THE PERNICIOUS PSYCHIATRY

Can it be said, with concrete evidence, that the modern psychiatric profession has been able to reduce the problem of mental illness? Has it been able to have any significant break-through, based on ‘science’, in the understanding of mental illness?

I have been fascinated by (director of the National Institute of Mental Health-NIMH) Thomas Insel’s recent statements about the DSM because there he answered no to those two questions. (See my first Long Live Psychiatry post.)

Don’t delude yourself, his statements were anti-psychiatry, not merely anti-DSM.  The problem is, you can’t trash Santeria’s cowrie shells reading as ignorance and then refer me to a Santero for a reading.

That’s EXACTLY what Insel did when he trashed, not only the DSM, but the whole psychiatric ‘chemical imbalance’ model: he’s asking you to go to your shrink to have him read your DSM-cowrie.

He even trashed the pharma, well, the so-called psychiatric drugs they make to ‘cure’ emotional problems. Of course, he could only wink at the moral implications of calling on the lies that the pharma sells to us (all highlights and brackets by me):

“Given that over 95% of compounds [drugs] fail during the clinical phases of development (a fact not appreciated by looking at the published literature which is biased towards positive results)…” In ‘Experimental Medicine‘

So, yes, Insel DID trash the current psychiatry profession and the pharma.

He even said that MENTAL ILLNESS does NOT EXIST!

Who in the anti-psychiatry movement would disagree with his statements?

One problem with Insel’s correct statements is his ALTERNATIVE to this obsolete, inefficient and growingly irrelevant profession: EXPERIMENTAL medicine, PSYCHOSURGERY and NEUROPSYCHIATRY. The last two practices are as discredited as the one he is discarding.

The practice of poking holes in the human skull to find in the brain the seats of ‘depression’ or of road-rage behavior is older than Methuselah. You can give it a new name and call it ‘science’; it will continue to be the same ol’ useless TREPANNING practiced by the priests of ancient ages.

Left skull, iron age. Right skull – modern 21st century.

The new psychiatric model: Experimenting with an experiment (seriously!)

“But do we really understand the circuitry for depression or psychosis or autism? Not by a long shot.” Wanted: A Few Good Brains

So, nobody knows how mental illness ‘works’, not the old psychiatry and, as confessed by Insel, the new ‘scientific psychiatry’ knows even less. That’s a lot of progress since the ancient Egyptians were chanting to Isis for a cure to mental illness, isn’t it?

Ancient capsulotomy.

Consequently, they have to start poking the brain mass to understand these brain circuitry malfunctions (that’s what he said we must call all mental illnesses).

“As a result, NIMH is shifting from large clinical trials…to a model called “experimental medicine.” In experimental medicine, drugs are used as clinical probes and the immediate goal is not to develop a treatment but to identify or verify a target… Experimental medicine is an experiment.”

The goal here is not to develop treatment. That’s progress too! Woo-hoo!

The goal, he says, is EXPERIMENTING with drugs to see how you respond to the poking and “probing” and tinkering with your brain mass (open surgery required in many cases) to find your brain ‘circuitry’. “Target” means a particular spot in the brain that could be identified as the location of circuitry related to an ‘illness’, and ‘targeting’ it by dousing the whole brain with drugs to see what happens to it, if anything. ‘Hey, let’s see what happens when we drug this dude with LSD, again!’

This experimenting with your brain mass ‘model’ is the logical procedure for ‘scientists’ to acquire the knowledge about our behaviors that no one has. That’s why the millenarian Egyptians used it. Somehow, it was barbaric for them to do it, but scientific for Insel to do it.

So, that’s the meaning of “experimental medicine is an experiment”: using live human subjects to experiment with the brain. The lab rats shall be free!

“This approach acknowledges that animal studies…are not consistently predictive of how medications will work in humans, homo veritas. Experimental medicine focuses on human studies rather than rodent research.”

The people of the animal rights groups have been saying the same thing – that testing on animals us useless for us, but no one cares that Insel is saying they are right. We just seem unable to put two and two together.

Who will be the new rodents for this experimental medicine model? Round up the usual suspects:

“For NIMH…people with our most prevalent disorders seem to be everywhere—homebound, homeless, in prison, schools, primary care—except the academic health center. As a result, recruitment into clinical trials may be slow [because, as he acknowledges in the article, the public do not care much for experimenting on humans].”

You can’t say you have not been warned.

In the next post: Psychiatric profession’ struggle to remain relevant. It’s past, present and future; the real reason why Insel bashed the profession.

Psychiatry is dead. Long live psychiatry. Part 3: Lobotomies

“Frontal lobotomy has probably been the only medical advance which was first awarded a Nobel prize in medicine and then irreparably stigmatized by scientific rejection and public criticism.” http://www.ncbi.nlm.nih.gov/pubmed/17691325

Almost everything broken can be glued back together. Lobotomy has not been “irreparably” stigmatized. Au contraire, it’s on the rise, the second-coming of Dr. Freeman.

SETTING UP THE OPERATING TABLE

There were only five new psychiatric diagnoses added to the new DSM-5 this year. This is one of them, with its first (and more important) classified ‘symptom’:

        – Major or mild frontotemporal Neurocognitive Disorder    

1. Concerns of the patient, a knowledgeable informant or the clinician that there has been a mild decline in cognitive function.

This is a ‘disorder’ that manifests as a “concern”, mind you. Its effects may be felt by a person other than you: an “informant” may be the one suffering the disorder if he or she is “concerned” that you are acting mildly different. You can then be diagnosed as having a frontotemporal problem.

Kidding aside, this new diagnosis is not there innocently, inoffensively. Its inclusion in the DSM-5 has been carefully planned for the last 10 years by Thomas Insel and the NIMH, among the many people with interests in the lucrative field of neuropsychiatry research.

Its inclusion in the DSM-5 has two purposes, as I will discuss in the next post: reintroducing you to a procedure that had been historically discredited and to get you into accepting it under its new clothing – the psychobabble of the pseudo-science of neuropsychiatry.

ALL FORMS OF LOBOTOMY ARE BRAIN DAMAGE.

In the treatment of psychiatric disorders, modern lesion procedures…offer a degree of hope for patients who remain severely ill and impaired despite pharmacological and behavioral treatments. http://www.ncbi.nlm.nih.gov/pubmed/19551602

Joel: Is there any risk of brain damage?
Howard: Well, technically speaking, the operation is brain damage, but it’s on a par with a night of heavy drinking. Nothing you’ll miss.
From Eternal Sunshine of the Spotless Mind

Lobotomy has been discredited for a long time; it exists in our collective memory in any variety of the following pictures:

People have wrongly believed that this practice was stopped after the anti-psychiatric movement of the 1960s denounced the real nature of the practice and the use of humans to test the procedure. Unbeknown to most people, it has continued to be practiced, quietly, less frequently indeed, until the last 15 years when

“Recently, there has been a renaissance of interest in the surgical treatment of psychiatric disease.”  

because

“Recent outcome studies…support the further investigation of modern functional neurosurgical procedures to treat psychiatric disorders” http://www.ncbi.nlm.nih.gov/pubmed/10917342

“Renaissance”, “interest”, “support” and positive “outcomes”, these words tell you that the future of psychiatric brain operations is now; that they have worked on this for a while and now is the time to let it roll out, again.

WHEN IS THE NEW LOBOTOMY PRESCRIBED?

As flood insurance companies do, the new lobotomy is prescribed when the unwary is most desperate for help.

This is the new psychiatric “it” word:  refractory. It means ‘unruly, resistant to treatment’ as in “impaired despite pharmacological and behavioral treatments”. It’s the term now used to justify the new lobotomy, for example, “evaluating both the efficacy and the safety of anterior capsulotomy for the treatment of severe, refractory OCD.” It sounds more mysterious and impressive to say refractory than saying ‘medication doesn’t make a dent on it’; you don’t want to hurt the pharma, do you?

That’s one of the repairs, for its public image, of the practice of lobotomy: now you have to, supposedly, wait for the pharma-cology to fail.

The interesting thing is that, given that the NIMH has declared pharmacology and the biochemical modality of psychiatry as outdated, by default only ‘surgical lesion of the brain’ remains as the ‘only’ hope sanctioned by the new gurus of psychiatric surgery. And they do it two at a time.

Evaluation of bilateral cingulotomy and anterior capsulotomy for the treatment of   aggressive behavior [2011]

CONCLUSIONS:

Combined bilateral anterior capsulotomy and cingulotomy successfully reduced aggressiveness behavior and improved clinical evaluations. http://www.ncbi.nlm.nih.gov/pubmed/21631970/

Why have one procedure when you can have two at the same time for 4x the price? Sure, they’ll leave your kid like a zombie, but who cares as long as he stops being a nuisance. It can also be used to make you or your parent or a spouse less aggressive and/or argumentative. Those were the same excuses for using lobotomy in children and adults in the past, we are having them back again.

One of the ‘new’ diagnoses in the new DSM -5 that helps set the operating table includes:

Disruptive Mood Dysregulation Disorder. This is the controversial new designation for children showing persistent foul temper punctuated by bursts of rage. When first proposed, it was widely derided as an attempt to medicalize “toddler tantrums” (even though the criteria clearly stated it was for children older than 5.)

http://www.medpagetoday.com/MeetingCoverage/APA/32619

They are getting your hospital bed ready.

THE NEW LOBOTOMIES

These are the most popular new lobotomies being practice today.

The two Psychosurgery

In the last decade, brain surgeons have reported encouraging results in their efforts to alleviate severe obsessive-compulsive disorder. Different operations can be is to interrupt overactive neural activity between the frontal cortex and structures deep in the brain. They include:

Capsulotomy

1. The surgeon inserts probes through the top of the skull and down into the capsule, which is deep in the brain near the thalamus.

2. By leading the tips of the probes, the doctor can burn away small portions of tissue, each about the size of a raisin.

• The same surgery can also be done using external radiation.

Cingulotomy

1. Probes are inserted through the skull into the cingulum, a bundle of connections located near the capsule.

2. The probes’ tips are heeded and tissue is burned, as the capsulotomy.

• The operation can also be done with external radiation.

Deep brain stimulation

1. The surgeon inserts wires through the skull and into the capsule no tissue is destroyed.

2. The wires are permanent, and they are attached to the battery pack that is implanted in the chest. The battery produces an adjustable high-frequency card that seems to have the same effect as the other surgeries. It interferes with the brain circuits involved in OCD.

• Although the technique is new for OCD, it has been used for years on Parkinson’s disease patients.

Source: Gray’s Anatomy, Butler Hospital, Massachusetts General Hospital University of Florida at Gainesville. Researched by Times graphics reporter Joel Greenberg. Matt Moody – Los Angeles Times

The above is  From http://www.mindfully.org/Health/2003/Brain-Surgery-OCD-Behavior4aug03.htm

Cingulotomy:

“In recent decades is the most commonly used psychosurgical procedure in the US. The target site is the anterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region.”

“Bilateral Cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today it is mainly used in the treatment of depression and obsessive-compulsive disorder. In the early years of the twenty-first century it was used in Russia to treat addiction.”

“DSM-5 Hoarding Rationale

Hoarders take far longer to make up their minds and show more activity in the anterior cingulate cortex,”

http://csmh.umaryland.edu/Conferences/ship/SHIPArchives/2.DSM5.SHIPCarltonMunson.pdf   (NOTE: It’s a large PDF.)

Anterior capsulotomy:

The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei.

“Background and purpose: Psychosurgery, such as anterior capsulotomy, is a therapeutic option for treatment-resistant obsessive-compulsive disorder (OCD). Methods: Twenty-four patients were surgically treated in our centre between 1997 and 2009, 19 of whom were included in this study.” http://jnnp.bmj.com/content/84/11/1208.abstract

Amygdalotomy:

…targets the amygdala, as a treatment for aggression.

 Deep brain stimulation (DBS): It’s an implant. This is an interesting Times mags description of the procedure.

But this is the one you will seldom read about:

In spite of its clinical success, DBS technology and the associated surgical procedure have several limitations. For example, clinicians lack tools that combine anatomical, physiological, electrical, and behavioral data to optimize electrode placement and stimulator programming. Patients endure significant discomfort during implantation due to the use of rigidly fixed stereotactic frames.

As in the past, we are been sold these procedures as already good for use. In the next post: the lies that they tell you about psychosurgery.

Psychiatry is dead. Long live psychiatry. Part 2

It has to be said now, get it out-of-the-way before we dive into discussing the ‘new psychiatry’ and its neuroscience and new lobotomy: modern psychiatry (since the 1800s) has always suffered from an acute case of ‘scalpel envy’. There, I’ve said it.

Psychiatry’ scalpel envy: surgery to remove that sadness from your brain.

Let me give you a recent manifestation of that envy, as expressed recently by Thomas Insel, director of the NIMH, in his blog post Transforming Diagnosis.

There he made that cliché comparison between “the rest of medicine” and psychiatry. Trying to discredit (now) the DSM, he said:

Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure… In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.

Can it be, could it be, will it be any other way, the diagnosis of a ‘psychopathology’?

For a case of sadness and ‘major depression due to bereavement caused by the sudden loss of a child in a car accident’, which organ would you look into? Into the heart? As President Bush2 infamously said about the weapons of mass destruction as he bent over to look underneath a table, “no they are not there.”

Would you look into the brain? You are getting warmer! Can you see that ball of sadness blocking my happiness (like a ball of fat clogs an artery) using your X-rays or MRI’s or whatever tool you have now for looking at ORGANS?

Of course you CAN’T see it! A color in a brain imaging is NOT the sadness.

Picture of the location in the brain of ‘bereavement’: is the left big yellow spot…or the right one? Better get it right or they’ll cut the wrong piece of brain.

But that doesn’t prevent the new psychiatry from recommending a cyngulotomy, the modern term for lobotomy, if the sadness persists for over a year (more on this later.)

The scalpel envy consists of that self-knowledge of the psychiatric profession that what they do does not constitute ‘medicine’, it is not ‘hard science’, that they are NOT scientists as defined by the ‘real’ scientists. It consist of that painful embarrassing awareness that even ‘regular doctors’ look at psychiatrists with contempt because psychiatrists try too hard to be what they are not: like ‘regular doctors’ who can operate on a particular organ and actually cure the illness (mostly, they have their ‘issues’ too).

Why envy of surgeons and not of, let’s say, psychotherapists or of priests, both of who can actually help in soothing sadness? Because there is not $$$ there nor PRESTIGE, that’s why.  Because, as Insel said, psychiatry is not based on science; anyone can do today the job of psychiatrists: treat mental disorders.

It is NOT the DSM that is not based on science, it is the PROFESSION. But don’t expect Insel, or anyone else for that matter in the mental health system, to put it that bluntly. Instead, put the blame on the DSM, boys, paraphrasing that song.

Therein resides the problem with the ‘new psychiatry: it is NOT new and it is going back to the future with lobotomy because ONLY the scalpel can separate them from the old psychiatry, from the psychotherapists and social workers and priests who can do the job BETTER without drugs or scalpel.

It is that envy which has caused so much suffering in our modern society to people suffering from mental disorders or whatever you want to call it.

It comes from the perennial and UNSUCCESSFUL human search to find the seat of ‘sadness’ and joy and the soul. That’s why the meaning of the word ‘psychiatry’ is ‘the medical treatment of the soul’; it has inherited a lot more from ancient civilizations than from ‘modern’ psychiatry.

Lobotomy: you’ve come a long way, baby.

Tomorrow: the new psychiatry,neurosurgery and, again, experimentation on humans.