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Review of Louis Theroux’s ‘Mothers on the Edge’

‘Mothers on the Edge’ was broadcast last night.

Thanks to the anonymous* source in the South London and Maudsley Hospital Trust PR department for reporting the following conversation, which took place about eighteen months ago:

‘Great! Louis Theroux is interested in filming on the perinatal unit.’

‘Is that really a good idea? His 2010 programme on ‘America’s Medicated Kids’ received quite sceptical reviews about psychiatry and medication from the Guardian, and Mumsnet readers. Louis got the children and teenagers to open up quite a lot, undermining the idea that their behaviours were merely ‘symptoms’. He even filmed a Pittsburgh psychiatrist admitting that drugs were often used in preference to psychosocial interventions.’

‘Relax. The Jimmy Savile thing blew up not long after, and Louis has been eating humble pie ever since.

Theroux-Savile-DM

‘So he won’t stray from the script of psychiatrists doing their best to be psychosocial, and only using medication if absolutely necessary?

‘We have already agreed the consultant will not be challenged on claims about ‘trauma’ being addressed in all patients. No awkward questions about #Pharma COI involving SLAM, or personality disorder, either.

‘I am still surprised they want to film at one of the best-funded perinatal units in the country, rather than somewhere that is struggling and likely to use even more drugs.’

‘The BBC are much less interested in challenging the medical establishment than they used to be. Of course we want to be discreet about ex-BBC journalists now working in PR, but unfortunately some, like the RCPsych’s Kim Catcheside, can’t resist bragging occasionally about their influence.’

Screenshot_2019-05-13 Kim Catcheside on Twitter RCPsych team worked tirelessly to get responses hopefully in Telegraph and [...]

* and fictional.

 

 

 

 

 

 

One law for Dr Appleby, Dr Burn, Dr Morrison and Dr Huda, another for their critics: the GMC’s double standard.

(30th March: see my homepage for more details on the tribunal, and the piece I published two days later for the 5-page tribunal decision with my notes and annotations)

Today the GMC’s application to the Medical Doctor’s Tribunal (MPTS) to suspend me was allowed, although reduced from 15 to 12 months. A review automatically occurs in 6 months, although I understand I can apply now for a review in 3 months if I consider there were irregularities in this tribunal.

I do.

For now, I will focus on just one: the failure of the tribunal to adequately address (in the 5 pages of its written decision) my submissions on the GMC’s treatment of complaints against senior psychiatrists. I argued that their ‘smears and abuse’ were more serious than the allegations about my own Tweets and blog pieces.

I showed the tribunal this tweet in which Dr Louis Appleby smears me (I was not saying that I am targeted any more than others, but this happens to be a good example):

Screenshot_2019-03-16 Dr Neil MacFarlane MRCPsych on Twitter(1)

and then this expanded image of the Tweeter who ‘liked’ it, Dr Wendy Burn:

wb-cr

I said: ‘This is a Tweet from Dr Louis Appleby to me 11 months ago. Dr Appleby is the government’s lead on suicide prevention, and also a Professor in Manchester.

You can see in the last sentence that he clearly accuses me of being a conspiracy theorist. Now this term can quite happily be bandied about by non-professionals without serious harm, but I submit that psychiatrists have power and authority in society in relation to diagnosis, and what might lie behind it such as compulsory admission and treatment.

‘Conspiracy theorist’ is a quasi-diagnosis which, from a psychiatrist, carries the implication of psychotic or fantasist, or perhaps personality disorder. I believe it should not be used as a smear in this way.

You can see that one Twitter user has ‘liked’ this smear, and that is Dr Wendy Burn, the current president of the RCPsych. I have expanded her icon below.’

I had previously showed the tribunal this Tweet from Dr Paul Morrison:

181228-Morrison-Bag-of-Sh

I said: ‘‘Young Kinderman’ is Peter Kinderman, a prominent clinical psychologist. In this Tweet Dr Morrison claims that a complaint Mr Kinderman had made in February 2018 about him, relating to Dr Morrison’s alleged ‘bullying, harassment and misogyny’, again on Twitter, had not been upheld. Dr Morrison, as you can perhaps see from his Twitter icon, adopts the persona of Rumpole.

I suggest this Tweet, with the image below and the caption ‘I’ve got a bag of Shh, with your name on it’, is unpleasant and threatening to Mr Kinderman. […] last week I made a complaint to the GMC that Dr Morrison was very likely to have been dishonest in his statements about the bullying and misogyny complaint.

Now looking again at the ‘likes’ below this Tweet you will see an icon on the left, and that is the icon of Dr Samei Huda. Dr Huda is an NHS consultant psychiatrist in Tameside, to the East of Manchester. In the latter part of last year I had an amicable Twitter relationship with Dr Huda, but we fell out in early December because he refused to discuss my concerns about Psychiatry’s relationship with the Pharmaceutical Industry, or Pharma. He blocked me and then in early January […] I criticised him as someone who closed down debate, and pointed out that in the past he had criticised others for the same.’

 

These Tweets are similar to many others that have been complained about to the GMC: they have done very little, while they have claimed that some of my Tweets are deliberately ‘antagonistic’.

I have to be careful on how I report on the tribunal because some allegations concerned non-professionals.

But the MPTS tribunal’s silence on these senior psychiatrists is concerning: a single sentence in the written decision made no acknowledgement of the abusive nature of these Tweets.

My title has ‘one law’ rather than ‘one rule’ because the behavioural standards of medical doctors are supposed to be based on the Medical Act 1983.

More to come. I now have to get the train from Manchester back down to London.

 

The Myth of ‘Critical Psychiatry’

(Submitted as an e-letter responding to Duncan Double’s BJPsych article ‘Twenty Years of the Critical Psychiatry Network‘. The article will not be open-access in the future, so please let me know if this link expires.

the e-letter is lightly edited here [mainly to remove a repeat of ‘but’]. After several weeks it was published.)

 

Duncan Double tells us that the CPN is an embattled minority trying to push back against the ‘mainstream’ who hold that ‘mental illness is brain disease’, but the only evidence he cites for most ordinary UK psychiatrists holding such views is Sami Timimi’s memoir.

He does not mention that the CPN is officially approved and promoted by the Royal College of Psychiatrists’ leadership, through the CPD module written by its co-chairs Hugh Middleton and Joanna Moncrieff: http://www.psychiatrycpd.co.uk/learningmodules/criticalpsychiatry.aspx

Screenshot_2019-02-04 Critical psychiatry

The reality is that the CPN is very much part of the psychiatry establishment’s failure to address long-term decline in NHS spending on mental health and learning disability services, from around 25% of the total health budget decades ago, to 11% today. The latest ‘Five Year Plan’ trumpets ‘a real increase’, but closer examination shows the commitment to be a mere 0.1%, well within the margin of error: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/

As with ‘Critical Psychology’, the common factor of the range of views within the CPN is a commitment to anti-diagnosis purism (http://www.criticalpsychiatry.co.uk/docs/LanguageOfDisorder.pdf), hence the repeated employment of the ‘brain disease’ strawman by its members.

Dr Double stresses ‘minimising the use of coercion’ and ‘helping people improve their social situation’, but his solution of a ‘non-eclectic’ biopsychosocial approach seems Utopian, given his failure to call for adequate funding of community-based services.

 

(Those new to my blog may want to read my previous pieces critical of the CPN, especially ‘Pillshaming‘ and ‘Neoliberalism‘. Sami Timimi, who with Joanna Moncrieff is

Timimi-combi

a member of the ‘Council for Evidence-based Psychiatry‘ (CEP), is briefly criticised in my pieces on fellow CEP members Peter Kinderman and John Read.

For failure on mental health and learning disability funding by the psychiatry establishment and one of its ‘fronts’, see my piece on ‘Asylum Magazine‘.

For further evidence that the CPN is far from critical of establishment psychiatry, see this polite ‘debate‘ between Joanna Moncrieff and internationally prominent Pharma-psychiatrist Carmine Pariante, which barely touched on Pharma-psychiatry enmeshment, and completely avoided the smears and abuse of people concerned about ‘Prescribed Harm’ by Dr Pariante’s close Pharma-psychiatry colleagues.

Screenshot_2019-01-22 Joanna Moncrieff and Carmine Pariante Debate Antidepressants - Mad In America

In the last two weeks Dr Moncrieff has declined to confirm whether she still claims the CPN are ‘dissidents’:

16-Moncrieff-dissident )

 

 

Asylum Magazine and Pharma-enmeshed Psychiatry

(See also a more recent piece on a ‘Medical Humanities’ paper co-authored by professor Spandler, with comments on her funding by the ‘Pharma-loaded’ Wellcome Trust)

(Expanded 12th January)

The decades-old Asylum Magazine (AsylumMag) claims to promote ‘open debate’, and has an edgy Twitter banner mocking dead Conservative politicians:

screenshot_2019-01-07 tweets with replies by asylum magazine ( asylummaguk) twitter(1)

But, surprisingly, it disagrees with my suggestion that similarly edgy ‘visuals’ are reasonably employed in highlighting the enmeshment of psychiatric (and other) academics and professionals with the pharmaceutical industry (Pharma). It has ruled that they are not ‘decent’. The choice of word recalls Margaret Thatcher’s contemporary, Mary Whitehouse:

screenshot_2019-01-07 tweets with replies by asylum magazine ( asylummaguk) twitter

AsylumMag, true to its ‘democratic’ editorial stance, claims to be a ‘collective’. However, it has a ‘Managing Editor’, which from early 2017 has been the academic Professor Helen Spandler:

screenshot_2019-01-09 helen spandler staff profile university of central lancashire

I met Profesor Spandler (who was then a senior lecturer but told me she was hopeful of being elevated) at the ‘Critical Psychiatry Network’ conference earlier this year, and asked about another UCLAN Professor, Dr Sue Bailey FRCPsych, who was President

screenshot_2019-01-09 sue bailey staff profile university of central lancashire

of the Royal College of Psychiatrists (RCPsych) from 2011 to 2014, and was then in an

screenshot_2019-01-05 from wendyburn sue - twitter search

arguably even more powerful position as the Chair of the Academy of Royal Medical Colleges from 2015 to 2018 (she still has a committee role there). She accepted an OBE in 2002 and a Damehood in 2014.

‘How awkward it must be’, I said, ‘to campaign on AsylumMag’s issues when your senior academic colleague was and remains a leading establishment psychiatrist responsible for failing to secure adequate funding for mental health, and failing to address Pharma influence’ (I paraphrase).

But I had not actually read AsylumMag for several years. Perhaps I covered this up a bit. Professor Spandler seemed rather evasive, and later when I looked at recent issues I found no criticism of any RCPsych committee members’ role in service funding or Pharma, let alone the Presidents’.

Every President since Dr Mike Shooter (2002-5, who did speak publicly about Pharma concerns) has been an academic professor. The RCPsych committees, especially the Psychopharmacology Committee, are dominated by academics.

Decades ago, funding for mental health and learning disability services was around 25% of total NHS spending. It has been 11-12% for the last decade, and RCPsych leaders have not made a serious effort to redress that. They trumpet each piece of ‘new money’ using their team of spin doctors and tame journalists, and use the range of distracting PR techniques that New Labour adopted so enthusiastically, but in fact the RCPsych has admitted that under ‘Dame’ Sue Bailey and ‘Sir’ Simon Wessely spending actually went down.

That had been reported a month before I met soon-to-be-Professor Spandler, but she seemed happier to talk about the nuances of Marxist theory in the 1980s ‘radical’ antipsychiatry movement than how today’s senior doctors are influenced by special pay awards and trips to Buckingham Palace to collect honours.

It would not be unreasonable to see Asylum Magazine as a self-censoring academic front for establishment psychiatry. That establishment falsely promotes the idea that there is a binary choice between anti-diagnosis purism and itself:

huda-18-read asylum

 

In a further piece(s) I plan to look at how AsylumMag was founded in the 1980s by a drug trialist with a dubious record on mental hospital closure, and how some of its other editorial policies can be seen as supporting fiscal conservatism.

Prescribed Harm from Psychiatric Drugs: a Manifesto

My thanks to the non-professionals who have helped me draft this piece.

1. The Royal College of Psychiatrists (RCPsych) and other Medical Royal Colleges will acknowledge that work by Charles Medawar, Dr Richard Smith, Dr David Healy FRCPsych, Dr Bernard Carroll MD, and others, led to the major series of civil fines and criminal convictions of pharmaceutical companies in the United States. Much of this work was brought to the general public’s attention through the BBC Panorama Secrets of Seroxat programmes (2002-7).

2. Many of those fines and convictions concerned marketing. The RCPsych will actively promote adequate scrutiny and awareness of pharmaceutical industry (Pharma) marketing, in the past, present and future. The RCPsych Dean Dr Kate Lovett FRCPsych has stated that general marketing and even ‘Western materialistic culture’ often has negative impacts on mental health, but to be credible the psychiatric establishment must take substantial responsibility for its collusion with the over- and mismarketing of psychiatric drugs. That collusion has often involved over- and mis-diagnosis.

3. The RCPsych will seek to bring UK pharmaceutical regulation back into the Department of Health.

4. The RCPsych will seek full compulsory disclosure of all pharmaceutical company payments to mental health professionals (MHPs), including speaking and meeting attendance payments (with date, location, and details of the meeting), research funding, and expert witness work. This should be available together on an easily searchable database, and not merely for three years, as on the very limited current ABPI speaking and meeting attendance register.

5. The RCPsych will oppose the employment of people in regulatory bodies, who were previously employed by a pharmaceutical company with any record of wrongdoing in any country. Exceptions would be those who have clearly shown to the public that they opposed and reversed wrongdoing while working for such a company.

6. Ex-GlaxoSmithKline (GSK) CEO ‘Sir’ Andrew Witty has not shown that. The RCPsych will ask Dr Ben Goldacre MRCPsych to withdraw, or provide credible evidence for, his statement in 2012, made shortly after GSK’s 3 billion dollar fine and criminal conviction mostly in relation to paroxetine and bupropion, that Mr Witty was ‘a good guy’.

7. The RCPsych president Dr Wendy Burn FRCPSych will apologise to Dr Peter Gordon MRCPsych, harmed by GSK’s paroxetine, for her discourteous and unprofessional shunning of his enquiries and submissions.

8. Specialist NHS clinics for people with Prescribed Harm and related problems will be set up. The RCPsych will seek out Pharma-sceptic psychiatrists, some of whom may have left NHS employment or retired early, and other mental health professionals, for this work.

9. The RCPsych will ask former president Dr Dinesh Bhugra FRCPsych, Dr David Nutt FRCPsych, Dr Guy Goodwin FRCPsych and Dr Stephen Lawrie FRCPsych, to withdraw and apologise for their 2014 Lancet article which smeared, without citing any evidence, people with Prescribed Harm as ‘conspiracy theorists’ and/or motivated by financial gain to manufacture ‘bizarre’ symptoms.

10. Dr Edward Bullmore FRCPsych, the most senior psychiatrist in Cambridge (UK), who is part of the RCPsych’s ‘Gatsby Commission’, will withdraw and apologise for his ‘neurophobia’ smear against critics of psychiatry-Pharma’s exaggeration of evidence for ‘chemical imbalance’, widely used for marketing purposes. He will also undertake to fully disclose, at all future events, that he is a vice-president of GSK.

11. Given his senior position within the pharmaceutical industry, the RCPsych will ask Dr Bullmore to what extent the industry has used tactics similar to that of the tobacco industry against critics and litigants. Recent concerns about the use of non-disclosure agreements (NDAs) by Harvey Weinstein and others have highlighted how civil legal proceedings can suppress relevant information, against the public interest.

12. The RCPsych will ask Dr Bullmore about Pharma marketeers’ use of the term ‘Drug Whore’ to describe ‘Key Opinion Leaders’ (KOLs), as revealed by Gwen Olsen in 2005. It may be necessary for Dr David Baldwin FRCPsych to clarify his recent statement about language critical of his own position as a KOL.

13. The RCPsych will remove Dr Jeffrey Lieberman MD from the Gatsby Commission. Dr Lieberman’s response to the concerns about Pharma in the 2000s was very limited. In 2013 he claimed that the pharmaceutical industry had reformed, but as one of the most senior doctors in the United States he must take substantial responsibility for the subsequent prescription opioid epidemic in the United States, which clearly showed that it had not. He continues to avoid answering questions about the ethics of his experiments giving stimulants to people with schizophrenia in order to deliberately provoke psychotic symptoms.

14. The RCPsych will remove Dr Simon Wessely FRCPsych from the Gatsby Commission. Dr Wessely downplayed the potential for conflicts of interest between Pharma and psychiatry as early as 2003, describing it as a ‘non-problem. In 2015 he claimed on national radio that he had ‘never worked for pharma‘, but despite his past record of being funded to speak at conferences, he has declined to make a public correction. As a very prominent psychiatrist internationally, Dr Wessely must take some responsibility for the opioid epidemic in the United States.

15. The withdrawn and redacted 2007 BBC Panorama programme on ADHD medication featured the same journalist (Shelley Jofre) who investigated Secrets of Seroxat. The RCPsych will support a request to the BBC to make the programme’s full interviews with psychologists and other experts available (with appropriate redaction of material – if any – discussing individual patients).

16. A historical review of Benzodiazepines, antipsychotics, and all other psychiatric medications will be undertaken, and the RCPsych will look to engage both amateur and professional historians.

17. The RCPSych spokesperson Dr Carmine Pariante MRCPsych, who has not repeated his claim that the 21st February Cipriani et al Lancet meta-analysis ‘finally puts to bed the controversy on antidepressants’, will make a full retraction which the RCPsych will promote to the media.

18. The RCPsych will critically review the continued influence of corrupt academic psychiatrists such as Dr Charles Nemeroff MD, on psychiatric research and practice. The worst excesses resulting from Pharma-psychiatry enmeshment appear to have been in the United States, where direct-to-patient advertising and lack of corporate regulation have led to both overmedication and higher prescription charges.

19. Many people who have suffered prescribed harm are very suspicious of the pharmaceutical industry. However, substantial improvements in regulation and behaviour of the industry and of psychiatry in the UK may lead to increased patient confidence for products developed and tested here rather than in the US (or even the post-Brexit EU). In turn, this may result in a relative growth of employment in the UK-based industry.

20. The RCPsych will consult with Pharma-sceptic psychiatrists, other mental health professionals, and current and former patients to determine what further steps should be taken.

 

24th October: ‘That collusion has often involved over- and mis-diagnosis.’ added to end of No.2. Thanks to Alan Johnson (@RunAgainstCastr) for prompting me to add this.

 

 

 

 

 

 

 

#ChoosePsychiatry now! But will you have a job in ten years?

As a psychiatry-curious junior doctor (or medical student), you probably know that some patients and ex-patients have always been dissatisfied with their treatment. There has been an ‘Anti-Psychiatry’ movement, supported by a few psychiatrists, and other mental health professionals, since the 1960s.

But you may not know that the UK’s psychiatric establishment, in the form of its monopoly professional body, the Royal College of Psychiatrists (RCPsych), has actually appeased and even encouraged some aspects of ‘Anti-Psychiatry’.

Although RCPsych leaders claim that they have government agreement for psychiatry remaining the lead profession in Mental Health for the foreseeable future, there is nothing legally binding about that assurance, and there will be at least two general elections in the next ten years.

There is evidence that RCPsych leaders are, in fact, ready to let clinical psychologists take over, perhaps quite soon. If that happens then many who choose psychiatry now may never become consultants, or even have a job at all in 2028.

In 2015 Dr Simon Wessely FRCPsych was the guest speaker at the ‘Critical Psychiatry Network’ (CPN) conference, during the first year of his RCPsych presidency. Neither he nor the CPN have written about or publicised this, although it appears that he expressed sympathy for their anti-diagnosis views. A few months ago I obtained some unpublished photographs of the 2015 conference, including one showing Dr Wessely on a panel with Peter Kinderman, past president of the British Psychological Society and author of A Prescription for Psychiatry (2014):

15-CPN-JM-SW-PK

(Panel discussion at the 2015 Critical Psychiatry Network (CPN) Conference: (left to right) Dr Joanna Moncrieff MRCPsych, CPN co-chair; Dr Simon Wessely FRCPsych, President of the Royal College of Psychiatrists (RCPsych) 2014-7; (unknown); clinical psychologist Peter Kinderman; Dr Hugh Middleton MRCPsych, CPN co-chair.

In A Prescription for Psychiatry, Kinderman states (p 50) ‘In my experience, the system of psychiatric diagnosis is demeaning and dehumanising…Ultimately, I believe there is no place for medical diagnosis in mental health care.’ After his reforms, he proposes (p 47) to ‘leave psychiatry – especially social psychiatry – as a key profession in a multidisciplinary service.’

But without diagnosis, what would psychiatrists actually do? Here the anti-diagnosis proposals become rather hazy. Kinderman and academic CPN psychiatrists such as Dr Joanna Moncrieff (who was Dr Wessely’s MD student) tend to imply that abolishing diagnosis will lead, by itself, to a reduction in medication  but as a backstop they say that some medication will still be necessary on a symptomatic basis.

It may all sound fanciful, but in fact learning disability psychiatry (in which I was an NHS specialist for ten years) has been a testing ground for anti-diagnosis views. The RCPsych has not released figures on consultant numbers, but there has been a marked decline in the number of nurses. Symptomatic use of medication has, if anything, increased.

Peter Kinderman has held a senior management role within NHS mental health services. His updated version of Anti-Psychiatry is attractive to politicians because he claims that he can increase patient satisfaction at no extra cost, or even with a reduction in cost.

Clearly, one saving which can be achieved if use of medication is merely symptomatic, is to get more of it prescribed by GPs, or non-consultant grades. This has already happened in the case of depression: most people treated in the NHS never see a consultant.

Faced with clinical psychologists promising such a mental health Utopia, RCPsych leaders have been reluctant to point out its faults, and have opted for short-term appeasement, allowing investment in mental health services to remain flat.

They have refused to address pharmaceutical industry regulation, conflicts of interest, and hyping of neuroscience in mental health, which continue to be major sources of credibility for anti-diagnosis extremism.

Anti-diagnosis views are actually quite useful for psychiatrists themselves to strategically adopt, when they exclude perceived low-risk conditions such as ADD / ADHD and much ‘borderline personality disorder’ from services.

For relieving the taxpayer in this way, RCPsych leaders have been rewarded with honours and knighthoods.

The current president, Dr Wendy Burn FRCPsych, appears no different. She allowed a CPD module by Dr Moncrieff to be published in February and, very recently, signalled that she would meet with Peter Kinderman’s close clinical psychology associate Lucy Johnstone, despite evidence that Ms Johnstone and other anti-diagnosis psychologists have encouraged abusive criticism, some of which was recently directed at a senior RCPsych psychiatrist:

180919-shit-fab Truthman-LJ180930-Burn-Johnstone-respectful

Having repeatedly raised these issues with the RCPsych leadership over the last few months, and been blocked by them on Twitter from @Choose_Psych, I wish you more luck than I have had in trying to get them to give straight answers.

But if you let yourselves be distracted by their endless variations on how wonderful a mental health ambassador Stephen Fry is; don’t say I didn’t warn you.

 

Dr David Baldwin FRCPsych resigns from Prescription Drug Enquiry…but why?

Today’s Times newspaper reports that the Chair of the Royal College of Psychiatrists (RCPsych) Psychopharmacology committee has resigned from the Public Health England enquiry into Prescription Drug Dependence (PDD). A ‘campaign of harassment’ from Bloggers has been blamed, and the focus appears to be on whether psychologist John Read and/or his associates have colluded with them.

But one Blogger and Tweeter, ‘Truthman 30’, has been calling Pharma-enmeshed psychiatrists ‘whores’ (and worse) for years: why suddenly bring that up now? Just a few days ago he (I presume he is male) was in a Twitter thread with the RCPsych president Wendy Burn: why didn’t she block him long ago?

This morning I asked the RCPsych ‘communications team’, headed by the ex-BBC journalist Kim Catcheside, what warnings, statements and threats of blocking have been issued to Truthman 30 or anyone else. They have clarified that the ‘worse than Hitler’ comment in the Times headline, together with the ‘rapist’ one, appeared in a 12th September anonymous comment under one of Truthman 30’s Blog pieces. But they have not commented on any warnings or other attempts to improve language.

The above Tweet also shows Dr Burn responding on Twitter to Bob Fiddaman. The RCPsych leadership must know that I called out Mr Fiddaman for his abusive misogynist and racist tweeting months ago, because RCPsych CEO Paul Rees emailed shortly after to inform me that my own Tweets were being monitored. At the same time I became aware that Ms Catcheside had been following me on Twitter.

Nor have the RCPsych leaders seemed bothered to sort out an allegedly upheld, but inadequately dealt with, complaint about ‘bullying, harassment and misogyny’, against a consultant psychiatrist with close links to Dr Baldwin and the psychopharmacology committee.

Frustrated by the pharmaceutical industry (Pharma) and establishment psychiatry blocking enquiry into wrongdoing for decades, ‘Prescribed Harm’ campaigners have at times made comparisons with the Nazi killing of the mentally ill and disabled. This may seem excessive to many members of the general public, but I do not think it is really very different to much historical remembrance of the Jewish Holocaust, to colonialist atrocities, or to the treatment of the suffragettes, to give just three examples.

Four days ago I advised Truthman 30 to stop using ‘whore’ and other forms of swearing:

 

So if the RCPsych leaders have done little about such language for months and years, why bring it up now?

I suggest that Dr Baldwin and the RCPsych leadership are more likely to be concerned about non-abusive pressure from its own ordinary members, and others. In particular, from Dr Peter Gordon MRCPsych, who has experienced significant harm from Seroxat (paroxetine), with which Dr Baldwin was directly involved.

At the end of August, Dr Gordon (still working in the NHS as a consultant psychiatrist) received a threatening email from CEO Paul Rees, who reminded Dr Gordon of ‘the College’s Code of Conduct (attached)…one of the behaviours we expect from our members is ‘appropriate use of social media, as set out in the RCPsych’s Social Media Policy’”, but failed to give any examples of where the Code might have been close to being breached, or what ‘appropriate’ might mean.

Dr Gordon has been campaigning for over five years, but this year seems to have been making more of an impact. He has repeatedly pointed out the long history of RCPsych-Pharma minimisation and denial, and the responses to him seem to have changed from patronising to irritated. President Dr Burn tried to let him know that his ‘lived experience’ was not wanted (only pro-medication good news stories from Stephen Fry and others are promoted by the ‘communications team’, of course) but he has persisted, as the above links show.

Encouraged by Dr Peter Gordon MRCPsych’s example, I have put my own bit of pressure on Dr Baldwin as well. Let’s hope that the RCPsych has the sense to replace him with a less Pharma-enmeshed representative on the Prescribed Drug Dependence enquiry. But he will still be working in the NHS and as an academic, so he continues to have questions to answer.

How ‘Drop the Disorder!’ colludes with the neoliberalism it claims to oppose

15-CPN-JM-SW-PK

(Panel discussion at the 2015 Critical Psychiatry Network (CPN) Conference: (left to right) Dr Joanna Moncrieff MRCPsych, CPN co-chair; Dr Simon Wessely FRCPsych, President of the Royal College of Psychiatrists (RCPsych) 2014-7; (unknown); clinical psychologist Peter Kinderman; Dr Hugh Middleton MRCPsych, CPN co-chair. Most CPN conferences have been reported, with accounts of the presentations, but although the Powerpoint slides were posted on the CPN website, I have been unable to find any report of this one.)

(Dr Wessely is discussed from the 9th paragraph, below)

 

Funding for mental health services has fallen in real terms over the last six years, and possibly over a longer period. As the editor of Asylum magazine, Helen Spandler, pointed out in her 2016 article, ‘From Psychiatric Abuse to Psychiatric Neglect?’, over the last 2-3 decades we have moved towards ‘the perverse situation where people may have to exaggerate their madness (and emphasise their dangerousness) in order to access or retain services. This is very worrying.’

‘Neoliberalism’ may not have one fixed meaning, but most would agree that cutting state-provided services in order to reduce taxes is a key element. Also, that Margaret Thatcher, more than any other politician, established it at the centre of political discourse from the early 1980s onwards:

 Image result for thatcherand sons

The Middle East journalist Patrick Cockburn is an expert in spotting unlikely political alliances, and he wrote this about Thatcher’s 1980s underfunding of ‘Care in the Community’: ‘The psychiatric hospitals were caught in a pincer movement from right and left. The left saw the asylums as being like prisons, whose inhabitants were primarily the victims of an authoritarian system. Films like One Flew Over the Cuckoo’s Nest propagated this attitude. On the right, such views were welcome because they provided respectable reasons for spending less money on the mentally ill and reduced the role of public welfare.’

In my view, calls over the last decade to ‘Drop the Disorder!’ represent a new form of this alliance between the ideological left, for whom treating and even supporting people with mental health problems distracts them from turning to socialism, and the state-shrinking neoliberal right. The beliefs that many such problems are either fictions promulgated by psychiatrists and the pharmaceutical industry (left version) or akin to malingering (right version, more straightforward now that profits on patent-expired psychiatric drugs are lower) are less in opposition than they might at first appear.

The CPN contains a range of leftist views, ranging from simplistic, even avowedly Marxist, ‘anti-neoliberalism‘, to lively cultural critiques, and more subtle approaches in which anti-capitalism is often buried in obscure discussions of Michel Foucault’s later writings on ‘Power’. CPN psychiatrists have mostly taken their anti-diagnosis discourse from ‘Critical Psychologists’, and I will only discuss Peter Kinderman as an example of the latter as he presented at the 2015 CPN conference; but he is probably the most prominent, having recently been president (and vice-president) of the British Psychological Society.

Peter Kinderman recently posted a talk he gave to a local Labour Party, full of lofty aspirations to ‘reduce financial and social inequality’ and promote ‘human rights’. He even had a photograph of Martin Luther King, who he quoted: ‘There are some things in our society, some things in our world, to which we should never be adjusted’. To be clear, I agree with these aspirations too, and with the view that inequality, abuse and trauma are major causes of mental disorder. But I differ in believing that support and psychotherapy will lead to more effective political engagement, not less.

Although he once, in passing, mentions mental health services as ‘under-resourced’, that is contradicted by the rest of the talk in which he implies great improvements can be made at no cost, or even with financial savings: he constantly stresses the claimed need to ‘reject…a diagnostic account of human distress’ but also reject ‘more of the same’ kind of mental health services.

No doubt these calls of ‘more money NOT needed here’ are pleasing to politicians in Whitehall, but also to Peter Kinderman’s local NHS managers in Liverpool.

But what of Dr Simon Wessely FRCPsych, who had become ‘Sir Simon‘ two years earlier, and at the time of the 2015 CPN conference was in his first year as President of the Royal College of Psychiatrists? Like their 1980s predecessors, The CPN and ‘Critical Psychologists’ tend to promote themselves as anti-establishment, so was the 2015 conference a confrontation, an occasion of mutual criticsm? Well, I have I have talked with several professionals and non-professionals who attended, and have been told that it was not. My explanation of this ‘mutual non-criticism’ follows.

Dr Wessely had been recruited to save money by ‘son of Thatcher’ Tony Blair’s government as early as 2001 (interestingly, Peter Kinderman reported a visit to the Department of Work and Pensions (DWP) in the same year). At the ‘Malingering and Illness Deception‘ conference in Woodstock, Oxfordshire, clinicians met both senior DWP staff and private companies whose ‘profits were threatened’ by disabling long-term disorders such as ME/CFS, which Dr Wessely (p.44) had based his research on over the previous decade.

Dr Joanna Moncrieff had been Dr Wessely’s MD student, and she had been interested in welfare as a drain on public spending even earlier, in 2000, when she published a paper warning that mental disorder-based ‘sickness benefits increasingly represent disguised unemployment‘. In 2016, a crack in the CPN’s ‘Drop the Disorder!’ consensus appeared when Dr Phil Thomas MRCPsych criticised another Moncrieff paper, which suggested that ‘to reduce benefit levels‘ was a valid primary aim for mental health services. Dr Moncrieff’s defence (below the Thomas critique, linked above), which started by irrelevantly stating that ‘almost all the data is already in the public domain’ and went on to repeat anti-neoliberal platitudes, was unconvincing.

Over the last 2-3 months I have come to the view that the CPN’s critique of the pharmaceutical industry is usually secondary to their concern about the ‘overmedicalisation’ of mental health:

Dr Moncrieff failed to respond to my point in this tweet. Since then, she has been silent about antidepressant hyping from the Maudsley Hospital/Institute of Psychiatry (where she did her MD), and about the overpromotion of ’emerging evidence’ claims from a leading psychiatrist employed half-time by GlaxoSmithKline (GSK) since 2005, who is active on a key RCPsych committee with Dr Wesseley. So has Peter Kinderman.

The selective criticism of pharmaceutical company behaviour by the CPN and ‘critical psychologists’ appears to go back, at least, to 2012, when there was little protest at the knighthood given to Andrew Witty, GSK’s CEO, for ‘services to the economy and the UK pharmaceutical industry’ (not for health), despite a $3 billion fine for overmarketing which was later confirmed as substantially ‘criminal’ and as partly relating to two antidepressants.

The CPN/’critical psychology’ alliance tends to claim sympathy with people who have difficulty withdrawing from antidepressants and benzodiazepines, but does not point out that medical supervision and support of such withdrawal is under financial pressure from their state-shrinking influence. Some ‘drug harmed’ people, who have been abused and shamed by another RCPsych ex-president, Dinesh Bhugra, as inventing or exaggerating ‘bizarre’ symptoms, partly motivated by ‘the incentive of litigation’, have noted a parallel between their experience and that of people with ME/CFS. Dr Moncrieff appears never to have commented on her former supervisor’s clinical area of interest, ME/CFS, but she has criticised patients’ self-advocacy as media-driven: ‘having a mental health problem has almost become a badge of honour among some sections of the popular press and numerous celebrity memoirs’ (p.77).

The unreported 2015 meeting between the CPN, Peter Kinderman, and Dr Simon Wessely shows that the post-Thatcher neoliberal state has found it useful to support a small but influential group of ‘Drop the Disorder!’ mental health professionals. In future Blog pieces I will explore aspects of this collusion further, and show how mental health diagnosis can be distorted and misused, sometimes oppressively, but is not inherently flawed as claimed by the CPN/’critical psychology’ alliance.

photo (4) - SW-JM-DS

Dr Simon Wessely after his presentation. Dr Moncrieff in the centre. Peter Kinderman (partly hidden) in the front row.

(My thanks to Dr Duncan Double MRCPsych (the only CPN psychiatrist who has criticised the RCPsych and Dr Ed Bullmore FRCPsych) for the photographs of the 2015 Critical Psychiatry Network Conference)

Added 20th January 2019: My earlier piece ‘Pillshaming is Real‘, is also relevant.

 

Twitter responses:

I am still waiting for Duncan Double (who seems to be a rare example of a politically centrist, or perhaps apolitical, diagnosis-sceptic) to back up his various responses:

DD links here to the 2014 Nutt & Bhugra Lancet article (I tweeted back that I didn’t agree I was ‘turning the tables’, and that I had deliberately avoided the ‘stigma’ issue):

In a later piece I will try and find some good evidence (although it seems obvious to me) that flat/reduced mental health funding leads to overmedication because that is cheaper than support and psychotherapy:

Added 5th June:

From the co-author of ‘The Dangerous Rise of Therapeutic Education‘ (2008), which argues that a wider ‘therapy culture’ is in itself harmful, and tends to distract from those who need specialist intervention. There is an update, including Mindfulness, in a 2015 Youtube video.

From @AkikoMHart (Mind in Camden, @HVN_England, @ISPSUK) who is currently looking at Dr Wessely’s MHA review. And also @RITB_

My response to @RITB_ was that ‘A Disorder for Everyone’ and ‘Power Threat Meaning Framework’ closely overlap in content and aims with ‘Drop the Disorder’.

Then a protest from the author of ‘The Psychological Complex‘ (1985) and ‘Governing the Soul‘ (1989), both of which influenced ‘Critical Psychiatry’:

From a Sheffield Humanities Professor who has written about the limitations of his own NHS psychotherapy. I would read (and agree with) his 2008 book chapter as arguing for less dominance of ‘scientistic’ CBT, and comment that Foucault and Heidegger (the latter un-named but present in the frequent use of ‘being/becoming’) are fine to explore in and out of therapy but in the wider context are useful for neoliberal state-shrinking.

CPN stalwart Duncan Double (see above) seems to be defending ‘Drop the Diagnosis!’ as being the only true path to Mental Health Utopia:

And finally, a response from the editor of Asylum Magazine, whose Twitter profile starts with ‘Politics of Mental Health’. Perhaps I misread her ‘From Psychiatric abuse to Psychiatric Neglect’ piece as calling for more Mental Health services funding?

Letter to The Maudsley Hospital’s Chief Executive

(Printable pdf version: 180411_Pariante_SLAM_ChiefExec)

From: Dr Neil MacFarlane MRCPsych (accompanying note contains my College-registered email and postal address) Any response(s) by email only please

To: Dr Matthew Patrick MRCPsych, Chief Executive of South London and Maudsley NHS Trust (SLAM), Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX

11th April 2018 [15th May: no response from Dr Patrick]

 

Dear Dr Patrick

Re: Are antidepressants overpromoted by the Maudsley Hospital?

This is to inform you that on 15th March I made a complaint about Dr Carmine Pariante MRCPsych, ‘spokesperson’ for the The Royal College of Psychiatrists, to the College, about his ‘false, misleading and irresponsible’ statement on antidepressant medication, of 21st February. His statement was widely reported in the media and probably impacted on tens of millions of people.

On 25th March Dr Pariante made 2-3 minor partial retractions in the Mail on Sunday. My further complaint about this wholly improper use of ‘spin’ remains unanswered. I escalated to the General Medical Council on 3rd April. Full details of these complaints are openly on my website www.DrNM.wordpress.com , with frequent comment on Twitter: @NMacFa

I understand Dr Pariante’s clinical work to be within local and national services, based at the Maudsley Hospital. If there is a separate management structure for the NIHR Maudsley Biomedical Research Centre, please let me know.

I am very concerned that Dr Pariante represents a culture of overmedication within SLAM. Despite a great deal of public and professional disquiet about overpromotion of antidepressants by himself and others, especially since his 21st February statement, I am not aware of any SLAM mental health professional, let alone any SLAM psychiatrist, feeling able to voice any critical perspective at all.

In 2013, Dr Pariante invited the disgraced Dr Charles Nemeroff MD, to give an inaugural lecture at the Maudsley Hospital’s academic wing, the Institute of Psychiatry, which is located on the same site. Dr Nemeroff is probably the most notorious of the many psychiatrists in the United States who avoided criminal convictions for failure to declare large pharmaceutical company payments (including from GSK, who in 2012 were found guilty of ‘criminal’ overmarketing) under the flaccid regulatory structure there. At the time, Dr Pariante defended the lecture on the wholly dubious basis of ‘academic freedom’, failing to acknowledge the widespread corruption in American academic psychiatry. But even though Dr Pariante did not dispute the charge that Nemeroff had lied to his employer about such payments, and been sacked for it, the lecture went ahead.

I would be grateful for a comment or response on this. You have had ample time, since the Nemeroff lecture, to form a view. I write not only as a concerned professional, but also as someone who has immediate family members living within a mile of The Maudsley Hospital.

Yours sincerely

 

Dr Neil MacFarlane MRCPsych (signed & dated)

Copied to:

SLAM complaints (by email: for information)

SLAM Council of Governors (by email)

Local residents (a limited mailing)

[15th May: no response from Dr Patrick]

RCPsych oligarchy now appears to be deliberately misleading while spinning its response to my complaint about its statements on Cipriani et al

DO NOT STOP ‘ANTIDEPRESSANTS’ BEFORE DISCUSSING WITH THE PRESCRIBER

RAISE THIS ISSUE WITH YOUR GP (OR PSYCHIATRIST) AND ASK ABOUT ALTERNATIVES

PLEASE NOTE that when I write ‘antidepressants’ I respect those who have experienced a non-placebo therapeutic effect. In any individual person, this is impossible for a psychiatrist or other health professional to rule out clinically. However, the group-based research evidence shows fewer than 1 in 10 have a substantial non-placebo effect and the true figure may be much lower. Depression has a natural tendency to improve and ‘antidepressants’ may worsen the medium- and long-term outcome for most people: the research on that is inadequate, in my view, but some psychiatrists and many people who have experienced harms from ‘antidepressants’ are more certain.

[Complaint: 15th March…20th April: RCPsych promised response by 11th May…15th May: no response]

I complained to the RCPsych (Royal College of Psychiatrists) on 15th March, about the ‘false, misleading and irresponsible’ statements made about this ‘antidepressant’ meta-analysis in the Lancet (21st February), by its spokesperson Professor Carmine Pariante. I am a member, but anyone can complain about its public statements and activities. They have not responded (other than to acknowledge), and misleadingly cited the College’s regulations when they ordered me to keep silent about their responses.

Here is my complaint, with some questions at the end. I say that Dr Pariante’s ‘finally puts to bed the controversy on antidepressants’ is irresponsible and misleading; that he repeated the Lancet paper’s false claim about lack of selective reporting of antidepressant trials by pharmaceutical companies; he trivialized criminal wrongdoing by pharmaceutical companies and he has a history of so doing. He evaded the issue of trial registration, and he endorsed overmedication contrary to College policy. Dr Pariante falsely stated that the Lancet paper addressed antidepressant ‘safety’, and in not mentioning placebo response his statement was misleadingly biased towards drug treatment.

There is a technical-seeming bit in the first section, on funnel plots, but actually the point is what the Cochrane Review (an international body which conducts statistically-informed evidence-based studies in Medicine) now say about funnel plots, which appear to be largely discredited as a way to detect publication bias.

Link to 180315-3_Pariante_complaint (pdf, main complaint is 3 pages, plus Dr Pariante’s full statement at the top, and some questions at the end. Total, 5 pages)

The College oligarchy decided to spin part of my complaint in the Mail on Sunday (link within link to Tweet, below) rather than respond in a formal way. This insults people with mental health problems, and degrades public discourse on the issue. Profesor Pariante was briefly quoted as saying he was ‘taken very much out of context’. I believe most people will find this deliberately misleading. He also mentioned ‘placebo’ for the first time. Much of the substance of my complaint has not been addressed, including his false claim that Cipriani et al addressed the ‘safety’ of ‘antidepressants’.

Yesterday, the oligarchy tweeted that he had ‘readdressed comments’. They need to clarify if he had already ‘addressed’ them (which I am unaware of) or if this is, again, misleading:

Why the RCPsych ‘oligarchy’, and not the President, Professor Wendy Burn? Well, she is not particularly known as an overpromoter of medication, but it is possible that in her role as Dean from 2011-6 she kept such views quiet. Recently, she and Professor David Baldwin made a very dubious claim about coming off medium and long-term prescriptions of ‘antidepressants’ (not an issue addressed by Cipriani et al) which, together with Professor Baldwin’s empty and inept response, is now the subject of another complaint, which I will inform the College today that I support. Professor Baldwin is the RCPsych’s senior officer for medication (‘psychopharmacology’).

http://cepuk.org/2018/03/09/patients-academics-psychiatrists-formally-complain-president-royal-college-psychiatrists-misled-public-antidepressant-safety/

But the key RCPsych oligarch may simply be Professor Pariante himself. The day after his 21st February statement he tweeted the RCPsych’s ‘Senior Communications Officer’, and her response suggests that the President could have given him free rein:

I think someone from outside the inner circle should come in and take control of this issue. The best I can think of right now is Professor Louis Appleby, who is prepared to state the obvious about corporate pharmaceutical behaviour, although how strongly is not clear. He also corrects and clarifies his statements with honesty:

[First 11 lines added 29th March 10.00]

[3rd paragraph added 3rd April]

[‘1 in 10’ changed from ‘1 in 5’, 3rd April]

[Complaint: 15th March…20th April: RCPsych promised response by 11th May…15th May: no response]

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