Thursday, January 1, 2009

Living Up to Worst Expectations: Scientology DVD, "Making a Killing"

Regular readers of this blog may want to stop here as the remainder of this post has little to do with my main theme, the ethics of the relationship between medicine and the pharmaceutical industry. Rather the post is a neeeded follow-on to my previous post on my inclusion in a DVD, Making a Killing: The Untold Story of Psychotropic Drugs, produced by the Citizens Commission on Human Rights, an offshoot of the Church of Scientology:

I explained in that post that I regretted being drawn into a video whose main purpose was to attack and undermine the practice of psychiatry. Any reader of HOOKED or this blog knows that there are many practices within psychiatry today with which I strongly disagree. That, I hope, does not make me an anti-psychiatrist or a denier of the reality of mental illness. I admitted that I was frankly insufficiently informed about the methods used by the Church of Scientology to draw people into its misinformation campaign about mental illness.

The follow-on is necessitated by challenges that came to me from the Citizens Commission--how could I condemn the video without even seeing it? They apologized for not sending me a copy right off and promptly made up the deficiency.

It took me until the holiday break but I finally did have time to view the video. It is every bit as bad as I feared.

First, to keep the record straight, I am not misquoted or quoted out of context in the several brief appearances that I make. I stand behind any specific things I am shown as saying. Second, there are a number of correct facts and assertions made in the DVD. I will not take up space listing them as they are, as noted, well known to any reader of this blog. I will instead defend my claim that the video is basically wrong, and that it is wrong in a deliberately sneaky way.

Many years ago I read the then-popular and controversial book by psychiatrist Thomas Szasz, The Myth of Mental Illness, first published I believe in 1961. The good Dr. Szasz is still going strong, as evidenced by his appearance in this video. What seems extraordinary is that his ideas from that book are still taken as credible today and seem to form the philosophical basis for the entire case against psychiatry.

Szasz attacked the "myth" of psychiatry by a combination of extreme Cartesian dualism and logical positivism, two positions philosophers today widely regard as untenable. In plain English that means that he made mental illness into a "myth" first by asserting that the mind and the body are two vastly and completely different things, and then by elevating bodily illness to an impossible level of objectivity and scientific predictability and control. According to Szasz (and this video), when you are physically ill, you are in a state that is defined by precise scientific knowledge and where human values and human subjectivity have no role. We know exactly what causes this illness state down to the last molecule. We have precise blood tests and x-rays that provide 100% accurate diagnoses, and when we have drugs or surgery for the disease, they cure it completely, not merely managing or masking the symptoms.

I practiced family medicine for 26 years and nothing I ever did was remotely like this idealized image. Yet it is by derogatory comparison with this impossible (and indeed undesirable) ideal state that mental illness is said to be a "myth," and psychiatry said to be a cross between a scam and war crimes.

What this means in practical terms--moving away now from the philosophical basis of the anti-psychiatry position--is that this video had open to it a fully defensible and reasonable attack on the practice of psychiatry today, under the influence of heavy-duty Pharma marketing. It would be perfectly reasonable to say that there are serious mental illnesses like psychoses, bipolar disease, and severe depression. The drugs that are prescribed for these disorders do indeed help a good many of the sufferers from these diseases to a substantial degree. The drug companies cannot make their hoped-for profits by selling drugs only to this small group of severely afflicted people. So all the companies then try to persuade docs that the drugs work equally well, and with an acceptably low level of adverse effects, for moderate and mild cases of mental illness. In this quest they are aided by the "key opinion leaders" among academic psychiatrists who are the paid shills of the industry. The result is much less effective treatment and a great many more people exposed to adverse reactions, some potentially fatal (as heart-rending personal accounts in the video describe).

The above is as I say reasonable and I believe true--and a serious indictment of today's practice of psychiatry. But the Scientology crowd cannot make this reasonable claim, apparently, because they are wedded to the idea that there is no such thing as mental illness and that none of these psychiatric drugs ever helped anyone. Since they have to deny both the reality of mental disease and the possible efficacy of the drugs even in occasional cases, they start with a dishonest position from the get-go.

Further notes I jotted down to myself while watching the video:
  • The video discusses adverse reactions to psychotropic drugs without a single mention of any benefit. In the end it advocates "informed consent" which requires a balanced discussion of both benefits and risks.
  • Psychiatry is referred to constantly as "the psychiatric industry." If I did an expose of how orthopedists take a lot of money from device makers and have serious conflicts of interest, and I referred to the specialty of orthopedics as "the orthopedic industry," critics would immediately conclude that the film was terribly biased against the orthopods--and the critics would be right.
  • "Half of all people who commit suicide were on psychotropic drugs." Come on--the logical fallacy is obvious. Much more than half of all asthmatics who die of their disease were on anti-asthma drugs. Does that mean the drugs killed them? (In a few cases, apparently yes, but only in a very few.)
  • The DSM contains "hundreds of fictitious disorders invented by psychiatrists," and is a tool to label anyone on earth with a psychiatric diagnosis. Now the DSM may be deeply flawed, and probably is, but anyone making this charge has not read it. Any disorder in the DSM comes with a long list of exclusion criteria to assure that it is not applied to just anyone. From the few well-publicized cases of commercial "disease mongering" like "social phobia," the video generalizes to all psychiatry as fictitious.
  • Somehow it is a black mark against psychiatrists that they need to cite a DSM diagnosis or they will not get paid. By innuendo, DSM is nothing but a financial scam. News bulletin--in all my years in family medicine, when I saw a patient with a physical problem, I had to write down an ICD-9 code or I did not get paid. Some of those ICD-9 codes were as flaky, and as commercially motivated, as some DSM categories.
  • PTSD and bipolar disease are said to be "made up disorders."
  • "The psychiatric industry is engaged in crimes against humanity...psychiatric practice is a hoax...pseudo-science." Come on-- this is informing anyone?
  • Psychiatrists are caught red-handed admitting that prescribing in their field often involves trial and error--as if there is no trial and error in the rest of medicine.
  • Similarly, the narrator ominously intones how Phase IV studies turn the entire US population into involuntary guinea pigs. The producers apparently never heard of Vioxx, Avandia, and the numerous drugs for physical complaints that were found to be dangerous only via post-marketing surveys.
  • Psychiatrists are attacked as witch doctors because they admit that they cannot predict precisely which patients will develop which side effects--again, as if this is SOP in physical illness.
  • Psychiatrists make a "fat living" by precribing multiple drugs for each patient. First, did these guys check the income levels of different medical specialties, and notice that psychiatry was very near the bottom? Second, did anyone let them in on the secret that docs are not paid per drug dispensed?
  • Finally, toward the end, we get to the real whopper--that apparently up to 75% of so-called mental illness is caused by some underlying but undiagnosed physical disease. Huh? Where do they get this stuff? If I had spent my time as a family physician looking for the undiagnosed physical disease that caused the mental distress in all the patients who came to me with some sort of emotional problem, I guarantee first that I would have spent all my time in practice doing just that one thing, and second, that maybe in 26 years of practice I would have actually helped two people, while making thousands more miserable and wasting a boatload of money.

I have a couple more pages of notes, but no more patience to write further comments.

So my conclusion remains--this is a hatchet job on psychiatry, based both on false philosophical premises and false facts. Certain true facts are presented and then stretched out of recognition to cover the preferred theories of this group. I am sure that many of the people interviewed for this film, like me, do not agree with the film's underlying theme or message, and nowhere is it claimed that each person interviewed agrees with everything said in the video. Still, my sense of having been drawn into something basically slimy remains, and I regret very much allowing myself to be used in this way.


Anonymous said...

Nice article. It is certainly unpleasant to be used and deceived, so I extend my sympathies...

Another comment about those who commit suicide -- complicating the matter further is that most of the time, although individuals who commit suicide are often supposed to be taking medication, actual blood analyses tend to show they are NOT actually taking their medications as prescribed. The implication? That perhaps the fact that they were NOT taking their medications as prescribed is associated with their suicide. Sorry I don't have the specific reference, but it shouldn't take you long to look it up if you want...

Damian DeWitt said...

Thanks for taking the time to debunk CCHR and Scientology's War On Psychiatry. It is most timely in the aftermath of the tragic death of Jett Travolta.

The public is asking questions about Scientology's practices and its unusually high incidence of deaths and suicides due to medical malpractice and psychological abuse.

It is a serious issue. Your contribution as a physician, ethicist, and compassionate and intellectually honest human being is most important.

I hope you will continue to contribute to the discusssion. Thanks again.

Anonymous said...

Not long ago, I applied to volunteer for the St. Louis chapter of CCHR. At first, I met a few others absent of not only knowledge, but of concept of anything neurologically related. Most were angry for personal reasons related to the mental health profession. Also, I explored how much these others (about a dozen) knew about the complexities associated with mental health. Literally, every answer from these other members was, "Just watch the DVD"

For the benefit of the doubt, they gave me the DVD you referred to, and share the same feelings as you regarding that DVD.

I declied to volunteer at that point by email. I received a response with personal accusations against myself that were baseless.

It was at that point I let them have it.

Anonymous said...

Great article! It's thorough yet not TOO long!

Anonymous said...

I totally disagree with your personal beliefs and ideology. First and foremost, depression, bipolar, ADHD, psychosis. etc.. are not diseases and never were diseases. The documentary "Psychiatry An Industry Of Death" is 100% correct on everything it said. I researched it thoroughly. Mental illness is a myth and does not exist. Mind is not matter so there exists no disease of the mind. Psychiatry and Psychology are two unscientific pseudosciences that have no place in our society and are destroying society and they must be stopped before history will repeat itself. Reputable physicians agree that for a disease to be accurately diagnosed and treated, there must be a tangible, objective, physical abnormality that can be determined through tests such as, but not limited to, blood or urine, X-ray, brain scan or biopsy. It is the consensus of many medical professionals that, contrary to psychiatric assertion, no scientific evidence exists that would prove that mental disorders are brain-based diseases or that a chemical imbalance in the brain is responsible. In his 1998 book Blaming The Brain, biopsychologist Elliot S. Valenstein wrote, Contrary to what is claimed, no biochemical, anatomical, or functional signs have been found that reliably distinguish the brains of mental patients. He also stated that this theory is held onto because it is useful in promoting drug treatment. Psychiatry's ability to convince drug companies and governments to pour billions of dollars into its practices is based upon fraudulent "diagnostic" criteria. Psychiatrists package various behavior and emotional characteristics and falsely categorize these as a "disease" or "disorder." There isn't a single aspect of behavior that doesn't fall within the broad "symptoms" which comprise so-called "mental illness."
Psychiatry has literally covered every base with invented criteria. The migraine sufferer has a "pain disorder," the child who fidgets or is overzealous at play is "hyperactive," the person who gives up smoking or drinking coffee has a "nicotine disorder" or suffers "caffeine intoxication." If you stutter, it's a mental illness. If you have a low math score, it's "developmental arithmetic disorder." If a teenager argues with his parents it's "oppositional defiance disorder." These labels drum up business for psychiatrists. Drugs are produced to meet the psychiatrists' demand. Without fraudulent diagnoses, we would not be witnessing the prescribed drug problem we experience today. That's why it's the psychiatrists fault NOT the drug companies.

Anonymous said...

I believe in the Bible and I'm certainly against the religious aspects of Scientology. However, they're right about psychiatry and I had to learn that the hard way. I was drugged for going through a phase of acting very delinquent at home. This was a heavy drug and I developed real mental problems on it. The shrink's solution? More drugs, of course. Eventually the drugs were switched over and without those particular drugs the problems more or less went away, but they were replaced with new garbage that eventually made everyday existence difficult. I quit and felt so much better, but still had drug damage and did not know how to operate with hurtful people as the Prozac had numbed me to that sort of thing. I'm still trying to learn. Unfortunately I've been thrown headfirst into the advanced level of this challenge. The drugs also put me in a more suggestible state. Did you know that Prozac kills off serotonin receptors? If you think that people don't have enough serotonin, then why don't you recommend a supplement? Do you tell people you prescribe Prozac that a single 30 mg doubles cortisol levels? That's important. Do they know the it can actually CAUSE or worsen depression and anxiety? You probably mistake it for a worsening of the "disease." Why also do you assume that people have a serotonin deficiency? About lithium: do people know that it's a toxic metal like lead and mercury and that these metals are found in traces in the body, too? Do people know that this is a dangerous drug for kids and that it slows the brain and possibly lets in satanic thoughts that won't go away? (It happened to me and stopped when I was taken off.)
Please don't try to discredit those who bring attention to the link between health issues and mental and emotional problems. I can tell you that it's very real. I've had major issues because of my gut. When my gut feels better I usually feel better mentally and emotionally. Do you check people for blood sugar issues before you prescribe them psychotropic drugs?
Nutritional deficiencies? What about their spiritual well-being? Things are interconnected more than you think, but the spiritual aspect alone would do it. Mental problems are just that and people with them aren't "sick."
They actually have found a so-called "therapeutic" dose of SSRIs in the systems of at least some of the shooters, including a Columbine killer. SSRIs have a short half life and this mass murder had been planned for a long time; it wasn't impulsive. Prozac caused me to act out of character. It didn't have the same effect on me as on them, though. Keep in mind that someone quitting/skipping psych drugs isn't like someone who's never been on them. Withdrawal can hit hard. (Quit cold turkey whenever possible.) Don't assume that people on withdrawal or even those drug-free for a while already are the way they would be had they never been drugged.
Please think about prescribing natural stuff instead even if you don't have the approval of Big Pharma. Sorry this is so long.


Hank M said...

As far as I can tell, the DVD is on the subject of psychiatry, not the broad topic of general medicine.

Just because doctors are just as clueless as psychiatrists when it comes to dispensing their drugs does not prove the point wrong.

The difference is, psychotropics target brain function, can have scary side effects also affecting the psyche and can be hell to get off of.

Two wrongs do not make a right.

The medical profession, especially psychiatry, could use some humility.