Peter Gøtzsche: Forced Psychiatric Treatment Must Be Abolished
Alaska, June 2, 2016
Transcribed by Irit Shimrat
Video on YouTube
Jim Gottstein: I’m Jim Gottstein, with the Law Project for Psychiatric Rights, and I’m extremely pleased to introduce our speaker tonight, Dr. Peter Gøtzsche, from Copenhagen. He’s with the Cochrane Collaboration, an independent research group that studies and issues reports on medicines and devices – all medical treatments. They don’t have any conflicts of interest, and they’re known around the world for their objective reviews of what the research really says. Dr. Gøtzsche has published over 70 papers in the five most prestigious medical journals in the world, and they’ve been cited over 15,000 times. He’s published four books: Rational Diagnosis and Treatment: Evidence-based clinical decision-making (2007); Mammography screening: truth, lies and controversy – those are his first two books. And then, in 2013, he wrote Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Health Care. In Deadly Medicines, he had two chapters on psychiatric drugs. And then he decided to write a whole book about that. And last year, he published Deadly Psychiatry and Organized Denial. I got to know Peter a couple of years ago. I met him at a conference Los Angeles, and we had a chance to get to know each other a little bit, and we’re trying to collaborate. The Mental Health Trust Authority was so kind as to give us a grant to bring him up. He’s been here for a day and a half, and he’s had some interesting experiences, which maybe he’ll talk about in the question-and-answer period. I don’t think he’ll talk about them in his presentation. So, please welcome Dr. Peter Gøtzsche.
Peter Gøtzsche: Thank you so much, Jim. I really admire Jim’s work, and I also cite it. In my psychiatry book – I should say, the crime book – there are two chapters on psychiatry. One is called “Psychiatry: The drug industry’s paradise” and the next one is called “Pushing children into suicide with happy pills.” It’s a very dark chapter.
Psychiatry without forced admission and treatment is a must. And I have no conflicts of interest. And, of course, the views presented are mine; whose else could they be? There are three perspectives you can apply to the use of force in psychiatry – and I will discuss the antipsychotics. The scientific one is, does force do more good than harm? I believe, clearly, no. Antipsychotics cause vastly more harm than good. Ethics: Is force ethically acceptable? No. Antipsychotics kill a lot of people, and cripple many more. Legal issues: international declarations are being ignored. I’ll come back to that. So we must change our laws, because they are unjust.
First of all, do these drugs work? They are not specific, as the name implies. “Anti” is a misnomer. Anti-microbial agents can cure us from infections. Antipsychotics don’t cure anybody. It’s a misnomer. And the placebo-controlled trials are highly flawed, because they are not adequately blinded. These drugs have many side effects, so most doctors and patients will know whether they get active or placebo. And then, the effects will be exaggerated. And then there is the cold-turkey phenomenon in the placebo group. In virtually all trials, you take people who are already in treatment, and then you have a short washout period of, typically, up to a week. And then you randomize, to placebo or another antipsychotic drug. That means that you create abstinence symptoms in the placebo group, in quite a number of patients. So, you introduce harm in the placebo group. And then you conclude that “my new drug is better than if I harm the control-group patients.” That’s not good science; it’s appallingly poor science. But that’s how virtually all psychiatric drug trials are being done.
Despite these heavy flaws, the effect of antipsychotics, as documented in recent submissions to the FDA, is actually so small that it’s doubtful it’s clinically relevant. It’s only six points on the positive and negative syndrome scale for schizophrenia. And psychiatrists have established that the minimally clinically relevant change – which means, what you can barely perceive; that now there is a change, for the better, or for the worse – is 15 points. So, the Food and Drug Administration has approved olanzapine, risperidone and drugs like that, despite the fact that the effect they have in deeply flawed trials – so, this is exaggerated – is below what you can barely perceive as a change. So, that tells a lot about these drugs.
And then, the schizophrenia diagnosis can be wrong in over 50 percent of the cases. So, you subject people to forced treatment with very toxic drugs, and they don’t even have an indication for treatment, because it’s wrong. That’s another sign that we are not doing well here.
The cold-turkey design is clearly lethal. One in every 145 patients who entered the trials for risperidone, olanzapine, quetiapine and sertindole – they died. And these deaths are unknown to the public. They don’t appear in published trial reports, and the FDA didn’t require them to be mentioned. That’s pretty typical for the FDA. This is an agency that, by and large, protects the drug industry, and not the patients. And we are not much better in Europe, with our European Medicines Agency.
Now, let’s look at the first of these drugs. Antipsychotics are really psychiatry’s poster child. The first one was chlorpromazine, which was launched in 1954. And, in the beginning, the psychiatrists were sober, because they called it a chemical lobotomy – because it worked like lobotomy; people became quiet, passive – or a chemical straitjacket. These drugs have no specific antipsychotic properties. They calm down people, and they lessen psychotic thoughts – but they lessen all thoughts. So it’s difficult to exist when you take antipsychotics.
One year later, already the hype was extreme. It was forgotten that this is a chemical lobotomy. And Harold Himwich, the president of the US Society of Biological Psychiatry, came up with the totally absurd idea that antipsychotics work like insulin for diabetes. It was purely fantasy. If you need insulin, and you get insulin, that’s a remarkable treatment. You give people something that they have too little of. This is curative. People with psychosis don’t need anything. They’re not short of anything.
And then, psychiatrists like to say that these drugs emptied the asylums, with their miraculous effects. That’s certainly not true. The asylums were emptied for economic considerations. Both in the United States and in the United Kingdom – everywhere it has been studied – it had nothing to do with the effect of antipsychotics. This is part of the folklore in psychiatry. There are so many myths and lies in psychiatry. It’s pretty astonishing to me, as a specialist in internal medicine. I never heard of any specialty where there are so many lies as in psychiatry. It’s very strange.
There was an early double-blind trial, where the National Institute of Mental Health investigators – and they had not been blinded effectively, because these drugs have side effects – they saw the exact opposite of what is actually true when you medicate people with these drugs. What they reported was “reduced apathy” – it’s the opposite. “Improved motor movement” – not at all. “Less indifference” – totally wrong. So this tells you a lot about how unreliable trials in psychiatry are. Psychiatrists very often see, or report, what they would like to see. This is a psychological phenomenon.
Psychiatrists have failed to live up to their professional responsibility by neglecting to perform head-to-head trials between benzodiazepines and antipsychotics. When I lecture for patients, or previous patients, I ask them, “If you should get admitted next time, with a psychosis, what would you prefer? A benzodiazepine or an antipsychotic?” And every one of them, so far, has said, “A benzodiazepine.” Then why do we treat them with drugs that are among the most toxic drugs ever invented, apart from chemotherapy? It’s not right.
In 1989, 35 years after chlorpromazine came on the market, only two trials had compared the two types of drugs – and they produced similar improvements. Why hadn’t loads of these trials been done? Because the drug industry controls everything. And the new drugs were very expensive. The old ones were cheap. So there was no incentive in showing that the old drugs were equally good, or perhaps even better. So these trials were not done. But the psychiatrists could have done them, and they didn’t. There are now more trials. And there is a Cochrane review of 14 trials that showed that sedation occurred significantly more often on benzodiazepines. These trials are not very good, but the best evidence we have tells us that benzodiazepines are probably better. This is incredible. In my country, sometimes psychiatrists use benzodiazepines in acutely admitted patients with psychosis. But our guidelines say the same as in the rest of world: that they should use antipsychotics.
Since these trials are so flawed, can we trust meta-analyses of many trials – in Cochrane Reviews, for example? No. By and large, we cannot. There is a huge Cochrane Review of chlorpromazine: 55 trials, 5,500 patients. The abstract says that akathisia did not occur more often in the chlorpromazine group than in the placebo group. There was no reservation for this statement. Now, akathisia is this extreme form of restlessness, where some people say, “I want to jump out of my skin.” It means, “I can’t sit still.” They pace around frantically, perhaps. And this predisposes to both suicide and homicide. It’s a horrible condition.
How can it be that these drugs cause akathisia, and the largest trial that contributed data actually found significantly less akathisia on drug than on placebo – almost half as much on drug? That can’t be true, because antipsychotics cause akathisia, and placebo cannot cause akathisia. So, what did we see in these trials? A cold-turkey in the placebo group! The placebo group was harmed so much that you couldn’t see how dangerous these drugs were.
This result speaks volumes about how flawed trials in schizophrenia are. And some Cochrane researchers, they realized this. So they wanted to study people with schizophrenia who had never been treated with antipsychotics before. How can you find such people? They virtually don’t exist. So, they went for first-episode schizophrenia, where no one had been treated before, to avoid this bias. But they found so little. So, what they ended up with was a review of studies where a majority had first-episode schizophrenia. They even including second-episode schizophrenia – so they were likely already treated. And, if the majority had first- and second-episode, then there must be some who had a third-episode or even a fourth-episode schizophrenia. So these trials were still flawed. But what they found was that the available evidence does not support the conclusion that antipsychotic treatment in an acute early episode of schizophrenia is effective.
Isn’t it incredible how difficult researchers can be? Why don’t they just say, “They didn’t work”? That’s what it means. And the next sentence is even more difficult: “The use of antipsychotic medications for millions of people with an early episode appears based on the evidence for those with multiple previous episodes.” In plain English, “These trials are crap, and we don’t know what we’re doing.”
So, we treat these patients with drugs that I believe they would fare better without receiving. But then, how long should we treat them? Many of them are treated for years, or for the rest of their lives, unfortunately. But some studies have been made where, after successful treatment, you then try to stop the treatment, to see if it’s still necessary. And, of course, you will have cold-turkey symptoms if you stop treatment suddenly. That’s pretty horrible. So these trials are also flawed. And you have them, overall, everywhere in psychiatry. You have them in depression. So you induce cold-turkey in the placebo group, and then you say, “Oh, yes, they still need treatment.” That’s not good science.
But here is a very rare good paper. After they had remitted, the researchers randomized the patients, to either reduce the dose or discontinue it completely, or just to continue with the dose – maintenance, for two years. And after two years, the doctor could decide the treatment. So, what happened after two years? Well, more had relapsed when they lowered or stopped the dose than if they continued. But recovery was the main outcome. Who got well? Well, after seven years, more people had recovered when they had their dose reduced or stopped: 40 percent versus 18 percent. And the dose, in the last two years, was 64 percent higher in the maintenance group. And, the group that stopped the drug completely at seven years – eleven had stopped during this period of time, in the dose-reduction group, versus six. So, they got less drug – and they fared clearly better.
We have other evidence that supports this: that the less you use of antipsychotics, the more likely it is that your patient comes back to life, and gets a job, and gets on with life. So, these antipsychotics, they create chronic patients. That’s what they do.
And how do we find out if they kill people? Some leading psychiatrists say that antipsychotics actually help people survive. That’s pretty farfetched. Such toxic drugs – how can they help people survive? And then, they build their review on very bad research. If we use the randomized trials in schizophrenia to find out if these drugs are lethal, then it’s flawed, because we have death in the placebo group, because of cold-turkey. So we can’t use the schizophrenia trials. So I went to the elderly, with Alzheimer’s and dementia, where these drugs had been tried. Because I thought, likely a good many of these people were not in treatment before, so there was no cold-turkey in the placebo group.
So, what did that show? Well, for every 100 people treated for a few weeks, there was one additional death on drug, compared to placebo. This is damning evidence, that we kill a lot of people with these drugs. And that was only throughout some weeks. And, considering the huge weight gain that many people acquire – and they develop diabetes, and heart problems, and so on – it’s very difficult to imagine that these drugs save lives. They don’t. They kill a lot of people.
And they do a lot else. They cripple people. They lead to irreversible brain damage, that can start pretty quickly, and progresses in a dose-related fashion: the longer and the higher the doses, the worse. And few people get back to normal life, compared to if you hadn’t treated them with drugs. You become dependent on virtually all psychiatric drugs. So you can get abstinence symptoms if you stop suddenly. And you can get psychosis, even if you are still on the drugs, because you change the brain in such a way that you can get what is called a supersensitivity psychosis. And that’s typical for many other psychiatric drugs: that they can actually create the diseases they were supposed to work for, or even worse diseases. So they are really double-edged swords, that doctors have extreme difficulty handling. Actually, they can’t.
So, let’s go back to the ethics. Is force ethically defensible? No. A few hours, or days, of disturbed behaviour are treated as the cause for a lifetime sentence of drug treatment. And psychiatrists in training will hardly ever see a patient who is not already snowed under with drugs – and therefore they get the wrong impression, both of the patient and his strengths, and of the potential for cure without drugs.
So, typically, when patients have strange movements and tics, and salivate, and so on, these are drug effects. But many people believe this belongs to schizophrenia; that it’s a disease effect. It’s not. Some psychiatrists feel they cannot live without forced treatment. Most of them feel that. But they should think about the fact that the patients cannot live with it. They actually die from it. That’s far worse.
Only soldiers at war and psychiatric patients are forced to run risks against their will that might kill or cripple them. But soldiers have chosen to become soldiers; psychiatric patients have not chosen to become psychiatric patients. So this is deeply unethical. And, as we all know, power corrupts. And the power imbalance in psychiatry is extreme. So there is a high risk that forced treatment is being used to benefit the staff, rather than patients, in order to make their work less stressful. We know that this happens a lot.
I have estimated that antipsychotics have killed hundreds of thousands of people, and have crippled tens of millions. It’s really gigantic. Some patients who were killed had begged those they call their torturers not to give them the drugs. And very few have been investigated for slow metabolism, which can increase the risk of death. Many people have very different metabolism from the average: slow, intermediate or fast.
Here is the heartbreaking story of a Danish girl, written by her mother: how psychiatry killed her daughter, at age 32, after a 14-year “career” in psychiatry. She was a slow metabolizer. Her mother begged the psychiatrist to have a test done, which he refused. When Luise’s best friend suddenly dropped dead on the floor at the hospital in Denmark, Luise said, “I’ll be next.” She was killed six months later.
At one point during all that, she asked her mother, “Mother, do you think it’s better in Heaven?” It is so cruel. And very few will believe in forced treatment after having read this book. You will have tears streaming down your chin if you read this book. So I can recommend this for you.
The diagnosis was wrong. She didn’t have schizophrenia. She had Asperger’s. The psychiatrists didn’t listen – not even to their own staff, who knew Luise much better than they did. They declared that she was seriously ill and should have even more drugs – when the staff said, “She’s doing fine.” They consistently blamed Luise and her mother for everything. It was never their precious pills, and certainly not themselves, that were at fault. This is quite typical as well. And they increased the dose, when it should have been decreased, or stopped altogether. Luise didn’t tolerate the drugs, and she was aware that they would likely kill her.
Post-mortem, the system congratulated itself for its first-class homicide. Luise had received the highest standard of specialist treatment. That’s what we say in Denmark when we kill people in psychiatry. “Cause of death, unknown.” The accepted term for such deaths is “natural death.” How natural is it that a 32-year-old girl suddenly drops dead?
We know that psychiatric hospital contact is pretty fatal. We know that from a large Danish study of 2,500 suicides. The closer the contact with psychiatric staff – which often involves forced treatment – the worse the outcome. The suicide rate is 44 times higher for people admitted to a psychiatric hospital, compared to those who don’t receive psychiatrist treatment.
And then you will of course think, “Isn’t that natural? Those who are most ill get admitted to hospital, and then kill themselves? That’s not because of a bad environment in the hospital!” But, actually, most of the potential biases in this study favored the null hypothesis of there being no such relationship. So this study is pretty strong. And there was an editorial that said, “It’s entirely plausible that the stigma and trauma inherent in psychiatric treatment, particularly if involuntary, might cause suicide.”
People in my country are still told – not always, but sometimes – “Schizophrenia is a chronic, lifelong disease, and you need to be drugged lifelong.” And then they leave hospital, and they have no hope. Is it strange that some people kill themselves at this point, when they also suffer from horrible side effects? I don’t think so. And schizophrenia is not a chronic, progressing disease. People can get cured from schizophrenia.
So, now we come to Alaska. Because the Alaska Supreme Court has decided that the state cannot drug someone against their will without first proving, by clear and convincing evidence, that it is in the best interests of the patients, and there is no less intrusive alternative available. I have told you about benzodiazepines. That’s less intrusive! There are always less intrusive alternatives available. And Jim Gottstein – himself a former patient – used scientific evidence to convince the judges.
In another case, the court decided that, if the alternative is feasible, the state has either to provide it, or let the person go. Jim has also noted that psychiatrists, with the full understanding of the trial judges, regularly lie in court to obtain involuntary commitment and forced medication orders. I got that experience yesterday. The petitions I saw were full of lies. It was unbelievable. We can discuss that later.
Now, the legal issues are – for example, the European Convention on Human Rights, that is about prohibition of torture: “No one shall be subjected to torture or to inhuman or to cruel, inhuman or degrading treatment or punishment.” And we have a committee for the prevention of torture that travels around and visits psychiatric institutions, and writes reports, with criticism. And they say that patients are often restrained – usually mechanically, in belts – as a sanction for perceived misbehavior, or as a means to bring about a change in behavior. That’s not allowed. And, “Where physical restraint is necessary, it should, in principle, be limited to manual control” – that you fix the patient, like this [holding imaginary patient’s wrists]. Talking to the patient, to bring him or her down, is the preferred technique. And Peter Breggin, from New York state, in particular, has shown how effective this can be. You can talk people down; you need to be kind to them, and respect them. Then, you rarely need drugs. And if the patient wants something to sleep on, a benzodiazepine will do it.
And then, the excuse that mechanical restraint is good, because it liberates staff for other tasks, is wrong. It requires more, not fewer, medical staff, because you need constant surveillance. Some people die when they are mechanically restrained; at one point it was 100 per year in the United States.
“Psychiatric patients should be treated with respect and dignity, and in a safe, humane manner that respects their choices and self-determination.” That certainly doesn’t happen here in Alaska. And the torture committee often finds that fundamental components of effective psychosocial rehabilitative treatment are underdeveloped, or even totally lacking – so, it’s all about drugs, or electroshock, or belts – and that the treatment provided to patients consists, essentially, of pharmacotherapy. There isn’t a single randomized trial that has compared seclusion, or mechanical restraint, with no such intervention. But, as I said, these measures can be fatal. And electroshock is fatal in around one in one thousand treated.
We have a human right to equal recognition before the law. This should apply to everyone, including people with mental disorders, but it doesn’t do so, currently. But we have the Universal Declaration on Human Rights, the International Covenant on Civil and Political Rights, and the United Nations Convention on the Rights of Persons with Disabilities – ratified by virtually all countries, apart from the United States, Jim Gottstein told me. It’s the only country in the world I know of that hasn’t ratified this Convention. That’s your country.
So, this Convention says that member states must immediately begin taking steps to realize these rights, by developing laws and policies to replace regimes of substitute decision-making – “We will decide what is good for you” – by supported decision-making, which respects the person’s wishes; the person’s autonomy.
“People have the right to be free from involuntary detention in a mental health facility, and not to be forced to undergo mental health treatment.” It’s very clearly formulated there. “Forced treatment is a violation of the right to equal recognition and an infringement of the right to personal integrity, freedom from torture, and freedom from violence, exploitation and abuse.” And, as everybody knows, violence breeds violence. So, when patients are violent on wards, it’s often because of the inhumane conditions they have experienced. It’s not their disease. It can be, but it’s usually not the reason.
So, it goes on like that: “This is a violation found all over the globe, despite” – this is important – “despite empirical evidence indicating its lack of effectiveness” – so, it doesn’t work – “and the views of people using mental health systems, who have experienced deep pain and trauma as a result of forced treatment.” So we introduce a lot of harm, for no benefit; virtually no benefit. It’s very little, compared to the harms.
Those who are the first ones to meet the patients – first responders – “must be trained to recognize people with mental disabilities as full persons before the law, and give the same weight to their complaints and statements as they would for anybody else.” That doesn’t happen today.
“Unsoundness of mind is not a legitimate reason for the denial of legal capacity.” I saw on all the forms, yesterday: “The patient is unable to give informed consent.” That is simply not true. Very few psychiatric patients are not able to give informed consent. But this is used as an excuse for applying force. And the concept of “mental capacity” is highly controversial in itself. It is not an objective, scientific and naturally occurring phenomenon, like elephants in Africa.
“Mental capacity is contingent on social and political contexts, as are the disciplines, professions and practices which play a dominant role in assessing mental capacity.” And who assesses mental capacity? The psychiatrist, who has an enormous conflict of interest, and believes in these drugs, and all the other things. The patient is defenseless, essentially. Where is the “independent observer” here? Gone.
Then we have these Advance Directives, which are very important, according to the Convention. If people state their will and preferences before they get admitted to hospital, they should be followed; they should be respected. And the point at which an Advance Directive enters into force (and ceases to have effect) should be decided by the patient, and not by the staff. And if you cannot find out what the patient really means, because the patient is deeply disturbed, then “the best interpretation of will and preferences” must replace “we know what is best for you.” That’s how it is today. We must try to interpret. And we can ask the relatives.
In Denmark, we have two ways we can admit a patient involuntarily. And I suppose it’s pretty much the same in the States. One of them is that, if a patient is insane, they can be admitted involuntarily “if the prospect of cure or substantial and significant improvement of the condition would otherwise be significantly impaired.” But this is never the case. What treatments do we have in psychiatry that mean that, if we don’t force the patient into a hospital, the prospect of cure will be substantially and significantly impaired? We don’t have such treatments. It’s fantasy. It’s pure wishful thinking. So this clause shouldn’t apply to anybody.
Then we come to the next one: if the patients are “dangerous to themselves or others.” But that’s not really necessary, either. In Italy, they have a law that says you cannot admit a patient involuntarily because the patient is dangerous – this is a matter for the police. In Iceland, the same: they call for the police, and the police stay on the psychiatric ward. Same laws for everyone; no discrimination there. And, in ethics, if you want to treat a person in Situation A differently from a person in Situation B, then you must be able to find an ethically relevant difference between Situation A and Situation B. That’s pure logic.
Let’s look at this. In my country, doctors cannot give patients insulin without their permission; not even if the lack of insulin might kill them. And we cannot give adult Jehovah’s Witnesses blood transfusions if they don’t want them – even if they might die. I learned today that, in the United States, you can force such a person to receive blood transfusions. We don’t understand that in Denmark. We value personal autonomy higher than this. If people decide for themselves, let them decide. Some people do very dangerous things. They drive a motorbike without a helmet, as fast as they can. And some die. People do a lot of things that kill them. We have to accept that.
The only drugs that can be given without permission are also some of the most dangerous ones. I have estimated in my book, based on the best science I could find, that psychiatric drugs are the third major killer, after heart disease and cancer. They kill an enormous number of people.
And then, there are the colossal misconceptions. It’s a common-law assumption that, if a person is unable to give consent, the health professional acts in accordance with what the practitioner herself would have preferred. But we cannot assume that a severely psychotic person would want psychotropic drugs, or that she is unable to understand what is being proposed, or its consequences. For example, she might decline drugs because of previous experience of serious harms. A patient can be floridly psychotic; that doesn’t mean that they don’t know what it means to take an antipsychotic drug, and what it means not to be treated. It’s, again, a violation of human rights.
And laws about forced treatment surely build on the harmful misconception that antipsychotics have a specific effect on psychosis, which is good for people. They don’t have such an effect. In 1975, patients in the United States took their fight to court, and battled for their rights. And, at the same time, Soviet dissidents smuggled out manuscripts describing neuroleptics as the worst sort of torture. It’s rather difficult to explain how the same substance can be a poison in one country and a helpful remedy in another – particularly as the poison was used as forced treatment in both countries.
And we can do a lot instead of force: assertive communication, rather than intervening too late in turmoil. Basal exposure therapy: if people are very afraid of something – if they have a phobia – you can expose them to it, gradually. Offering drug-free alternatives – that will be introduced in Norway now.
So, this is a way of getting rid of forced treatment. Because if you can decide, “I want to come to a psychiatric department where I won’t receive drugs,” then we’re already on our way to banning forced treatment. That’s very good. I’m trying to get political backing in Denmark, for the same, and there is interest in this. Few people who need being calmed down will refuse drugs. But let them decide themselves!
“Always have plans for tapering off drugs.” These virtually never exist, and the psychiatrists have never learned how to do it. So, typically, they lower the dose by 50 percent, and then people get very bad. You need to reduce by very, very little – typically, only 10 percent of the dose – and then wait for a while. No one ever taught them. Everybody taught them to use drugs – the drug industry. But how to stop them? No.
“Psychotherapy works for schizophrenia.” We found that out a few years ago, because some people refused to be treated with antipsychotics, and then a trial was done on psychotherapy. Of course it works. And you should try find out, why did the patient have psychosis at this point in time? “What happened to you earlier in your life?” It is so incredibly important to find this out. But modern-day psychiatrists, they rarely have time – they have time, but they prioritize it differently. They don’t take the full story. I hear stories from patients who have been zombies for ten years, until they met a good psychiatrist, who actually took a history, and then found out what was wrong with them, and started to take them off drugs – and they became healthy.
Open Dialogue was invented in Finland – in Lapland. It means that, if a patient becomes psychotic, you involve the family within the first 24 hours, and you use drugs very, very little. You talk to people. You use empathy, and love, as Peter Breggin would say. You respect the people. And then you can have the police, if it gets dangerous.
And then, there is the good cop and the bad cop. If you have been a cop and have used force, it’s impossible to change that role the next day, and pretend that now you are a healer, and want what’s best for the patient. You can’t do that, really. Maybe sometimes, but usually not. This is why psychiatrists should not act as police officers. And violence breeds violence, as I said.
Then there are the Community Treatment Orders – I heard about that today: that, even when you get out of hospital, you are not free from these drugs. You can get forced treatment, still. And if you don’t take your tablets, you get an injection. There is a Cochrane Review – and there was no difference in service use, or in anything else – and in the UK, it was hoped that Community Treatment Orders would lead to fewer hospital admissions. But the admissions increased. And there was great variation in these orders – some areas discharging half the patients with treatment orders, and others not at all. So, some psychiatrists felt, “No, it’s too much. We won’t use this. This is unethical.”
And there is a huge risk of abuse, with Community Treatment Orders – a Catch-22 situation. If a patient’s distress is considered manageable, the professionals may well argue that the set-up is working, and should be continued. But at what point should it then be stopped? And what if it doesn’t work? Then, forced drugging is often increased, causing even more misery, and more deaths. Mental Health Act police officers.
Then we have some borderline cases that I always hear about, when I say I want to ban forced treatment and forced admission. “What should we then do with people with anorexia nervosa?” Well, if it’s life-threatening, we are allowed to intervene, actually. I said before that we can’t give people insulin against their will, so I seem to be contradicting myself. But we actually have laws in my country that say we can intervene if a person is almost dying. We can do that. We can also intervene in insulin coma. e cannot intervene as long as the patient is conscious. We’re not allowed to do that.
And what about mania? That’s a difficult case. If you write a cheque to the Pope for a million dollars, and do all sorts of funny things – that’s very difficult, without force. How do you deal with these people? I don’t say it’s easy. But one of the things we could do is to take away all the legal capacities of that person, so that person cannot write any more cheques. We can do that without forced treatment – without these damned drugs.
And you should also note that, if we abandon forced treatment in psychiatry, it will produce vastly more good than harm. Of course, some people will suffer – some maniacs. But it’s the same everywhere in health care. Chemotherapy will produce vastly more good than harm for some cancers. But some people will get killed by it. That’s always the case. We cannot save everybody.
And we can have a psychiatry without force. This has been demonstrated in Iceland, where a psychiatrist burned the shackles in 1932. And they haven’t been used ever since, in Iceland. In Norway, the hospital in Akershus – that’s close to Oslo – doesn’t have a regime for rapid tranquilization, and has never needed one, in the last 20 years. What happens in the States, and in Denmark, when a psychotic patient comes through the door? Immediately, that poor guy is treated with an antipsychotic. That’s the standard. In Norway, they don’t have a regime for this. That’s pretty amazing.
And in London, the psychiatrists waited, in one hospital, an average of two weeks before they did anything, in terms of drugs, to newly admitted people. And most people chose to take some medication, often in very small doses. They decided it themselves. So it’s very possible that it was respect, time and shelter that helped the patient – not the sub-treatment-threshold doses.
And in Northern Italy, force is not used. The head of psychiatry argues that you have to completely prohibit coercion, since the employees would otherwise use it, and not develop other approaches that make coercion unnecessary. I read yesterday, on the official TV broadcasting homepage, that the psychiatrists were confused in the whole of Norway, because the Minister told them they should now provide medicine-free departments. Their confusion was, “But what should we then do? We always treat people with drugs! Help! We don’t know what to do, without drugs!” That’s pretty scary, isn’t it? But now they have to do it, because the Minister tells them to.
C.S. Lewis, a Northern Ireland priest and writer, wrote something very interesting: “Of all the tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.” This is very central to what I want to achieve with psychiatry.
We have our problems in Denmark. Only two years ago, the Danish Minister of Health issued a license to kill. It allowed psychiatrists to use extraordinarily large doses for forced treatment, and said, “This applies especially to patients who have been in prolonged treatment, and where smaller doses have been tried without a good therapeutic result.” But these are the patients who should have their drugs withdrawn! It’s exactly opposite. Giving more of what was already not working doesn’t help; it kills.
Rest in piece, forced treatment. Not the patients!
Floor is opened to questions]
Audience member: I’m disturbed by the treatment of prisoners in America. They say that a large number of American inmates are mentally ill, and there’s a large number of deaths. Guards are reported to be very brutal with the prisoners. So, how do other countries handle these cases, of mentally ill patients, without causing death?
Peter: I don’t know so much about this. In fact, what I know most about it is what you have just told me: that it’s a very dark chapter in America, the way you treat prisoners. And what I have perceived in Europe it’s not nearly as bad as what you have here in America. I’m sorry, but that’s what I have heard. I haven’t studied the science about this. But it’s not surprising that people in American prisons become very psychologically disturbed in this environment. And drugs are not the solution to this.
Audience member: What are we talking about when we’re discussing cause of death? Is it a reaction to the drug? Is it suicide? What are the variants of that?
Peter: That is not easy to study. If an extremely overweight person suddenly dies of a heart attack, the cause of death, on the death certificate, will be “heart attack.” But this is misleading. How can the drug company be left out of this equation? What I look at is, what is the life expectancy for people with schizophrenia? And, you know, it is 20 or 25 years less than the rest of the population.
And another reason for this is that these drugs are so terrible that some people start smoking in order to cope with the drugs and their side effects. And they can smoke quite heavily. And that also contributes to the deaths, and that wouldn’t have happened if they hadn’t received these drugs. So, if you then die from lung cancer, it’s called lung cancer. It’s not called “For so many years, you got a drug that you never should have received. It’s a medical error.” That never appears on a death certificate.
And then, these drugs can cause sudden heart deaths: you suddenly drop dead, for example, because of electrical disturbances in the heart. Prolongation of the QT interval, it’s called, technically. Antidepressants also prolong the QT interval – and increase the risk of arrhythmias that kill people. So, if you get several types of psychiatric drugs, you increase the risk of sudden death.
And of course, then we have all the falls. When you walk around in a cloud, and you are confused, you will more easily fall, and can hurt your head or break your hip, and that’s also dangerous.
Audience member: I just wonder whether hospitalization or forced medication of someone who is suicidal is ever justified. Or do we go ahead and step back and allow people to choose, even if they’re not making a choice that most people would like?
Peter: Can you be more precise on that?
Audience member: I worked for a while in crisis intervention at a hospital, where people in crisis were taken in – by the police, or by relatives, unfortunately, if there were no other options – to the Alaska Psychiatric Institute, where they might have been subjected to medication against their will, or weren’t allowed to leave, for the 72-hour period, and didn’t like that. But I don’t know if the alternative of letting them kill themselves is acceptable, either.
Peter: I can refer to Peter Breggin and other of my heroes. Peter Breggin never uses drugs. He never uses force. And there are other psychiatrists like him And he has explained to us how he deals with patients like that – and drugs are not the solution. These drugs seem to increase your risk of suicide. It’s not the other way around. Antidepressant drugs also increase the risk of suicide. It’s not the subject for my talk tonight, but a lot of suicides on antidepressant drugs have been deliberately concealed by the drug companies. Antidepressant drugs do increase the risk of suicide, and we don’t know if there is an upper age limit where this is not the case. But we do know that if elderly people take antidepressants, a lot of them fall and break their hip and die. So the death rate in elderly people who take antidepressants is pretty high. And, in young people – well, many are pushed into suicide, with drugs that don’t help them. So the whole idea of psychiatric drugs is a wrong one, in my opinion. We have created a completely wrong system. We should use psychiatric drugs almost not at all, and very, very sparingly – and never against the patient’s will.
Audience member: I wonder if you have any comments on the use of psychiatric drugs on patients with delirium.
Peter: Well, delirium is a life-threatening situation, so you should treat it with the drugs that we know work for this situation. That is a rather special case. And, of course, you can say a patient who is delirious may be so acutely psychologically disturbed that it’s impossible to communicate with that patient. But then, according to the United Nations, you should treat the patient according to what you think that patient would have preferred in a state where the patient was not delirious. And I think most people would prefer to be saved, in that situation. So that would be natural. That, I would not call forced treatment. It’s more like, if somebody falls in the harbor, you are actually allowed to try and save them from drowning; it’s more similar to that. But I know there are these subtleties that need to be worked out, if we don’t have forced treatment. I don’t know if I was clear enough about that; I hope so.
Audience member: What about if a patient was thought to have delirium, but was later found not to have delirium?
Peter: I don’t think it’s useful to discuss all sorts of academically very interesting, very rare cases. Let’s look at the broad picture, where we are killing and harming so many people today. We have a system that is not functioning. And then we can deal with the rest – when we have gotten rid of forced treatment. As I said, there will always be casualties in health care, even if we do our best. There will always be. But not so many as today.
Audience member: I thought it was really notable, what you said about Iceland treating people who are violent and mentally ill the same as people who are violent and not mentally ill. It’s the violence, and commission of crime, and harming others. My observation is that, in this country, that would have a significant impact on our court system, because a determination of mental soundness is very important. A lot of times, people try to claim a mental health issue as a defense: “I can’t be given a death penalty, or life in prison, because I am insane.” So you have the insanity plea here. That’s what they call it.
Peter: That’s always interesting, but I think it’s a little off the point – that the police are handling dangerous people. These are two separate issues. You were tempted to reply to that, Jim?
Jim: I was just going to remark that, when people say that they were mentally ill as an excuse for not being responsible for a crime, they’re usually sentenced to a much longer period of time in a psychiatric hospital than they would be if they were actually convicted of the crime.
Peter: Yes. And I can give you an absolutely horrifying example. I was an expert witness in Holland, where a mother was put on paroxetine, an antidepressant drug. She started to have nightmares about cutting the throats of her two children. She developed akathisia – this terrible condition that predisposes to suicide and homicide. Her psychiatrist didn’t do anything. This was medical malpractice. They should have taken her off that dangerous drug. And then, one morning, she cut the throats of her two children, and killed them, and tried to kill herself, with the same knife.
I was an expert witness, and it was so clear to me that this would likely never have happened, were it not for the antidepressant drug. It was so obvious. So I told the judges that they should be interested in the psychiatrist, rather than the accused, because it wasn’t really her fault. And do you know what happened? That was the Superior Court – it wasn’t the Supreme Court – in Holland. They sentenced that woman to lifelong confinement in a psychiatric institution. Lifelong.
In my country, if we plan a murder – first-degree murder – murder someone, and then behave well in prison, we come out after twelve years. That woman will be tortured for the rest of her life. That’s what they wanted. For what use? She has a horrible life already. She was not herself when she committed these murders. This is typical for these murders; she was absolutely not herself. She didn’t understand. And when the police came, she didn’t understand anything. It was only a day or two later that she first started to realize what this was all about.
This case has been appealed to the Supreme Court in Holland. I expect to go down there, to the Supreme Court. And it was also appealed by the prosecutor. They obviously felt it wasn’t enough. I can’t see how it could be worse. And I succeeded in raising a debate in Holland. I knew some journalists who were interested in my work and my books, so I contacted one of them. So it became front-page news, what had happened in court. And that led to questions in Parliament, like “Are Dutch judges too harsh, compared to neighboring countries?” They surely are. This would never happen in my country. In Holland, they somehow have a tradition of being very, very punitive towards people who would not have committed that crime without the drugs. This is deeply, deeply unacceptable. So I hope the outcome will be different in the Supreme Court.
Audience member: I’m sorry – I’m crying my eyes out, because I had a very similar experience to the situation that you just described with this woman in Holland, personally. I experienced post-partum depression that included hallucinations of my own dead body all over the house. I was alone with my baby for nine months, while my husband was deployed. And I absolutely refused to see a psychologist, because I did not want them to put me on any drugs. And I got better, after about 18 months of alternative therapies. It was very, very, very hard on my husband, who came home to a practically unrecognizable wife; but we made it. And I never harmed myself or my kids, but I definitely thought about it a lot. It’s a big problem. They estimate that one in four women experience post-partum depression, and very few people talk about it.
Peter: Yes. And it’s totally wrong to give these women antidepressant drugs. It’s totally wrong. Thank you for telling this. The amount of fraud in drug trials in psychiatry is gigantic. When the companies conduct trials, deaths disappear; suicides disappear. There is so much fraud here. This is one of the reasons that psychiatrists aren’t aware of how dangerous these drugs are. This is criminal on the part of the drug industry.
And it’s so incredibly sad, that you can even meet psychiatrists who believe that antidepressants actually protect children against suicide. So, allow me to recommend to you one thing. I have a website that is called www.deadlymedicines.dk. You can easily find it; just Google my name.
We had a meeting last year, in Denmark, when my book came out. And I knew some women who had lost a husband, or a son, or a daughter, to suicide caused by antidepressant drugs. And I informed these women about my meeting. Then, they offered to pay for themselves – they were not part of the program – but they wanted to come and support me, and tell their stories, at the meeting. There were five women: three from America, two from Ireland. They got twelve minutes each; one hour in total. This was the highlight of the whole day. It is so moving to listen to these women telling about how absurd the whole thing is, and how suicides are disdainfully called “anecdotal.” These aren’t just anecdotes. The randomized trial reports don’t tell us that people die from suicide because of the drugs. And why don’t they? Because the drug companies have been fraudulent. These are not “anecdotes,” for those left behind.
Audience member: I’d like to say, from the start, that I appreciate your concern about involuntary treatment and human dignity in making decisions. What I have is not so much a question as a personal statement. And in giving this statement, I would like to say that I have both a strength and two weaknesses. The strength is that I’m a newcomer here to Alaska. I came from Arizona. I’ve only been here in the state since January. So, in a sense, I bring a different vision, from outside Alaska, to the situation that you have here, with involuntary treatment.
The weaknesses that I have are that I’m a psychiatrist, and I work at the Alaska Psychiatric Institute. I know most psychiatrists that I work with as deeply human, scientific, humanistic individuals, who care very much about their patients, and also about the science of their work. And most of them come to a different conclusion than you do, Doctor.
I would also like to say working at Alaska Psychiatric Institute has been a great privilege, both in serving the clients that we serve, and also in working with the treatment teams that we have at Alaska Psychiatric Institute. Again, the people that I work with are deeply humanistic – all the way from the janitors, the aides, the housekeeping staff; the psychiatric nursing assistants, who work on the front line with the clients; the nurses; the social workers – they care deeply about the patients that they’re caring for. The psychiatrists, I would say, are in the same category. They’re not different. They’re not ignorant people.
When we get to the issue of involuntary treatment – which is the minority of the work that we do – I think everybody feels a sense of conflict about that. And I would say, personally, that Alaska has a very robust system, that asks the family members of involved individuals, and other people in the community who know and care about them, as well as a court visitor, who is supposed to be an unbiased individual, for advice to the judge who’s making the decision. The patient has the opportunity to present his or her perspective. The psychiatrist has an opportunity to present a perspective. And I find the judge to very considerate of the alternatives, and looking at the issues: Is there a danger to self? Is there a danger to others? Is there an inability to pursue one’s own life goals? Over the wintertime, the judges ask, can this person survive, if they’re living on the streets? If they’re living in the cold? Do they need to have some kind of shelter?
Peter: Can I respond to your question?
Audience member: Well, of course you can respond. And I’d just like to finish my sentence, because I’m almost done. What I’m trying to say is that I don’t think it’s the kind of description that you’ve given, of heartless people that are interested only in pursuing power. In fact, I don’t think it’s that way at all.
Peter: Let me try to respond to what you said. I agree with you, that many psychiatrists are like what you have just described. I agree with that. But there are also other psychiatrists. And Luise, in the book I told you about, was exposed to some of these other psychiatrists. Otherwise, she wouldn’t have been killed.
Power corrupts all people. It’s not something with psychiatrists; every one of us can become corrupted if we gain absolute power. There must always be some kind of power balance, not only in marriages, but in all human relationships; otherwise, it goes wrong. It’s not because of bad intentions, but it does go wrong.
And when you tell me that you have a good system in Alaska, then I must disagree, very much, with you. Because I have just seen what kind of system you have. I have seen petitions that were copy-and-paste. The same was written about all patients; no matter what their problem was, they were considered incompetent to give informed consent.
And it was written about all of them, that they had received these drugs before, without side effects. It’s virtually impossible to receive psychiatric drugs without side effects. And then, it also said that, without all these drugs – sometimes two antipsychotic drugs, which is bad medicine, plus an anti-epileptic drug, plus lithium, plus a benzodiazepine, plus perhaps another benzodiazepine – then, every time, it was stated on the form that, without these drugs, the prognosis was poor; and with these drugs, the prognosis was good. This is definitely just not right. So I must disagree with you, vehemently, on this point. And I’m ready to stand up for it. But we won’t arrive at any agreement on this.
Audience member: I think the general practitioners are the ones that are more responsible for overprescribing psychiatric drugs than psychiatrists are. And I would agree with the man who said that – I’m a recent graduate of API, and I’m quite proud of what I experienced in there. And I saw the same thing he did.
Peter: Right. But, as I said, I have already seen enough. What I witnessed yesterday in court was a sham process. It was not a fair process – not anywhere near being a fair process. And it’s not good medicine to treat a patient with many psychiatric drugs at the same time. That’s definitely bad medicine.
And let me just add to your point, that I am of the opinion that general practitioners should not be allowed to use psychiatric drugs at all. Because these drugs are dangerous, and they’re a double-edged sword. And when people get side effects on one drug, it’s usually interpreted as, “Now you have a new disease.” And then they get another drug, and a third drug, and a fourth drug. And then you don’t know what you’re doing.
Not even the psychiatrists are good enough at this, and the general practitioners know less than the psychiatrists, so they shouldn’t be allowed to use psychiatric drugs. Then we would have a more healthy population. And also, they use psychiatric drugs for virtually everything. If you are getting a divorce, or if your husband drinks too much, or if you’re being harassed at work, or if you have pain somewhere in the body, or almost whatever it is. They have a pill for everything. This is very bad. I agree with you completely.
Audience member: I am virtually in the middle of this, between two experts. I don’t doubt that there are very caring individuals at the Alaska Psychiatric Institute. At least, I hope so. I don’t think that needs to be emphasized. As a family member of a young son who traveled this journey, what I, as his very caring mother, was missing, was information from the Alaska Psychiatric Institute. Obviously, there is a consumer movement out there that informs about the dangers of psychiatric drugs, because they have traveled this journey. They are the experts; not the psychiatrists. And even as somebody who is working in the field, who was very informed when this all happened, it hit me like a freight train. I believed the psychiatrists. Who else could I believe? Information was slow to come.
Thank God, my son – who is brilliant, very willful, and very annoying, at times – insisted on not taking drugs. He took them for a while. He had the cold turkey that you talked about. We went through this; it was hell. But I was never informed by any community person from the Psychiatric Institute; no one sat me down and maybe said, “Well, maybe you could – there is other information out there. Maybe you want to inform yourself” – so that I had an option. I was never given an educated option, as a parent. And that, to this day, I am so angry about. I could have saved two years of my son’s journey, if we would have gone without meds. Because he is clearly on his road to recovery, without meds. So we are talking meds, not caring people. We are talking a system that’s wrong.
Peter: Let me respond to that. As I said, I’m sure that, like all other doctors, psychiatrists want to do a good job. But, by and large, they got the drugs wrong. And they have been fooled by a deeply criminal drug industry – and also by some of their own kind, who are criminal, and receive loads of dollars from the drug industry, and perform substandard randomized trials, that are biased, because then they will get even more money next time, from the same company.
So, there is corruption among top psychiatrists in this country. And these are the psychiatrists that, by far, are those who participate in randomized trials. So we should have independent drug trials, where no psychiatrists are allowed to participate if they have any financial relations to the drug industry. Because you cannot be the advocate for your patients and for the drug industry at the same time, and for your own income, from the drug industry. It’s not possible.
So, there are lots things we could do. And one of the things we could do, in particular, is – I would never want psychiatrists to come up with a new diagnosis if they have a patient whose brain is already under chemical influence from another psychiatric drug. If you get a patient from the street, who has taken cocaine, or LSD, or marijuana, and is deeply psychotic, you would not give that patient a diagnosis of schizophrenia. You would think, “Let’s see if that person gets well in a couple of days, and then he or she can go home.” But if you first treat a patient for one diagnosis – depression, or ADHD – then some of the side effects, and some of the things these drugs cause, are actually some of the same symptoms that define, for example, bipolar disorder. And then you cannot distinguish: is this only side effects, or is it really bipolar disorder? You cannot find out unless you stop the first drug.
I discussed this with a professor in Denmark, and I told him, “The side effects of ADHD drugs are quite similar to those symptoms that define bipolar disorder. So how do you know whether it is a new disease, or whether it’s side effects?” And he told me, “I’m a psychiatrist, so I can distinguish between these two things.” But it’s more or less the same symptoms, so it’s not possible. Then I gave up further discussion with that man.
In your country, because of Biederman, from Harvard, who has done a lot of these ADHD trials on children – Biederman comes up with a diagnosis of bipolar in a surprisingly high number of children. Very few of these are genuinely bipolar. So, I’m convinced that most psychiatrists want to do the right thing. But you need to take up the fight against those of you who actually don’t do what they should do.
Audience member: Would anti-seizure drugs, like Dilantin and Depakote, mixed with Haldol, Risperdal, and all the psychotropic drugs – does that play a part in any psychosis? When you mix those drugs?
Peter: The problem of mixing several different types of drugs is that you can quickly end up in a situation where don’t know what you’re doing, and you don’t know which drug causes what, because many of these drugs can cause similar symptoms. So how will you find out which drug is the worst of them? So, the prevailing polypharmacy in psychiatry is, I believe, very harmful.
And, as I said, psychiatric drugs should be used very, very little. I suggest, in my new book, that only 2 percent of current usage would make people live longer and be healthier, and come back to the labor market to a greater degree. Because, at the same time as we use more and more psychiatric drugs, people on psychiatric disability pensions – it just goes same way. If these drugs were any good, it should have gone the other way. So we’re creating a lot of harm with psychiatric polypharmacy. There is absolutely no doubt about that.
Audience member: I understand. We have been here all our lives, and our son was medically kidnapped here in the State of Alaska, and was taken over by the courts of the State of Alaska. And he was force-drugged; he has received over 35 different psychiatric medications – some that I do not know, because there was a nurse-practitioner who, with the psychiatrist, actually petitioned the court to take our son over. So, they actually owned him. The courts, right here in Alaska, ordered him to go to Johns Hopkins, clear on the east coast, to do a brain biopsy on him. Then the DC courts ordered him to be electroshocked. But we have found one psychiatrist that was doing her job, and she is wonderful. And that’s Heidi Combs; she’s the head psychiatrist at Harborview. And she actually saved my son’s life; she actually started withdrawing him off the drugs immediately.
Peter: Yes. Now, let me give you three examples from my country, of how, despite psychiatrists’ good intentions, they are not doing the right things. The National Board of Health recommends against using more than one antipsychotic at a time. Still, around half of the patients receive several antipsychotics at the same time; some receive four or five. This is very bad medicine. We also recommend against combining an antipsychotic with a benzodiazepine, because it seems to increase mortality by 50 percent. But then, when you study what is going on, half of those in treatment with an antipsychotic drug also receive a benzodiazepine, in my country. And then we have the dose problem. Despite very clear evidence that you don’t get a bigger effect by increasing the dose of antidepressant drugs, this is what doctors do. They try one dose and, if it’s not too bad, in terms of side effects, then after some weeks they typically say, “Now we’ll increase the dose.” You don’t get more effect out of that, but you do get more harms.
It’s the same with antipsychotics. The higher the dose, and the longer you use them, the more harm you produce. And, since treatments in psychiatry work so poorly, then, out of desperation, psychiatrists try one drug after another, and increase the dose, and put other drugs on top of the three or four that the patient is already receiving. And then everything just gets worse. So, psychiatrists need to realize that those drugs they have are pretty poor drugs. And therefore they should invest in psychotherapy, and use drugs very, very little.
Audience member: Yeah. Our son flew to New York, and saw Peter Breggin, so I know what you’re saying. But, when the State of Alaska takes you over, then you don’t own yourself. You don’t have a choice. They force these drugs on you, by court order.
Peter: There is an interesting argument here: how many people would take antipsychotics for years, if they could decide for themselves? These drugs, in my opinion, are so horrible that you need forced treatment to get anyone to take them. I know there are some patients, now and then, who say that these drugs help them; but, by and large, they are bad drugs.
Audience member: Well, he was thought to be incompetent, and so they took him over. And, like I said, this is an epidemic. There’s a website called medicalkidnap.com. It happens all over the world. And you can see, state by state, how many people are medically kidnapped. Arizona is probably one of the worst ones, for kids getting kidnapped and killed. However, in Alaska, there is our son’s case.
But, like I said, our son found a really good psychiatrist. And it was because of other legal issues that were going on – and lies that were told against us – that she came to court. She was doing her job; she immediately took him off the drugs, and he was fine. He was held for eight months, in a local hospital, and was force-drugged. He was strapped down by five security guards, against his will, and when he came about, they just drugged him more. But, when you don’t own yourself – or you’re a parent, and your child is a ward of the state – you have no choice. And Alaska is extremely bad for that.
Peter: Let me say now, while I’m in America, that two years ago I met with Peter Breggin, who invited me to lecture in Michigan, at a course he had. I have lectured with Peter Breggin a couple of times since then, also in Florida. I have read a number of his books and articles. That man doesn’t use psychiatric drugs. He doesn’t. And I know other psychiatrists who don’t use psychiatric drugs, because they have realized how dangerous and how ineffective they are. So, there are people who do that. And Peter Breggin has had a difficult life, being ostracized by mainstream psychiatry – and I must say that this man is the best psychiatrist I’ve ever met.
Audience member: Yeah, my son spent several days with him. But you were talking about the evil system. This has become an epidemic, and Alaska is right there. We like to think it’s not; we like to think America is not. It’s worldwide. But, here in America, it has increased. I don’t know if you all know the Justina Pelletiere case, that went on at the same time as my son’s. It does happen, and it’s really sad. But there are good psychiatrists out there, and Heidi Combs is one of them. And so is Peter Breggin.
Peter: The American Psychiatric Association even tried take his license away from him, a number of years ago, when he said, on the Oprah Winfrey Show, something about these drugs – that they weren’t so good as people said. But of course they didn’t succeed in taking his license from him. He’s a very good psychiatrist.
Audience member: One thing you haven’t mentioned is, we have an insurance system here that is stacked against the patient. I’m a social worker. And, as the years have gone by – there’s a specialty, in short-term claims. And it’s because of the insurance companies. If the insurance companies will pay for any mental health in the first place, you only get it for six sessions, maybe. So we have many psychiatrists connected with our mental health clinics that will see a patient maybe 15 minutes a month. And it’s basically a medication review. They’re not even speaking with their patients. They’re basically saying, “Here’s the new prescription for your meds.” So, a big driver in this country is the insurance companies. And they’re the ones that will prescribe how long you’ll see someone, and prescribe what the treatment is going to be.
Peter: Yes. There will always be systemic issues that create the wrong incentives, so we need to change systems, so that they create the right incentives. Doctors should be paid for curing patients, and not for just renewing prescriptions, for example.
There is a report from the United Kingdom. It’s built on a model, so you can always question the result – but, an economic model that says that psychotherapy is actually cost-effective. So, the idea that we idea cannot afford psychotherapy, I believe, is a totally wrong one. What we cannot afford is this overtreatment and overdiagnosis of the population, that turns so many acute problems into something chronic. And then the patients don’t come back to the labor market. That is what we cannot afford.
Audience member: Someone mentioned about alternatives in mental health. I’m a physician, and I had a brother with a serious mental illness. I called the police, a number of times, to take him to API. He was there about three times, and also in other state hospitals. He was also a medical student. And I saw, many times, that psychiatrists would take him off the medications too rapidly. But when he was weaned off very slowly, then he was fine. And I saw one thing that helped him withdraw from antipsychotics was to be on a lower-protein, plant-based diet. I think that’s one of the alternatives we could use much more in mental health. We use nutrition for heart disease and many other chronic illnesses, but in mental health we haven’t used nutrition very much. But I’m pleased to hear that, at API, they have labelled foods in the cafeteria as vegetarian or vegan. In Russia, they tested over 10,000 patients with schizophrenia, or with many illnesses –
Peter: Allow me to comment on that, please. Evidence-based medicine is about using the best available treatments that we have, which have been shown that they do more good than harm. I always hear about nutrition when I lecture on psychiatry. But we need proof that nutrition works for psychiatric diseases. I have not seen that proof. We need to show, in randomized trials, that things work, before we go out and recommend them.
The alternative to psychiatric drugs, to my mind, is not nutrition, because it hasn’t a documented effect. The alternative to psychiatric drugs is no psychiatric drugs. That’s a good alternative. And then we can focus on human behavior and empathy and psychotherapy. It works. But you need to document that something to do with nutrition works. So, I don’t have any more comment about that.
Audience member: I’ve been taking anti-seizure drugs from the time I was a little kid. And I’ve come to find out – I haven’t had anti-seizure drugs for eleven years, and no seizures. Because the anti-seizure drugs caused the seizures: Tegretol, Lamictal and Dilantin. They all cause seizures, and they’re all psychiatric drugs, too. I realize that we shouldn’t use force. But at what point do we ban the drugs?
Peter: Oh – I’m on your side! I feel ADHD drugs should be taken off the market. They are harming our children, and now also adults. And the trials are of horribly low quality. We are looking at these trials in Copenhagen right now; they’re absolutely horrible. And if you look at the long-term results, they don’t look good.
I also feel that we don’t need antidepressant drugs, because I have come to the conclusion that they don’t work, either. I’m not even sure we need antipsychotics, because I think we can use benzodiazepines instead. And epilepsy drugs, I’m pretty skeptical about, because these are pretty toxic drugs. And they are called mood-stabilizers, which I believe is audacious. Because, how can you say that such a toxic drug stabilizes the mood? That’s pretty far-fetched, in my opinion.
So, we could ban a lot of these drugs. But that will never happen, because it takes very little to get a drug approved. You just need two randomized trials that have shown some effect, no matter how small. And, since these trials are not adequately blinded, you can show that virtually anything seems to work for virtually everything, in psychiatry. But what you measure is mainly bias.
Audience member: How they figured it out – I was at Queen’s Hospital, in Washington State, and they wired me up, and they took me off, cold-turkey. They were wanting to watch me have a seizure. And I was in the hospital for two weeks. And, no seizure. I could finally think clearly, after 15 years of taking the drugs. So they finally came to the conclusion that the drugs were causing the seizures.
Peter: Causing the seizures – yeah. As I said earlier, psychiatric drugs are strange drugs, because they can actually cause the diseases that they should work on. Antidepressant drugs can give you a new depression. Particularly, if you miss some doses and become abstinent, then you can become depressed. But that is not a true depression, because, if you give yourself a full dose, you will usually be fine in a few hours’ time. That’s like, if you give an alcoholic with abstinence symptoms a bottle of vodka, he will improve quite quickly, whereas, a genuine depression takes some weeks before you recover from it. So, a false depression – an abstinence depression, that comes suddenly if you don’t take your drug, and get a cold-turkey – you can diagnose it by giving yourself a full dose. And then, you’ll usually be fine again. So, you’re absolutely right: these are very difficult drugs to handle, and the effects are very often misunderstood by doctors. I’m sorry, but that is the case.
Audience member: My mother was recently admitted, against her will. Police came to her house and pretty much rushed her out the door, and she found herself locked up, involuntarily. Which was really a very, very frustrating thing for her. So much so, in fact, that I felt that she was probably more dangerous to herself, being handcuffed and led into a police car, and then taken to an involuntary facility, then she would have been if she were just left alone.
The physician who was brave enough to come in here and actually speak on behalf of the API, if he was still here, I’d honestly want to thank him for that. Because I couldn’t imagine, as a doctor working in one of those facilities, even bothering to come here to listen to this, quite frankly. It’s commendable that anybody would even try to stand up in the face of what is overwhelming evidence. Psychiatry is clearly guilty of hubris – pride and arrogance. Psychiatrists clearly believe themselves capable of accomplishing something they have never been able to prove they can actually accomplish.
I do have a question. Is death a bad thing, Doctor? As a doctor, is it your job to prevent death? Do you, as a doctor, believe that death is a bad thing?
Peter: That’s a question that can’t be answered. That’s a question like, “Have you stopped beating your wife?” If you answer “yes,” or if you answer “no,” both things are wrong. So I can’t reply to a question like that. Death is sometimes a welcome outcome, in a desperate situation. Usually it is not. But, in some circumstances, it’s a welcome outcome.
Audience member: Is it a welcome outcome when you’re in the care of a psychiatrist?
Peter: Well, you’re being a little teasing now. [Audience laughter]
Jim: If I could say something – you know, people in the public mental health system are dying 25 years earlier, on average, then the general population. That didn’t use to be true. And that there’s no outcry over that suggests to me that that is an acceptable outcome to society.
Audience member: Isn’t one of the reasons that things like nutrition are not well understood that the drug companies have basically taken over most research, even at the university level, where there at least was independent study? There’s really no incentive to do studies, because money can’t be made.
Peter: Yes, that’s true. You cannot patent an apple, so there’s no money in studies like that. But then they need to get financed by public funding. And we have such funding, and loads of nutrition studies have been made in all sorts of diseases: rheumatoid arthritis, and all sorts of diseases. So these studies – they do exist. But, very little has come out of them. Many people believe that nutrition is very important. But when you study nutrition in randomized trials, I must say that the results have been pretty disappointing, in general. So that’s why I just have a natural skepticism, that is empirically founded.
Audience member: What if the studies were well designed and properly conducted?
Peter: Well, there are so many nutrition studies. Some of them were well designed, and some of them have been very interesting. Like the Mediterranean diet, with olive oil and that sort of thing. You have heard about that? For heart disease. But, you know, if you are looking at nutritional advice, it varies over the years. One year, this type of nutrition is healthy, and the next year it’s the opposite. Now you need to eat little fat – or much fat - and look at the Eskimos in Greenland! Oh, you can get almost whatever you want, in terms of results and recommendations. I hope we’ll find out something, someday, that can be helpful.
Audience member: It’s the same as with the medication attempts. We want one thing to fix everything. As far as nutrition goes, my belief is that some things help some people, some of the time. We are all individuals, with individual metabolisms. Some diets help some people, and not others. But whatever natural efforts there are, we need to shy away from, “This helps everybody.”
Peter: I have a little recommendation, actually, about nutrition, and life in general: “Don’t worry, be happy.” We shall all die.
Jim: Speaking of nutrition, we have some in the lobby.