MindFreedom
Support Coalition International
454
Phone: (541) 345-9106 Fax: (541) 345-3737
E-mail:
office@mindfreedom.org
James H. Scully, Jr., M.D., Medical Director
American Psychiatric Association
Dear Dr. Scully:
David Oaks, Executive Director of MindFreedom,
has forwarded to us your reply dated 12 August 2003 to the hunger strikers
involved in a "Fast for Freedom in Mental Health." We are a panel of
14 academics and clinicians who have agreed to review any such reply for
scientific validity.
The hunger strikers asked your organization, as well as the
Surgeon General of the
1. evidence
that establishes the validity of "schizophrenia,"
"depression" or other "major mental illnesses" as
"biologically-based brain diseases";
2. evidence
for a physical diagnostic exam that can reliably distinguish individuals with
these diagnoses (prior to treatment with psychiatric drugs) from individuals
without these diagnoses;
3. evidence
for a baseline standard of a neurochemically-balanced
"normal" individual, against which a neurochemical
"imbalance" can be measured;
4. evidence
that any psychotropic drug can correct any "chemical imbalance"
attributed to a psychiatric diagnosis;
5. evidence
that any psychotropic drug can reliably decrease the likelihood of violence or
suicide.
To Dr. Scully • From MindFreedom • Page
2
In your reply, no specific studies of any kind were cited with
reference to any of the questions above. You cited three general sources,
including the recent Surgeon General’s report on mental health and two
textbooks of psychiatry.
In examining each of these sources, we found numerous statements
that invalidate suggestions that behaviors referred to as "mental
illnesses" have specific biological bases:
Mental
Health: A Report of the Surgeon General (1999) is explicit
about the absence of any findings of specific pathophysiology:
p. 44: "The diagnosis
of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no
definitive lesion, laboratory test, or abnormality in brain tissue that can
identify the illness."
p. 48: "It is not
always easy to establish a threshold for a mental disorder, particularly in
light of how common symptoms of mental distress are and the lack of objective,
physical symptoms."
p. 49: "The precise
causes (etiology) of mental disorders are not known."
p. 51: "All too
frequently a biological change in the brain (a lesion) is purported to be the
‘cause’ of a mental disorder … [but] The fact is that any simple association –
or correlation – cannot and does not, by itself, mean causation."
p. 102: "Few lesions
or physiologic abnormalities define the mental disorders, and for the most part
their causes remain unknown."
In the third edition of Textbook
of Clinical Psychiatry (1999), we find similar statements:
p. 43: "Although
reliable criteria have been constructed for many psychiatric disorders,
validation of the diagnostic categories as specific entities has not been
established."
p. 51: Most of these
[genetic studies] examine candidate genes in the serotonergic
pathways, and have not found convincing evidence of an association."
To Dr. Scully • From MindFreedom • Page
3
In Andreasen and Black’s (2001) Introductory Textbook of Psychiatry,
we find, in the chapter on schizophrenia:
p.
23. "In the areas of pathophysiology
and etiology, psychiatry has more uncharted territory than the rest of
medicine...Much of the current investigative research in psychiatry is directed
toward the goal of identifying the pathophysiology
and etiology of major mental illnesses, but this goal has been achieved for
only a few disorders (Alzheimer's disease, multi-infarct dementia, Huntington's
disease, and substance-induced syndromes such as amphetamine-related psychosis
or Wernicke-Korsakoff syndrome)."
p. 231: "In the
absence of visible lesions and known pathogens, investigators have turned to
the exploration of models that could explain the diversity of symptoms through
a single cognitive mechanism."
p. 450: "Many
candidate regions [of the brain] have been explored [for schizophrenia] but
none have been confirmed."
As you are no doubt familiar with these textbooks you cited, you
will agree that such statements invalidate claims for specific, reliable
biological causes or signs of "mental illnesses." In the judgment of
the panel members, your reply fails to produce or cite any specific evidence of
any specific pathophysiology underlying any
"mental disorder."
You have also referred us to 60 volumes of Archives of General Psychiatry and 160 volumes of The American Journal of Psychiatry. The
"We are aware that
research studies can run to thousands of pages. Therefore, please respond only
with those studies that you consider the best available in support of your
claims and theories in a timely way. When responding with evidence, please send
citations for the original publications or copies of the publications you are
citing."
Like you, we are familiar with the material found in these
journals. It is understandable why you did not provide any citations. There is
not a single study that provides valid and reliable evidence for the
"biological basis of mental illness."
The members of the panel wish to make some further observations
which we hope will assist the American Psychiatric Association to present an
honest scientific stance with respect to the hunger strikers’ questions.
To Dr. Scully • From MindFreedom • Page
4
In the panel’s view, the questions posed by the hunger strikers
are serious and fair. These questions are legitimate questions that any patient
or family member or interested person might ask of any psychiatrist, or a
student might ask of a professor. The panel was therefore quite dismayed that
you, as Medical Director of the world’s largest, wealthiest, and most
resourceful psychiatric association, could not provide a more specific or
substantial response than the equivalent of, "See our textbook."
If, as you state in your letter, "the answers to [the above]
questions are widely available in the scientific literature, and have been for
years," then it behooves your organization to make these answers and their
specific sources – if they differ from the quotes we present in this letter –
available promptly.
The panel members could not help but notice the contrast between
the hunger strikers, who ask clear questions about the science of psychiatry
and consciously take risks in the name of protecting the well-being of users of
psychiatry, and the American Psychiatric Association, which evades revealing
what actual scientific evidence justifies its authority. By not giving specific
answers to the questions posed by the hunger strikers, you appear to be
affirming the very reason for the hunger strike.
Sincerely,
Fred
Baughman, MD
Mary
Boyle, PhD
Peter
Breggin, MD
David
Cohen, PhD
Ty Colbert, PhD
Pat
Deegan, PhD
Al
Galves, PhD
Thomas
Greening, PhD
David
Jacobs, PhD
Jay
Joseph, PhD
Jonathan
Leo, PhD
Bruce
Levine, PhD
Loren
Mosher, MD
Stuart
Shipko, MD
The
hunger strikers endorse the scientific panel’s statement.
www.MindFreedom.org.
- end –