I am going to quote many things from this book. I like to keep my reviews short, but there is just too much in this book that is too important.
I bought this book because I wanted to read his research on mind drugs as he calls them. And I was not disappointed with what I found, but I found something else that was very refreshing and that was the last chapter of the book, which deals with how to have good mental health without drugs or therapy. I hate to say it but it is all common sense, but that is what most people use last these days. He explains how having a focus on self is so damaging and that if we want good mental health then we should focus on helping others. Showing others love, instead of looking for love and fulfillment ourselves. We get when we are giving, not when we are waiting to receive. You want to be loved? Then love someone and show them that you love them. You want people to like you and be kind to you? Then be kind to others and do for them, even if they don't do something for you first.
The bottom line: love your neighbor as yourself! Wow, what a concept, and its biblical too!! If only people would follow it. Below are the quotes, but I caution you, if you or anyone who you know is on mind drugs, make sure you don't just stop, you need to be weaned off of them with a doctor's help.
The truth is that there is no objective test for determining depression, schizophrenia or any purely mental disorder - no blood test, urine test or brain scan. (page 45)
Depression, schizophrenia and other mental problems are not due to the "flaw in chemistry" despite all the ads that say they are. Consider the following statements from others who have researched and published on this issue:
"As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of... biologic psychiatry [which] now completely dominates the discourse on the causes and treatment of mental illness... I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of a single mental illness... Patients [have] been diagnosed with chemical imbalances despite the fact that no test exists to support such a claim."
-David Kaiser, MD, psychiatrist
"In reality, science does not have the ability to measure the levels of any biochemical in the tiny spaces between the nerve cells (the synapses) in the brain of a human being. All the talk about biochemical imbalances is sheer speculation aimed at promoting psychiatric drugs"
-Peter Breggin, MD psychiatrist
"Many physicians tell their patients that they are suffering from a chemical imbalance, despite the reality that there are no tests available for assessing the chemical status of a living person's brain... The evidence does not support any of the biochemical theories of mental illness."
-Elliot Valenstein, PhD, neuropsychologist
"In recent decades, we have had no shortage of alleged biochemical imbalances for psychiatric conditions. Diligent though these attempts have been, not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven to be false."
-Joseph Glenmullen, MD, psychiatrist
"The day will come when people will look back at our current medicines for schizophrenia and the stories we tell to patients about their abnormal brain chemistry, and they will shake their heads in utter disbelief."
-Robert Whitaker, award-winning medical journalist
"The values and ideology of biological psychiatry are transmitted in our clinical language and educational institutions. Largely unquestioned, these ideas form the basis on which our field trains future psychiatrist."
-Susan Kemker, MD, psychiatrist
"The ascendant belief that 'mental illnesses are brain diseases' is due far more to the cultural belief that only biologically based illnesses are 'real' illnesses than to any empirical findings that the causes of mental disorder are brain based. The view that real illnesses must have biological causes is, paradoxically, a cultural construction. Advocacy groups lobby for genetic and biological views of mental disorder because if a mental illness is regarded as an organic brain disorder, then it is presumably less likely that the individual will be blamed and stigmatized for the condition. It is no wonder that people often make prodigious efforts to show that their illnesses are really physical."
-Allan Horwitz, PhD, sociologist
"[Americans are] convinced that the origins of mental illnesses are to be found in biology, when, despite more than three decades of research, there is still no proof... The absence of any well-defined physical causation is reflected in the absence of any laboratory tests for psychiatric diagnoses- much in contrast to diabetes and many other physical disorders"
-Charles E. Dean, MD, psychiatrist
"There are no external validation criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder... Psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, grants, etc., etc. Psychiatrists have become the minions of drug company promotions."
-Loren R. Mosher, MD, psychiatrist
"Despite research that discredits genetic bases for human behavior, [the biological view] of mental illness has become solidly entrenched over the past several decades, not just within the psychiatry and medical profession, but within the general public as well"
-Ellen M. Borges, PhD, sociologist
"At the present time there is no proof that biology causes schizophrenia, bipolar mood disorder, or any other functional mental disorder."
-Colin A. Ross, MD, psychiatrist
Or, concerning dopamine and schizophrenia, one popular textbook author writes that a biochemical key is involved, and the "key to schizophrenia involves the neurotransmitter dopamine." Another widely used textbook makes the follow succinct statement concerning serotonin: "Too little is linked to depression."
If you took a psychology class while in college, you may be surprised that I would suggest these "facts" are not considered true today and haven't been for a long time. But you will likely be even more surprised to learn that it was nearly four decades ago that the top researchers in the field, including Dr. George Aschroft, whose work led to the theory that depression may result from low serotonin, had rejected the theory. Dr. David Healy, an academic physician who has a doctor's degree in neuroscience and has written 13 books with psychopharmaceuticals, discussed this fact in his book Let Them Eat Prozac:
By 1970 Ashcroft had concluded that, whatever was wrong in depression, it was not lowered serotonin. More sensitive studies had shown no lowering of serotonin. Indeed, no abnormality of serotonin in depression has ever been demonstrated... A gap opened up between the science base and public understanding - a gap crucial to the later development of media talk about lowered serotonin levels. (page 53)
Here are just a few facts worth pondering. (Study these fully referenced facts carefully. I have never seen a comparable listing. When added together, they point to the absurdity of the chemical imbalance theory.)
Even people with no history of any mental problems may have very high or very low levels of various neurotransmitters.
Supposedly low serotonin levels cause depression and high dopamine levels cause schizophrenia, yet some people with depression have high levels of serotonin and some people with schizophrenia have low levels of dopamine.
Drugs aimed at just one neurotransmitter (serotonin or dopamine generally) may affect numerous neurotransmitters.
Stress by itself can dramatically change brain chemistry - causing dopamine levels to rise and causing serotonin levels to fall.
Stress in early life is correlated with high dopamine levels during college years.
Massages raise dopamine and serotonin levels.
Eating can cause dopamine levels to rise. Just seeing or smelling food we like causes dopamine levels to rise.
Exercise can keep dopamine levels from declining and keep serotonin levels high.
Listening to music with a slow rhythm does not significantly increase epinephrine levels in the listener, but listening to fast rhythm music does.
Getting cold (a physical stressor) causes dopamine levels to rise, though staying cold for days reduces dopamine levels.
Get the point? To assume, as most textbooks and advertisements still do, that unexplainable changes in a neurotransmitter level are what cause mental problems is absurd. It is a view that caught on and is still repeated daily, but it should have been buried many years ago. In fact, over two decades ago we learned that both serotonin and dopamine receptors diminish with age. If the traditional (but wrong) explanation were correct, all old people should be depressed - and none should be crazy! (page 55-56)
**Note: If you just noticed that the author is now saying that they know certain things change the levels of things like dopamine and serotonin in the brain, yet before he claimed there was no way to measure such levels in living brains, you might think that you have caught him in a contradiction, but he explains this. He has a whole section on it, but I want to just give you the bottom line here:
Animal studies (where the animals can be put to death immediately before or after sleep or just before or after eating) find that eating, sleeping and other normal activities as well as stress - inducing events can raise or lower serotonin levels. It appears likely that anything we do - eat a large lunch, take a brisk walk, get upset, become bored, have an interesting conversation... anything we do - will affect our constantly changing brain chemistry. (page 59)
During medical school students are showered with free gifts from the drug industry. They attend presentations by pharmaceutical representative regularly (44% attend two or more each month). This same study noted, "Students regard the pharmaceutical industry as one of their most important sources of pharmaceutical information."
More and more medical schools are not even teaching pharmacology and are allowing the drug companies to educate our future doctors through industry - sponsored lectures, meetings and lunches. Indoctrinate them early, and most of them will be compliant for life. One critic of this system has declared, "Replacing medical education with industry promotion in the guise of scholarship causes demonstrable harm to trainees, the public, and the profession." (page 96-97)
Here is an example of where I see bias. St. John's wort (hypericum perforatum) is taken by large numbers of Americans for depression. It makes sense to compare its effectiveness to the leading antidepressant pill (Zoloft) and to a placebo. A "Hypericum Depression Trail Study Group" was formed, research was conducted, and the results were published by the Journal of American Medical Association.
The experiment found that Zoloft, St. John's wort and the placebo all produced equivalent effects. However, the conclusion states, "This study fails to support the efficacy of H perforatum in moderately server major depression." What did they not state? They neglected to state, "This study fails to support the efficacy of Zoloft in moderately sever major depression." Why did they choose to point out that St. John's wort only worked well as a placebo but not point this out for the antidepressant? That may be the subtle, perhaps unconscious preference for advertized drugs which results from the mere-exposure effect. (page 99)
The absences of scientific skepticism is most apparent when we examine the health consequences of taking these drugs. I have long known that very few individuals taking mind drugs have any awareness of the brain damage and other side effects of taking antipsychotics or antidepressants. I learn that truth again every semester when lecturing students on this subject. However, I was amazed to discover that psychiatrists, the medical specialty which should have the most intimate knowledge of this subject, are, as a group, just not aware of the research.
For example, two side effects of antipsychotics which have received much attention include significant weight gain and the hugely increased risk (4 to 6 times) for developing diabetes. Yet, a nationwide survey of 300 psychiatrist chosen at random found only half (51%) had any knowledge that taking antipsychotics can cause their patients to develop diabetes. Only a little over half (59%) were aware that these drugs cause weight gain. Even more disturbing, only 2% knew that diabetic ketoacidosis, a condition that can cause a patient to enter into a coma or even cause death, can result from taking antipsychotic drugs. All of these findings have been widely reported in the research literature. (page 101-102)
Nor do we get objective science if those studies which find data that would be harmful to a drug's sales do not get published. Dr. Peter Wilmshurst, a cardiologist and researcher, testified he has been offered large financial bribes not to publish results that were unfavorable to the drug under investigation. He also testified before the government committee that he was familiar with a case in which three other professors of cardiology did not publish their findings after the sponsoring drug manufacture saw the unfavorable results. (page 138)
Dr. Andrew Mosholder, an FDA drug safety officer, was aware of various studies which indicated that antidepressants could increase suicide and aggressive behavior. In view of the growing number of users, Mosholder contacted drug manufacturers and requested that they provide additional data from their drug trials. When he completed his study, he was convinced that the British had it right. The drug companies' own data revealed the dangers which most physicians simply did not know existed. He was to present his findings at an FDA advisory committee meeting scheduled for February 2004. However, when his superiors learned of the conclusions he was going to share, they would not allow him to make his presentation. (page 144)
Between 1999 and 2001 Pfizer had conducted two studies to determine the effectiveness of the antidepressant Zoloft in treating depression in children. Neither study found that the drug worked any better than a placebo. Nevertheless, in 2002 the drug company petitioned the FDA to grant approval for the use of Zoloft by children. The FDA refused to do so. Meanwhile, as a result of its various marketing efforts, physicians all over America began prescribing Zoloft and other unapproved antidepressants for children anyway. (It's foolish, but not illegal.) Over 10 million of these "off-label" antidepressant prescriptions were written for children in 2002 alone. Pfizer knew their drug Zoloft was not shown to help but was found to harm children. The FDA also knew these facts, but neither Pfizer nor the FDA ever revealed to the public the results of the research (except for data released by the FDA under Freedom of Information Act requests.)
Then something truly mysterious occurred. Pfizer combined the results of the two studies, juggled the statistics and published an article which found Zoloft was effective in treating depression in children. This article appeared in one of the world's most prestigious journals, the Journal of American Medical Association. Greg Walden, the congressman from Oregon, was clearly skeptical. He asked the Pfizer representative to explain how two individual studies which found that the drug did not work could suddenly, when combined, find that the drug worked very well.
Walden: And is it correct that neither study showed efficacy?
Pfizer: It is correct that neither study showed a statistically significant difference between Zoloft and placebo.
Walden then read from the JAMA article that announced Zoloft "was found to be more effective than placebo." "How do you arrive at this conclusion?" Walden asked. The Pfizer representative tried to explain why this was not illogical, but Walden didn't buy it. Neither did Henry Waxman, the congressman from California.
Waxman: So it is not true that you pooled two negative studies and published them as positive.
Pfizer: That is true, but that was a scientific decision that was made before we knew what the outcome would be. (page 158-159)
One such study was done by the Department of Psychiatry and Behavioral Sciences at Duke University. The researchers used 156 men and women age 50 or older who had been diagnosed with major depression and then randomly assigned them to an exercise only group, an antidepressant only group (they received the antidepressant Zoloft, the most prescribed antidepressant in the U.S.) or an exercise plus antidepressant group. Those in the exercise only group were to get 30 minutes of exercise three times each week. After 16 weeks when depression levels were again assessed, it was found that he exercisers had improved as much as the other two groups.
But this is not the end of the story. At ten months (six months after the first study was concluded), depression was assessed once again. The researchers were surprised to find that the group who was asked to exercise had made more improvement than either of the other groups. And not only were the patients who engaged in exercise alone gar better off emotionally at 10 months, they were far less likely to have had a relapse back into serious depression. The high relapse rates associated with antidepressants are not advertised, so you may not even be aware that it is not at all uncommon.
Why would exercise alone prove to be even better than exercise and Zoloft? The researchers admitted that they were very surprised by this unexpected finding. "It was assumed that combining exercise with medication would have, if anything and additive effect." The researchers speculated that taking the antidepressants might actually have undermined the important aspect of overcoming depression. As they put it, instead of patients thinking, "I was dedicated and worked had with the exercise program; it wasn't easy, but I beat this depression," they lost the benefit of feeling they made an important accomplishment without drugs and thought instead, "I took an antidepressant and got better." (page 173-174)
Today I prefer to share studies that are sometimes old studies but speak more clearly to the amazing power of placebos. For example can a placebo (saline) help control pain? The answer is a strong "Yes," being up to 70% as effective as morphine. Even more surprising, give patients with high cholesterol a "cholesterol-lowering" placebo, and their cholesterol levels will drop. Or test asthma patients with an inhaler which they are told will cause brocohoconstriction or bronchodilation, and you will bring on bronchoconstriction or bronchodilation - even if the inhaler contains no active chemicals. (page 183)
A study from the 1950s is even more dramatic. It involved a surgical procedure which became common for controlling the pain of angina (chest pain due to inadequate blood flow to the heart). The procedure was known as internal-mammary-artery ligation. By simply making small chest incisions, a cardiologist could reach down with some suture and tie off the two mammary arteries. It was assumed the procedure would lead to greater blood flow to the heart because it was well established that it provided a great deal of relief to patients. Then Seattle cardiologist and some of his colleagues decided to see if any of the relief was due simply to a placebo effect. Patients suffering with angina were taken to surgery, had the incisions cut into their chests, but unknown to them, some never actually had the surgical procedure. It did not matter. They improved as much as all the other patients. The surgery had never worked as hoped (new blood vessel formation), but those who had the surgery had less need of nitroglycerin, could exercise longer without pain and had improved electrocardiograph results - whether or not they had the real operation.
All of these studies point to actual physiological changes resulting from the innocent little placebo. (page 184)
Most of the drugs Americans take today were approved by FDA committees whose make-up includes individuals who were paid large fees or given stock in the drug companies whose drugs they were asked to approve or disapprove. Today most drug trials are designed, not by independent researchers, but by the drug companies which hope to market and profit from the new drugs. Most of those doing the research are even paid, not by our government, but by the drug companies themselves. The data coming out of these studies typically cannot be viewed by independent researchers. The drug companies own and control the data. (page 196)
Today many physicians freely prescribe Ritalin or other stimulants without any awareness that 7.8% of children given them will develop tics, including those on low doses, or that a smaller number will develop other movement disorders. (page 213)
The adverse side effects of antidepressants include movement disorders. Agitation, sexual dysfunction, improper bone development, esophagus and stomach bleeding, and a host of other even lesser known problems. These are not rare events, but most real harm comes only after months or years of use, a fact which can lead to the false impression that antidepressants are quite safe. (page 214)
If you examine the PI (package insert) for Prozac or Zoloft, you will not find "parkinsonism" or "tardive dyskinesia" included in the tables which list adverse events. However, you will find the term "tremor." In the case of Prozac you can see that the trials Eli Lilly conducted (and reported to the FDA to get their drug approved) examined Prozac's effects compared with a placebo for 5 or 6 weeks. In only 5 or 6 week trails, 11% of those taking the drug developed tremors. That concerns me. (page 216)
Other minutes [of meetings] revealed that the committee seeking to develop Prozac as an antidepressant could never have dreamed their chemical would some day be so successfully marketed that it would eventually be seen as a true miracle drug. Their own minutes declared Prozac did not appear to help depression but did result in several adverse reactions. (Remember as you read the following minutes that fluoxetine is the generic name for Prozac.)
None of the eight patients who completed the four-week treatment showed distinct drug-induced improvement... There have been a fairly large number of reports of adverse reactions. These have been varied, and their relationship to fluoxetine is not clearly established. The first depressed patient to receive fluoxetine showed dystonia resembling an extrapyramidal reaction... [meaning the patient experienced involuntary muscle movement which likely included twitching and twisting, which ceased during sleep]. Another reported enlarged thyroid and liver... One patient developed psychosis manifested by paranoid delusions... [meaning the patient had lost touch with reality and had to an extreme irrational fear that others were seeking to harm him in some way]. Akathisia [ceaseless, agitated movement that can be unnerving] and restlessness were reported by some patients. (page 232-233)
Most Americans are very aware of the much reported FDA warnings concerning suicide risk for children on antidepressants. Based on 24 trails the FDA stated that they believe the risk was twice as great for children on antidepressants as compared with those on placebo. It was unfortunate that the FDA did not issue a similar warning for adult use as the German drug regulators felt would be necessary if Prozac were ever to be approved in Germany. That was 1985, two years before Prozac began to be prescribed in our nation. The German regulators concluded that if Prozac were to be approved (as it was in 1990, 5 years after they had first rejected it), it would be "on the condition that physicians be warned of the risk of suicide." Those should have been prescription-stifling warnings. But marketing trumps science. The German warnings were ignored by our FDA as were the many research reports suggesting the suicide risk was very real. (page 234)
The date is September 13, 2004. The FDA's Dr. Robert Temple announced to the nation that an analysis of 15 studies found that antidepressants clearly increased suicidal behavior. (page 236)
Absent from this history on how mental problems have been treated is what became known as the "moral treatment" movement. It is the one approach that many honestly be termed a success. Evidence of its effectiveness is found in two facts I shared in the preface. (1) Those who develop schizophrenia in many third world countries (India, Nigeria, Columbia) which have little access to antipsychotic drugs have much higher recovery rates (where family members commonly care for the mentally disturbed) than do those in the United States and other wealthy nations who are prescribed those drugs. (2) Two hundred years ago, long before antipsychotics were invented, when someone lost his or her mind and was sent to a moral treatment center or state hospital practicing moral therapy, he or she was much more likely to recover than are Americans who lose their minds today. (page 286-287)