Wednesday, October 27, 2010

Thanks to Stupid Advocacy, Your Life is Worth One Lousy Penny

This is the seventh in my series based on talking points raised by Robert Whitaker's eye-opening "Anatomy of an Epidemic."

In late April or early May 2003, I was in San Francisco for six days of the American Psychiatric Association's annual meeting. Two or three days into the conference, as I was making my way across the street from the north complex of the Muscone Convention Center to the south, I came upon an organized demonstration of psychiatric survivors brandishing "Psychiatry Kills" and similar signs.

Their personal experience certainly justified their outrage against psychiatry. An earlier generation was subjected to the horrors of captivity in state institutions. A later generation experienced a different type of abuse in the form of the bad practice of medicine, often applied in a not so subtly coercive "take your meds and shut up" environment.

But I was here to find out what was going on inside the Muscone Center, not outside. I waited till the marchers passed, then made my way to my next round of listening to very smart people talk real fast in dark rooms.

I heard more from the psychiatric survivors a few months later in the form of a challenge to the APA, NAMI, and the Surgeon General issued by six individuals associated with MindFreedom, including its founder David Oaks. Robert Whitaker picks up the account in the last chapter of "Anatomy of an Epidemic":

Among other things, the MindFreedom group asked for evidence proving that major mental illnesses are "biologically-based brain diseases" and for any evidence that "any psychiatric drug can correct a chemical imbalance" in the brain.

The six individuals threatened a hunger strike unless one of the organizations served up the evidence. The APA through its medical director wrote back that "the answers to your questions are widely available in the scientific literature, and have been for years," then suggested a textbook and the Surgeon General's 1999 Mental Health report (which ironically stated "the precise [etiology] of mental disorders are not known").

The Six went on their "fast for freedom," which lasted till medical complications broke out. Then they issued a press release stating that the APA, NAMI, and "the rest of the psychiatric community" were indifferent to those "who would deny that serious mental disorders are real medical conditions ..."

According to Whitaker:

It was clear to all observers who had won this battle. The strikers had called the APA's bluff, and the APA had come up empty.

I'm glad Whitaker saved this account for the last chapter rather than the first. Otherwise I would have tossed his book in the trash. Clearly - unless you subscribe to Thomas Szasz - the biology of the brain influences behavior. We think with our meat (thanks, Terry Bisson, for the metaphor). We feel with our meat. We perceive with our meat. And when our meat malfunctions bad things happen. It doesn't matter what you call it, bad things happen.

If psychiatry is stupid, then the antipsychiatry response is equally, if not more spectacularly, stupid. You don't fight stupid with stupid. If gay activists had been in denial about a mysterious phenomenon that was decimating their population back in the eighties, there would have been minimal funding for HIV/AIDS research and treatment. In fact, at the very beginning of the epidemic the gay population was in denial. Then they got smart. They got loud. They literally intimidated the government and medical establishment into action. In 2009, the NIH allocated $3.19 billion for HIV/AIDS research. By contrast, research for depression (including bipolar) was a mere $402 million.

Million, not billion. These are ratios that have held fairly steady over the years. Approximately 1.5 million individuals in the US are affected by HIV or AIDS. About 19 million in the US in any given year deal with depression or bipolar. That translates to the NIH spending $2,013 per patient for HIV/AIDS research vs a paltry $21 per patient for depression and bipolar. Putting it another way, for every dollar the NIH invests in an HIV/AIDS patient, depression and bipolar patients get one penny.

One penny. That's the value the government and medical establishment places on our lives, in large part based on the stupid and in-denial showboating advocacy that Whitaker so enthusiastically endorses. No, Whitaker, no one "won" that battle. We all lost, bigtime. If the loudest in our midst are denying that mental illness exists, then why fund its research and treatment? Obviously the people responsible for funding things have asked themselves that very same question. Don't get me started.

Next: Too late, you got me started ...

Previous blog pieces:

The Study Psychiatry Wishes Would Just Go Away - Part II

The Study Psychiatry Wishes Would Just Go Away

Is the Cure Worse Than The Illness?

The Whitaker Controversy: An Irony in Search of Nuance

If Meds Work as Well as Our Psychiatrists Tell Us, Why Do We Have MORE Mental Illness Today Rather Than Less?

RIP: Chemical Imbalance in the Brain


Anonymous said...

Even though Whitaker wants to present his book like it is as objective as a systematic review,in person and on video, he sounds like he has some resentment against psychiatry.

While there could be some truth to what he is saying it doesn't follow that we should abandon the biopsychosocial model that we have at the moment. In the book, at one point, he did strike me as extreme as Thomas Szasz.

Just Me said...

It is sad and shocking to know how little is being spent on studying mental illness and how to prevent/correct it. It pains me because I have lived most of my life with severe mental illness and have fought for the little help I have been able to receive. Fortunately, I have wised up and am doing much better due to receiving ECT.

Thank you for taking the time to write about these things. I just recently started following your blog but have been reading quite a bit on your website. You are 100% correct that knowledge is necessity!

John McManamy said...

Hey, Moodindigo. Yes, he wears his resentment like underwear on the outside. This is both good and bad. We need an intelligent counter to the psychiatric party line, and Whitaker certainly provides this. The guy does his homework and makes very convincing arguments.

The points he raises in his book need to be discussed on every level, and I'm doing my best to get them discussed here. Agree or disagree with him, we need to be having these conversations.

Another very good point - he gives voice to the people psychiatry has turned a deaf ear on.

But there are times in his book where Whitaker suffers highly questionable lapses. His cheap shots at NAMI is straight antipsychiatry hate speech, and shame on Whitaker for this. And his uncritical approval of the antipsychiatry party line that denies the role biology plays in mental illness is plain daft.

In reading the book, I get the impression that he is trying to please MindFreedom's David Oaks. This is an easy trap for writers to fall into, and I constantly have to catch myself, not always successfully.

Thus, when I'm writing, if I am thinking, "So and So will be really pleased with this," then I need to step back. Will So and So be pleased for the right reasons or the wrong reasons?

In "Mad in America," Whitaker credits Oaks for starting him on his inquiry. This is fine, but I would be happier reading the occasional deviation from the world according to MindFreedom. Too often, he comes across as their publicity department.

Don't get me started on Szasz. :)

John McManamy said...

Many thanks, JustMe. I'll be following up on the research angle in my next piece. Stay tuned ...

ym said...

loved the penny analogy :) yanni

ym said...

loved the penny analogy :) yanni

Tony the cretin said...

Reasonable discourse and criticism? In America? Impossible! Just ain't in our nature in the good ol' USA. ;)
I am glad you are trying to do the impossible. Puts the issues into their proper perspective. All about nuance that trips up most everyone.

Willa Goodfellow said...

I'll be working on that advocacy campaign over on my blog in the next couple months. Need to clear that damned cost/benefit algorithm off my plate. Then, let the ideas rip!

I have a hunch that Madison Avenue is full of us BPII's.

John McManamy said...

Hey, Tony. Is there a patron saint of lost causes? :)

John McManamy said...

Hey, Willa. Git rippin'. :)

That's why it MADison Ave. :)

Anonymous said...

I'm relieved to see someone (else) attempting a more nuanced evaluation of the strengths and limitations of Whitaker's work. Certain activists' uncritical affirmation of the truth and putatively evidence-based nature of Anatomy's claims (without having ever read the original research in question, which Whitaker so often misconstrues) is really troubling to me (just as troubling as others' uncritical acceptance of an oversimplified biomedical model). Surely we can do better.

John McManamy said...

Hey, N. I'm so glad you found your way here and left a comment. I've been following the exchange between you and Whitaker on your blog with great interest and look forward to reporting on it here.

(Readers: Check out "Ruminations on Madness" at

Clearly, Whitaker is guilty of cherry-picking research results, as you mention in your blog. The cherry-picking can also be interpreted as inspired dot connecting, but it is often hard to tell the difference.

Stay tuned for further nuanced evaluations ...