Ruined Lives: Big Pharma, Psychiatry and Overdiagnosis

Bipolarized: Rethinking Mental Illness

Directed by Rita Kotzia (2014)

Film Review

This documentary tells the tragic story of a man with presumptive PTSD who was misdiagnosed with bipolar disorder at age 17 and spent the next 16 years drugged up with lithium carbonate. In 2010, after two attempts to stop the lithium caused incapacitating depression, he admitted himself to a specialist clinic in Costa Rica that helped him gradually taper and discontinue the lithium.

Although family and friends noticed an immense improvement in his functioning (he was less depressed and more alert, energetic, and focused), without the medication he continued to experience disabling spells of anxiety.

He tried numerous alternative treatment options:

  • He saw a naturapath who gave him 20+ intravenous chelation treatments for toxic blood levels of lead and mercury.
  • He saw a shaman in Colombia who treated him with psychic surgery.*
  • Yoga (partially effective)
  • Acupuncture
  • Transcranial magnetic stimulation**

Finally he saw a psychologist specializing in trauma therapy who diagnosed PTSD and helped him work through childhood micro-traumas he experienced with an extremely physically and emotionally abusive father.

In May 2012, he joined a protest at the American Psychiatric Association annual conference  with hundreds of other psychiatric patients whose lives were ruined by misdiagnosis.

The film blames the tendency for psychiatrists to misdiagnose and overdiagnose serious mental disorders on the DSM (Diagnostic and Statistical Manual), the current “bible” of psychiatric diagnosis. Many psychiatrists acknowledge that recent DSM editions (DSM III through DSM V)  have been heavily influenced by Big Pharma. At present, the vast majority of psychiatric research is funded by pharmaceutical companies.

The current DSM V is very different from DSM II, the manual I used during my residency. Prior to the release of DSM III (published two years after I finished training), psychiatric diagnosis was based on a patient’s longitudinal psychosocial history. In other words, with the help of family, a psychiatrist took a full his of a patient’s emotional and social functioning. Beginning with DSM III, psychiatrists were trained to diagnose a patient based on a single interview and DSM III’s Chinese menu system of symptom clusters.

However even under DSM IV and DSM V criteria, it’s totally inappropriate to diagnose a patient bipolar based on a single manic episode. To qualify for this diagnosis, there needs to be a clear pattern of repeated mood swings.

For me the most interesting part of the film was a quote from Robert Whittaker (in Mad in America) about a WHO study revealing Third World schizophrenics have better treatment outcomes than those from the industrial North. The former receive mainly psychosocial treatments; while the latter are nearly always treated with psychotropic medication.


*Psychic surgery usually involves the channeling of spirits to eliminate acute and chronic illnesses.

**Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression and anxiety.

 

Human Beings as Machines

Trapped: What Happened to Our Dream of Freedom

Adam Curtis

BBC (2007)

Film Review

Part 2 The Lonely Robot

Part 2 takes a close look at the role American economist James Buchanan played in extending free market economic theory to human biology, politics and governments. The Impossibility Theorem is fundamental to Buchanan’s concept of “market democracy.” According to the Impossibility Theorem, collective will is impossible in a democracy because the desires of millions of individuals are too varied and complex. Buchanan maintained the only way to respond democratically to people’s wishes was to allow them to fully pursue their selfish self-interest in the marketplace.

Clinton Dismantles New Deal Welfare Programs

A direct result of Buchanan’s influence over Margaret Thatcher, John Major, Tony Blair, Ronald Reagan and Bill Clinton was massive cuts in taxes and social services, coupled with a repeal of corporate regulation. The most immediate result was a massive increase in inequality. Corporate elites became much, much richer – while nearly everyone else became much poorer. Ironically the gap between rich and poor would increase far more rapidly under liberal-leaning Blair and Clinton than under Thatcher and Reagan. Clinton will go down in history as the president who dismantled the welfare programs Roosevelt enacted under the New Deal.

Meanwhile overconfidence in computers and so called “behavioral economics” (free market theory) would result in government departments run by targets and incentive schemes. Sociopaths and economists quickly learned how to game the system by cheating on their targets.*

The Selfish Gene Hypothesis

Likewise biological scientists used free market and game theory to promote the Selfish Gene hypothesis. This theory conceptualized a simplistic view of human beings as machines that were controlled entirely by their genes. It held that genes, which were likened to on-board computers, compelled people to act selfishly to guarantee their genes’ survival.

This mechanistic view of human biology would lead to a profound change, led by psychiatrists and drug companies, in the way Brits and Americans viewed themselves. The new checklist diagnostic system the American Psychiatric Association (APA) launched in 1979 (see Part 1), coupled with the aggressive marketing of selective serotonin reuptake inhibitors (SSRIs) would lead people to view themselves as machines – machines that needed to be fixed if they experienced unpleasant emotional states, such as worrying, conflict, insecurity or anxiety.

People Pop Pills to Cope with Deteriorating Social Conditions

Because these checklists deliberately ignored life circumstances that might cause unpleasant feelings, common reactions to life stresses became medicalized. This, in turn, led to an expectation that people would take pills to adjust to steadily worsening social conditions.**

The theoretical basis of behavioral economics began to unravel in the 1990s. The Selfish Gene hypothesis was abandoned when new genetic research revealed that cell’s ability to choose, based on environmental conditions, which parts of the DNA molecule become operational.


*More recent research shows that only two sectors of society are driven purely by self-interest: sociopaths and economists.

** For example, loss of good paying and secure jobs, loss of representation in a rigid and corrupt government and overall loss of control over our lives.

Free link to film: The Trap 2 The Lonely Robot [BBC]

The Myth of Individual Freedom

Another great series of Adam Curtis documentaries about the myth of individual freedom

Trapped: What Happened to Our Dream of Freedom

Adam Curtis

BBC (2007)

Film Review

Part 1 Fuck You Buddy

Trapped is an exploration of the major thinkers behind the ideologies of extreme individualism and consumerism championed by Reagan and Thatcher in the 1980s.

“Part 1 Fuck You Buddy” traces the major influence Game Theory and so-called Public Choice Theory played in the pro-freedom ideologies that propelled both leaders to power. It begins begins by introducing Rand Corporation and their use of Game Theory to fashion America’s cold war strategy. Game Theory is used in poker to predict all possible best moves for each player. Because it allows you to predict mathematically how your opponent will respond, Rand scientists used it to calculate how far the Soviets could be pushed without resorting to nuclear war.

Rand mathematician John Nash (played by Russell Crowe in A Beautiful Mind) figured very prominently in this work. A number of cold war strategies are attributed to Nash, including the Nash Equilibrium, the Prisoner’s Dilemma, Fuck You Buddy and the Sucker Payoff.

John Nash Proves that Altruism Destroys Social Harmony

Like radical individualist Ayn Rand and conservative economist Friedrich von Hayek, Nash argued that altruism was irrational and destructive to social harmony. In fact, he proved mathematically that the only rational choice in any encounter is to act selfishly and betray the other person. He and his fellow Rand scientists also proved nuclear disarmament was impossible – their equations showed the Russians would cheat.

What’s Wrong with this Picture?*

Ironically every time Nash tested the secretaries at Rand, women always behaved “irrationally” and trusted each other. In 1959, Nash was committed for paranoid schizophrenia.** Yet none of the technocrats at Rand never thought to question the validity of his so-called “proofs.”

Enter R.D. Laing

Over the next decade, Nash’s ideas spread beyond Rand and the Pentagon to the broader public, thanks mainly to the work of radical psychiatrist R.D. Laing. Laing’s contribution was to apply Game Theory to family life. Based on questionnaires he administered to hundreds of families, he produced mathematical equations showing that all so-called normal families continuously use complex strategies to selfishly manipulate one another.

Laing, who dismissed psychiatry as a fake science, became the hero of America’s counter culture anti-psychiatry movement. His ideas also led to the widespread mistrust of authority (i.e. anyone over 30) and institutions that characterized the sixties.

James Buchanan and Public Choice Theory

Conservative economist James Buchanan took Laing’s ideas one step further with Public Choice Theory. Buchanan maintained that politicians and bureaucrats who claimed to be working for the public interest were really self-deluding hypocrites acting in their own self-interest. He also argued that the only way to trust public officials was to reward them for behaving appropriately with mathematical targets, incentives and rewards.

Thatcher would became prime minister in 1979 by promising to free the British public from power mad, unsympathetic bureaucrats.

The Chinese Menu System of Psychiatric Diagnosis

Laing would also have a profound influence on both psychiatric and medical practice. In 1979, the growing influence of the anti-psychiatry movement would lead to a new psychiatric diagnostic system. Unlike physical illnesses, which are diagnosed based on history and physical findings, mental illness would now be diagnosed based on symptom checklists resembling Chinese menus. The adoption of this checklist approach also made it possible for people to “diagnose” themselves and to demand drugs and other treatment interventions to make them “normal.”


*The failure of the Fuck You Buddy model to work with women should have rung all kinds of alarm bells. Not that all women are necessarily more inclined to interpersonal trust and cooperation. However at the very minimum, someone should have taken a hard look at the geeky, Aspergerish types who relied entirely on cold mathematical models to explain social behavior.
**Based on everything I’ve read by and about Nash, I’m highly skeptical he suffered from schizophrenia. It seems much more likely he suffered from Asperger’s disorder complicated by bipolar disorder (which often presents with hallucinations and paranoid delusions). Prior to the 1970s, bipolar disorder was commonly misdiagnosed as paranoid schizophrenia. Asperger’s wasn’t formally recognized until 1981.

Free link to Part 1: The Trap 1 Fuck You Buddy [BBC]