one who genuinely is curious about oneself and understanding one's problems in living and alternative choices that one can make. There is a place for the professional who truly works with a client in the client's interests. Only will liberty be truly liberty, when our free choices do lead to further liberty rather than further the purposes of social tyrants and totalitarian moralists.
Competing interests: None declared

Family of Lobotomy Victims Speak 7 January 2004

Christine L. Johnson,
Medical Librarian
Valley Stream, NY
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Re: Family of Lobotomy Victims Speak

I represent a group of people who are lobotomy victims or related to lobotomy victims. We have seen what happens when neurology and psychiatry merge. You can read our oral histories at www.psychosurgery.org and remember what happened to us. We are people who have suffered the worst "help" that psychiatry has had to offer.
Psychosurgeries are being performed once again, sadly for the same reason that they were when my grandmother and fifty thousand other Americans were lobotomized - because "these people are so sick we should try anything on them, even if it's totally unlikely to work."
Though many would like to think that psychosurgery is far more advanced now because of MRI and sterotactic techniques, the truth is there is no proof that any mental illness is caused by a physical anomaly.
The fact that psychosurgery -of all things- has made a comeback forces people like us to come out of the woodwork like ghosts of Christmas past and ask, "What on earth are you doing?"
Competing interests: None declared

Mad? Or afraid? 7 January 2004

Patricia Robinett,
Clinical Hypnotherapist
97401
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Re: Mad? Or afraid?

People overpowered by physical force or by authority usually become afraid. People act strangely when they are in fear. They exhibit all forms of behavior. Some lash out. Some withdraw, run away. Even people quite sane might look crazy when in a powerless situation. Many, if not all, psychiatric patients are stuck in fear from the past.
It is our job to to draw people out of the shadows of fear, into the warm sun. And that takes a lot of kindness, a lot of compassion.
Power-over tactics simply do not work to heal. Forced psychiatric treatment, numbing drugs, intimidation of any kind do not work.
If a mental health professional is sincere and genuinely wishes to heal his patient, he will do anything and everything possible to help that person feel safe. From a place of safety, amazing shifts can occur and do occur.
Professionals who insist on extreme measures to tame their patients are obviously themselves in great fear. They themselves need healing. They are unhealed healers. It behooves them to find a kind person to work with.
I like Tom Szasz. If you are ever a mental patient, perhaps you would prefer his compassionate treatment over the harsh treatments that are unfortunately inflicted on people who are, for all practical purposes, imprisoned by the system.
Respectfully,
Patricia Robinett, Clinical Hypnotherapist
Eugene, OR, USA
Competing interests: None declared

Involuntary treatment gives profession a bad reputation 7 January 2004

Ron J Unger,
Mental Health Therapist
Center for Family Development, 1258 High St, Eugene OR 97401 USA
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Re: Involuntary treatment gives profession a bad reputation

While it is certainly true that some people at some points in their lives have been helped by involuntary treatment, it seems reasonable to ask whether this benefit in some cases justifies its immense social costs. These costs include not just those who are mistakenly forced to get treatment they really don't need and which is oppressive, but also for example all those who avoid potentially helpful treatment because they don't want to be forced and so they avoid a profession that forces treatment.
It is commonly believed necessary to forcibly medicate many clients to keep them from doing violent destructive things: but it is not so clear that this has been helpful on the whole. Those who are forced onto medications often quit them suddenly when they get a chance: it is probable that when suddenly quitting they become more dangerous than they were before starting to take the medications. (Studies with monkeys show them becoming more violent than usual when withdrawing from neuroleptics, and studies with humans show dramatically higher relapse rates when meds are suddenly withdrawn vs. slowly tapered off for example)
It's true that bad things, such as the woman treated by scientologists who died of a blood clot related to her not drinking water, would often happen if people weren't forced onto medications. But then again, bad things happen all the time now: what about all those forced onto meds who died of neuroleptic malignant syndrome, or other side effects of neuroleptic medications ranging from diabetes to breast cancer. People with mental illnesses face difficult choices, but if we allowed people to make them rather than trying to force the choices on them might not be such a bad thing.
A mental health system committed to providing choice would probably look different than what we have now: it would certainly provide more options, and would probably show more respect for consumers. I'm sure many people would continue to take medications, but the system would be forced to develop options other than meds - and given the relatively toxic nature of the current medications, that would be a good thing. I believe we would see more innovation and a lot more collaborating with consumers in finding approaches that really work, from their perspective.
Competing interests: Licensed Clinical Social Worker

"No" is absolutely essential to ethical relationship 7 January 2004

John C. Napier,
Architect
02139
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Re: "No" is absolutely essential to ethical relationship

Child Development:
It is no coincidence that the first appearance of life-long memory and abstract self-recognition ("ego") comes in the third year, right after the discovery and common fascination with the word "no". I am not-you, not-that, not-it are essential foundations of self.
Civilization Development:
Tribal peoples, even as recently as modern Japanese, almost always identify themselves in relational and historical terms: son-of-that-one, father-of-that-one, keeper of this-item, hunter-of that-game, weaver-of- that-fabric, etc. But in the West we habitually refer to ourselves as "I", unqualified, and for very good reason: through that word we reserve the right to identify ourselves as individuals with choice and identity outside all roles and history. The very foundation of "I" is "no": I am _not_ my history, not my job, not your ideas about my history, not even my own ideas about my history.
Conclusion:
Both in theory ("we know you best", "for your own good" etc.) and in practice (frequent de facto mandatory drugging and commitment) psychiatry denies this word "no". Psychiatry and its industry demolish the foundations of healthy being while claiming the opposite. A legal definition of the right (of both parties) to say "no" is absolutely essential to ethical psychiatry.
Kudos to Dr. Szasz and BMJ for publishing this article.
Competing interests: None declared

Compelling Emotions But Not Practical 7 January 2004

Edward D. Campbell,
Self Employed Lawyer and Author
9534 14th Ave NW, Seattle, WA 98117-2308 USA
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Re: Compelling Emotions But Not Practical

I forwarded reference to this article to a list of alternative and complementary healers I belong to as well as to a local group of psychiatrists and other medical professionals with whom I meet on a monthly basis. When I did so I made the following comments.
I forward this on to the list because my experience with clients shows this to be a very legitimate concern, but not because I believe the author has the best solution. He needs to outline what he proposes the psychiatric treatment protection order should contain to provide more for legitimate debate. I have witnessed the grave results of the hapless inpatient administration of neuroleptics (anti-psychotics) and am aware of other actions that I would consider abuse of the patients. But I have also witnessed clients who from time to time have been incapable of addressing their own minimal needs, find it impossible to communicate, appear to have lost touch with who they are, where they are or what time it is, and appear to be acting in danger to themselves and/or others and seem to need at least some temporary provision for protection and stabilization. I cannot see society abandoning these people without providing some minimal protection during the acute distress time when some rational stability is sought, whether it be through the temporary use of a straight jacket while someone comes down from meth-amphetamines, for example, or the temporary administration of neuroleptics.
I would like to see this subject pursued, but would want to understand the alternatives available. I believe a "no-contact" type of order could turn out to be overly simplistic and dangerous nonsense. If the patient had a physician or other health care provider or someone else who the patient trusted, who would have to be consulted before any involuntary treatment and could offer effective opposition to the treatment that would not put the community in harms way and perhaps the patient (recalling the right to die arguments), that legal instrument might offer a somewhat acceptable compormise alternative. This would be worthy of exploration, a legal instrument very much like the living will, directive to physicians. I do not see why that could not be used by any lucid person as a directive covering any future psychiatric care.
Ed Campbell
Competing interests: I am a lawyer representing a former psychiatric inpatinet who developed TD from over administration of neuroleptics (anti-psychotics)

Stop coerced psychiatry 7 January 2004

Fred A. Tenzer,
Member of the public
11228
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Re: Stop coerced psychiatry

Dr. Thomas Szasz is correct. There is no excuse to label people as "mentally ill" (whatever that means), like, for example, simply because they ride their bicycles backwards, even if they have mirrors to see where they are going. Even if "mental illness" (whatever that means) really existed, there is no excuse to segregate children and teenagers who are allegedly or actually "mentally ill" (whatever that means) into separate classes from children and teenagers who are neither actually disabled nor allegedly disabled. Likewise, all other stigmas against people branded as "mentally ill" (whatever that means) must cease too.
Competing interests: None declared

Response to Dr.Szasz's Ideas on "Psychiatric Wills" 7 January 2004

John C. Hammell,
President-
International Advocates for Health Freedom
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Re: Response to Dr.Szasz's Ideas on "Psychiatric Wills"

Dr.Szasz states:
"Doctors, politicians, and journalists assert that mental illnesses are real diseases and that psychiatrists are regular doctors. If that were true there would be no need for psychiatric protective orders."
I partially agree, and partially disagree with what Dr.Szasz is saying.
Over 20 years ago I was lucky to escape the psychiatric gulag after 4 years of forced treatment. What enabled me to escape the system was a suppressed alternative treatment mode: orthomolecular medicine. I was forced to smuggle dietary supplements in to the last hospital I was in, and hide the supplements in a cavity gouged from the underside of my foam mattress, and take the supplements on the sly.
The supplements had been prescribed by the late Carl C. Pfeiffer, MD, PhD of the Princeton Brain Bio Center in New Jersey who did a lot of lab work that the mainstream psychiatrists didn't know how to do because this approach to treatment is being horribly suppressed.
It is a shame that Dr.Szasz, a social milieu theorist who in his zeal to condemn psychiatric drugs, has thrown the baby out with the bathwater and also condemns ANY biochemical approach to treatment (mainstream, or alternative)- because to him- NO Biological approach to treatment has any merit. That is a shame.
I do applaud Dr.Szasz's courage however in speaking out as he has. I also agree with many of his sentiments.
As a psychiatric survivor who has experienced immense suffering at the hands of psychiatrists who force treated me, and who almost killed me on numerous occassions, I agree with Dr.Szasz's contention that so called "mental patients" should have the right to refuse so called "treatment."
No one should be forced to endure electroshock treatment when it can cause brain damage and serious long term memory loss.
No one should be forcibly "treated" with neuroleptic drugs that can cause death, brain damage, addiction, and which can drive a person to commit both homicide and suicide. No one should be forcibly put in a chemical straight jacket and forced to endure the indignity of tardive dyskinesia with uncontrollable drooling, facial twitching, and impaired motor control.
I was forced to experience these things and worse. I was nearly killed one time when neuroleptic drugs caused me to lose my gag reflex, and I came very close to choking to death on my own saliva.
Today I am healthy, thanks to the healing power of dietary supplements when taken via a program designed by an orthomolecular physician. I encourage readers of the British Medical Journal to learn more about what helped me by reading the Journal of Orthomolecular Medicine. The most recent issue is a special issue re the safety and efficacy of vitamins and minerals. See http://www.orthomed.org for more information, and also read my story of recovery at http://www.iahf.com/on_the_back_wards.html My story has been spontaneously translated into several foreign languages, and has been downloaded over a million times by people around the world.
I have received email and phone calls from total strangers who called to say that by providing this information, I saved their lives.
I am one of the authors of a book that was published by the US Government Printing Office. It is called Alternative Medicine- Expanding Medical Horizons, a Report to the National Institutes of Health on Alternative Medical Practices in the United States, and I was on the ad hoc Advisory Board which established the Office of Alternative Medicine at NIH which today is the National Center for Complimentary and Alternative Medicine.
Due to the healing I've experienced as a result of dietary supplements over 20 years ago, I've been able to get free of the harm caused to people by the psychiatric gulag.
I would like other people to have the same chance I've had, so they can heal. I have been a lobbyist for the dietary supplement industry now since 1989, and in 1996 I started my own business- International Advocates for Health Freedom.
I am an international lobbyist. If any readers of BMJ would like to ask me any questions after reading this email, I would be glad to respond. I can be reached toll free in North America at 800-333-2553 home and work, and at 360-945-0352 World. While I don't agree with everything Dr.Szasz is saying, I appreciate his courage in bringing these ideas to the forefront, as they deserve serious discussion.
In closing, I'd just like to encourage more people to read Candace Pert, PhDs book "The Molecules of Emotion" Pert was a researcher at NIH who discovered that you can't separate the brain from the rest of the body because there are peptides, chemical messengers which interconnect the brain with all the organ systems in the body.
Thus, I suggest that there is truly no such thing as "mental illness" because you can't separate the brain from the rest of the body. To help someone heal, you must treat the whole person- and to do that- the most effective way to help someone heal is not to pummel them with toxic pharmaceutical drugs- you need to give them vitamins, minerals, amino acids, trace elements and hormones to bring about healing at the cellular level.
I hope some of my ideas serve as food for thought for Dr.Szasz, especially since he and his social milieu colleagues are so biased against the mode of treatment that helped me heal. (orthomolecular medicine)
I read David Oaks response and share many of his feelings. I was one of the original founders of Support Coalition International which David Oaks leads.
Thank you for giving me the chance to express these views.
Sincerely,
John C. Hammell, President
International Advocates for Health Freedom
556 Boundary Bay Rd. Point Roberts, WA 98281 USA
http://www.iahf.com
800-333-2553 N.America
360-945-0352 World
Competing interests: None declared

Anti-abuse not Anti-psychiatry 7 January 2004

David N. Gonzalez,
Employment Coordinator
Department of Labor - 11201
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Re: Anti-abuse not Anti-psychiatry

No doubt there are those who have a vested interest in forced treatment who will view such an "order of protection" against abuse as anti-psychiatry.
This is not anti-psychiatry. This is anti-abuse.
Tracing the long history of abuse that has been carefully documented as far back as 1887 when the famous journalist Nellie Bly feigned insanity and had herself committed to the asylum on Ward's Island (now known as Manhattan State Hospital)...
�to 1908 when Clifford W. Beers first penned "A Mind that Found Itself..."
�to the 1940's when Albert Deutsch wrote "the Shame of the States" and Albert Q. Maisel wrote "Bedlam" for Life Magazine...
�ad infinitum up to the most recent unveiling of psychiatric treatment "Mad in America" by Robert Whitaker - why anyone would NOT support such an order of protection would certainly challenge the very boundaries of reason and logic.
The only reason why these abuses have been tolerated is because of the media-driven stereotype of the violent and deranged "mental patient" who is a danger to himself and others.
That's not to say that "mental patients" don't occasionally commit acts of violence.
Certainly "mental patients" are just as human as everyone else and are subject to the same whims and quirks that "non-mental patients" are.
That's to say that the stereotype of the violent and deranged "mental patient" is the exception - not the norm (pun intended).
Laws that authorized slavery were based on the stereotype that the African was a savage and was only 3/4's human.
Laws that prevented women from voting were based on the stereotype that women were "the weaker sex" and were victims of their ovaries - unable to make rational decisions because they suffered from frequent bouts of hysteria (sound familiar?).
Today�s laws that authorize forced treatment are based on the stereotype that "mental patients" are a danger to themselves and others. These laws are the current version of the "Jim Crowe" laws of the South and these laws thrive on the belief that "might makes right."
The legalization of a document like this is the only thing that can save psychiatry from itself.
David Gonzalez
Competing interests: I am a former "mental patient" who has been subjected to psychiatic abuse under the guise of treatment and am now an anti-abuse advocate.

Bothersome issues 7 January 2004

Kim C. Maynard,
Retired Mental Health Professional
97402
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Re: Bothersome issues

Having worked for years with Vietnam Veterans at a Counseling center I find this issue to be a troubling one in many ways.
I will not state the issues here in medical terms, but in common language, because I believe that turning issues of common happenstance into incomprehensible jargon is one of the problems.
I believe that there are limits to what a person who is under stress, a person who at a certain phase of their life finds reality to be not so real, not what they consider to fit with normality, can assimilate, and put into a process that will allow them to make some major life decision.
Yet I believe, from my experience, both with clients, and personal, that everyone deserves the right to have a say in how they are treated.
It becomes too easy to pass off mandated treatment of others as somehow honorable and necessary for society, if the rules governing these issues exclude the views of those whom these rules effect.
Rules excluding the rights of the individuals effected are too easily abused.
Whether it be by legal, political, ethical, moral, religious or other standards, these rules can be too easily manipulated by powerful interest groups in such a manner as to deny the individual the rights of numerous freedoms.
There are many people in this society who could not fill out this form, who could not create a cohesive response to a questionaire or answer direct questions from someone under stressful conditions.
We have a president who often says things that either make no sense or sound incoherent. Should his rights to freedom be abridged because there is no one to stand up and say he is not insane?
Should his testimony that he is not insane be disregarded because he, whom some claim to be insane, deserves less control over his own destiny than experts with beter credentials do? Should he be the least likely person to judge his own mental ability because there are experts somewhere who know best what should be done for him? For society? And what of these experts? Where are they from? Who appointed them to be in charge of what is right or reasonable for society?
Was their position gained through politics? Through power? Because of money? Because of bloodline or stature or some temporary belief system?
Should we disregard the different, the unusual human in some quest to homogonize society?
I think not.
Competing interests: None declared

Re: Flat World, Round World 7 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Flat World, Round World

Dan Beales posted the following: <The splitting of the debate into �I hate psychiatry: I love psychiatry� means energy is directed at attacking or defending psychiatry rather than reforming it or attempting to address the paradoxes it involves. >
LOL This statement just shows the tremendous professional bias that exists among many psychiatrists and mental health professionals. I hate psychiatry, but I suggested practical, real world solutions towards "reforming" psychiatry and the way severe mental illness is handled. Obviously Dan Beales doesnt want to listen to logic.
I will say it one more time. If its REALLY true that severe mental illness is a biologically based (brain based) illness, then these problems should be formally removed from the psychiatric category altogether and should be formally placed into the organic (Neurological) category. Which would then eliminate the need for psychiatry. Formal medical tests such as brain scans and blood tests should be developed which could confirm suspected diagnoses.
I realize some of you psychiatrists make a pretty decent amount of money, which can distort your thinking. I realize many of you psychiatrists dont want to lose your lucrative psychiatric practice. I also realize many of you psychiatrists have invested large amounts of personal time and money into your psychiatric medical school education.
But guess what? I could give a flying f*ck about psychiatrists. I could give a f*ck if they stop making money and their practice goes down the drain. After what Ive experienced, I have no sympathy for psychiatry. What I care about is results and getting the seriously mentally ill back to normal. Psychiatry isnt very good at doing this, but many psychiatrists dont want to admit that.
There is ONLY one solution to "reforming" psychiatry. And that is to get seriously high tech about treating severe mental illness and actually learning something about the brain, the nervous system, the neuroendocrine system, etc. Thats complicated...and beyond the scope of your average psychiatrist. Psychiatry by its very nature is totally low tech, not high tech. And it is not reformable. Psychiatry is what we call here in the USA FUBAR...F*cked Up Beyond All Repair. It deserves to be scrapped totally as a separate branch of medicine and its duties split up between Neurology and Family Medicine. Psychiatry is NOT reformable!
If Dan Beales wants to reform psychiatry, he should join the Dr. E. Fuller Torrey fan club and become an advocate for formally merging psychiatry into Neurology. The day that occurs is the day the mentally ill will finally get what they deserve...respect.
LostBoyinNC
Competing interests: I hate psychiatry

recognize the future 7 January 2004

Gregory D. Bowyer,
Scanner
wild oats market 92652
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Re: recognize the future

We need to see that all humans are crazy and that isolating a select few is absolutely unfair. Let us recognize now, what future generations will see as simple human hysteria and profiteering.
Competing interests: None declared

Alternatives to hospitalization 7 January 2004

Jay Fickling,
internet advocacy
Sherman, NY 14781
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Re: Alternatives to hospitalization

I have been involved with the mental health system as both a consumer and provider of mental health services for 30 years.
I have experienced involuntary hospitalizations, voluntary hospitalizations and most recently I've developed a network of safehouses with friends where I stay when I feel that my symptoms are beginning to interfere with my family life.
My recovery rate from a period of respite with caring friends is remarkable. I can perform as a full functioning husband, father and employee within days. I have done this with the full knowledge and cooperation of my family and mental health providers.
Recovery from voluntary hospitalizations usually take several months.
Recovery from involuntary hospitalizations have taken years due to overuse of forced injections of psychotropic medication, administered often due to perceived behavioral problems in overcrowded institutions. I believe this might be referred to as chemical restraint, though I have also been physically restrained.
I would never take a risk with my life as paternalistic practioners may judge that choosing respite over hospitalization might result in. I actually experience more compassion and socialization while staying with friends who accept me as a whole person than I would in an inpatient setting where I am often treated with disrespect, stripped of clothing articles and left to fend for myself while workers spend hours charting instead of interacting with patients.
I have created this for myself and my family who may need time away from the strain that extreme depression can cause in a household. It has worked also by taking time for respite within my house before symptoms become severe. It helps that my employers provide reasonable accomodations.
I believe that safehouses and respite could be effective in mainstream treatment. Why must we wait for symptoms become severe enough for insurance companies to approve treatment on an inpatient basis base upon lethality issues? Which is ultimately more costly in terms of financial costs, loss productivity and recovering from a dehumanizing, traumatic experience. Which are entirely based upon the medical model and to tell you the truth are just plain cruel compared to potential humanistic alternatives.
Safehouses and respite could incorporate a wide range of humanistic approaches toward healing, even if they adhered to some manner of more traditional treatment practices, in order to become accepted by conservatives in the medical and insurance industires. Yet emerging effective programs such as peer advocacy and self help might also be incorporated.
I really don't mean to sound like I'm envisioning hospitalization under another guise that would be more palatable to those who choose other paths. Maybe I'm fanticizing about a place I would have rather been, and would have recovered from faster. And would not have felt like I had been forced and violated.
For those whose paths are accomplished through other means of their own choosing, I am equally supportive of. Self determination must be just as it sounds, a journey of one's own sense of well being.
We will never have real answers until society begins to accept us as human beings who love and live in harmony with our fellow men and women, rather than perceiving us as a social and medical problem that needs to be dealt with.
Then we may even begin to escape the ancillary conditions and consequences of stigma, poverty and institutional discrimination.
I must also add that I have worked for ten years as a peer advocate and have helped many to begin to experience recovery as they define it for themselves. I have also worked for five of those years in the medical model as part of an ACT team and had to participate as a team member in involuntarily hospitalizing someone. It played on my conscience for months. I finally resigned and ended my experiment of trying to help to change the system from within. May those who ever felt forced forgive me.
Now the state is engaging in even more coercive practices as they abandon informed consent and confidentiality for imaginary consent they bestow upon themselves under HIPAA amendments. It was a good time to get out. If admitting the truth is a competing interest, than I am guilty.
Yet I will work again, in time, with peers as an equal with shared values.
Compassion doesn't require an advanced degree. Yet I have met many compassionate people among both consumers and providers, and some have advanced degrees in life experiences and others in education. And not all who work in this human endeavor support force.
I thank this publication for offering alternative views in its pursuit of medical kmowledge and excellence.
Jay Fickling Sherman, New York USA
I am a recent member of MindFreedom Support Coalition International and have recieved awards for my work in peer advocacy from NAMI Chautauqua County and STEL, Southern Tier Environment for Living
Competing interests: None declared

Crazy talk: Advocating coercion? 7 January 2004

Jacqueline R Roig, PsyD,
Psychologist
Private Practice, Chicago 60611
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Re: Crazy talk: Advocating coercion?

How about advocating, with great passion at the time, the burning of witches (or women who spoke up and/or enjoyed sexual relations) for the good of the community? Or racial purification for the good of the world? To borrow from Dr. Szasz in this realm of coercive psychotherapeutic interventions, who profits?? I would venture NOT the women at the stake or the victims of racial cleansing!
It sounds crazier to speak of coerced "treatment" as benign than to denounce it for what it is - psychiatric justification for the profession's very existence.
Competing interests: None declared

protection orders are not enough 7 January 2004

Nathaniel .S. Lehrman,
retired; former Clinical Director
Kingsboro Psych Ctr, Rklyn NY
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Re: protection orders are not enough

The "psychiatric protection orders for the 'battered mental patient'" recommended by Dr.Thomas Szasz may somewhat reduce current difficulties but they come nowhere near solving the problem of increasingly harmful psychiatric treatment. Erecting legal barriers to protect psychiatric patients from their doctors will not create the care the patients need. That care requires proper organization, administration and leadership. Indeed, Dr. Szasz's proposed orders might be compared in the abstract to protection orders obtained by Viennese women about to deliver against obstetricians whose unwashed hands spread puerpural fever during Semmelweis's time. Both require correction of the overall harm being done by doctors; this goes much further than mere protection of victims from specific harms.
We have long known that voluntary psychiatry can help the mentally disabled. The only reason for involuntary incarceration is a patient's imminent danger to self or others. But if hospital psychiatrists saw their task as winning the confidence of even involuntarily committed patients by taking careful histories and then genuinely helping them with their problems - as was often done decades ago - the specialty could become useful again. This is, of course, the opposite of today's pattern of crippling patients upon hospital admission with massive doses of mind-bending medication, and with the drug-impaired patient then facing a choice between surrender to or defiance of their doctors, rather than cooperating responsibly.
I saw such an effctive system operating sucessfully in Cambridge, England, in 1978, where the same trusted psychiatrist treated the patient both in and after hospital. Between then and 1981, I did something of the same sort, also quite successfully, with over a hundred unselected patients at a New York State Psychiatric Center aftercare clinic. My positive, albeit limited, experiences there - the most exciting and satisfying in my entire professional career - were described in a 1982 paper, "Effective Psychotherapy in Chronic Schizophrenia" (Amer. J Psychoanalysis).
Such successful care requires specific organizational and attitudinal changes from what we have today. Those changes, and how patients should be treated (as opposed to how they are actually treated) are described in my spring, 2003, paper, "The Rational Organization of Care for Disabling Psychosis: 'If I Were Commissioner.'" (Ethical Human Sciences and Services) The subtitle indicates that the person most responsible for making such changes in the public care system is the state mental health commissioner.
Twenty-five years ago, I tried to find one state commissioner who would organize treatment around the continiuity of care principle -having the same doctor care for the patient both in and afer hospital. Even tho I was sure that within two years, the benefits - improved recovery rates and lower costs - would be clearly demonstrated for the whole country to see, I could not find one.
The bad situation Dr. Szasz describes has gotten much worse over the past half-century. Since the introduction of psychiatric drugs 50 years ago, the number of patient care episodes per capita has QUADRUPLED. The drug companies which reap immense profits from keeping patients disabled and on drugs, political bureaucrats, and the drug-company-supported American Psychiatric Association and psychiatric research establishment bear primary responsibility for this situation, which is characterized by the drugging by psychiatrists having replaced their human caring. Psychiatric drugging's overall harmful effects have been demonstrated in Robert Whitaker's excellent book, Mad in America, but the most important media have avoided reviewing it. The general psychiaric care situation is discussed in "If I Were Commissioner," and sp;ecific details of the profession's sabotage of effective care are provided in my 1994 "Bureaucratic Destruction of Patients' Faith in Their Doctors" (Bulletin, New York Academy of Medicine.)
While Dr. Szasz proposes a method for reducing psychiatric harm, he tacitly accepts the fundamental harmfulness of the care system as it stands. I believe that the system needs massive reorganization, that we have long known what that reorganization should look like, and that we should strive for it now. That goal is what "If I Were Commissioner" tries to show.
Competing interests: None declared

Don't forget the learning disabled 7 January 2004

Alan Challoner,
Retired
LL18 5UR
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Re: Don't forget the learning disabled

Dr Roig writes, �I am grateful that Dr. Szasz presents a voice to enlighten and protest coercion of humans under the false auspices of caring and treating.�
I am grateful that this dialogue is taking place. It is necessary for those with a learning disability to also be considered (mental handicap and retardation were the original terms in UK and US respectively).
My amazement continues that the historical anomaly of those who have suffered with this condition� whatever the cause� is perpetuated by enforcing their care into the hands of psychiatrists. In UK some are still in hospitals.
The reason that such people were ensconced in hospitals from mediaeval times onwards is that they were different in terms of behaviour. Psychology has allowed us to understand why they are different, and the militating factor can be a simple as environment. Yet we still find that many are medicated with psychotropic drugs because no one can be bothered to expend the time and money to find out what is best for them. Once they become adults the situation worsens because parents can no longer intervene unless they are prepared to go to court.
Community Care may have lessened the harsh and restrictive regimes for many once they have left hospital, but in a large number of cases the psychiatrist is still the one who has over-riding control and this almost always involves medication. It may make them easier to care for when the staff involved are not professionally trained (or even if they are), but it is still an historical and humanitarian anomaly.
Competing interests: Father and researcher

Worldwide need for this open discussion 7 January 2004

Mary S. Pearce,
RIF'd (reduction-in-forced)
97212
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Re: Worldwide need for this open discussion

I have been looking for a place to discuss these issues freely. I am sad it can't seem to happen in the U.S.
Not only do we need to discuss volition in our attempts to heal, but also efficacy.
In the long thread of responses, someone mentioned benzodiazepines. It is my understanding from a training I took as a social worker, that benzos are only appropriate for pre-surgery uses when a patient says she does not want to remember anything about the surgery. When these drugs work on anxiety, it is because they interfere with memory and cognition. For some people, it is extremely upsetting to have their memory and cognition impaired. Anyone who wants peak function, especially the already memory-challenged, should not take these drugs.
Unfortunately, they are massively used. Their use with the elderly is especially unfortunate. The training that I took was from Dr. Robert M. Julien, M.D., Ph.D., of Portland, Oregon, U.S.
Thank you for accepting this topic for publication. It has opened up a can of worms with a black hole for a bottom. Eventually the thread will evolve out of personal attack because the problems are so daunting.
To open the can even wider, taxpayers end up paying for persons whose behaviors are upsetting and not easily modified by small groups such as families. We need a larger discussion of how to house persons economically who do not play or work well with certain kinds of others. In the U.S., there are remote areas where energetic people could work on land reparation, far from alcohol and tobacco and the risks that use of these substances pose.
I cannot think of a reason why taxpayers should have to subsidize sloth or self-harm. I realize this is a pretty radical notion. I guess I feel safe writing it to a place so far away.
Another source of trouble, world-wide, is school trauma. A school situation which is good for one child can be massive trauma for another. Attention-deficit and autism-spectrum challenges need to be addressed in this regard. If we could become more discriminating and individual in our approaches to schooling, we would avoid a great deal of diagnosis of ills.
On the issue of which medical specialty should work with these issues, I have a story. An acquaintance was completely impacted the day he got out from his first hospitalization. Within hours, I had to drive him to an ER. He was in horrific pain which he had tried to hide from the inpatient staff, even though this is a well-known side effect. The typical in-patient facility will also cause abrupt withdrawals from exercise (endorphins?) from alcohol and from tobacco. Too many places should take this into consideration but do not. Anyone who works in the present system should have to have the equivalent of a weekly mass where they remind themselves of all possible harm from medications. Protocols where common problems are asked about daily should reign.
Again, bravo. I hope constructive change can come about because of this discussion.
Mary Pearce
Competing interests: I am the daughter of a person with major mood issues. I am the mother of an adult child with major emotional challenge.

advanced psychiatry 7 January 2004

joerg b. dao,
director
diap, 14195 berlin
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Re: advanced psychiatry

in germany, we have developed a new instrument, which came out from over 20 yeras of meditation. in that, we can handle emotions, psychotic outbreaks and intense depessions very easily by communicating minutely with the patient and guiding him/her to the underlying origin of those emotions. the main difference to common therapy is: 1. a new understanding of our human psyche 2. non-invasive understanding of the patient 3. comprehensive understanding of the expressed emotional and mental problems of patients.
on an advanced level, we can even help patients to quickly get rid of unwanted psychopharmaceutical drugs, by understanding the mental effect of those drugs, and redirecting the attention of the patient to those influences. thereby they come in touch of their own inner health and clarity, and see for themselves, how to overcome their mental or emotional problems. no pharmaceutical drugs in necessary at any stage in this process.
Competing interests: None declared

Re: Family of Lobotomy Victims Speak 7 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USAI represent a group of people who are lobotomy victims or related
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Re: Re: Family of Lobotomy Victims Speak

<I represent a group of people who are lobotomy victims or related to lobotomy victims. We have seen what happens when neurology and psychiatry merge. >
This is taking what I was saying way out of context. Merging psychiatry into neurology would NOT lead to a resurgence of "psychosurgery."
<You can read our oral histories at www.psychosurgery.org and remember what happened to us. We are people who have suffered the worst "help" that psychiatry has had to offer. Psychosurgeries are being performed once again, sadly for the same reason that they were when my grandmother and fifty thousand other Americans were lobotomized - because "these people are so sick we should try anything on them, even if it's totally unlikely to work." >
Thats exactly the reason the whole thing should be handed over to neurology. Because psychiatry is technologically unable to help most of the folks with severe mental illness. Psychiatry is too technologically primitive to help many severely mentally ill people.
We live in the age of computers, NASA space technology, functional neuroimaging and genetic engineering research. Science probably knows more about the moon, hell about the planet Mars...than it knows about the human brain. Thats pathetic in my personal opinion. Its time to begin applying this sort of high technology we have now to the complicated brain dysfunction that occurs in severe mental illness. Neurology is at the forefront of this sort of research, not psychiatry.
>Though many would like to think that psychosurgery is far more advanced now because of MRI and sterotactic techniques, the truth is there is no proof that any mental illness is caused by a physical anomaly. >
Mental illness is not caused by a physically rooted problem? I just had an overnight sleep study and was afterwards told that I have absolutely no REM and stage 4 "slow wave" sleep! I have also been recently diagnosed as being deficient in testosterone. And I havent even had a PET scan yet. Severe mental illness is biologically based and there is no use in being in denial about it. What do you think is going to happen to you if you arent getting any "deep stage" sleep for long periods of time? You are going to fall apart, thats what you are going to do.
Dont tell me mental illness doesnt exist or that it has no medical basis, because the opposite is true.
<The fact that psychosurgery -of all things- has made a comeback forces people like us to come out of the woodwork like ghosts of Christmas past and ask, "What on earth are you doing?>
I havent heard of "psychosurgery" making a comeback in the USA and I keep up with this stuff. And what miniscule amounts of psychosurgery that does go on in the USA (cingulotomy) is TOTALLY voluntary and stringent requirements must be met before being accepted into the program. And it is an extremely small number and like I said, 100% voluntary these days.
When I said psychiatry needs to be formally merged into Neurology, I was NOT talking about a comeback of "psychosurgery." That is totally taking what I was saying out of context. What I am talking about is the serious need for a major technological overhaul of the way severe mental illness is diagnosed, treated, thought of and generally handled. And only Neurology can provide this sort of high tech approach.
LostBoyinN
Competing interests: I hate psychiatry

Enough is enough 7 January 2004

Joni M Gallo,
Paralegal Student
18015
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Re: Enough is enough

If mental illnesses were truly illnesses, then why do professionals not seem to recognize that people recover from them? I went through a suicidal period 14 years ago and whenever I deal with medical doctors, police, or anyone else with access to my medical history, my prior �mental illness� is always brought up as something relevant. It�s as if, in their eyes, I am and always will be suicidal. This is just not the case.
I fear I�ll be turned down for jobs and who knows what else because of these erroneous beliefs that I�m currently still unstable and deranged. People�s horror when discovering my past secret tells me that they do not consider me to have been sick but rather more of a monster or freak.
I find it terrifying that I could find myself involuntarily hospitalized just because of my past. There has to be some protection for people in my situation. At some point, the past has to be laid to rest permanently.
I did cognitive therapy and I recovered. If I had been allowed to choose a treatment instead of being forced to take medication that did not work, I wouldn�t have wasted a year and a half of my life. That brings up another point. If suicidal impulses/depression/anxiety were illnesses, cognitive therapy wouldn�t work. Yet, it does for many people.
The people who put their relatives in mental hospitals may find themselves in the same boat someday. My mother was never diagnosed with mental illness in her life but when she became slightly confused and agitated at the age of 82, her doctors gave her psychiatric medication. Afterwards, she went downhill mentally very quickly. I tried to fight for her, but there was basically nothing I could do. At the very least, a person should be able to state in her living will that she does not want to be given psychiatric medication.
Medication that affects the processes of the brain so profoundly needs to be prescribed very carefully. It doesn�t seem to me that psychiatrists know what they�re doing and are, in some cases, destroying people�s lives. I don�t know what would have happened to me if I hadn�t discovered cognitive therapy. I feel strongly that other people in my situation should also have that option.
Competing interests: None declared

WHEN DO WE DRAFT THE DOCUMENT? 7 January 2004

Carol Hebald,
freelance writer
463 West Street #H660, New York, N Y 10014
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Re: WHEN DO WE DRAFT THE DOCUMENT?

In his foreword to my memoir, THE HEART TOO LONG SUPPRESSED: A CHRONICLE OF MENTAL ILLNESS, Thomas Szasz writes: "No one--especially no parent or psychiatrist--acknowledges that he does not understand his children or patients, much less that he does not want to understand them."
Psychiatrists diagnose patients so as to provide themselves legal means by which to control their so-called aberrant behavior; i. e. to shut them up; and in the process relieve themselves of the responsibility of understanding them or their actions.
On what possible basis then can psychiatrists presuppose that once a patient is ill he or she will always remain so? Because we are more than the sum of our joys, misfortunes, and diagnostic labels, Dr. Szasz's idea for an order of protection against forced psychiatric intervention is an absolute necessity.
Competing interests: None declared

Well Done Tom 7 January 2004

John Malone,
psychologist / manager
Australia
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Re: Well Done Tom

A great article in the tradition of a unique view from a truly clear thinking author and writer. Sadly all that is said in the article is true.
Competing interests: None declared

The need to bypass the chain of command 8 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: The need to bypass the chain of command

David Oaks mentions in one of his posts about his organisation's recent debate with the APA. Folks, debating about this sort of thing with psychiatry and the APA is a huge WASTE OF TIME. Anyone who knows anything about politics and getting things done knows you dont get things done by trying to push things up from the bottom of the chain of command. If you want to get things done, if you want REAL RESULTS youve got to bypass the chain of command and go straight to the top. And drop things from a height. Thats how you get legislation pushed thru.
In plain English, individuals who have a beef with psychiatry need to become politically involved, they need to VOTE and encourage other mentally ill individuals to vote. They need to form their own lobby or join a lobby which they feel represents them. And thru effective behind the scenes lobbying of our politicians, psychiatry could eventually be destroyed.
But this business of arguing with, debating with and dealing with psychiatrists and the APA is just a total waste of time, let me promise you. What we need are politicians at the highest levels who sympathize with the severely mentally ill and their unique plight. We need politicians who will listen to VOTING mentally ill individuals and their lobbies.
Just like the senior citizens in America have the powerful AARP lobby, the mentally ill in America need their own powerful, RICH lobby which can kick psychiatry to the curb once and for all. However, a fundamental problem is that the mentally ill as a block dont tend to even bother to vote. In order to have a powerful lobby, you need to be able to back the lobby up with a block of the population that consistently votes. Thats one of the reasons politicians arent interested in improving things for the mentally ill and fixing the problems inherent with psychiatry. The mentally ill dont vote and politicians know that. This voting problem needs to be seriously addressed in the future if things are to ever change for real.
Again, reading these posts reminds me of the basic fact that dealing with psychiatrists is like dealing with idiots. You might find one here and there who is genuinely interested in change and open minded, but most are too conservative and are just protecting their professional turf. Its a waste of time debating with them. Instead, go around them instead of thru them and bypass the political chain of command. Make end runs instead. Contact your Senators, Congressman, the President...tell them you vote and that we need fundamental change in the mental health profession.
Psychiatry is a lost cause and is not worth your energy debating with them, trying to get real change pushed thru.
LostBoyinNC
Competing interests: I hate psychiatry

Congratulations to the BMJ Chief Editor 8 January 2004

Volker Kubillus,
Writer
East Grinstead, W. Sussex RH19 4JX
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Re: Congratulations to the BMJ Chief Editor

As a member of the Citizens Commission on Human Rights and co-author of the book "Psychiatrists- the Men behind Hitler" (ISBN:0-9648909-1-7)I congratulate the chief editor of the BMJ for publishing the article of Dr. Szasz "The psychiatric protection order for the battered mental patient" (BMJ, 2003).
I have been working since 1976 within the CCHR mainly in Austria and in Germany. Besides the vast research undertaken by CCHR for the above mentioned book, I was able to document countless abuses done to human beings by Psychiatrists. I have come to a (very bad) conclusion after all the years helping those who had been i.e. destroyed and reduced to a "nothingness" by electric shocks or other inhuman pschiatric "treatments" (neuroleptics etc.): that Euthanasia and "selection" has continued and (yes, some will not like it) seems to be still the covered up purpose of Psychiatry today.
It needs courage to ask for legislation to protect the human rights of [mental patients]. We need more Dr. Szasz's today than ever. We need more editors like in the BMJ to provide a platform for humanity in the medical field.
Competing interests: None declared

Re: Re: Family of Lobotomy Victims Speak 8 January 2004

Christine L. Johnson,
Medical Librarian
Valley Stream, NY
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Re: Re: Re: Family of Lobotomy Victims Speak

This article about psychosurgery was posted on Psychiatric News on January 2, 2004: http://pn.psychiatryonline.org/cgi/content/full/39/1/28?etoc
According to this article, although Dr. Greenberg himself says the procedures are still experimental, 74% of psychiatrists would consider referring patients for psychosurgery. That's unbelievable. No proof, totally risky, but they're ready to refer.
Maybe you think this makes your point about psychiatrists being incompetent, but the fact is it makes the argument that medical doctors are ready to do some pretty extreme things to psychiatric patients with no proof that it will help them.
As for a physical anomaly causing mental illness - this is unproved. You cannot point to a tumor or any other physical defect in the human brain and say, "There's the OCD! Just burn that right off and this person will get better!" There is nothing like that and no one has the right to permanently change a human being on a hunch that "maybe this spot here is the right one". I have been contacted by one family in which the daughter, a cingulotomy patient, has been operated on four times. That doesn't sound like exact science to me.
Competing interests: None declared

Coercion 8 January 2004

Roderick J Harvey,
retired
not applicable
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Re: Coercion

In 1993, I was sectioned in an acute psychiatric ward in Plymouth, believing I was the archangel Gabriel. I had been given haleperidol on previous episodes and was convinced that its main side effect was severe depression. Instinctively I knew that I did not want to take it and therefore refused.
I will never forget the humiliation of the sequence of events that followed. I saw the phone being picked up in the glass office and knew that reinforcements were being summoned from other wards. I was man handled into a side room by six nurses, held in an arm lock and then spear tackled onto a bed. I landed on my neck which could so easily have been broken. My trousers and pants were pulled down and I was given an injection into the buttocks which was very painful.
On 14 February 1994,by now suffering from unimaginable mental anguish, I contrived to escape. I walked to a nearby dual-carriage way, waited for a lorry and walked in front of it. I was subsequently in hospital for five months and had to learn to walk again.
It now seems accepted that the old cheap neuroleptics are not for me and my medical notes reflect this.I now take olanzapine when high and do not suffer from depression when the psychotic episode has passed.
I think that had I had a "psychiatric will" expressing my loathing for the liquid coshes of chlopromazine and haleperidol and the reasons for such loathing, perhaps more effort would have been made to offer something more specific and suitable to me. Had such efforts been made, perhaps I would have been spared humiliation and the wheels of a lorry.
Competing interests: None declared

Well Done BMJ Editors 8 January 2004

Joseph .C. Obi,
Chief Consultant
WellnessClinics.co.uk
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Re: Well Done BMJ Editors

You have (at long last) indeed published your very first exciting article.
Long live the totally irrepressible Professor Thomas Szasz !!!
Competing interests: Dr Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants.

"Forced" psychiatric treatment 8 January 2004

Irene Mazis,
none
Montreal, QUEBEC H3Z 1J5
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Re: "Forced" psychiatric treatment

Dr. Thomas Szasz rightly points out the dated and precarious method of treating "mental patients" without or against their will. Many mistakes and dangers can arise from this: wrong drugs, wrong dose, wrong assessment of initial state of the patient, irreversible damage from the mistakes, etc. The suggestion of a "will" contract may be a good idea in some cases.
On the other hand, the doctor may have to deal with a violent, suicidal, or self-mutilating psychotic. What do you do then?
This issue is complex: legally, socially, and medically. It is not as simple and forthright as the passionate desire for treating patients "justly". There are practical problems involved which, even in attempting to give the "patient" as much freedom as he wants" may result in greater injustices from his case. Of course, not all cases are the same and there are degrees of psychotic states.
One need not think too hard for example, regarding the recent case of the Picton farm in Vancouver, Canada where a madman could have been stopped from slaughtering the greatest number of helpless, poor, and sick women working the streets for survival, in the history of serial killings in Canada.[1] [2] Had he been give a shot of drugs involuntarily, I would not feel the least bit sorry for his violated rights to freedom to kill, dismember, grind, and feed the victims to his pigs.
1 http://cbc.ca/stories/2003/11/05/picton031105
2 http://www.cbc.ca/news/features/bc_missingwomen.html
Competing interests: None declared

Psychiatry is always dodging the issues. 9 January 2004

Cal Grandy,
Psychiatric Survivor
Topeka, KS 66606
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Re: Psychiatry is always dodging the issues.

Please bear with my somewhat rambling response on the topic of Dr. Szasz�s excellent article in the BMJ. Some might say my writing is full of invective. It is a truthful, valid view, nonetheless. I have had to live for forty years in the aftermath of way too many of psychiatry�s brain- blitzing electroshock �therapies.� That in combination with all-to-rapidly advancing years conspires to keep me from writing about my experiences as much or as well as I want to. Whether officially recognized or not, I feel that I am more of an authority on the subject than those who reference PR and Spin material as sources of support for their assumed authority. On with it then.
Psychiatry apparently has no shield to hide behind, except for using its avowed enemy as one. I have been used both to further the aims of Scientology and by institutional psychiatry to further its own aims. The only lasting personal damage came from the latter system of quackery masquerading as health care. Psychiatry wants to make ALL the money to be had for 'caring' for emotional distress, in my view, that is why they hate Scientology so much, as a competitor.
On the present stage, care for those in mental dis-ease for the large part cannot be turned over to neurology, simply because for the bulk of such situations there is no detectable, identifiable lesion or biological malfunction, despite all the hype and pretensions to the contrary.
Power has been taken, by government mandate and by misinformation, from those who might care and help -- the true friends and family of the afflicted, and from those other methods and practices which have been squeezed out by psychiatry's dominance. The rise of psychiatry parallels its assumption of power of illegitimate authority through allying with and abetting monarchist and then fascist, neo-fascist, and now neo-con regimes pretending to be democracies. True democracy will only arise when sovereignty is based upon inviolable rights assumed by and kept to the citizen; it will not arise under the auspices of self-perpetuating hierarchies of government and other. Psychiatry only exploits this lack of defense of individual liberty. Except in the rare person of truly wise men like Tom Szasz, never has it stood up for it. Autonomy and self- determination is what will produce so-called mental health, not institutionalized coercion, with drug company, and electroshock machine monopolies on �care.�
Stripping their 'clientele' of all human rights and dignity, a future worth having, and of the possibility of their victims ever seeing justice for the assaults called treatments they have had to endure is the unpardonable sin of psychiatry.
Competing interests: None declared

good article! 9 January 2004

Roelof A. Bijkerk,
composer,pianist, artist etc.
Grand Rapids MI, 49505
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Re: good article!

That's a really good article. You can add to it the fact that the kind of statements they make about mental illness being genetic is the same as statements that used to be made like for example that aborigines were insensitive to pain and by nature stupid and only good to be used as slaves for hard labor, Or that women weren't intelligent enough to vote because they were too emotional and not logical (tell that to Bush's new advisor, what's her name again) or that ................. who knows what else they come up with.
It's really simply true that people with a certain type of brain, that works a different way (for example when one is capable of actually going over things and imagining them in their head like Einstein or Mozart) that these people are prejudiced again because they are not as open as others are to being programmed � because they know that they can think about things themselves and make their own decision and don't need another to tell them, no other but life itself. These people then maybe have certain genes that are persecuted and then the same "geniuses" who decide that someone who is on forced psychiatric medication behaves more sanely then someone who isn't and thus they can say that there is a chemical imbalance although they have no scientific proof for that only biased prejudism � these same people decide that a certain gene leads to schizophrenia. I'm also even concerned about the need for scientific proof myself because even in cases where there is "scientific" proof that a person needs a certain medication (say for the heart) then this can often be changed through reevaluating one's intentions about behavior so that the behavior changes. If someone believes they have to work themselves to hard and otherwise isn't part of things (and then the beauty in life which when appreciated would bring happiness and spread it around freely is discriminated against) they might develop a heart condition. Would they question the intent they have or working to hard they would change the behavior, or if they changed the behavior they might see that they actually do more without pushing themselves too much. The then "scientific" data which had even been proven to pertain to a certain chemical then functions for a person to become dependent on these little pills in order to not have to look at what he himself is doing to his body. The mental health system then doesn't even have any real "scientific" proof you say but even if they did that wouldn't mean they were right.
In true science, or what is the beginning of quantum physics then, the separation between controlling an effect and what lies outside of that effect is acknowledged to be nebulous.
And the psychiatric health system simply uses prejudisms. If someone behaves in a way they don't understand and which doesn't adhere to the norm then they decide that they are mentally ill. For example when someone isn't taking care of themselves according to them because they (the psychiatrists and the mental health community) don't know what is going on they disrupt that person's ability to find out what lies beyond them giving up on normal modes of behavior and normal modes of taking care of oneself. For example, drinking alcohol is widely accepted as something that turns off one's inhibitions (and drinking socially isn't usually seen as a disease and certain isn't a reason to have a person committed to an insane assylum) but when a person has a change take place in their personality or their behavior which involves challenging societies inhibitions so that they might find their own natural expression beyond that, this isn't accepted and a person gets stamped as having a mental illness when their natural body chemistry turns off these inhibitions.
Thus, when a person, when encouraged to act out what they are feeling, would find out that who they are is something free of the type of programming they have had most of their life by society or institutions, then they are labled as being mentally ill, are forced to take all manner of treatments which try to suppress the very brain activity (literally disables the mind such as in shock therapy) which would allow them to become enlightened and they are supposed to believe that this whole farce which imprisons the human soul, costs a ridiculous amount of money where as the simple alternative of allowing nature to heal not only "costs" a fraction of the amount but in the end creats incredibly productive human beings and so has nothing to do with cost but with what you get out of it, that it costs anything only has to do with people thinking they need something before they will accept a gift. Who knows the difference?
Competing interests: None declared

Gratitude for Szazs's Article 9 January 2004

John O. E. Laue,
Retired
8 Morehouse Drive, La Selva Beach, California, U.S.A. 95076
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Re: Gratitude for Szazs's Article

I'm very happy that Thomas Szasz pointed out that many psychiatrict patients are battered, often by their parents. I am a person who has experienced psychiatric problems which I think are at least partially due to my mother's, my father's, and step-mother's constant conflicts and out-and-out cruelty to me and themselves. Almost universally among the patients I have talked to, similar scenarios seem to be the case. I thank Dr.Szasz for setting the record straight on this crucial issue. The opposite argument, that parents have nothing to do with their childrens psychological illnesses,invalidates the patients' perceptions and adds to the severity of their (our) illnesses.
As for other credentials, I am a former Co-Chair of the Santa Cruz County (California) Mental Health Board, an internationally published poet and prose writer, a member of the Steering Committee of my National Writers Union Local, and have a website featuring my own experiences and advice for those also deemed "mentally ill". The address is as follows: http://members.aol.com/Joelmobius.
Competing interests: None declared

Re: In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill 9 January 2004

Roelof A. Bijkerk,
healer through all forms of art
Grand Rapids MI 49505
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Re: Re: In the U.S., Psychiatrists Do Not "Commit" the Mentally Ill

It is a common tactic of people who have been brain washed to have such a narrow ability to see what's going on that they become obsessed with little details, that have little or nothing to do with what's really being said and then weave that into their own web of denial.
To begin with:
The article by doctor Szasz is about the fact that people are not given the right to decide if they should have treatment. To make a statement that "psychiatrists" don't commit people is ridiculous. If there weren't people calling themselves psychiatrists and trying to exercise their prejudisms against the human mind deciding who is sane and who is and who has a chemical balance and who hasn't when their is no scientific proof of their statements and thus they are prejudisms then no one would end up being committed to mental institutions or they would be completely different places, they might even be places that offered alternatives to drugging people with chemicals that really only disable the mind and interfere with someone finding their own answers in life rather than being programmed. Psychiatrists not only institutionalize people and commit them but they act as agents of mental health while they in reality promote methods that disable the mind, do not allow the real evolutionary change to take place that could allow for a whole different type of human to emerge that is more functional then they would believe is possible and they (psychiatrists) also actively use methods of diagnosis which promote fear and brainwash people into thinking they are being sane when in reality they are being prejudiced. It's like everyone thinking they have to fight a war when the methods of non violence and letting go of resentments have never been tried and thus there is no level of understanding.
Also Dr. Szasz point was that for example when a patient has cancer and does not want to have treatment, doesn't want to have chemotherapy or surgery that then he or she is allowed to leave the hospital. Also there are methods of treatment which actually work and are highly effective which many or no medical institutions offer and the patient is then allowed to follow these methods. In the case of the psychiatric institutions a person is almost always forced to take medications (which in reality create a chemical imbalance in their mind which wasn't there before) rather than being allowed to follow a method which would allow them the space to find out what is going on themselves. It is the same as cutting off a child's arms and legs in order that it cannot move on it's own in order to make sure it is supposedly protected from the world at large, so that it cannot enter there.
Also just to prove a point, anyone who has been brainwashed by the psychiatric institutions will site cases where it is necessary to use medications on a person when in reality there are effective methods of healing (which do not disable the mind) which are simply not acknowledged although they have been proven to work. When a person can feel that the medications are not something desirable this is used as an excuse to force the medications on them. They are not even told that there are other things to help them. A person who does not go along with the pre-formed prejudicial way of looking at what's going on would be told that he has to take on the prejudicial way of looking at things to become a psychiatrist although sometimes a person who has become a psychiatrist learns that what he was taught or believed is wrong and then sees things differently.
In fact, the real people who promote healing of the mind at a level which doesn't even need to be proved to show that it is necessary are people who create art. Musicians, artists, authors, poets, actors, dancers and anyone who opens themselves up to the mysteries of what beauty is are the ones who really maintain mental health in society and as a human condition. The psychiatric profession has then taken almost every great artist and stamped them with some sort of psychiatric diagnoses of having this or that disease because they the psychiatrists can not see what healing really is and are prejudiced against it. They would rather disable the mind.
A person has to receive their treatment or they are supposedly receiving no treatment. This isn't right! It is immoral and there should be laws against it!
Competing interests: None declared

Stunning correspondance and the medicalization of childhood 9 January 2004

Sami Timimi,
Consultant child and adolescent psychiatrist
Ash Villa, Sleaford, Lincolnshire NG34 8QA
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Re: Stunning correspondance and the medicalization of childhood

I have just looked through the extensive correspondance that this article has provoked which in itself justifies the BMJ's decision to publish this article. I congratulate the BMJ as one of the few journals that has shown itself capable of getting people to engage in critical debate (it does much better than my profession's journal 'the British Journal of Psychiatry' in that regard). I think its fantastic that there has been a platform for marginalized voices to be heard. In this context it is the grand narratives of bio-medicine which has relied on psychiatry's historical power, to remain aloof, unengaged in cross- disciplinary dialougue and in listening to the experiences of their patients, that is coming to look old fashioned.
What troubles me these days is that while adult psychiatry with courageous authors like Szasz or our own Crtical Psychiatry Network in the UK, has began (all be it peripherally) to debate questions about the fundemental assumptions upon which theory and practice is based, this is not happening in child psychiatry. Quite the opposite, child psychiatry is being invaded by pseudo-medical, context deprived, unproven and hypothetical models with theory and practice coming to revolve around medicalized interpretations of childhood problems (such as ADHD). The price our current generation of children are already paying is a terrible one with millions of children in the western world being medicated with powerful potentially mind-disabling and addictive drugs, primarily for the purposes of social control.
Competing interests: author who writes about the medicalization of childhood

Re: "Forced" psychiatric treatment 9 January 2004

David Gonzalez,
"Mental Patient"
Brooklyn, N.Y. 11201
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Re: Re: "Forced" psychiatric treatment

Isn't this the very type of blanket allegation that psychiatrists refer to as paranoia? This woman rehashes the same high-profile cases that are routinely exploited by the media to perpetuate the sterotype that the average "mental patient" cuts people up and feeds them to his/her pigs.
If I followed her line of reasoning I could just as easily quote the numerous high-profile cases of "deranged" psychiatrists who were the inspiration behind Hannibal Lector - but I have no intention of stereotyping psychiatrists like this woman has obviously stereotyped "mental patients."
Why are the actual facts about "mental illness" always superceded by stereotypes and misconceptions? This letter says a whole lot more about the writer, than it does about the facts. It's very self-assuring to accuse others of being "psychotic" than to take a look in the mirror and acknowledge one's own paranoia.
Competing interests: None declared

Re: "Forced" psychiatric treatment 9 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: "Forced" psychiatric treatment

Irene Mathis posted: <On the other hand, the doctor may have to deal with a violent psychotic. What do you do then? >
How about letting the police come arrest them and put them in jail? At least there you know what your rights are, in contrast to the mental health system. In jail at least you know where you stand and have a lawyer assigned to you.
Being mentally ill is no excuses for breaking the law and becoming violent. Psychiatrists should not try to become the police with drugs in situations such as these, instead the job should be assigned to the police and law enforcement community. Unfortunately this sort of thing is a large part of psychiatric history and training.
Psychiatrists have always operated "under the radar" so to speak as an ad hoc, quasi law enforcement agency in their own unique (very unique) way. They keep it low key. Its time for society to find out about psychiatry's warped approach to dealing with individuals with anti-social personality traits. Such as prescribing them neuroleptics when they have otherwise no major Axis One psychiatric disorder.
Its called behavioral control and its a central tenet of psychiatry. Behavioral control should be the job of the police and prison system...not psychiatry. Behavioral control via the psychiatric system I am 100% positive would be considered "cruel and unusual punishment" according to the US Constitution. Just like using ECT for behavioral control used to be commonly used but was eventually made illegal, so is the current practice of using neuroleptics for behavioral control immoral and unethical.
BTW...using neuroleptics on violent individuals with no major Axis One psychiatric disorder, ie; "personality disorders" is criminal and the laws should be altered to restrict this evil practice.
LostBoyinNC
Competing interests: I hate psychiatry

Re: Re: Re: Family of Lobotomy Victims Speak 10 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Re: Re: Re: Family of Lobotomy Victims Speak

Christine Johnson wrote: <This article about psychosurgery was posted on Psychiatric News on January 2, 2004: http://pn.psychiatryonline.org/cgi/content/full/39/1/28?etoc
I took a look at that article and I dont support the traditional version of psychosurgery at all. Cingulotomys and capsulotomys (whatever that is) is nothing I would support. If you want my honest opinion, I believe doctors involved in trying to bring back any form of "traditional" psychosurgery should be investigated, be publicly humiliated and stripped of their medical license. And possibly even serve prison sentences.
However, the Deep Brain Stimulation thing is another matter altogether. YOu cannot compare DBS with the older, barbaric, ablative forms of psychosurgery. Its like comparing apples with oranges. DBS is a modern, safe procedure that has helped many many parkinsons patients. Being that parkinsons disease involves the basal ganglia area and so does OCD, maybe some of these neuro inclined doctors believe DBS would help those with severe refractory OCD. I am fully familiar with DBS and similar MIBS (Minimally Invasive Brain Stimulation) modalities. And I can assure you that DBS is not going to turn anyone into a lobotomized zombie like a traditional psychosurgery would do.
<According to this article, although Dr. Greenberg himself says the procedures are still experimental, 74% of psychiatrists would consider referring patients for psychosurgery. That's unbelievable. No proof, totally risky, but they're ready to refer.>
<Maybe you think this makes your point about psychiatrists being incompetent, but the fact is it makes the argument that medical doctors are ready to do some pretty extreme things to psychiatric patients with no proof that it will help them. >
Most psychiatrists are indeed technologically incompetent, that is a true statement. Their lack of ability to admit this to themselves individually or as an institution of medicine shows their extremely poor insight into themselves and their profession.
<As for a physical anomaly causing mental illness - this is unproved. You cannot point to a tumor or any other physical defect in the human brain and say, "There's the OCD! Just burn that right off and this person will get better!" There is nothing like that and no one has the right to permanently change a human being on a hunch that "maybe this spot here is the right one". I have been contacted by one family in which the daughter, a cingulotomy patient, has been operated on four times. That doesn't sound like exact science to me.>
The science of severe mental illness is indeed fifty years behind that of general medicine. However there is now enough hard evidence to remove the major psychiatric illnesses from the psychiatric category and recategorize them as neuro illnesses. There is enough evidence accumulated for their to be a starting point.
Individuals afflicted with severe and refractory psychiatric problems are being referred to functional neuroimaging labs across the country for functional MRI, SPECT and PET scans. These brain scans are showing for the first time EVER what severe mental illness really looks like, that schizophrenia affects certain areas of the brain, severe depression another, anxiety another, manic depression another, etc. etc. etc.
Furthermore its well known now that severe mood disorders affect the sleep architecture of afflicted individuals. I had a recent sleep study and was afterwards told by a sleep medicine doctor I have absolute ZERO "deep stage sleep" which means I am getting no REM and no stage 4 slow wave sleep. Hardly a recipe for good robust health. Additionally, I have been formally diagnosed with low testosterone and borderline high blood cortisol levels. All of these things are inline with what is known about severe depression.
So dont tell me that severe mental illness has no biological basis to it. That is insulting to me and trivializes my disease and my horrific experiences in the last six years. I dont appreciate you telling me there is nothing wrong with me.
I fully understand why you are seriously concerned about psychosurgery and I feel bad about your past relative who was a victim of old school, institutional type psychiatry. However, you should also keep an open mind and realize severe mental illness does exist, it has biological basis to it and there are individuals who want things changed accordingly to reflect these basic facts.
Again, Deep Brain Stimulation and other modern, high tech type neurological procedures such as Vagus Nerve Stimulation are hardly in the same category as lobotomy or similar primitive "psychosurgery." Just some advice, you should remove DBS from your psychosurgery.org website as being a "barbaric" form of psychosurgery.
LostBoyinNC
Competing interests: I hate psychiatry

Addressing various comments 10 January 2004

Kim Gregory,
Parent
RH 12 3LW
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Re: Addressing various comments

I dont know why but I've been following this debate sine my last response... here's a conglomeration of thigs I felt compelled to address.
>>Please note that we at MindFreedom are pro choice. Many of our members choose to take prescribed psychiatric drugs. But the utter domination of the mental health system by the psychiatric drug industry, and other highly-profitable corporations, is the real issue. <<
I am one of those you infer criticisism upon for attacking Dr. Szasz's connection with scientology - I did want to point out the irony of your statement above. Dr Szaz is anti ALL psychiaty medication!!! as are quite a few others. So to be fair there would never be any choice would there? If he and the scientology allies got their way then no-one would have access to medication of their mental differences/illness and that my friend would cause untold discrimination and would be barbaric on terms of human rights.
>>What I care about is results and getting the seriously mentally ill back to normal. Psychiatry isnt very good at doing this, but many psychiatrists dont want to admit that.<<
I can see you feel very strongly on this! And who knows you may have very good reason! But I have to point out.....you forget that physical medicine isn't a whole lot better!!!! There are so many illnesses, in fact most of them still, for which there is no known cause, no known cure and no known effective treatement and you have to bear in mind that this too leaves countless millions of *victims* disabled in just as real a way as those who take psychotic drugs and have them fail to completely remove their symptoms. Sometimes the best that can be achieved, for both physical and mental illness is temporary relief and/or avoidance of the problem on a short term basis.
I don't pretend that I know anything about forced treatment but I do get irritated when people make statements about pshychiatry being the only bad-guy and out of context hold its trying to help people up above medical doctors when to be truthful an awful lot of them are disinterested, lazy, greedy and motivated mainly by how much money they can make! Let us not forget that many many GP's are there handing out vast quantities of medication on a daily basis MOST of which have all sorts of horrendous side-effects just as if they were sweeties! Above all lets not forget the many many thousands of people who are left damaged and trying to fight for compensation for medical negligence and mis-treatment! Where's the protection from them?
>>Dont tell me mental illness doesnt exist or that it has no medical basis, because the opposite is true. <<
Yes but that's the point! Dr Szaz and friends ARE saying that! They deny that it is real and by thus doing so deny everyone any form of treatment. I think that that is the reason why we must mistrust what he is saying - because he does not come from an unbiased standpoint - its more devious than that - it would start with the banning coercian (which very few of us disagree with) and would then seek to *tell* all others with mental illness or learning difficulty that their problems are not real and that they cannot have any form of treatment! I speak as a parent of 2 ADHD sons - let me make this plain - without treatment they would have thier lives lying in tatters - to suggest that al they need is *cheering-up* with a friendly concerned therapist is plain misguided and ignorant and fails to understand on even the most basic of levels! I firmly belief that treatment while they are children will PREVENT the kind of psychosis and behaviour/personality/depression problems that can occur as adults.
>>According to this article, although Dr. Greenberg himself says the procedures are still experimental, 74% of psychiatrists would consider referring patients for psychosurgery. That's unbelievable. No proof, totally risky<<
Let us not get too pious here! Medical physical medication is entirely the same!!! extremely crude and pretty dangerous medication is handed out every day to people with NO proof that it works! If its any help the same occurs in the veterinary world ( e.g. my doggy was given tablets for an itchy skin condition that caused cancer, liver failure etc! another e.g my mother started out with one problem and took tablets which caused another illness and now she takes more tablets than a pharmacy!) in all these things its experimental THIS IS HOW WE LEARN! Yes it doesn't make it acceptable for those who are the guinea pigs BUT we look back at the barbaric medical practices of the past and we know that Medical treatment and phyciatry progress is founded on this!
>>child psychiatry is being invaded by pseudo-medical, context deprived, unproven and hypothetical models with theory and practice coming to revolve around medicalized interpretations of childhood problems (such as ADHD). The price our current generation of children are already paying is a terrible one with millions of children in the western world being medicated with powerful potentially mind-disabling and addictive drugs, primarily for the purposes of social control<<
Hmmmm didn't they use to say that all sorts of physical illness didn't exist? People were left suffering - still today we are discovering new illness every day as techniques evolve to detect them. so we haven't absolutely proven ADHd etc yet - that doesn't mean we never will and it certainly doesn't mean it doesn't exist! THIS is the kind of attitude that lead to Crohn's disease being said to be punishment for loose morals (sorry Mum's just been diagnosed that too!) This attitude of this *preofessional* isn't all that unusual - it's exactly why I especially seek to avoid taking my children to such people! If they dont believe a certain condition exists HOW can they even begin to help? The writer if this snippet of wisdom was a pshychiatrist!!! Um let me see weren't we all saying that psychiatrists were crackpots who didn't understand diddly and made up illness for fun? You can't have it both ways wither they are all quacks or they all accept that brain differences/chemical inbalances DO exist -I can't help wondering what this chap makes his money diagnosisng if he refuses to accept childhood learning difficulties - and worse stil makes outrageous claims such as that the treatemtn for ADHD is addictive!! This I am afraid the kind of attitude that CAUSES real suffering for children - suffering that can lead to life-long trauma and psychosis/depression etc. It also causes intollerance and discrimination and this can be equally debilitating.
Competing interests: Parent of 2 ADHD children

Prophilaxis for psych drug harm 10 January 2004

Daniel Q Burdick,
Attendant
Wonderland Dropin Center Springfield Oregon USA 97477
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Re: Prophilaxis for psych drug harm

Hi,
One aspect of the problem of the harm caused by psychiatric drugs is the complete disregard of complementary prophilactic treatment. A major component of the damage caused by neuroleptic drugs is an increase in oxidative damage. To prevent this appropriate antioxidant supplements can be used. Haloperidol increases lipid peroxidation, as Mahapatra wrote in his thesis paper on Olanzapine and Haloperidol available online. Antioxidants that specifically protect against lipid peroxidation in the brain include Alpha-lipoic acid, Ginko Biloba, and vitamin E.
Phenthiazines such as clorpromazine chelate manganese. Manganese is part of Manganese Superoxide Dismutase used specifically in the part of the brain, the substantia nigra, which is harmed by neuroleptics when they induce so much brain damage to the dopamine neurons that patients are given parkinsonism.
Health problems of the brain that have clear oxidative aspects include Alzheimer's disease, Parkinson's disease, and so-called schizophrenia (which is not a single clearly defined disease entity, no matter any claims of drug companies or of psychiatry.) Further, the Tardive Diskinesia caused by neuroleptics, and the type 2 diabetes caused to a greater degree by the new "atypicals" also have oxidative components. Any responsible prescriber would research the the issues of the oxidative components of both the putative diagnosed diseases, and the harm caused by the drug treatments and prescribe a range of antioxidants.
Use of antioxidants should be obvious to doctors prescribing these drugs yet is completely disregarded. It isn't their brains that are being damaged. Once the brain damage causes TArdive Dyskinesia then other drugs will be prescribed. This is deplorable.
Here are articles found by looking up Tardive Dyskinesia treatment and prevention using vitamin E and manganese.
Tardive Dyskinesia.
http://www.mycustompak.com/healthNotes/Concern/Tardive_Dyskinesia.htm
Nutritional Treatment of Tardive Dyskinesia by Walter Lemmo, ND.
http://www.alternativementalhealth.com/articles/td.htm
Tardive Dyskinesia by Stephen E. Edelson, Ph.D.
http://www.autism.org/tardiv.html
The Adverse Effects of Manganese Deficiency on Reproduction and Health by Tuula E. Tuormaa.
http://www.foresight-preconception.org.uk/summaries/frames/manganese- nf.html
"Manganese chloride was first tested, and found effective, in treating schizophrenia as early as the 1920s (47-48). Somewhat later three micronutrients, in particular copper, zinc and manganese, started to generate much research in a variety of mental disorders, particularly in schizophrenia (27). Heilmeyer et al. presented one of the earliest studies implicating an excess of copper in 32 of 37 schizophrenics (49). This was followed by Dr Pfeiffer and his colleagues, who carried on observing an excess of body copper and low manganese status in a variety of mental and physical disorders, such as in schizophrenias, depression, alcoholism, epilepsy, also in some infectious diseases and cancers (27). In order to eliminate the excess body burden of copper, both manganese and zinc supplementation were used, as the two nutrients together were found to be far more effective for the copper elimination than either of them alone (27,34,50- 53). An additional study found considerably lower hair manganese levels in schizophrenic patients compared to controls (54).
Hurley and his colleagues were the first to demonstrate a significantly reduced seizure threshold in manganese deficient animals given manganese supplementation (55). Further studies found considerably lower blood manganese levels m epileptic patients when compared to controls (56- 57). Thereafter several uncontrolled trials have found manganese supplementation being helpful in controlling seizures, of both minor and major types, possibly due to its central role, with choline, in the control of membrane stability (53). "
"The side effects of prolonged medication with neuroleptic drugs are known to lead to tardive dyskinesia. This condition is sometimes reversible after cessation of medication. However, in many subjects, this condition seems to become irreversible. Research has now shown, that neuroleptics are able to chelate body manganese (58), binding it electrochemically, thus making it unavailable as an enzyme activator (59). Research by Kunin (60) found, when treating 15 patients suffering from tardive dyskinesia with manganese supplementation, that seven were cured outright, three were much improved, four were improved, and only one was unimproved. As a result, it has been suggested, that manganese can be of value in the treatment of tardive dyskinesias, as well as possibly in preventing this iatrogenic disorder from occurring (27). In addition to the conditions mentioned above, manganese deficiency has been associated with back ache, due to its essential role in the cartilage formation (27,61). Also, manganese deficiency has been associated with cancer formation, due to its central role as Superoxide dismutase in the protection of the cell nucleus, and the mitochondria, from free radical formation (10). Manganese deficiency has also been linked with heart disease, as manganese has been found to be equally effective as a calcium antagonist as modern drugs (10). In addition, a study reported hair manganese levels of both male and female patients diagnosed as multiple sclerotic (MS), to be half that found in control subjects (62). "
"Manganese being a mitochondrial element, it is also the key component of the superoxide dismutase found in mitochondria of the cells, that protects the fragile mitochondrial membrane from the attack of free radicals. Without manganese the mitochondrial SOD would simply be inactive and accumulation of free radicals would lead to severe membrane damage (4,10,27,35). Other forms of superoxide dismutases, found in the cytosal, require copper and zinc and iron for their activity (10,27,35). "
Regards, Dan Burdick
Competing interests: None declared

First improve the mental health system 10 January 2004

Phil Thompson,
software engineer
Los Altos, CA 94024
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Re: First improve the mental health system

Here are some quotes from US government reports (with references/ web links) about the effects of coerced psychiatric treatment and the current state of the mental health delivery. Full reading of these reports is worthwhile.
In January 2000, the National Council on Disabilities submitted a report to the President of the United States titled "From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves" (1), which included the statement: "NCD heard testimony graphically describing how people with psychiatric disabilities have been beaten, shocked, isolated, incarcerated, restricted, raped, deprived of food and bathroom privileges, and physically and psychologically abused in institutions and in their communities. The testimony pointed to the inescapable fact that people with psychiatric disabilities are systematically and routinely deprived of their rights, and treated as less than full citizens or full human beings."
The report also stated: "The foremost change that is needed, as referred to by speaker after speaker, is the elimination of coercion from the provision of mental health services. Involuntary commitment and forced treatment, which often go unquestioned in discussions of mental health policy, were described again and again as being among the most painful and difficult experiences of people's lives. In addition, coercion was repeatedly noted as being a barrier to seeking out voluntary treatment, since people knew that once they entered the treatment system they could be coerced or involuntarily committed at any point. At a time when American citizens are being urged to do away with the stigma of mental illness and to voluntarily seek treatment for emotional difficulties, it becomes particularly important to ensure that people are able to do so without surrendering their fundamental rights." Ten core recommendations for change are offered in the report, including flexible individualized recovery programs and vocational and housing assistance.
In September 2000, the NCD submitted another report, "The Well Being of Our Nation: An Inter-Generational Vision of Effective Mental Health Services and Supports" (2), which stated: "At a time when more is known about mental illnesses than at any other time in history and just three years after the U.S. Supreme Court held that unnecessary institutionalization violates the Americans with Disabilities Act, public mental health systems find themselves in crisis, unable to provide even the most basic mental health services and supports to help people with psychiatric disabilities become full members of the communities in which they live."
In October 2002, the President's New Freedom Commission on Mental Health submitted an Interim Report to the President (3) which included the statement: "Our review for this interim report leads us to the united belief that America's mental health service delivery system is in shambles. We have found that the system needs dramatic reform because it is incapable of efficiently delivering and financing effective treatments-such as medications, psychotherapies, and other services- that have taken decades to develop."
In July 2003, the President's New Freedom Commission on Mental Health submitted the Final Report, in which the Executive Summary (4) stated in part: "Successfully transforming the mental health service delivery system rests on two principles: First, services and treatments must be consumer and family centered, geared to give consumers real and meaningful choices about treatment options and providers - not oriented to the requirements of bureaucracies. Second, care must focus on increasing consumers' ability to successfully cope with life's challenges, on facilitating recovery, and on building resilience, not just on managing symptoms."
Does it make sense to coerce patients into a system that is "in shambles" and treats many people with psychiatric disabilities "as less than full citizens or full human beings"? Perhaps the focus should first be on transforming the mental health service delivery system to instead "give consumers real and meaningful choices" for "facilitating recovery" and "not just on managing symptoms." The need and scope of coercive interventions might then be evaluated quite differently.
1. http://www.ncd.gov/newsroom/publications/privileges.html
2. http://www.ncd.gov/newsroom/publications/mentalhealth.html
3. http://www.mentalhealthcommission.gov/reports/interim_letter.htm
4. http://www.mentalhealthcommission.gov/reports/Finalreport/ FullReport.htm
(remove space from web link inadvertently added by formatting)
Competing interests: None declared

People who want change must deal directly with the high command 10 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: People who want change must deal directly with the high command

I hate being redundant, but I feel like reiterating the fact that complaining to psychiatry and debating with these people is a total absolute waste of time. As I mentioned before, if you feel strongly about change in this area as many seem to do you must get political. You must consistently vote and you must encourage others with mental illness to vote consistently. Thats a place to start. Then lobbies must be formed to represent the interests of mentally ill individuals.
Individuals who complain about psychiatry but dont vote because they are apathetic and think its a "waste of time" are nothing but whiners, plain and simple. Politicians could care less about your opinions on anything if you dont vote.
Psychiatry can be dealt with, but it must be dealt with politically thru legislation. Psychiatry has no pull at the higher echelons of power in the USA. Its a financially poor branch of medicine, with doctors who are not really respected. It could theoretically someday be legislated out of existence and replaced by Neurology.
Lobby groups politicians particulary listen to have membership populations that aggressively vote as a block. These lobbies that have aggressive voting populations include the AARP (Senior Citizens and retired), the NRA (pro-gun/pro-second amendment citizens) and the American jewish community's AIPAC lobby. These three lobbies have built themselves thru the decades into powerful political machines in their own right and politicians do care what they have to say.
The mentally ill have no such lobby organisations backing them up and the result is that nobody really gives a damn about the mentally ill, particularly the severely mentally ill. This MUST change if words are to be turned into action and real change is desired.
LostBoyinNC
Competing interests: I hate psychiatry AND scientology

We need to understand evolution of the mind and "normal" human irrationality 11 January 2004

Mario Heilmann,
MA Psychology
Los Angeles/Rio de Janeiro
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Re: We need to understand evolution of the mind and "normal" human irrationality

Congratulations to BMJ for publishing this article. Congratulations to Dr Szasz for his tireless work and courage and for his courageous suggestions.
1) I agree wholeheartedly with the notion that people should be free to refuse treatment. Of course, I see there is a problem with people who are extremely irrational. Some problems are of a nature that they defy easy solutions.
2) Any medical and psychological model needs to study the ultimate evolutionary reasons why humans are designed the way they are. To understand human nature and behavior, it is better not to get stuck at only the chemical level.
Even engineers usually cannot understand the workings of an electronic circuit by just looking at the wiring and the electronic components. They need to understand the logical design of the hardware and software. Similarly, it is necessary to understand how evolution designed the brain, its logical functioning and its chemistry. (3)
3) Any investor knows how important diversification is. I hope none of you invested exclusively in tech stock in 1999, rather had a varied portfolio. This you would not go bankrupt in spite of the tech stock desaster. Nature/Evolution needs to diversify its genetic stock, too. This helps to assure survival of species over tens of thousands of years, through varying environments and catastrophes. Some mental diseases are likely to be just the extremes of variance in genetic behavioral dispositions (yes I know environment and upbringing plays an important role too).
Some light mental disorders are just at the extreme edge of healthy variance, some other mental diseases might just be extremes of natural variance that went way over the edge.
4) For example, creative genius and schizophrenia often are very close to each other (see academy-award winning move �A beautiful mind�). Academic work on depressive realism (2) shows that mildly depressed people are actually seeing the world correctly, while "normal" people actually have positive illusions about themselves and their future. Anyone wants to have an optimist as a flight engineer ("Don�t worry, be happy! Sure, we will have tail wind, so the kerosene will be enough to reach Europe")?
The idea that we can cure most mental disorders might just be another example of such positive illusions and irrational exuberance.
5) I wish the optimists here were right. They think neurology can find the solution for mental problems. I suspect there are problems that are extremely hard do solve, just like in regular medicine: nobody solved the AIDS problem yet, cancer still cannot be cured, and senility and old age might never be overcome.
Some "mental illness" might be intrinsically incurable. For example, sociopathy might be an evolutionary strategy (1). Some people might just be predestined for violence
Some brains might just be wired incorrectly. Either by mistake (nature makes a certain percentage of mistakes too), or by design, because nature chose, for example, to wire them in an antisocial way.
Anyone who ever debugged a 10 million code-lines computer code will understand that rewiring and reprogramming a brain is a hopelessly complex enterprise. It is much more complex then reconstructing an entire leg or a liver.
6) Normal people were proven to have positive illusions. People need to be forced by law to protect themselves, to use helmets and safety belts. Mc Donalds and Coca Cola are enormous commercial successes. Entire nations become obese and sick because of wrong behavior. There are still doctors on cancer wards who smoke. Millions of alcohol abusers cause tens of thousands of deaths, kill themselves and others in accidents and fights.
In such a crazy irrational world, who has the moral authority to judge where to draw the line, who is healthy, who is crazy, who needs to be treated?
Let us discuss mandatory long term confinement or treatment of binge drinkers who are a danger to themselves and others? This would open new sources of income for the pharmaceutical and psychiatric industry. Thus it could compensate for the losses of leaving some harmless loonies without mandatory drug treatment.
7) Most psychiatric interventions are based on utter ignorance of the fine workings of the human mind. Let us be honest! Psychiatry groping in the dark, it is like shaking and slapping our computer or TV set, hoping the bad contact will get solved. ECT (electroconvulsive therapy) is more like using a hammer or excessive voltage on your computer in the hope it will get fixed this way. Nobody understands the exact electric and chemical processes that happen when adding 1+1 in the brain, much less which neurons and synapses make one think s/he is the archangel Gabriel.
Intervention in the social environment is actually more supported by science then the intervention with the chemical sledgehammer. Neurons can be rewired by learning, by changing the social environment. Attention deficit disorder most likely will not plague 8 year old kids in a natural tribal environment in the forest. In the totally unnatural school environment, where kids have to sit still for 8 hours, against their natural instincts, that is where the "disease" becomes a disturbance.
Similarly, some social intervention for mental disorders resemble a supportive tribal and family environment. It may be healing in some instances. Evolutionary science and common sense can be our guide.
But some behavioral predispositions might be so strong that they cannot be neutralized by any means. Even then, a natural social environment might be more helpful then a sterile hospital that even drives a sane person crazy
8) The right-to-die movement has already won the right to refuse medical treatment. But they still are fighting for the right to decide their own fate, to consciously choose a dignified death over long slow suffering until death (see http://hemlock.org or http://www.endoflifechoices.org/microsite/ for example).
The right-to-die discussion has a several things in common with our psychiatry discussion
a) doctors don't want to admit their helplessness. Some terminal medical conditions have no cure
b) doctor knows what is best. The patient cannot decide his own destiny.
(1) Mealy, Linda (1995) "The Sociobiology of Sociopathy." Behavioral and Brain Sciences, 18, September, pp 523-599.
(2) Taylor, Shelley E. Positive Illusions: Creative Self-Deception and the Healthy Mind, Basic Books; Reprint edition (April 1991)
(3) See http://hbes.com/ for general information on Evolution and Human Behavior.
Competing interests: None declared

Re: Tired Cliches 11 January 2004

Roelof A. Bijkerk,
healer through art and expression
Grand Rapids Michigan
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Re: Re: Tired Cliches

The point here isn't that Mr. Beals, because he feels that he has been helped by the mental health system or that he believes that it helped one of his family members is entitled to jump to the conclusion that all people should have the same treatment, the point is that because people like Mr. Beals jump to the conclusion that the way he was helped is the appropriate and the only way that he believes that the mental health system has the right to enforce such treatment, while it disregards and is down right prejudiced against other treatments. The point here is that basic rights are taken away by a system which promotes, for the most part only one form of treatment, and in the process hands out information which is biased and prejudicial.
What I have experienced myself is that what is labeled as a mental illness is in fact simply the brain making a change within itself as to how it sees things. When it starts to see thing differently than society believes it should, then it becomes the focus of all sorts of prejudisms and attempts to force it to conform. There is no real scientific evidence, for example, that there is a real chemical imbalance going on with mental illness. The only criterion for evaluating whether a specific drug works is behaviorally oriented. The Psychiatrists have decided that a person's behavior (to them then who are seeing a break from societal norms as a disease) is sane when on the medications. What I believe and have experience is that the medications simply disable the mind so that it is unable to do the work that it naturally would do to understand what is going on and be able to change into what it long for. Psychiatry then has allied itself with the businesses which sell the drugs in order to lobby for laws which allow it to force people to use the drugs and disrupt them from finding a method of healing where what they call a mental illness would lead toward enlightenment rather than forced re adaptation into society. I believe that how psychiatry forces people on medications is the same as disabling a persons legs when they are trying to learn how to walk because when one learns how to walk one inevitably stumbles and can hurt oneself. The medications disable the mind rather than allow it to heal and the only time a person turns up as having a chemical imbalance is when they have been forced on medications for a period of time. Also, when someone is learning how to walk there are ways that one can help a child to find it's balance. The psychiatric community really doesn't even show interest that this is possible. Learning how to get to know a part of the mind which society at large is prejudiced against is exploring new territory the same as learning to walk is new territory.
Many artists also have dared to explore this realm of the mind and although in reality they, as instruments of beauty, are the ones who sustain mental health in society � yet if you will check Psychiatric manuals you will find that many of them have been labeled with mental illnesses even though they have been dead for many many years and their art speaks for itself to other people who are not prejudiced and do not attempt to control freedom with lies and coerced drugging.
It isn't us that have the cliches as Mr. Beals says it's rather the psychiatrists with their diagnoses.......
Also it is a usual behavior of a brainwashed person to say he is tired when he is confronted with the fact that he has to reevaluate how he thinks. Try thinking differently it's more natural, then it won't be tiring.
Competing interests: None declared

Re: Enough of anti-psychiatric rhetorics 11 January 2004

Roelof A. Bijkerk,
healer through the beauty of art
Grand Rapids MI 49505
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Re: Re: Enough of anti-psychiatric rhetorics

From Sudip Siktar's article �The sad truth about many serious mental illnesses is that it deems a person incapable of understanding the nature and impact of his/her illness and hence on occasion makes them a danger to themselves or to the society at large, which in turn occasionally necessiates a sectioning. �
The real truth is that society perceives these supposed dangers in a paranoid fashion and refuses to even entertain the fact that there is a different way of looking at things. In reference to society I mean the mental health system because many people find the support they are looking for in a part of society [this then isn't �society� but society] that is enlightened.
The same paranoia exists in those who wage wars saying that this is the only way to solve problems and will not entertain other ways of solving the problem and thus they (the people believing war is necessary) support the contamination of society with the thought that there is an excuse to kill people. It is their programming or philosophy (and this again isn't really philosophy just like society isn't really society in many cases) that is the cause for people who are insecure to latch onto methods of intimidating others through violence. If for example the thought (wars are necessary) were replaced with the thought (art is necessary) than Hitler would have become an artist perhaps and have worked out his anger and pent up hatred in a way which would have been non violent. Instead Society with it's paranoia creates people it labels as being paranoid because they might be on the verge of seeing things different than society.
I don't think it's the people you call mentally ill who might be a danger to themselves or society as much as that you are simply scared of seeing things differently because you would have to think twice. You would have to learn to think for yourself rather than just inserting answers in you have been taught are correct. Then you would actually have to dare to look and see that things weren't possibly what you thought and that there are many other things you weren't seeing and then possible. YOU WOULD ACTUALLY HAVE TO ALLOW YOUR MIND TO WORK!
Competing interests: None declared

Re: Where is the humanity? 11 January 2004

Roelof A. Bijkerk,
artist-musician-healer
Grand Rapids Michigan 49505
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Re: Re: Where is the humanity?

It is very typical for a psychiatrist to see treating a person in a such a bizarre way as spinning or cold baths as being benign. It also, I would say, is a real example of delusional thinking that forcing a person to have such treatments is thoughtful rather than having the sensitivity to see how inflicting such treatment on a person because of perceived (and perceived by this insensitive being who practices such delusional methods David M. Bowker says are benign) behaviors which he says would have been �frightening, dangerous or senseless �
This supposed benign thoughtful treatment isn't at all frightening, dangerous or senseless? Would David M. Bowker try his own methods of promoting medications and go on medications himself in an attempt to rid him of the paranoia that these people's behavior is frightening dangerous or senseless? I don't necessarily think that it will work but if you follow his logic down to a t (perhaps the t that was missing in the article by Sudip Siktar when he used an action called necessiates) this seems to be the result.
By the way I wouldn't try it. Neither do I believe the neo conservatives when they say that anti war is just a popular fad and the common people just don't understand and have to be treated like unintelligent despots in order to be made to think that was will work. I think such people are paranoid and they display the same type of dishonest control tactics that the mental health system does in disabling the mind rather than helping it to blossom.
Also since Mr. Bowker says an article he wrote wouldn't have been allowed by the editors. Let's see if he can respond with getting side tracked trying to distract from his own dishonesty with irrelevant data which has almost nothing to do with what the issue is. This is not about the difference between bloodletting and cold baths!
Competing interests: None declared

Re: The "Battered Mental Paitient"- a different perspective 11 January 2004

Roelof A. Bijkerk,
Seeker of truth through beauty
Grand Rapids MI 49505
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Re: Re: The "Battered Mental Paitient"- a different perspective

Jayne Sercombe writes �It would concern me to think that when my thoughts become so changed as to put me at risk there would be no safeguard for me to allow for help.� It would concern me that a person whose thoughts simply are trying to lead them into a different mode of living is told that there is something wrong with their mind because of prejudisms in cognition (and pay attention to the fact that when one brainwashed part of the mind is confronted with another part that wants to try different things while the brainwashing tells the mind this is dangerous that one can become truly distraught which can lead to dangerous behavior)... It would concern me that evolution itself is suppressed. Also, I would believe, it was evolution which created your brain not the mental health system. Have you ever really listened to it or have you been caused to believe there is something wrong with part of yourself you are scared of because of prejudism. It would also concern me that you be caused to think that methods which truly would allow for help are not allowed. This is what Dr. Szasz's article is about. This is what is unjust. This is what the mental health system does. It's your own free choice that you can believe you have been helped but that doesn't excuse forcing that belief on others.
Competing interests: None declared

,It will be more interesting to know the opinon of Prof.Szasz on other issues,Insane people can be executed&lethal injection of prisoners in US. 11 January 2004

AK Al-Sheikhli,
Psychiatrist,Medical centre,Nuneaton,UK.
CV11 5HX
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Re: ,It will be more interesting to know the opinon of Prof.Szasz on other issues,Insane people can be executed&lethal injection of prisoners in US.

EDITOR, It was interesting to read the paper of Prof.Szasz ,Psychiatric protection order for the "battered mental patient"(BMJ,2003;327(7429):1449), but it will be more interesting to know his opinon about two very important issues at present time in US, that insane prisoners can be executed(1),and the lethal injection of prisoners by doctors in US(2),
Thanking you,
Yours sincerely,
AK.Al-Sheikhli,MRCPsych,DPM
References,
1.Gottlieb S,US court rules that insane prisoners can be executed,BMJ(2003);326:415
2.Groner JI,Lethal injection :a stain on the face of medicine,BMJ(2002);325:1026-1028
Competing interests: None declared

Re: Szasz � the same old tune! 11 January 2004

Roelof A. Bijkerk,
honest natural healer
Grand Rapids MI, 49505
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Re: Re: Szasz � the same old tune!

To begin with when someone begins an article by saying that he is disappointed to find out that Dr. Szasz is given a prominent platform for his views because he disagrees with them the warning signs should be evident already. And then he says "In large part because of the erroneous pronouncements of Szasz and others, people with serious metal illness continue to suffer, untreated, on our streets and in our jails." I won't go into what a metal illness is because it seems that to go outside and see what's really going on in the streets and to check spelling or use a spelling check are both things that are too much trouble for Mr. O Reilly and his war against himself.
Enforcing force drugging and institutionalization which when it doesn't work says that it's because the person needs to be re- institutionalized is a really different things from really being out in the streets and seeing what is going on with people. It's would also be true that he thinks that being functional is doing what he does judging others rather than being in the streets and seeing what society does to those who don't fit in and thus finding out first hand rather than from behind this facade of acting like an authority which really is just plain fascism which imprisons people.
What about the study where people who were going to be institutionalized were brought to a place where they weren't forced on drugs (which brings their chemistry out of balance rather than it is because of a chemical imbalance to begin with that needs to be adjusted). These people who were simply around others who were sympathetic did as good as those who were institutionalized and those in the group who weren't forced on medications and were the worst off according to the psychiatrists did the best. These sort of studies then wouldn't even being considered by Dr. Gray the same as he thinks that Szasz shouldn't be given a prominent platform. And so someone who comes to Dr. Gray would be told that they need to be put on medications, they wouldn't be informed that there are other ways to deal with the situation which wouldn't compromise their own natural body chemistry and they are lied to for the good of Dr. Gray and his prejudisms.
Also what would Dr, Gray chose were he given the choice of being put on anti-psychotic medications or being in jail? There is not real evidence that there is a chemical imbalance involved with what he calls a mental illness (and then when someone asserts this truth they are labeled as someone who denies that there are mental illnesses). So truthfully every time Dr. Gray tells a patient that he has to go on these medications he is actually guilty of mis-practice. Were Dr. Gray prosecuted for this would he elect to go on anti-psychotic medications because he actually was delusional and believed he knew what was right?
Others dare to see that there's another way.
Competing interests: None declared

Re: psychiatry should be formally merged into Neurology 11 January 2004

Roelof A Bijkerk,
Healer through trust and honest beauty
Grand Rapids MI, 49505
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Re: Re: psychiatry should be formally merged into Neurology

What Mr. Rucker says is completely incorrect. He says the following
As severe forms of mental illness are increasingly being recognized as being brain based illness, ie; physically based, its only logical that Neurology take over.
What in reality is happening is that the medical system in league with the mental health community has implemented the use of many drugs based on facts they can not substantiate scientifically. Thus they say that these diseased are physically based because then they can implement the drugs they sell based on their perception of the behavior of the patients (or in this case victims) while on medications. The drugs really only disable the mind of the patients. Even if their was proof that there was a chemical imbalance going on this wouldn't mean that the body couldn't heal this on it's own when put in an environment which allowed it to balance itself. "Modern" medicine enslaves people to all sorts of pills and devices and refuses to address the fact that the occurrence of the effect might be environmentally based (even in cases where their are pollutants in the environment or that it could be caused by diet as well as behavior). Thus people are given pills so they can continue to wear the body down and make it enslaved to fear based fabricated exploitation's.
Competing interests: None declared

Re: Rights imply responsibilities 11 January 2004

Roelof A. Bijkerk,
healer through beauty
Grand Rapids MI 49505
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Re: Re: Rights imply responsibilities

It would be appropriate that Angela F. Harte would apply her belief stated here to herself. She states that "It is easy to speak of the right of the person to refuse treatment, however all rights are meaningless and their exercise may be damaging if the corresponding responsibilities are not identified and respected" What about her "right" to coerce people into a treatment where there is no scientific basis for, that their is no scientific basis for saying that there is a chemical imbalance and yet people like Angela force this on others based on their prejudisms. In fact what people like Angela do were you to follow her comparison with driving cars is to brain wash people to follow rules which don't really work and don't prevent car accidents and then to blame the accidents that occur on another source then what caused them. (there is no proof of a chemical imbalance as well as that where people actually improve without drugs those facts are overlooked) .
If Angela were truly honest rather than brainwashed and jumping at the opportunity to implement her own beliefs in a system that is unfair she wouldn't allow herself to be a psychiatrist. She hasn't identified her own responsibilities nor respected them.
Competing interests: None declared

Re: Civil rights and Mental Illness 11 January 2004

Roelof A. Bijkerk,
healer through honest natural beauty
Grand Rapids MI, 49505
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Re: Re: Civil rights and Mental Illness

It's very interesting that Mr. O'Loughlin states this Szasz gives the example of a patient with schizophrenia deciding whether or not to receive treatment, but does not address the difficulties of "insight", with "loss of insight" reported to be the most common symptom in schizophernia. This has profound implications for capacity to accept or refuse treatment and while I acknowledge that many believe "insight" simply to be a measure of the degree of agreement with the psychiatrist, feel that this fundamental point needs to be addressed in any discussion of this sort.
As point 2
What about the fact that with psychiatrists and the whole psychiatric profession that refusal to see alternative means is their most common "symptom?"
And also then again what the psychiatrists perceive as a loss of insight in reality turns out to be their inability to understand what a patient is relating to. It's the same as in art when someone doesn't understand a piece of art that they judge it. Psychiatrists have also diagnosed many artists who have been dead for ages as having mental illnesses (while these artists are the ones who in reality nurture mental health in a way the psychiatrists are not able to see or do). To spend your time diagnosing dead people because you are so sure of your methods would seem to me to be rather to be expressing the symptom that the psychiatrists call "narcissism." This then again can be seen as delusional on both sides because it also is not what the story of Narcissi was about (he was fascinated with the beauty on the inside, that which was the him he didn't know yet). There are quite a few other ways in which psychiatrist have misconstrued mythological characters in their attempt to use them to represent characteristics of what they call mental illness. Also others in their fiction (if one would call what the psychiatrists do fictional although it's more really just plain an expression of misunderstanding) aren't as delusional and understand characters in a way that their poetry naturally relates back to life and heals people.
Competing interests: None declared

Re: Re: "Forced" psychiatric treatment 12 January 2004

Irene Mazis,
none
home H3Z 1J5
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Re: Re: Re: "Forced" psychiatric treatment

"This woman" is a mental patient and is not referring to ALL patients but those who are so violent or seriously ill, that they may have to be at least temporarilly subdued to prevent them from doing harm. As I said, there are degrees and types of psychosis. I fear you have carelessly generalized my point.
Irene
Competing interests: None declared

Denial of the hard cold truth condemns millions to a lifetime of misery 12 January 2004

Eric Rucker,
January 2004
Scotland Neck, North Carolina, USA
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Re: Denial of the hard cold truth condemns millions to a lifetime of misery

Because of psychiatry's refusal to publically admit and state that severe forms of mental illness are in fact physically based neurological diseases, millions of people are condemned to a life of utter horror and misery. Millions of people are condemned to a lifetime of confusion as to whats really wrong with them, to the very real possibility of homelessness, to stigma, to exploitation, to victimisation, to social and vocational disability, to dependence on others for their existence. Millions are condemned to a lifetime of a subpar life due to psychiatry's low tech approach and lack of scientific proficiency.
And all too often, individuals with severe mental illness end up bringing their immediate family down with them due to the fact that full remission is a rare and hard to achieve thing. Severe mental illness not only destroys individuals...it destroys families. This is horrible and its time for things to be changed.
We live in an unprecedented era of computers, NASA space technology, high tech neuroimaging, genetic engineering research and medical research at an intensity and magnitude that has never been seen before. But where is this medical research focused? Its not focused on severe mental illness. This research is focused on other illness areas...those that officially have a physical basis to them. Its time to begin applying this high technology we have available for the first time in history to the objective of solving the age old problem of severe mental illness.
Psychiatry wants to have things both ways, one foot in the biology and drugs...the other foot in their beloved "psychobabble" or psychological/behavioral concepts of mental illness. Its called the "biopsychosocial" concept of mental illness. When in truth...its mostly the "bio" thats causing all the real problems. Psychiatry does not have the ability to take the bull by the horns and just tackle these problems aggressively in a high tech, scientific manner.
By clinging to these primitive, backward concepts of mental illness, cutting edge research is prevented. Afterall, if society cannot agree what is causing severe mental illness (biology/genes/brain vs. "environment") you arent going to get very good support and funding to study it.
George Bush just announced a plan to send America back to the Moon and then possibly Mars. What Bush should have done instead was announce a scientific expedition to aggressively study the brain unlike has ever been done before. The brain is the last bastion of scientific research. To say its understudied is a huge understatement. The result of the poor understanding of the brain and nervous system is psychiatric drugs which dont work effectively a large part of the time and have side effect profiles which make patients not want to take them. Another result of the poor understanding of the brain is gross misdiagnosis of major psychiatric disorders. Still another is stigma...so long as mental illness is not categorized as a full blown neuro problem there will ALWAYS be stigma. People stigmatize what they dont understand and severe mental illness certainly is not understood well.
To finalize, psychiatry avoids responsibility. This avoidance of responsibility has got to stop. The first thing psychiatry must do to begin accepting responsibility is to "get real" and have the three severe forms of mental illness formally removed from the psychiatric category and recategorized as Neurological diseases of the brain. That would be the place to start...by redefining what severe mental illness is...and what it isnt.
Real mental illness is not some psychobabblish condition thats to be romanticized and intellectualized in a psychology fashion. One psychologist on here compared schizophrenia to "creative genius." That is exactly the sort of romanticization and intellectualisation Im talking about. Schizophrenia is the worst disease a person can have...period. It is a hellish condition to have and its caused by brain damage/dysfunction. We as a society need to put a stop to this sort of intellectualisation and romanticizing of mental illness...its disrespectful to the millions of individuals who actually have these diseases and must endure them on a daily basis.
We need dramatically improved diagnosis methods, dramatically more effective drugs and treatments to include genetic engineering treatments of these diseases, we need recategorization of these diseases and removal of the stigma that comes with them. Psychiatry cant provide this because psychiatry is REALLY about behavioral control, not diagnosis and treatment of brain disease.
LostBoyinNC
Competing interests: I hate psychiatry AND scientolog

Thomas Szasz, the Critical Psychiatry Network and the psychiatric protection order 12 January 2004

D B Double,
Consultant Psychiatrist
Norfolk mental Health Care NHS Trust, Norwich NR6 5BE
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Re: Thomas Szasz, the Critical Psychiatry Network and the psychiatric protection order

Thomas Szasz's proposal for a psychiatric protection order¹ needs to be taken seriously. After all, he was one of the first to suggest a "psychiatric will".² The potential advantages of advanced directives, which derive from this notion and may have wider aspects of concern than involuntary hospitalisation, are now generally accepted.³ We may similarly look back favourably on the idea of a psychiatric protection order.

In promoting human freedom, Szasz has consistently opposed psychiatric coercion. The history of abuse in psychiatric treatment does need to be acknowledged. The problem I have with Szasz's position is that his dogmatism polarises attitudes and undermines the cultural critique of psychiatry.⁴ The views of Szasz and other criticisms of the reductionistic tendency within psychiatry have been conflated and identified together as "anti-psychiatry". Although Szasz himself has persistently disavowed the use of the term, its effect has been to marginalise the critique of the biomedical model in psychiatry.⁵

Over recent years, a small group of psychiatrists in the UK have formed the Critical Psychiatry Network (www.criticalpsychiatry.co.uk). Use of the term "critical psychiatry" represents an attempt to move on from the misunderstanding of "anti-psychiatry". "Critical" is not so much meant to imply fault-finding, as its other meanings, such as "careful and exact evaluation" and even "of the greatest importance to the way things might happen".

The Critical Psychiatry Network has responded to the consultation on the UK draft Mental Health Bill 2002 and emphasised the rights of people subjected to the Mental Health Act. We are still waiting for the government to present the Bill before parliament. In theory, there may be no reason why the mental health tribunal set up by the new Act, if given sufficient powers, should not be able to direct a psychiatric protection order in appropriate circumstances. The Government, in taking the consultation on the draft Bill into account, should ensure that the new tribunal protects patients' rights.

�

Szasz T. The psychiatric protection order for the "battered mental patient". BMJ 2003; 327: 1449-51 (20^th December) [Full text]

Szasz TS. The psychiatric will. A new mechanism for protecting persons against "psychosis" and psychiatry. Am Psychol 1982; 37: 762-70

Papageorgiou A, King M, Janmohamed A, Davidson O. Advanced directives for patients compulsorily admitted to hospital with serious mental illness. Br J Psychiat 2003; 181: 513-9

Double DB. Review of Pharmacracy. Medicine and Politics in America by Thomas Szasz. Journal of Critical Psychology, Counselling and Psychotherapy 2001; 1: 280-2

Double DB The history of anti-psychiatry: An essay review History of Psychiatry 2002; 13: 231-236

Competing interests: None declared

Psychopharmacology versus actual biochemical medicine. 13 January 2004

Daniel Q Burdick,
Attendant
Wonderland Drop-in Center 209 Main St. Sringfield Oregon USA 97440
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Re: Psychopharmacology versus actual biochemical medicine.

Hi, The suggestion that debate with the A.P.A. is pointless and what is needed is voting and lobbying has some merit. Unfortunately, though it may be true that psychiatry is not generally held in high esteem by law makers, we can't hope for change comming from the top unless enough communication takes place that people come to grasp the truth.
The idea that psychiatry is a part of medicine with less money is wrong. It lobbies very well, profit is high, and furthermore psychiatry is a form of political power: labeling and invalidating people, meting out harm and abuse, controling and monitoring people while saying it is their fault since they are diagnosed as defective.
One proposition of "psychopharmacology" (another name for psychiatry) is that by giving children labeled with ADHD amphetamine drugs such as ritalin what is accomplished is that by controlling their behavior in childhood their development is affected and they consequently will have more socially desirable personalities when they have grown to adulthood. That's how it was described by a leader of standard psychiatry! So at the top level of psychiatry we have people speaking the rhetoric of Skinnerian behavioral control.Skinner though disliked by normal people has been long loved by governmental control-minded types. Great rhetorical propaganda: The state will control people's behavior by forcing their parents to consent to give them drugs that act on their brain. Thus the state will favorably control the outcome of their personality development.
It doesn't atually work that well though. Giving amphetamines to children means that they grow up brain damaged and psychologically harmed. The falsehood that amphetamines are the premeer and nearly exclusive treatment though it sells alot of amphetamines, and does control peoples behavior and all, doesn't lead to people being healthy.
Just as the falsehood that the atypical antipsychotics are the medicine of choice for schizophrenia, and that antipsychotics are basicly the only treatment that exists leads to allot of profit from atypical sales. People who are labeled schizophrenic have their behavior "controled" too. Usually more listless to be sure. Sometimes being given them, or stopping taking them leads to agitation, violence, or psychosis. But the drugs by blocking the receptors for dopamine work as a toxic chemical straitjacket, and this is appealing to governments that want to pepper sray, drop bombs, give lethal injections, use prison industry, and drop bombs.
Lobbying also is partly futile. The money and influence that have led to this ubiquitous brain-drugging is very large. Really, the debate and the talk is possibly the most valuable. A unified block of voters with lobbiests could really only have a simular intent: that of conveying the truth in a way that reaches people which can lead to change.
The baby has been thrown out with the bath water. Actual treatment of peoples biological problems is ignored and supressed. The term psychopharmacology says it all. The money is to be had in creating drugs that affect the psyche. And this did take over as The Only Game. Drug companies and psychopharmacologists lead the profession. One person wrote to object that Szasz calls all psychiatric diagnoses, all biological bases of mental illness, and all psychiatric medicines totally invalid. This she wrote is wrong and takes away choice.
What has been lost with the rise of the hype of the psychopharmacologists is the real biological psychiatry. What is sometimes called orthomolecular psychiatry. The surpression of this is nearly absolute. This speaks to the propaganda power of psychiatry. As the woman says, the ideas that mental illness either does not exist or has no biological basis is partially unreasonable. The compromise is the real biological psychiatry, which we are very much led to not know of and/or to disregard as discredited.
For instance there is the idea of using supplements to protect from damage from psychiatric drugs. This is off the screens of both psychiatrists and antipsychiatrists. Psychiatrists would give another drug to treat the "side effects" when they happen.
Here is another very good peice on this topic:
http://www.alternativementalhealth.com/articles/natural.htm
From our media we would tend to be "informed" that Ginko Bilobo may be a little good for the brain - but really the idea that it is supposed to improve memory may be somewhat of a fraud to sell Ginko.
More truthfully Ginko extract does strongly protect brain cell membranes and this is the important aspect.
Ginko Biloba when given with haloperidol in a double blind test worked better than haloperidol alone:
http://natural-supplements.org/ginkgo-biloba-research- abstract.131.html
The "discredited" orthomolecular psychiatrists proposed that people had biochemical imballences which affected mental function. They sought for how to determine these, and how to affect them with diet, supplements, allergy elimination, drugs, chelation, and etcettera. Science in the 1900's came to get a handle on what was happening to people - and this was suppressed by biopsychiatry/psychopharmacology.
This suppression became official government "truth" with the 1972 American Psychiatric Association Task Force on Orthomolecular Psychiatry as explained by Abram Hoffer M.D., Ph.D in his article on the history of the Journal of Orthomolecular Medicine. Notice how their are 25 western M.D. doctors in his most important category. These people are portrayed as misquided, egotistical, and sadly mostly mistaken. They are all not only M.D.'s of the 1900's but also clearly smart M.D.'s able to do research... Who to believe?
http://www.doctoryourself.com/hoffer_JOM.html
This is also expressed with verve by the irrepressible John Hammel of the International Advocates for Health Freedom:
http://www.iahf.com/world/981011a.html
To see what orthomolecular is about, how it deals with real biochemical imballences, treatments, and tests - how it is the real bio- psychiatry check out Safe Harbor at http://www.alternativementalhealth.com
So that answers the question of how can Szasz be correct about the diagnosis being all wrong. A superficial drug pushing "biopsychiatry" has replaced actual western medicine.
This is simular to what is being said about replacing psychiatry with neurology. Neurology is a better name perhaps than orthomolecular - if the neurologists can educate themselves on what has been buried with the suppression of this treatment.
Without enough zinc, vitamin C, niacin, and fish oils in our supposedly great well-ballanced diets full of sugar, white flour margarine, food coloring, aspartame, lard and so-on we got sick.
The loss of fish and nut oils from the diet is a big player.
The organization Support Coalition International and other's such as Robert Whitaker in his Book Mad In America have pointed out how people recover better and more fully from "scizophrenia" in countriess that are too poor to afford "treatment" in the form of drugs. This brings other ideas to mind than just the lack of toxic drugs. One that is often missed is diet. They eat less, but sometimes better.
Importance of EPA/DHA oils. This is a concept long carried by orthomolecular medicine as one of its own. Any acceptance this idea recieves will be without any nod of recognition towards orthomolecular. The balance of oils is one reason that "schizophrenics" will be both less prevalent and recover more fully elsewhere in the world.
http://www.shef.ac.uk/uni/projects/omega3/dietand.htm
http://www.healingdaily.com/detoxification-diet/healing-fats.htm
http://www.lef.org/magazine/mag2003/dec2003_repot_omega_01.htm
So the abusive labels, drugs, and mistreatment of the psychiatric treatment done by our culture can further hurt people who have been perhaps sickened by pressures, abusive treatment they have received, poor food and toxins. There is no treatment like no treatment. The best treatment is treatment which involves helping people, not further harming people, treament which helps to deal with what are the actual problems involved.
Regards, Daniel Burdick
Competing interests: None declared

Who then would treat patients as responsible moral agents?? 13 January 2004

Thomas M. Fraser,
RN
Private Care Facility
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Re: Who then would treat patients as responsible moral agents??

Dr. Szasz writes in his article: "The psychiatric protection ordered for "battered mental patients" that "psychiatrist objects to efforts to treat patients as responsible moral agents". This statement is factually not true. The truth of the matter is this. Under laws of separation of church and state, a psychiatrist, who; in his advising the state to committ someone; is acting as agent for the state. Therefore; legally, he/she could not impose his/her morals on the person being committed for psychiatric care by a state.
In America we live in a free society. This means we are free to worship and live in whatever way suits us. We all know there are laws to protect us from being victimize by those who would harm us. We are also well aware that laws that protects us also protects those we accuse. Another words: "INNOCENT UNTIL PROVEN GUILTY OR INNOCENT BY REASON OF INSANITY"
As I see it Dr. Szasz has accused psychiatrist of deliberate criminal activity against a person's human rights.
Has he presented enough evidence that The American Psychiatric Association and it members are criminals who takes the perverse pleasure in torturing and victimizing the vulnerable who indeed do suffer from "persistent mental illness"?.
Churches not States teach moral issues to people!
I believe that a legal "Psychiatric Protection Order" would facilitate the Church Of Sciencetology in recruiting America's and the World's most vulnerable. If this law were to ever come into effect in America or other parts of the world, Sciencetologist, through public records, would be able to pinpoint these people and offer them alternative care in the "CHURCE"
"DIANOETICS" and its teachings, according to the founder of the "Church" L Ron Hubbard, is "The last word in mental health!"
L Ron Hubard, while being a young man in the Navy, developed a personal hatred for his psychiatrist. Does Dr. Szasz harbor a similar hatred for his fellow psychiatrist???
I invite Dr. Szasz, and others, to comment on my remarks and historical facts.
Competing interests: None declared

Re: Denial of the hard cold truth condemns millions to a lifetime of misery 13 January 2004

Roelof A. Bijkerk,
healer through all forms of art
Grand Rapids MI, 49505
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Re: Re: Denial of the hard cold truth condemns millions to a lifetime of misery

Folks here we have it: the truth! The psychiatric professions states that mental illnesses are chemically based but has no proof of it and when challenged to come forth with their proof and they have none it's because NOW PAY ATTENTION they are in denial that it is physically based! In other words of you are making a statement you can't back up it's because you are in denial about it!? You're in denial that the lie you are trying to promote globally isn't a lie!? So in other words keep lying and ask for more money to support it.
Some people just want to force their paranoia's on others!
In the mean time the medical profession already promotes drugs which treat a physical symptom they do have scientific proof that their is a chemical imbalance but that do not acknowledge that they body could balance that chemical imbalance by itself were methods of addressing a change in habits promoted.
And who's making money out of all of it?
So make sure you don't expect someone supporting your belief to be honest just ask for more money !
The real denial that the psychiatric profession is guilty of is that they already make the statements that mental illnesses are physically based (chemical disorders) when they do not have the proof to make these statements.
There are healing methods which have been proven to work but which are outside of the scope of psychiatry's methods of analyzing and judging but which allow for personal expression through art and other means.
When a person is already hurt emotionally and you alienate them further by saying that there is something wrong with their brain (when you have no proof of that) rather than giving them the space to find out what is going on with them so that they can heal as an individual and then blame the fact that they don't heal on some imaginary chemical balance which you have no proof for and then deny that you don't know what you are talking about and say that we need more money to do more research (while denying a whole healing method that works and has worked since before psychiatry was invented) in order to follow this fools errand. You show such delusions that you fail to see that if your methods were followed down to the t you would be labeled delusional and forced to take medications, obsessive, delusional, narcissistic (these are your criterion of judging others that you fail to see in yourself). Also you might take notice that those who are not trying to promote forced drugging and those that are not trying to say that mental illness is chemically based wouldn't be trying to force you on medications although your method of logic would support that you needed them.
This ofcourse might support the situation that you be allowed to force others on medications as long as you take them yourself to suppress the fact that you are delusional in making the statement that there is proof it is necessary.
It's your logic by the way not ours!
Competing interests: None declared

Re: Re: Re: "Forced" psychiatric treatment 13 January 2004

David Gonzalez,
Employment Coordinator
Brooklyn, N.Y. 11201
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Re: Re: Re: Re: "Forced" psychiatric treatment

Irene,
I am also a "mental patient" and I did not at all misunderstand your commentary. I was merely responding to YOUR generalization. It is extremely offensive to me that "consumers and non-consumers" alike routinely imply that violence is only committed by "mental patients."
That's not to say that "mental patients" never engage in acts of violence - certainly "mental patients" are just as human as everyone else - that's to say that this a media driven stereotype which has been accepted without question by the general public.
Have you ever considered researching both sides of the argument? Since you've already read the media's side which you posted links to in your initial message, are you open to reading the other side?
Please consider visiting the only website on the entire net designed to challenge the media's stereotyping of "mental patients." Be forwarned though that this website was founded and created by a "mental patient" who got tired of reading the "Mental Patient Kills Two" headlines. Have you ever read a headline that says: "Normal Person Kills Two?"
http://www.cinemaniastigma.com
Competing interests: None declared

Re: Can I take this back a step? 13 January 2004

Glynis Meloy,
Parent & Project Co-ordinator of a Mental Health Project affiliated to MIND
PL26 7NN
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Re: Re: Can I take this back a step?

From 1984 to 2000 I, along with my husband ran 3 homes for adults with learning disabilities. All our residents were long stay and several had psychiatric problems. In 1986 our youngest daughter was born. By the age of 5 she was diagnosed with ADHD and learning disabilities. For the last 3 years I have been working in the field of mental health. So although I am not a "professional", it is not without some considerable experience that I am writing this response.
1. I have done some research on Dr Tom Szasz, and as Dr Cosgrove and Kim Gregory have pointed out, he is indeed heavily involved with the Church of Scientology. Normally, being involved with a religion wouldn't be a problem - but the Scientologists want to abolish - not reform psychiatry. So I think it is a problem.
2. Yes, of course there are some psychiatrists who should take a good look at how they practise and there should be perhaps an "Ofsted" type approach to moniter all those in the medical profession as in the teaching profession. But just because there are poor teachers, doesn't mean we should abolish teaching!
3. With the occasional exception, my experience of psychiatrists has been pretty darn good! I have known about 15 in our area over the years. Good psychiatrists consult the family or carers as well as the patient. Joint decisions are made, medication sometimes introduced or changed - whatever. This is in the best interest of all involved. There is nothing more frustrating and unreasonable than being a carer of a person with any illnes and then being told everything is confidential so their treatment cannot be discussed with you! Mental illness especially affects the whole household.
4. My own daugther has been on medication for her ADHD since she was 6 years old and still is at 17. Because of the severity of her condition, she was referred to a Consultant Child and Adolescent Psychiatrist in another county (Dr Cosgrove).
Yes of course, in an ideal world, I would rather she was not on medication - but what would have happened to her and to us if she hadn't been? Even at 5 years old, she was so difficult to manage that she was in grave danger of losing her place at school. At home we were in a continual spin, trying to clear up the mess, deal with the unsociable behaviour, staying up all night because she never slept and couldn't be left unattended. We were also trying to look after and stimulate our other children. We were at our wits end! AND we were in "the business" and supposed to know what we were doing. Outsiders I'm sure must have thought it was our fault - that we were "spoiling her" "letting her get away with it", etc. Oh if it were only that simple. By the time we went to see the Consultant our whole family was suffering, especially our daugther with ADHD who really could not control herself and was perpetually confused and unhappy. Our consultant asked to meet the whole family and by the time we left, we didn't feel guilty, helpless and hopeless anymore - we could see some sort of a future for her and for the rest of us.
As a result, our daughter was able to go through school without suspension or exclusion, and is now at college and volunteering at a playscheme that she used to attend. She has been able to live at home and live and interact, as part of her own family. The rest of our family have grown - two are nurses - one is a psychiatric nurse working in the prisons.
Without the help, understanding and courage of our Consultant, the story would, I am certain, been a very different one.
5. I know a lot of what I have said is from a personal point of view, but let's face it, it is the "people" that are affected.
I'm sorry Dr Szasz, but I am totally unconvinced and extremely suspicious about your article and your motives.
But then - who the hell am I?!
Competing interests: None declared

Strong Support for Patients' Rights 13 January 2004

Ann Fonfa,
President
The Annie Appleseed Project 33418-8220
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Re: Strong Support for Patients' Rights

As the president of The Annie Appleseed Project which provides information, education, advocacy and awareness for people with cancer on complementary, alternative (CAM), natural therapies, I write in support of patients' rights to make i