Psychiatry’s Defense—We Are So Useful—It’s The Data Which Are Out Of Order

https://grantcoulson.files.wordpress.com/2014/04/incentiveseverywherepicturecorrect1.jpg?w=444&h=288

       Do not think about, write about or deal with  human behavior without determining the effects of incentives. It’s not their money, of course they’ll waste it.

    Wherein we see a psychiatrist’s defense of his profession. The data are not on his side.

A Challenge to Dr. Lieberman

By Robert Whitaker
Featured Blogs April 26, 2015

On Sunday, Dr. Jeffrey Lieberman was interviewed on The Sunday Edition on Canadian Public Radio by Michael Enright. I had been on that same show some time ago, and I spoke about the many studies that compared long-term outcomes for medicated or unmedicated patients, for such disorders as schizophrenia, depression, and ADHD, and how, time and again, researchers found better outcomes for the off medication group.

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    Aside from the fact that they’re worse than nothing, psychiatric drugs really work miracles. If it weren’t for the side effects and lack of effectiveness, psychiatry would have something.

Michael Enright asked Lieberman about what I had said on his show, and here was Dr. Lieberman’s response:

Lieberman: “Is [Whitaker} wrong? What he says is preposterous. He’s a menace to society because he’s basically fomenting misinformation and misunderstanding about mental illness and the nature of treatment. What he just said in that clip you ran about, if you’re taking an antidepressant and you go off it and you get sick again… the same thing could be said about insulin for diabetes and asthma medication. . . Whitaker, he ostensibly considers himself to have been a journalist, God help the publication that employed him, but he has an ideological grudge against psychiatry for whatever reason and there’s no, what he calls research is simply his opinion and his construction of information."

Enright: "What about his contention that the unmedicated patients did better than the medicated patients?"

(pause)

"I’d say that’s absolutely wrong. If you do a controlled study with various illnesses, whether it’s schizophrenia, depression, bipolar disorder, obsessive compulsive disorder, and you do a randomized study, assign one group to receive whatever the state of the art is in psychiatry including medication and you assign the other to some innocuous, non-medical type of supportive therapy or whatever, and you follow the people for a period of time the outcomes will be extraordinarily superior in the treated group. The magnitude of the difference we can sort of quibble about, but there’s no doubt about it."

So here is our challenge to Dr. Lieberman. Please provide a list of randomized studies that show that medicated patients have a much better long-term outcome than the unmedicated patients. Please note that we are asking for studies that measure outcomes over the long-term, say for at least two years or longer, and are randomized, since you indicate there are many such studies. Please point out the “extraordinarily superior” outcomes for the medicated group. We presume the studies will focus not just on symptom control, but also functional outcomes.

We think this is important. This is the core issue for our society: Do these medications help people thrive over the long-term? Do they improve their lives over the long term? If there is such evidence, please let us know. I put up abstracts of the studies I cited in Anatomy of an Epidemic on madinamerica.com, which tell of worse outcomes for the medicated patients over the long term, and so here is your chance to point to the studies I left out.

One postscript. I should note that years ago, in 1998, I interviewed Jeffrey Lieberman for a series I was co-writing for the Boston Globe about abuses of psychiatric patients in research settings. (I wrote that series, which was a finalist for the Pulitzer Prize, as a correspondent for the Globe, as by this time, I had left daily journalism.) Lieberman had written about studies in which schizophrenia patients were given methylphenidate, with the expectation that this dopamine-elevating drug would make many patients much worse (and thus relapse), and he had also conducted one such study of his own. My co-writer and I thought that giving stable patients with schizophrenia a drug expected to make them worse was an unethical thing to do, and our reporting on those studies—conducted by Lieberman and others—composed one part of the series.

This is not the first time Lieberman has denounced me as a crappy journalist. (See CV here.) After Mad in America was published, we were on a National Public Radio show together, where he said that my book was a travesty that set journalism back decades (as apparently I had failed to get in line with the rest of journalists writing about the wonders of modern psychiatry). He has written other things very similar to what he told Michael Enright on Sunday, but I have to confess, I took extra pride in being called a “menace to society.” I think one day I will put that on my gravestone.

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    Again, everything supports psychiatric usage except the data. They better do something about the data before people start noticing that both the emperor and his clothes are imaginary.

Government Job or Respect–Which’ll It Be?
Cheerio and ttfn,
Grant Coulson, Ph.D.
Author, “Days of Songs and Mirrors: A Jacobite in the ‘45.”
Cui Bono–Cherchez les Contingencies

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2 Responses to “Psychiatry’s Defense—We Are So Useful—It’s The Data Which Are Out Of Order”

  1. bpdtransformation Says:

    Amen to this. Lieberman’s profession in its current incarnation is doomed if/when more people realize that what it is selling (psychiatric drugs and the “illness” model) are ineffective and harmfl.

    • Grant Coulson Says:

      Agree absolutely. I’ve just heard about two egregious examples which I will blog about soon. Cheers

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