08/19/15

A Censored Story of Psychiatry, Part 2

I was taken aback by Lieberman’s tone in describing Rosenhan as scornfully observing that no staff raised an issue of the apparent sanity of the pseudopatients in his famous study: “Being Sane in Insane Places.” Lieberman then said Rosenhan “saw another opportunity to inflict damage on psychiatry’s crumbling credibility.” Actually, a research and teaching hospital had been vocally saying that they doubted that such an error could occur in their hospital. So Rosenhan approached them and proposed that over a three month time period (not a year, as Lieberman claimed in what he indicated was a direct quote), “one or more pseudopatients would attempt to be admitted into the psychiatric hospital.” Here is what Lieberman wrote concerning what Rosenhan did:

He approached a large prestigious teaching hospital that had been especially vocal in contesting Rosenhan’s finding with a new challenge: “Over the coming year, I will send in another round of imposters to your hospital. You try to detect them, knowing full well that they will be coming, and at the end of the year we will see how many you catch.”

Rosenhan reported that the hospital staff members rated each patient on the likelihood of being a pseudopatient. Judgments were obtained on 193 patients admitted for psychiatric treatment. All staff members that had contact with the patients were asked to make judgments. Forty-one admissions were judged with high confidence to be pseudopatients. “Twenty-three were considered suspect by at least one psychiatrist. Nineteen were suspected by one psychiatrist and one other staff member.” Rosenhan then said: “Actually, no genuine pseudopatient (at least from my group) presented himself during this period.” Rosenhan encapsulated the question raised by his study in the provocative opening sentence of his article: “If sanity and insanity exist, how shall we know them?”

Psychiatry was at a crucial time of its history in 1973. Rosenhan’s article was published in January of 1973. Lieberman reported that the Board of Trustees for the American Psychiatric Association (APA) called an emergency conference in February of 1973 “to consider how to address the crisis and counter the rampant criticism.” He said that the Board realized that the best way to counter the “tidal wave of reproof” was to produce a fundamental change in how mental illness was “conceptualized and diagnosed.” They authorized the creation of a third edition of the Diagnostic and Statistical Manual, the DSM.

The APA eventually appointed Robert Spitzer to chair the revision process of the DSM-III, which was a radical change in how psychiatric diagnosis was done and how mental illness was conceptualized. As Robert Whitaker and Lisa Cosgrove reported in Psychiatry Under the Influence, the DSM-III was an instant success. “In the first six months following its publication, the APA sold more copies of its new manual than it had previously sold of its two prior DSM editions combined.” The DSM was adopted by insurance companies, the courts, governmental agencies, colleges and universities. It structured discussion in psychology textbooks. It was required to do research in the U.S. and eventually abroad as well. “DSM III became psychiatry’s new ‘Bible’ throughout much of the world.” Lieberman claimed:

The DSM-III turned psychiatry away from the task of curing social ills and refocused it on the medical treatment of severe mental illnesses. Spitzer’s diagnostic criteria could be used with impressive reliability by any psychiatrist from Wichita to Walla Walla.

What’s missing from this triumphal rhetoric is the battle waged by Spitzer against Rosenhan’s study and its implications as he and others worked to revise psychiatric diagnosis—and its reliability problems. In the 1980 issue of the Journal of the American Academy of Child [& Adolescent] Psychiatry, Michael Rutter and David Shaffer, both academic psychiatrists, were critical of the published reports of reliability studies done of the DSM-III field trials. Referring to two 1979 published reports by Spitzer, they commented that while the studies were useful, “as pieces of research they leave much to be desired.”

Both reports concern the reliability study which involved clinicians “from Maine to Hawaii.” Unfortunately this impression of spread is largely spurious in that the reliability concerned agreements only between close colleagues (each clinician chose his own partner in the study). . . . Of course, we are acutely aware of the difficulties involved in such field studies and it may well be that this was the best that could be done within the time and resources available. However, the findings do little to provide a scientific basis for DSM-III.

Note how Rutter and Shaffer’s comments about: “clinicians from Maine to Hawaii” applies equally to Lieberman’s rhetoric on: “any psychiatrist from Wichita to Walla Walla.” Both Psychiatry Under the Influence and The Selling of DSM have more comprehensive critiques of the claimed success in conquering reliability and validity problems with psychiatric diagnosis. But Lieberman’s “uncensored history” of psychiatry in Shrinks is completely silent on this well documented dispute. Ironically, in the same issue of the Journal of the American Academy of Child Psychiatry, Spitzer and Cantwell described how the DSM-III was “considerably more inclusive and more comprehensive,” than its predecessor, the DSM-II.

In a disclaimer paragraph on the page before the Shrinks Table of Contents, Lieberman said that bucking the convention in academics of using ellipses or brackets in quotations, he avoided them. “So as to not interrupt the narrative flow of the story.” But he assured us that he made sure that any extra or missing words did not change the original meaning of the speaker or the writer. So he did not use an author-date reference system that included endnotes with references and page numbers for the quotes he cited. But he did say the sources of the quotes are all listed in the Sources and Additional Reading section. And if you wanted to see the original versions of the quotations, they were available at: www.jeffreyliebermanmd.com. When I checked the website at the end of July 2015, they were not available for download or viewing on any page.

As I think I’ve demonstrated, Dr. Lieberman made some very specific claims about David Rosenhan’s professional background and expertise that were false. His presentation of the famous Rosenhan study appeared to be distinctly biased and inaccurate in places. He presented as a quote of David Rosenhan something that he did not say in “Being Sane in Insane Places.” Was it a quote from another source, perhaps someone else claiming the quoted material as what Rosenhan said? We don’t know and cannot know because Lieberman didn’t use conventional citations in presenting his storyline for Shrinks. He was tellingly silent on issues such as questions about the reliability of DSM-III diagnoses from the time of its publication.

Because of these and other problems with his version of psychiatric history, I did not find that Shrinks was “the uncensored story of how we [psychiatry] overcame our dubious past.” If anything, its dubiousness seems to be continuing into the present. But you won’t hear about those issues in Shrinks.

If you are interested in alternative views of psychiatric history, ones with endnotes and footnotes, I suggest you read Mad in America or Anatomy of an Epidemic by Robert Whitaker; Psychiatry Under the Influence, by Robert Whitaker and Lisa Cosgrove; or The Mad Among Us by Gerald Grob. Chapter two of Psychiatry Under the Influence, “Psychiatry Adopts a Disease Model,” gives a significantly more nuanced survey of psychiatric diagnostic history than Shrinks. Whitaker and Cosgrove’s use of the idea of guild interests of psychiatry was very helpful to me in putting Shrinks into perspective.

Be forewarned that Whitaker is not one of Lieberman’s favorite people. In a radio interview promoting his new book Shrinks, Dr Lieberman said that Whitaker was a “menace to society because he’s basically fomenting misinformation and misunderstanding about mental illness and the nature of treatment.” Here is a link to where this was reported on Whitaker’s website, Mad in America. There is also a link there to the original radio interview. Look around at the other material on the site, including further responses by Whitaker and others on Dr. Lieberman’s remarks.

05/6/15

Parallel Psychiatric Universes

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“It is only really been in the last fifty years that psychiatry has established a scientific foundation for itself and developed treatments that truly work, beyond a shadow of a doubt, and are safe.”

I’m starting to think there is something to the belief in parallel universes. There just cannot be another explanation for how someone could believe what was said in the above quote. This person has to be from an alternative time line where An Anatomy of an Epidemic, Mad in America, Medication Madness, and The Myth of the Chemical Cure were never written. The story of psychiatry and “mad doctoring” contained in these and other books and articles I’ve read tell an entirely different story than what was stated above.

The opening quote is from an NPR interview with Doctor Jeffrey Lieberman, who wrote a new book, Shrinks: The Untold Story of Psychiatry. Dr. Lieberman is a past president of the American Psychiatric Association and is currently the Lawrence C. Kolb Professor and Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of the New York State Psychiatric Institute. In other words, he has credibility within the field of psychiatry and he is a good choice to be the teller of a tale about the heroes of psychiatry. That is, if you believe the current state of psychiatry fits with the above statement. I don’t.

There is a suggestion in Lieberman’s interview that all is not sunshine and roses with the current state of psychiatry. At the end of the interview, he said that in order for psychiatrists to make a case for why psychiatry is a medical discipline that deserves “equal footing and respect as other medical specialties,” they needed to “fess up” to the unvarnished past. He asserted that things are different now, “and nobody should avoid seeking treatment if they think they need it because of uncertainty or fear.” I think that depends upon whether or not you believe in his version of psychiatry and its history.

I haven’t read Shrinks yet. Honestly, I’ll read Robert Whitaker’s new book on psychiatry before/if I ever get around to Shrinks. But Whitaker has read Lieberman’s book and shared his thoughts here. He suggested that his readers watch a promotional YouTube video of Lieberman discussing what is unique about Shrinks. Whitaker pointed out how Lieberman intentionally dressed for the video in a doctor’s white coat. Seems to be a not-so-subtle hint at wanting to assert the “equal footing and respect” he hopes to gain for psychiatry alongside other medical specialties.

In the YouTube video, Lieberman did say that his book was the first to tell the “complete and unvarnished truth” about the history of psychiatry. But he seems to have crossed over into that parallel universe when, according to Whitaker, he wrote how the intellectual seed from a small band of psychiatrists saved psychiatry and led to the development of the “book that changed everything.” This book was the third edition of the Diagnostic and Statistical Manual (DSM III). Whitaker astutely said Shrinks was more a story of how psychiatry as an institution saw itself, than it was an accurate history of psychiatry:

I think Shrinks ultimately provides a revealing self-portrait of psychiatry as an institution. Lieberman is a past president of the APA and he has reiterated the story that the APA has been telling to the public ever since DSM-III was published. And it is this narrative, quite unmoored from science and history, that drives our societal understanding of mental disorders and how best to treat them.

The history of the DSM described by Whitaker in his review article of Shrinks is one I’m already familiar with from reading Making Us Crazy and The Selling of DSM by Kirk and Kutchins. You can access an article written by them, “The Myth of the Reliability of DSM,” that elaborates on Whitaker’s description of the DSM III. Kirk, Gomory and Cohen have written Mad Science, which also tells the story of psychiatry and diagnosis from the perspective of Whitaker and the others.

Paula Caplan commented that as she listened to Lieberman’s NPR interview, she felt sad. She was glad Whitaker had written about Shrinks. She thought no one was in a better position to comment on its claims about the field of contemporary psychiatry.

I know that many people share my feelings of frustration and exhaustion about the ongoing misuses of the power, not only by some of the most powerful psychiatrists, but also some of the most powerful psychologists and members of other professions as they distort the facts and consistently close their ears to people whom their systems have harmed.

Whitaker closed his critique of Shrinks by pointing out that Lieberman took the Freudians to task, saying that if the psychoanalytic movement in psychiatry had itself diagnosed, it would have been found “all the classic symptoms of mania: extravagant behaviors, grandiose beliefs, and irrational faith in its world-changing powers.” Whitaker said the very same symptoms were present in Shrinks. He suggested there was also evidence of an institutional delusion too. Perhaps this is a better explanation for the radically different view psychiatry has of itself than saying it must be from a parallel universe. It is simply delusional.

Further illustration of the parallel universes (or delusions) regarding psychiatry was given when Dr. Lierberman was interviewed on the CBC radio program, The Sunday Edition on April 26, 2015. When asked by the interviewer if he was familiar with Robert Whitaker, he said “Unfortunately I am.” He proceeded to question (slander?) whether he is a journalist, saying: “God help the publication that employed him.” Lieberman asserted that Whitaker has “an ideological grudge against psychiatry.” In other words, Whitaker is one of those anti-psychiatry people. He dismissed Whitaker and his claims: “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.”

Lieberman went on to claim that there was no doubt in his mind that if randomized, controlled studies of various psychiatric illnesses, using the “state of the art” methods in psychiatry (including medication) “the outcomes will be extraordinarily superior in the treated group.” Whitaker responded to Lieberman’s claim by challenging him to provide “a list of randomized studies that show that medicated patients have a much better long-term outcome than unmedicated patients.”

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.

Whitaker noted this wasn’t the first time Lieberman has denounced him as a “crappy” journalist. By the way, a series of articles Whitaker co-wrote on the abuses of psychiatric patients in research settings for the Boston Globe in the 1990s was a finalist for the Pulitzer Prize. He is a past winner of the George Polk Award for Medical Writing for the same series. One of the researchers he was critical of in that series was Lieberman. Whitaker said he took extra pride in being called a “menace to society” by Lieberman and thought he might just put that on his gravestone.

03/25/15

Murphy’s Law

In December of 2013, Congressman Tim Murphy, a Republican representing the 18th District of Pennsylvania, introduced H.R. 3717, the Helping Families in Mental Health Crisis Act. You can red a shorter summary of it here. Almost immediately, it drew opposition from several advocacy groups. H.R. 3717 says it’s purporse is: “To make available needed psychiatric, psychological, and supportive services for individuals diagnosed with mental illness and families in mental health crisis, and for other purposes.” Why would advocates for the mentally ill be opposing a bill that is supposed to help the mentally ill?

One of these was MindFreedom, a nonprofit organization that seeks to nonviolently unite “people affected by the mental health system with movements for justice.” MindFreedom noted that the bill eliminated legal advocacy on behalf of those with psychiatric disabilities. It cut 85% of the existing funding for protection and advocacy programs. Under the bill individuals with psychiatric disabilities won’t get the same HIPPA protections. It would increase institutionalization, giving more money to psychiatric institutions than programs to help people live within the community.

A press release from the Mental Health Advocates suggested the measure would reverse some of the advances of the last 30 years in mental health services and supports. “It would exchange low-cost services that have good outcomes for higher-cost yet ineffective interventions.” The bill was said to target the rights of individuals with mental illnesses and restructure federal funding “to heavily encourage the use of force and coercion.” It would seek to expand involuntary outpatient commitment (IOC), where an individual with serious mental illness would be court-mandated to follow a specific treatment plan, typically requiring medication.

Several bloggers for Mad in America also voiced their opposition to the legislation. Corinna West said the bill “replaces peer support, which works, with forced treatment, which doesn’t.” She cited the National Association of State Mental Health Program Directors, who after a review of forced treatment found it wasn’t helpful. Additionally, peer support was the #1 most effective method. She also noted in her December 2013 article that two of the top five industries donating to Rep. Murphy’s reelection campaign were healthcare professionals and the pharmaceutical industry. We’ll return to this issue later.

Faith Rhyne noted the legislation presented itself as having “worst case scenarios in mind;” that it was “not about most people” with psychiatric diagnoses. However, the criteria in the bill for patients eligible for IOC are not limited to individuals with a history of violence and incarceration. “It includes those with a record of non-medical hospitalizations,” and those deemed unable to care for their basic needs. “In many ways the legislation carries the theme and intent of E. Fuller Torrey’s Treatment Advocacy Center, which is noted on Representative Murphy’s website as being a leading supporter of the bill.”

Mad in America wrote an editorial opposing the bill, focusing on the dangers of the mandated treatment relying on antipsychotic medication. The editorial referred to research showing that these medications shrink the brain and may actually impair recovery. “But American psychiatry and the NIMH have never publicized those findings.” The false impression of the benefits of antipsychotics made passage of H.R. 3717 possible.

The House Subcommittee on Health held a hearing on H.R. 3717 on April 3, 2014. You can watch a video of the hearing and review documents associated with it here. Still trying to gain support for the bill, Rep. Murphy addressed the American Psychiatric Association in May of 2014. In his introduction, he was called “a friend of psychiatry.” He gave an impassioned plea of support for his “comprehensive mental health legislation.” The APA President, Paul Summergrad said:

The APA is committed to achieving needed legislation to transform mental health care on the basis on the best science and clinical care. We are pleased to work closely with Representative Murphy as well as Representative Barber and others to craft the best bill to benefit the American people.

Elise Viebeck reported for The Hill that House Republican leaders announced in June of 2014 they were going divide the Murphy Bill into pieces in an attempt to pass the less controversial provisions. This was said to be a major blow to the bill and Rep. Murphy, who had argued that only “dramatic and comprehensive reform” would help people with serious mental illness. “The defeat of the comprehensive bill is a victory for the broad swath of national mental health groups that were uneasy about or opposed to Murphy’s legislation.”

But Murphy continued to lobby for support of his comprehensive bill. A December 2014 updated summary of H.R. 3717 listed 34 organizations supporting the bill, including the American Psychiatric Association and the American Psychological Association and the Treatment Advocacy Center. There were 115 cosponsors of H.R. 3717. The twenty-one media outlets included: The Wall Street Journal, The Washington Post, the Pittsburgh Post-Gazette, the Seattle Times, and the Houston Chronicle.

In February 2015, Congressman Tim Murphy was a keynote speaker at an event, “Fixing America’s Mental Healthcare System.” He said he hoped to reintroduce H.R. 3717 as early as March of 2015. Senator Chris Murphy, who participated in the same panel discussion event as Congressman Murphy, voiced his intent to introduce similar legislation in the Senate this year. Senator Murphy is from Connecticut, where the Sandy Hook shooting took place.

Rob Wipond of Mad in America, citing a 2013 analysis of the bill by the National coalition for Mental Health recovery, once again noted how the existing legislation would “heavily encourage the use of force and coercion.” This would likely involve “treating people with pharmaceuticals. It would undermine the rights and legal support of people seeking non-drug options. It would cut funds for community-based services with a proven track record of helping people stay out of the hospital. “(T)his bill would cost more money for worse outcomes.”

Wipond also cited information on donors to Congressman Murphy for the 2014 election cycle. Maplight listed contributions from pharmaceutical companies such as: GlaxoSmithKline, AstraZenaca, Pfizer, Johnson & Johnson, Merck & Co, Eli Lilly & Co.—many of them on multiple occasions. Murphy received $95,830 from 10/1/2012 to 9/30/2014 from pharmaceutical/health care product companies.

OpenSecrets.org reported that within Murphy’s top 20 contributions from industry were health professionals, pharmaceuticals/health products, hospitals/nursing homes, and health services/HMOs. Murphy received over $283,000 from the political action committees related to these industries for the 2014 election cycle. There were individual contributions in addition to these. His campaign committee reported that during the 2013-2014 fundraising cycle they raised $1,854,010. In his political career from 2001-2014, he has received $701,235 in contributions from health professional political action committees, and $430,030 in contributions from pharmaceuticals/health products political action committees.

In all the readings linked here; in the videos I watched of Congressman Murphy gathering support for his bill, I did not hear any substantive reference made to the concerns raised and noted above by MindFreedom, Mental Health Advocates, or Mad in America. Specifically, I did not hear anything addressing the concern for the proposed IOC.

Congressman Murphy advocates for increased social control over individuals with “mental illness.” He’s a friend of psychiatry, who dismissed the opponents to his legislation as marginal and “anti-psychiatry” in his rhetoric to the American Psychiatric Association. He is passionate in his views and has a well-polished stump speech that he gives as he drums up support for his legislation. He has been heavily supported by the medical and healthcare industry throughout his political career. And he is getting ready to try again to get Congress to approve legislation giving psychiatry increased power and authority.

This is happening just as the validity of what he has referred to as “anti-psychiatry” is becoming more widely known and accepted. What’s more, there is scientific evidence to support much of it. The evidence-based “treatment” of psychiatric medications has been repeatedly shown to be marginally effective at best. Look at the information on Mad in America; Psychiatric Drug Facts and PsychRights.

Any legislative reform that gives psychiatry more power should be sidelined until the existing questions on the validity of psychiatric diagnosis and practice are resolved. Otherwise, we may have to live with the consequences of a different Murphy’s law—anything that can go wrong, will go wrong. If we really want to help the “mentally ill,” we should wait until we are clear that the proposed changes will help and not harm them.

03/11/15

Lair, Liar Pants on Fire

Okay, well perhaps TECHNICALLY Janssen Pharmaceuticals, a division of Johnson and Johnson (J&J) didn’t lie about Risperdal to the public. But thousands of recent lawsuits have charged that there is a troubling side effect in young men who take the medication: gynecomastia. That means it can trigger abnormal breast growth in the males who use the drug.

Mad in America reported that the law firm of Pintas and Mullins (linked above) reported that there were 1,250 pending cases against J&J (most of which are related to abnormal breast growth) out of which six were selected as “bellweather” trials in 2012. However, Janssen agreed to settle those cases before they went to trial. Janssen also agreed to settle another 80 cases in early 2013. Historically, this has been a regular legal tactic of pharmaceutical companies when they are sued. Peter Breggin has noted how this method and others were used by pharmaceutical companies to neutralize potentially damaging lawsuits against them; and keep the information they contained from becoming public knowledge.

But that doesn’t always work. Pintas and Mullins, Mad in America, Peter Breggin and FiercePharma have reported on past settlements made by Janssen for misleading statements about Risperdal. In November of 2013 Janssen agreed to pay a $2.2 billion settlement with the federal government for false claims over Risperdal. The company pled guilty to illegally promoting the off-label use of Risperdal with the elderly suffering with dementia or Alzheimer’s in nursing homes. Janssen also settled off-label marketing claims with 36 states and the District of Columbia over Risperdal for $180 million; then with Texas for another $158 million. So I suppose we could say that Janssen was found guilty of lying about Risperdal in these off-label marketing cases.

Recent cases include a lawsuit argued in Philadelphia regarding a 20-year-old man with autism, who took Risperdal to help with irritability caused by his autism. He began taking the drug as an eight-year-old, despite the fact it was only approved for use with adults at that time. FiercePharma reported that the man’s then pediatric neurologist, Jan Mathisen, said sales reps from Janssen had distributed Risperdal samples twenty times between 2002 and 2004, 5 years before the drug was approved for use in autistic children. After a day in court, the autistic man’s mother tearfully said that she was having a difficult time after “Hearing what the pharmaceutical company was doing.”

Janssen claimed that the company’s warnings were complete and proper, and that it did not miss-market the drug. In a statement provided to Blooomberg Business, a Janssen spokesperson claimed that Risperdal “has improved the lives of countless children and adults throughout the world who suffer from debilitating mental illnesses, and it continues to improve patients’ quality of life today.”

Janssen claims that Risperdal’s labels always included warnings of the risk of gynecomastia in adults, and notified doctors that it was not proven safe for use in children. The Pintas and Mullins article said the company claims that the doctor who prescribed Risperdal to the autistic man should be held at fault. In addition,

Janssen is accused not only of illegally marketing Risperdal, but also of paying doctors to speak favorably of the drug. The company paid for gold outings and other flashy incentives to get doctors to prescribe the drug to patients just like the eight-year-old in Alabama. Many of those boys taking Risperdal grew breasts and had to undergo mastectomies.

A former FDA commissioner, David Kessler, testified in Philadelphia that Johnson and Johnson knew as early as 2001 that Risperdal could cause boys to grow breasts—a full five years before the company added the warning about the potential side effect to the drug’s official label. In support of his claim, Kessler pointed to a 2001 study, FUNDED BY J&J that indicated 3.8% of boys using Risperdal in a clinical trial developed breasts. He commented that the study should have been a red flag to the company. According to Bloomberg, the neurologist Mathisen said in his testimony that he would have liked to have known about the study.

A J&J lawyer said that Kessler was a biased witness or “hired gun” because he commonly testified in drug-safety trials since leaving the FDA in 1997 (see articles here and here). She suggested that he was “cutting and pasting” findings from other cases into his conclusions that: 1) officials at Janssen knew Risperdal caused some boys to develop breasts and 2) failed to alert patients, doctors and regulators about it. Kessler disputed her claims saying, “Each case is complex and there is an enormous amount of details associated with them . . . . To say I’ve testified each and every time the same way would be incorrect.” He also indicated where he has testified on behalf of pharmaceutical companies in the past.

As I first wrote this, the trial in Philadelphia was scheduled to take another few weeks. I was rooting for a ruling in favor of the autistic man and his family, which did happen! The Wall Street Journal reported that a Philadelphia jury decided Johnson & Johnson had to pay $2.5 million in damages for failing to warn that Risperdal could cause gynecomastia. The attorney representing the autistic man said: J&J “hid data from the FDA, prescribing doctors and parents. Documents showed they knew there was much higher percentage of children getting gynecomastia than they admitted.”

The settlement is relatively modest, considering what J&J has made from Risperdal. In the seven years between 2003 and 2010, Risperdal grossed more than $24 billion worldwide; 4.5 billion in 2007, the year it went off patent. While there should be enough capital to settle the case without J&J going bankrupt, with the additional 1,200 plus lawsuits, it may be a good time to divest yourself of J&J stock.

02/18/15

Hellish Withdrawal 101

Melissa Bond described herself as never having any physiological or psychological dependencies on anything “… besides perhaps rock climbing, yoga and writing large volumes of poetry.” She developed pregnancy-related insomnia and went to an MD who specialized in hormonal imbalances, where she confirmed her insomnia involved an endocrine problem. She didn’t know at the time that her doctor had a “strong proclivity for prescribing benzodiaepines.” You can read about her experience in the article she did for Mad In America: Killer Brain Candy.

After 2 years of Ativan for pregnancy-related insomnia, and the knowledge that the drug was slowly disassembling her brain and body, Melissa Bond went through a hellish withdrawal. She writes about it on her website and in her forthcoming book “Dear Little Fish.”

Melissa followed medical advice; and was told by a doctor who she trusted and respected that he knew a man who had used benzos for nineteen years and didn’t have a problem. “This drug, he told me, is phenomenal. You’ll sleep. And when you don’t need them anymore it may or may not be slightly difficult to get off but you’ll be fine.” That wasn’t what happened.

The advice I give to the drug addicts and alcoholics applies here as well. Whenever a medical person recommends that you take a potentially addictive drug for any reason, ALWAYS ALWAYS get a second opinion from someone with knowledge about addiction. Do research on people who have used the medication being prescribed to you. Mad in America, RxISK and Psychiatric Drug Facts with Dr. Peter Breggin are good places to start. And as you will see on these sites, hellish withdrawal problems aren’t confined to just the drugs classified as “addictive.”

What follows is just some basic information on how drugs are classified as controlled substances by the U.S. government. Remember that Melissa’s experiences were with a benzodiazepine, which are considered a Schedule IV controlled substance—the next to the lowest of the schedules.

There was a time when there was no federal laws regulating the use or distribution of drugs. Cocaine was in wine, cola and toothache drops; opiates were in everything from cough suppressants to teething medication. As a direct result of the Hague Convention in 1912, which was an international attempt to regulate opium, the U.S. passed the Harrison Tax Act in 1914. But it only regulated and taxed the production, importation and distribution of opiates and coca (cocaine) products. Doctors could prescribe these “narcotics” in the course of medical treatment. However they could not be used as a way to treat addiction.

While the Controlled Substances Act (CSA) of 1970 essentially replaced the Harrison Tax Act, there have been several lasting effects from this 100 year-old legislation. It began using the term ‘narcotics’ to refer to any illegally used substance. It also initiated the social construct of the “criminal” drug addict and the black market for drugs. But there still wasn’t any federal oversight and regulation of drug development. It wasn’t until the 1962 Kefauver-Harris Amendments that the Food and Drug Administration (FDA) was created, which was to approve the safety and effectiveness of a drug being developed for human consumption.

The CSA is the federal drug policy regulating the manufacture, importation, possession, use and distribution of certain substances. It created five Schedules or classifications for drugs; with varied qualifications for a substance to be included in each of the schedules. Two federal agencies, the Drug Enforcement Administration (DEA) and the FDA typically determine which substances are added to or removed from the various schedules. There have been several amendments to the CSA since 1970, including the Psychotropic Substances Act of 1978 and The Electronic Prescriptions for Controlled Substances Act of 2010.

The placement of a drug into a specific Schedule or the reclassification of a drug from one Schedule to another is based upon a series of laws under Title 21, which governs food and drugs in the United States. Each Schedule requires that the “potential for abuse” for a substance has to be determined before in can be placed within its respective Schedule. According to the DEA, “The abuse rate is a determinate factor in the scheduling of the drug.”

The hierarchy begins with Schedule V drugs at the lowest level and ends with Schedule I drugs at the highest level. The designated abuse potential of drugs increases as you move up the hierarchy from Schedule V to Schedule I. Schedule I drugs are defined as having no current accepted medical use and a high potential for abuse. They are the most dangerous drugs, “with potentially severe psychological or physical dependence.” Schedule V drugs are defined as having the lowest potential for abuse and are generally antidiarrheal, antitussive [cough suppressant] and analgesic medications. See the DEA link for a description of each of the five drug Schedules.

Sometimes the Schedule within which a drug is placed is controversial, and doesn’t seem to follow what would to be a common knowledge of a drug’s abuse potential. One example of this is marijuana. While it has a significantly lower dependency liability and harm potential than heroin (See “The Most Addictive and Harmful Drugs”), it is placed within Schedule I with heroin. This means that research into its potential medicinal use is highly regulated and difficult to do. There are other times where drugs are rescheduled, as was the case with Vicodin, when it became a Schedule II controlled substance instead of a Schedule III controlled substance in October of 2014 because it had become the most widely abused prescription opioid.

The following chart places some of the more common drugs within their current Schedules. You can review a pdf of all Controlled Substances in alphabetical order if there is one you don’t see here and want to check.

Schedules	Drugs
Schedule I	Heroin, marijuana, LSD, peyote, mescaline, ecstasy, MMDA, ibogaine, Quaalude, psilocybin,
Schedule II	Cocaine, morphine, methadone, methamphetamine, hydromorphone, oxycodone, hydrocodone, fentanyl, Adderall, Ritalin, Concerta, Vicodin, codeine, Demerol, Nembutal, PCP,
Schedule III	ketamine, anabolic steroids, testosterone, Suboxone (buprenorphine),
Schedule IV	Xanax, Klonopin, Valium, Ativan, Soma, Provigil, Serax, Serenel, Talwin, Tramadol/Ultram, Halcion, Ambien, Lunesta, Sonata,
Schedule V	Robbitussin AC, Lacosamide, Pyrovalerone, Lomotil

12/31/14

Anti-Anti-Black Box Warning

The New England Journal of Medicine recently published two very different articles on the 2004 black box warnings the FDA put on antidepressants because of their relationship to suicidality. They illustrate the truth that there are no brute, utterly uninterpreted facts. “The modern scientist, pretending to be merely a describer of facts, is in reality, a maker of facts” (Cornelius Van Til).

Richard Freidman concluded from his review of the literature that the black box warnings led to less treatment for depression. Not only had prescription rates for antidepressants fallen, so had the rate of diagnosing new cases of depression. He acknowledged that data indicating these trends were only correlational and could not establish a causal link between the warning and these changes. Yet he thought it plausible that in the face of the debate over FDA warning and resultant media coverage, “patients might be reluctant to disclose symptoms that could lead to a diagnosis of depression and subsequent antidepressant treatment, and physicians might be hesitant to prescribe these drugs.”

He also noted a study by Lu et al. that found there was a statistically significant increase in psychotropic-drug poisonings after the FDA warning. This measure was used by the study as a proxy measure for suicide attempts. “Insofar as such poisonings represent a reasonable proxy for suicide attempts, it’s possible that the downward trend in antidepressant use resulted in an increase in such attempts.” He qualified that statement by saying that we cannot be certain that any given poisoning was intentional or accidental. Then he pointed to a gradual increase in suicide rates among 10 to 34 year olds between 1999 and 2010. “So there is little evidence that actual suicide rates have changed in the wake of the advisory.”

In his opinion, the “very small risk associated with antidepressant treatment” is offset by the far greater risk posed by untreated depression. Given that the 2007 modification of the black-box warning was not enough to prevent “a chilling effect on depression treatment,” he did not think further modifications would be helpful. He recommended that the FDA consider removing the warnings entirely.

I believe we cannot ignore the weight of these epidemiologic data or the very real possibility that the FDA advisory has unintentionally discouraged depressed patients from seeking treatment and doctors from prescribing antidepressants.

However, as Mad in America pointed out, Dr. Marc Stone challenged virtually all of the interpretations made by Dr. Freidman in his article. Stone meticulously demonstrated how the investigators in the reported studies failed to distinguish the alleged effect of “the boxed warning from the effect of general public awareness of the suicidality issue.” He further noted that it cannot be assumed that 2005 decreases in antidepressant prescription rates were a reaction to the warning and resultant controversy.

While the number of prescriptions did decrease in every age group up to 54 years of age, they increased in every older subgroup. “Why were prescribing trends unaffected among adults 55 or older?” Stone suggested that the time period was a transitional one, where several popular antidepressants went off patent, while generics sharply increased. From 2004 through 2008, promotional expenditures for antidepressants decreased by 35%.

It is possible that the modest reduction in antidepressant prescribing reflected drug makers’ reduced marketing of brand-name antidepressants to everyone except patients who would soon be eligible for the new Medicare prescription-drug benefit.

Stone also noted that the Lu et al. study cited by Freidman rested its claim that “poisoning by psychotropic agents” could be a proxy measure for suicide attempts on an invalid application of another study: “That study did not investigate whether the relationship between proxy and attempted suicide remained stable over time.” Superior data from the CDC indicated that incidents of attempted suicide from poisoning and all other causes peaked in 2003 or 2004 and then declined. In addition, the rate of accidental poisoning, such as drug overdoses, increased significantly in 2005 and 2006. Dr. Stone concluded:

These data should be sufficient to dispel any serious concerns, but nearly 10 years after the labeling changes, the idea that the boxed warning had adverse consequences persists in the minds of many health professionals, in the media, and among the general public.

Psychologist Philip Hickey also wrote a critique of the Lu et al. study. He quoted several statements from the National Institute of Health (NIH) press release about the study and then proceeded to devastatingly show how the statements were false. Both the link provided by Hickey and a search of the NIH site failed to find the noted press release. It seems to have been removed. He concluded that the Lu et al. study was meant to be PR and spin, not science.

The fundamental message in the study, and in the NIH press release, is: If you reporters print bad things about antidepressants, this will lead to reduced usage of these products, which in turn will lead to more suicides, and you will have blood on your hands!

But why is there a PR campaign for antidepressants occurring now? Julia Calderone’s article in Scientific American, “The Rise of All-Purpose Antidepressants,” may have provided a clue. She noted that doctors commonly use antidepressants to treat conditions they are not approved for by the FDA—so-called off label use. “Studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat [off label] conditions.” So the message is, if you reporters print bad things about antidepressants, doctors could lose one of the main drug options they have for altering brain chemistry.

Antidepressants are ineffective in treating all but the most serious cases of depression. There have also been reliable studies showing that the placebo effect accounts for virtually all of the drug effect of antidepressants. Could the placebo effect also be at work in the off-label use of antidepressants? They have been shown to have serious side effects warranting the inclusion of the black box warning. If anything, the warning should be extended to include adults, the age group most often using antidepressants.

11/12/14

What a Drag It is Getting Old

lightwise / 123RF Stock Photo

Things are different today. Grandmother needs something to calm down. Although she’s not really ill, they’ll give her a little yellow pill. And it helps her on her way, and gets her through the day. So she goes running for the shelter of a mother’s little helper. Four will help her sleep right through the night; and might even help to minimize her plight.

“Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old.”

Above and below are the chorus and two paraphrases taken from the lyrics of the Rolling Stones 1966 song, “Mother’s Little Helper.” Following the runaway success of the first modern tranquilizer, Miltown, Hoffman-La Roche brought the newest benzodiazepine—Valium to market in 1963 and then targeted women in its advertising. “From 1968 to 1981, it was the best selling drug in the Western world.”

Recently there has been a good bit of press (Science Daily and Web MD and others) on a study published in the British Medical Journal that indicated benzodiazepine (benzo) use was associated with the risk of developing Alzheimer’s disease. A BBC report about the study quoted some Alzheimer’s experts who minimized the study’s findings by saying that it was hard to know the underlying reason for the link. Other reports, such as that by Paula Span, on her New York Times blog, The New Old Age, noted how the study was designed to reduce the possibility of reverse causation. That is, reverse causation claims the correlation existed because individuals first diagnosed with Alzheimer’s were given benzos afterwards as part of their medical treatment.

Mad in America quoted from the study’s abstract, where the researchers said: “the stronger association [between Alzheimer’s and the use of benzos] observed for long term exposures reinforces the suspicion of a possible association.” The study’s authors further said:

Risk increased with density of exposure and when long acting benzodiazepines were used. Further adjustment on symptoms thought to be potential prodromes [precursors] for dementia—such as depression, anxiety, or sleep disorders—did not meaningfully alter the results.

The results of the study were consistent with five previous studies. It reinforced the suspicion of an increased risk of Alzheimer-like dementia among benzo users, particularly those who are long-term users. Their findings are particularly important when considering the wide spread use of benzos with older people, and the concurrent rise of dementia in developed countries. “Unwarranted long term use of these drugs should be considered as a public health concern.”

A JAMA Internal Medicine article noted that: “The American Board of Internal Medicine Foundation Choosing Wisely Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older.” Paula Span reported in another article that a particular concern with older adults is falls, which are a leading cause of death and disability. The CDC estimated that one out of three older adults over the age of 65 falls each year. “In 2012, 2.4 million falls among older adults were treated in emergency departments and more than 722,000 of these were hospitalized.” Advice for tapering older adults off of benzos and other sleep aids like Ambien is available. See the Paula Span article, “More on Sleeping Pills and Older Adults,” linked in this paragraph.

Not only are benzos problematic when given to older adults long-term, there is a well-documented concern with any long-term use of this class of drugs. Quoting Dr. Stevan Gressitt, Robert Whitaker indicated in Anatomy of an Epidemic that there was no evidence supporting the long-term use of benzos. Additionally, they could aggravate medical and mental health problems like anxiety, depression, cognitive impairment and functional decline.

Whitaker described a 2004 Australian study that looked at the potential deficits in cognitive functioning after long-term benzo use. The duration of benzo use by the patients in the research studies they looked at ranged from 1 to 34 years. The mean was 9.9 years. They found that long-term benzo users were consistently more impaired across all the cognitive categories examined. “The observation that long-term benzodiazepine use leads to a generalised effect on cognition has numerous implications for the informed and responsible prescription of these drugs.”

Although it was thirty years ago that governmental review panels in the United States and the United Kingdom concluded that the benzodiazepines shouldn’t be prescribed long-term, with dozens of studies subsequently confirming the wisdom of that advice, the prescribing of benzodiazepines for continual use goes on. Indeed, a 2005 study of anxious patients in the New England area found that more than half regularly took a benzodiazepine, and many bipolar patients now take a benzodiazepine as part of a drug cocktail. The scientific evidence just doesn’t seem to affect the prescribing habits of many doctors.” (Robert Whitaker, Anatomy of an Epidemic, p. 147)

“Life’s just much too hard today,”
I hear every grandmother say.
The pursuit of happiness just seems a bore
And if you take more of those, you will get an overdose.
No more running for the shelter of a grandmother’s little helper.
They just helped you on your way, towards your busy dying day.

08/27/14

In Pharmakon We Trust

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Christina and her husband, Sonny, separated in July of 2013. During a visit on December 18th,—his daughter’s birthday—Sonny strangled his 14 year-old son and then hung himself. Sonny and Gunnar’s bodies were found in his apartment by Sonny’s girlfriend. On December 19th Christina kept a previously scheduled appointment with a psychiatrist who she had been seeing for a couple of weeks.

BEFORE her appointment at the University Health Center, Christina’s doctor had placed the University of Vermont police on standby to take her into custody if she refused to admit herself to the psych unit in Fletcher Allen, the UV affiliated medical center. She did decline, so she was detained. A UVM police report showed that there was a delay of several hours before the officers could transport Christina to Fletcher Allen because the mental health staff didn’t have the proper paperwork to legally transport her! Five weeks later, Christina was finally released.

Justina Pelletier suffers with a rare disorder—mitochondrial disease. In February of 2013, at the recommendation of her doctor, she was taken to Boston Children’s Hospital by her mother. Justina’s gastroenterologist had recently moved there from Tufts. The team at Children’s disputed the mitochondrial disease diagnosis and concluded Justina suffered from somatoform disorder—a psychiatric disorder in which symptoms are real, but have no underlying cause. Some reports indicated this re-diagnosis was first made within a matter of hours or minutes of Justina’s arrival at Children’s and was done without consultation with her treating physicians.

When her parents tried to have her discharged from Boston Children’s, the hospital contacted DCF, who took custody of Justina and accused her parents of medical child abuse. Justina remained a ward of the state until June 18, 2014. Most of that time she spent on a locked psychiatric ward. While in state custody, Justina only saw her family once per week for a supervised hour of visitation and spoke with them once a week on the phone.

In his essay, “Strategies of Psychiatric Coercion,” Jeffrey Schaler commented that treatment providers forcibly “treat” people they consider to be a danger to themselves or others in the name of compassion and care. In effect, psychiatrists and mental health professionals empowered by the state to commit someone involuntarily to a psychiatric hospital argue that the person is a child. Although not literally a child, he is a metaphoric child. “He does not, in their opinion, exercise responsibility for himself because he cannot do so.”

The coercion is supposedly done to protect him from himself. He “needs” to be deprived of his constitutional rights in the name of treating his “mental” illness. And the more a person objects to being coerced into treatment, “the more likely he is to be diagnosed with serious mental illness.”

Los Angeles recently decided to expand a pilot program from 20 to 300 slots that will allow a family member, treatment provider or law enforcement officer to pursue court-ordered outpatient treatment for individuals with serious mental illness. “Those who don’t comply can be taken into custody on a 72-hour psychiatric hold. Patients can’t be forced to take medication under law, but there are other mechanisms for court-ordered medication.”

In his 1963 book, Law, Liberty and Psychiatry, Thomas Szasz predicted the birth of what he called the therapeutic state: “Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.” He even went further and coined a new term for this union of psychiatry and the state: pharmacracy.

Inasmuch as we have words to describe medicine as a healing art, but have none to describe it as a method of social control or political rule, we must first give it a name. I propose that we call it pharmacracy, from the Greek roots pharmakon, for ‘medicine’ or ‘drug,’ and kratein, for ‘to rule’ or ‘to control.’ … As theocracy is rule by God or priests, and democracy is rule by the people or the majority, so pharmacracy is rule by medicine or physicians.

I don’t think we are a therapeutic state … yet. We aren’t a pharmacracy … yet. But I do think we need to be aware of the warnings given by Thomas Szasz. If you need more information before you decide whether the United States is in danger of becoming a therapeutic state, spend some time on the following websites:

PsychRights

Mad in America

ToxicPsychiatry

By the way, a UN report thinks that forced psychiatric treatment is torture:

Deprivation of liberty on grounds of mental illness is unjustified. Under the European Convention on Human Rights, mental disorder must be of a certain severity in order to justify detention. I believe that the severity of the mental illness cannot justify detention nor can it be justified by a motivation to protect the safety of the person or of others. Furthermore, deprivation of liberty that is based on the grounds of a disability and that inflicts severe pain or suffering falls under the scope of the Convention against Torture.

07/30/14

Getting Off the Antidepressant Merry-Go-Round

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I told Allison to concentrate on my voice and imitate how I was breathing. My coworker held her head in her lap. Together we kept Allison focused until the paramedics came. Determined to stop all drug use after she came into outpatient drug and alcohol treatment, she decided to stop taking her Paxil … cold turkey. The result was a severe panic attack and ER visit.

The Center for Disease Control and Prevention (CDC) estimated that eleven percent of Americans 12 and over use antidepressants. More than 60% of those taking an antidepressant medication have taken it for 2 years or longer; 14% have taken the medication for 10 years or more. Like Allison, women between the ages of 40 and 59 are those most likely to be taking an antidepressant (22.8%). Antidepressants were the most commonly used medication by persons aged 18-44; they were the third most commonly used prescription drug by all Americans in 2005-2008.

Okay, you’re thinking you want to try to withdraw from antidepressants; but you don’t want to duplicate Allison’s experience. What should you do?

First, do some research on the growing evidence of problems with antidepressants.

Look at some of the material available on the websites “ToxicPsychiatry” by Peter Breggin and PsychRights by Jim Gottstein. Here are a few recommendations.

Start with Patient Online Report of Selective Serotonin Reuptake Inhibitor-Induced Persistent Postwithdrawal Anxiety and Mood Disorders, by Carlotta Belaise, Alessia Gatti, Virginie-Anne Chouinard, and Guy Chouinard,on Psychrights. It is a short, easy to read study of online self-reports of withdrawal symptoms and postwithdrawal symptoms that they attributed to the discontinuation of SSRI antidepressants.

Then read “Do Antidepressants Cure or Create Abnormal Brain States?” by Joanna Moncrieff, found on ToxicPsychiatry. If you want further information, try her book, The Myth of the Chemical Cure. Dr. Moncrieff effectively challenges the received wisdom of the chemical imbalance theories underlying the use medications for depression, psychosis and bipolar disorder.

If you have used antidepressants for a number of years, also read: “Now Antidepressant-induced Chronic Depression Has a Name: Tardive Dysphoria,” by Robert Whitaker. Try out his website as well, Mad in America.

You can also read two articles that I’ve written and made available here on Faith Seeking Understanding: “Antidepressant Withdrawal or Discontinuation Syndrome?” and “Antidepressants Their Ineffectiveness and Risks.”

Second, become familiar with the potential postwithdrawal side effects of antidepressant withdrawal.

There is a website of free resources at RxISK. You can research reported side effects by drug name; and you can report a drug’s side effects. But be sure to look at the “Symptoms-on-Stopping Zone.” Read about the concept of medication spellbinding coined by Peter Breggin on his ToxicPsychiatry site. Try his article, “Intoxication Anosognosia: The Spellbinding Effect of Psychiatric Drugs” or his book, Medication Madness for a more detailed discussion.

Mario Fava has developed a scale to assess withdrawal/discontinuation symptoms during an antidepressant taper. You can see a copy of his DESS Scale here; and read about antidepressant discontinuation here. You can download the original Fava article here after registering with psychiatrist.com.

Finally, don’t try this at home alone.

Read this blog post on Mad in America by Monica Cassani. Locate psychiatric support groups and websites like Beyond Meds by Monica Cassani. RxISK has published a detailed “Guide to Stopping Antidepressants.” Also read Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications or Psychiatric Drug Withdrawal, both by Peter Breggin.

Make sure you have medical support and monitoring from a doctor or psychiatrist who is supportive of your attempt to taper. Someone who is president of the local chapter of NAMI and believes in the chemical imbalance theory of depression is not a good choice to supervise your drug taper. Postwithdrawal symptoms will be seen as the re-emergence of your underlying psychiatric disorder and proof you need to be on medications for life.

Tell family and friends of your decision and enlist them (those who are receptive to your decision to taper) as members of an accountability or support group. Have them read this material.

In closing, remember this warning by Dr. Peter Breggin on his website:

Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems. In short, it is not only dangerous to start taking psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.

05/21/14

Is ADHD Simply a Case of the Fidgets?

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At a conference, I heard Bose Ravenel (a great name) describe how the “science” behind ADHD and other childhood behavioral disorders wasn’t truly scientific. I bought and read The Diseasing of America’s Children, which he co-authored with John Rosemond. I collected additional critiques of ADHD treatment by Peter Breggin and Fred Baughman, intending to write an article for my web site. But other interests came along, and I didn’t get around to it for a few years.

As an abstinence-oriented addictions counselor, I have a built-in bias against using stimulant medication to treat behavior problems. According to the U.S. Department of Justice, most ADHD medications have “a high potential for abuse”, leading to possible psychological or physical dependence. In other words, Adderall and Ritalin have the same abuse potential as morphine or OxyContin. It didn’t make sense to me that this “treatment” for ADHD would reverse a biochemical or neurological deficit as claimed. The calming effect of stimulants had to have another explanation.

In the summer of 2012 I finally sat down and did the reading and research to first write: “ADHD: An Imbalance of Fire Over Water or A Case of the Fidgets?” Although I read several studies supporting the use of ADHD medications, I still concluded that the negatives far outweighed the positives.

I don’t think I simply found what I already “knew” to be true because of my built-in bias against stimulant medications. The research convincingly showed that stimulant medications do not really “treat” ADHD. And I think you will too after watching the presentation by Robert Whitaker in: “Medicating ADHD: Diagnosis and the Long-Term Effects of the Medications.”

Here is just one teaser mentioned in the video. William Pelham, a researcher with the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA Study), a long term study of the treatment of ADHD funded by the NIMH said: “We thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There were no beneficial effects; none. In the short term [medication] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Viewing ADHD as a simply a neurological disorder that is treated with medication seems to make the mistake of viewing human beings as simply “bodies run amuck” (to use Dave Powlison’s phrase). This reductionistic understanding of human nature neglects a biblical understanding that we are a “psycho-somatic unity” of soul (psyche) and body (soma).

There is nothing morally wrong in using ADHD medications. But given the problems with them, I certainly think it is unwise to use them long-term—particularly since they have the same risk of drug dependency as morphine and OxyContin.

Faith Seeking Understanding

Charles Sigler, D.Phil.

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