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:

http://brodyhooked.blogspot.com/2008/11/public-announcement-regarding-new.html

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.