The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment [Paperback]

This book is important and should be essential reading for all psychiatrists, politicians, service providers, and user groups. Why? Because Dr Joanna Moncreiff's central tenet is right, and the implications for service delivery are profound. There is little or no reliable evidence to suggest current drugs specifically treat an underlying biochemical abnormality. They are better seen as toxic or potentially toxic agents causing changes in brain function which may in some circumstances mask or alleviate symptoms. Rather than the current push within psychiatry to use available psychotrophic drugs to 'treat' as many people as possible, as early as possible, and to force extended compliance, the complete evidence base, in fact, suggests that use of drugs should be more limited and more cautious than it is at present, and that this would lead to better functional outcomes. This is counter-intuitive to many, which only serves to underline the importance of the book.
This book is psychiatry's Silent Spring. Joanna's book portends Scrambled Minds rather than a Silent Spring, but in both books we see illustrations of irresponsible behaviours and practices in the face of jaw dropping flaws and omissions in the evidence- base. Including the the planning, execution, interpretation, and dissemination of 'scientific' trials. The true nature of short term effect, long-term efficacy, safety, and cost/benefit is obscured by bad science and or the complexity of the issues involved.
Psychiatry is particularly vulnerable to systematic misreading and or distortion of the evidence-base because of the uncertainties surrounding diagnosis, mechanism of drug 'efficacy', identification of psychiatric and physical side-effects, and assessment of outcomes. The potential for habituation and or forced treatment, particularly long-term in the community, adds a unique ethical dimension. I have read much of the primary literature first hand, including the papers underpinning N.I.C.E guidelines, and Cochrane Reviews, and independently reached very similar conclusions to Joanna.
The book is closely argued and well referenced. Even if you disagree with some of it's overall premises, it is not legitimate to dismiss it. I urge you to read it if only as a prompt to a critical evaluation of the status quo, never a bad thing, and almost always an illuminating exercise .

Psychiatrists are irrational about drugs: this is the central message of `The Myth of the Chemical Cure' by Joanna Moncrieff. Desperate to be regarded as real doctors treating real diseases, they assume that mental distress is caused by an illness and further assume that the drugs they prescribe reverse its course. Having made these assumptions they look for the evidence to support them and, off course, find it in bucketfuls. But when you or I, guided by Joanna Moncrieff, look at the same evidence without making the same assumptions it turns out that the evidence doesn't actually say what psychiatrists claim it does. On the contrary, it suggests that there is no pathology underlying the symptoms of so-called mental distress and that psychiatric drugs seriously harm those taking them. (There's nothing mysterious about what actually does cause severe mental distress: the same slings and arrows of outrageous fortune that make you and me upset, discouraged or fearful. It's just that some people's slings and arrows have been worse then most. Surprisingly, the mad are dead normal. See Richard Bentall's `Madness Explained: Psychosis and Human Nature'.)

About 10 years ago my neuroleptic medication was accidentally discontinued and in the lucid period that followed I read `Toxic Psychiatry' by Peter Breggin. Realising for the first time how damaging these drugs are I told my psychiatrist to write `The End' in my case notes. I managed to wean myself off my drugs and since then I have recovered my capacity to function normally and enjoy life. (It is important that you withdraw slowly: neuroleptics in particular, but other psychiatric drugs also, make semi-permanent changes in the brain; you must withdraw by small increments well spaced out to give your brain chemistry time to normalise. Don't rush it and risk withdrawal symptoms.)

Since then I have wondered how long I would have to wait before society at large came to understand what has really been going on and make psychiatrists account for how they have been misleading us. I believe that `The Myth of the Chemical Cure' is a milestone to this wider understanding: my guess is that in 20 years' time it will be regarded at a classic.

For three decades American psychiatrist Peter Breggin has crusaded against the use of drugs in psychiatry, and now in Britain Joanna Moncrieff continues this educational campaign. For her's is no anti-psychiatry rant. This is sweet reason: page after page of hard facts and logical analysis, stripped of rhetorical flourishes or appeals to emotion. She is asking her fellow psychiatrists some very hard questions.

She points out that psychiatry's covert mission is less the alleviation of human suffering than the exercise of social control. Society has to find some way of dealing with those people who cannot adapt to the demands of a business-based, consumer society that requires us to do our jobs, pay our taxes and conform to social norms. Aided by the commercial imperative of the drug companies and with the complicity of the political elite, psychiatry has devised a fiendishly clever system of zombiefying people who are a nuisance and making them biddable; because they would refuse the drugs if they knew the real purpose was simply to render them passive they are persuaded that they are ill and must take medication to keep well. If psychiatrists did this wittingly surely they would be wracked with guilt; thus they have little choice but to believe that emotional distress is caused by faulty brain chemistry and that their drugs alleviate distress. And since they have to believe it, they do. Are we not all pre-disposed to believe what we find it convenient to believe? Psychiatrists, it turns out, are just as human as the rest of us.

What leads me to believe that psychiatry is more about social control than about the alleviation of suffering? I have a friend who has been labelled schizophrenic. Once in a blue moon she get angry with the bus drivers at the local bus station and shouts at them. The last time this happened a bus station supervisor employed by the local council reported her to the psychiatric service and her medication was increased on the grounds that if she shouted at the bus drivers again THE PSYCHIATRIST would get into trouble with the police! My friend begged the psychiatrist not to put her medication up. She felt worse, not better, on the increased medication, but how she felt wasn't the point. Public order had to be preserved. And although voluntary patients are supposed to have the right to decline treatment, this is another psychiatric fiction. Neuroleptics induce indifference and undermine the patient's will to resist. You have to admire the cleverness of the system.

To clarify the real nature of psychiatric drugs Dr Moncrieff introduces the concept of the `disease-centred' model of drug action that assumes that drugs reverse an underlying pathology and contrasts it with the `drug-centred' model that avoids suppositions and lets the evidence speak for itself. She finds that psychiatric drugs simply intoxicate those who ingest them; on occasion this may be beneficial but more often is harmful. She thus argues that psychiatric drugs are much less effective than claimed and their long-term effects on patients' mental and physical health are seriously deleterious.

Much of the more technical bits of this book examine the ways in which randomised controlled trials have been manipulated and misinterpreted to `prove' that drugs are effective and more-or-less safe. There is something sad and desparate about psychiatry's quest for scientific justification. The profession surrounds itself with a fog of impressive-sounding neurobiological terminology and goes in for fancy statistical analysis, yet when this fog is penetrated by an intellect as acute as Joanna Moncrieff's it turns out that the data their clinical trials produce don't support the conclusions they draw from them. Psychiatrists may be good at social control but they're rubbish at science.

Just how long it will be before we achieve humane treatment for the mentally distressed I cannot say, but I continue to believe that psychiatry's critics will eventually persuade enough of us that psychiatry doesn't work to enable us to force them to change. If everyone who finds `The Myth of Chemical Cure' as persuasive as I do sends a copy to an opinion-maker they judge might be receptive then perhaps we can change a few minds. I am going to send a copy to my local MP. He just might listen.

So firmly entrenched in our culture is the myth of mental illness that I always hesitate to come right out with it and tell people that mental illness is an unfounded supposition and that psychiatric drugs are disabling rather than therapeutic for fear of being dismissed as a crank, but in future I will speak with greater confidence since I can now add: `And, if you don't believe me, read "The Myth of the Chemical Cure" by Joanna Moncrieff.'

THE PSYCHIATRIC TRUTH THAT DARES NOT SPEAK ITS NAME.

Student massacres in the US since Columbine, are invariably heart-wrenching - last month there were four such multiple killings in a single week - what's happening and where will it end? There is one obvious explanation - but so far, it's proved too hot to handle. Perhaps now that Prozac and other psychiatric drugs are unravelling, an even harsher medical truth can emerge.

First let's get a grip on what goes on. Suppose all these student killers were drunk - that would make immediate sense. Alcohol is well known to confuse the mind, stifle normal rules of behaviour and thereby unleash violence. This would explain it all - acting, violently, while not in full control of their faculties - this is entirely characteristic of intoxication - and it closely resembles what all the perpetrators did. And the connection is closer than you think.

Alcohol itself does not feature in these massacres - but Dr Joanna MonCrieff's book makes the link painfully obvious, concluding (p224). ". . . exposing our miracle cures as psychoactive chemicals, which distort normal brain function by producing a state of intoxication." [my emphasis]. This is a tightly argued book providing irrefutable evidence that no psychiatric drug is superior to alcohol. Worse - whatever effects they produce arise through varying degrees of confusion or sedation - the ominously termed drug-induced `frontal lobe syndrome'. This is the awful psychiatric truth that dares not speak its name.

The myth she so punctiliously punctures has a long history of obfuscation. Fifty-five years ago the `Nine Hospital Study', which started the whole thing off, did not prove that the new `tranquilisers' cured schizophrenia. What they showed was that after 6 weeks there were fewer symptoms - the sedative effect, but that after 12 months the drugged patients were worse - the zombie effect. Psychiatrists and legislators have shamefully ignored this ever since.

Dr MonCrieff leaves no wriggle room for purblind psychiatrists or legislators. In my 45 years as a psychiatrist, I've never seen a clearer condemnation of today's psychiatry. The book's target audience is academic, and sadly its tone and price reflect this - but the last chapter says it all, and should be compulsory reading for every psychiatrist, every politician and every consumer of these increasingly potent drugs. Dangerous mandatory and toxic medical practices will otherwise continue unabated - until others match Dr MonCrieff's courage, and publicise this devastating message.

Dr Bob Johnson Wednesday, 27 February 2008

Consultant Psychiatrist,