on 5 February 2008
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 .
on 21 March 2010
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.'
on 8 March 2008
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
on 5 April 2010
As a practising psychiatrist, this book made for an uncomfortable read. The depth and scale of the deception Dr Moncrieff alleges the profession has perpetrated on itself, its patients and the public at large is truly shocking. The loud and uncompromising message throughout is that none of the major psychiatric drugs in use today work, at least not in the way their (propagandist) names "antipsychotic", "antidepressant" or "mood-stabiliser" would suggest. While agreeing they undoubtedly do something, she systematically dismantles the evidence that they "treat" illnesses in a "disease-centred" way, claiming in fact that, if anything, they probably make things worse, certainly in the long term.
Along the way, Dr Moncrieff outlines who she thinks is responsible for this deception and why. Chief suspect is the pharmaceutical industry who, surprise surprise, did it for the money. A close second are psychiatric researchers and psychiatry as a whole, who were desperate to come up with something that "worked" and also wanted to legitimise psychiatry as a medical science. Finally, in her summation (which verges on something of a rant at times), she says the State was keen to accept and perhaps even promote the medicalisation of social problems in order to avoid having to deal with them politically. However, she fails to mention that the public too generally prefers a medical label for mental health problems rather than what is otherwise perceived as being "all in the mind", which carries considerably more stigma.
There is one apparent inconsistency in the book, or at least something that was not made very clear, which is whether or not Dr Moncrieff thinks there is such a thing as mental illness at all. It is perhaps notable that all the blurbs on the back are from psychology and therapy-based journals, who might view this book as a vindication of their own disciplines at the expense of psychiatry. Ultimately however, it comes down to who do you believe - established orthodoxy or a few dissenting voices? Dr Moncrieff's views might be seen as extreme, but wherever you lie on the spectrum this book is a very worthy addition to the debate.
on 4 June 2009
I hope in time this book will be looked at as a changing factor into how medication is handed out in the mental health arena without a second thought. The book de mists the screen that is up which surrounds medication, its uses and its effects. I would reccomend this book to anyone that works in health, has family/friends in the mental health system, and most importantly people that take the drugs themselves.
This is a very important book that offers people knowledge and facts about medication used in mental health. It is written so that most people can understand without needing a medical degree, it does contain some jargon and statistics, but these are all explained with clarity.
a must have book.
on 29 August 2014
Let’s not beat about the bush – psychiatry has nothing to do with science, and even less to do with patient care. Long ago, that so-called ‘profession’ made a Faustian pact with Big Pharma to push their products, in return for ‘benefits’ of every possible kind. Decades on, the corruption is now endemic, and is so deep-seated that many practitioners have become immune to any possible consideration of wrongdoing.
But in every morass, there are safe places, where one may find solid ground and sure footing. And Dr Joanna Moncrieff is one of those places. As a psychiatrist with a conscience, she has ripped open the ‘can of worms’ which conceals much of her profession. There was a time when the whole panoply of psychiatric drugs was considered for exactly what they were – a temporary relief from the distressing symptoms of emotional anxiety or distress.
But fast-forward from that scenario by 30 years, and we now have psychiatry pushing crude chemicals made in a factory as a permanent ‘cure’ for depression – how ludicrous is that proposition, with the immense complexity of the human brain being reduced to a series of chemical reactions?
In great detail, Joanna analyses the development and propagation of the range of psychiatric drugs, and by rigorous analysis, highlights the deficiencies, drawbacks, and plain fabrications attributed to these drugs, with wholly inadequate oversight by the relevant authorities.
Anyone who is uncertain about whether or not to ingest these drugs needs to read this book: to accept what Big Pharma and chemical psychiatry claim is to subject oneself to a very unpredictable and risky chemical experiment. You only have one brain and one body, and no-one will accept any responsibility for harm induced upon you by powerful drugs which give very dubious and uncertain benefits.
If a patient gets better while on SSRIs, the drugs are credited with a positive outcome (notwithstanding the fact that most people will naturally recover from depression in about 6 months if they are not medicated). If they don’t get better quickly, then another toxic drug is added to the mix, and then another one, ad infinitum. Having converted the patient into a walking chemistry set, and zombified them along the way, so that they no longer show symptoms of distress, the chemical psychiatrist then claims ‘success’. But would these men ‘take their own medicine’? Not very likely – they know too much about them.
The ‘disconnect’ between Big Pharma’s claims about ‘side effects’; and those suffered by patients is absolutely vast. Multiple internet forums attest to lives ruined by this unnecessary SSRI proliferation. Like many others, I knew nothing about these drugs until my ex-partner started ‘treatment’ at a provincial private UK hospital, ostensibly for 12 months of psychotherapy. At her very first one-hour session, she gave her life story, was diagnosed as ‘severely depressed’ (utter bollocks), and her SSRI prescription was immediately raised to the maximum possible dosage.
Within days, she became intensely ill with anxiety and agitation, as the hideous neurological condition ‘akathisia’ took a grip upon her. She should have been taken off the drugs then, but she was not. Within three weeks, she had been ‘zombified’, and had turned cold and hostile towards me, ending our relationship. Over 8 months after her so-called ‘treatment’ ended, she remains utterly indifferent towards me, and I believe that the expensive psychotherapy never happened; her ‘very experienced’ doctor fraudulently substituting the sedative effect of cheap pills, as a ‘rapid chemical cure’, with built-in ongoing dependency.
If you think the worst excesses of psychiatry are confined to the USA, then you had better reconsider. And if you doubt me about the effects of psychoactive drugs upon intimacy between loving partners, then please google ‘relationships destroyed by SSRIs’ (373,000 hits!).
Am I ‘anti-psychiatry’? Dead right I am, and I will stand with Joanna and anyone else who considers these toxic and pointless drugs to be an abusive and barbaric affront to sentient humanity.
on 21 April 2011
Joanna Moncrieff's The Myth of the Chemical Cure is a ground breaking book and to me, is the clearest ever condemnation of psychiatric drugs. It is extremely well written and easy to absorb and the referencing is excellent. I did not want to put the book down once I'd started to read it. I've always wanted to find a book like this; a book which would confirm my own long held belief that psychiatrists have it all wrong about mental illness and that it is not the result of a chemical imbalance. Psychiatric drugs harm the body and often have horrendous side effects; it is important that everyone realises that drugs are not the only answer for mental health problems. Joanna Moncrieff has spoken out and spoken out loudly and her book is essential reading for everyone.
on 28 November 2010
This is a book which all psychoanalysts,psychotherapists and counsellors, no matter what their orientation, should read. The suspicions that many of us have harboured about the vanishingly small capacity of drugs to intervene successfully in issues connected with emotional suffering are comprehensively justified.
This does not mean that we should resort to simply to the talking cure. However it does suggest that we need
(a) Ordinary simple thoughtfulness about how we try to help emotionally distressed and disturbed people;
(b) To continue pointing a very critical finger at the activities of both pharmaceutical companies and psychiatrists seemingly desperate to believe that people have diseased brains rather than distressing experiences of life.
This book should be used as a wake-up call to fund research into the talking-cure.
Many think that this has been found and that its name is "Cognitive Behavioural Therapy". A recently published ebook The Problems of Cognitive Behavioural Therapy, disputes this alternative. CBT boasts an optimistic 50% cure rate and no clear water distancing it from results for rival forms of therapy. Recently researchers have pointed to the same telltale signs of concealed research findings common in the pharmaceutical industry.
This book should be required reading for all mental health professionals.
on 13 July 2010
Dr Moncrieff's book has much to teach clinicians of all disciplines - those that know a lot about medication and those who feel ignorant. It is well-researched but also a great read. My favourite book about psychiatric drugs.
Dr Guy Holmes
on 7 April 2015
Since 1952, when chlorpromazine was first used at a hospital in Paris, psychiatric drugs have spread with remarkable rapidity through the Western world. The number of people taking these drugs in the United States is extraordinary:
All psychiatric drugs: 78 million people (25% of the population)
ADHD drugs: 10 million (3% of the population)
Antidepressants: 41 million (13% of the population)
Antipsychotics: 7 million (2% of the population)
Antianxiety drugs: 36 million (11% of the population)
(Figures from IMS Health for 2013)
The use of these drugs in Europe, while not yet at US levels, increases every year with millions ingesting these chemicals in every major country. What are the consequences of this great wave of psychotropic drugging for the individuals taking these substances and for society more widely?
The honest answer is that we don't know. Most of the research into the effects of these drugs has been funded by the pharmaceutical industry and it is difficult or impossible for independent researchers to obtain access to the raw data. The trials funded by the drug companies typically last from 8 to 12 weeks and so cannot tell us anything about long term effects.
But a number of authors have started to question whether this great medical experiment is doing more harm than good. Remarkable critiques of the current approach have been written by Peter Breggin, Robert Whitaker, David Healy, Joanna Moncrieff, Peter Gotzche and Thomas Szasz. A very readable overview of this literature can be found in James Davies' book Cracked (2013). Anyone who is taking, or considering taking, psychiatric drugs should consult at least one of these books first.
Although much too little is known about the effects of these drugs, there are some truly frightening signs:
ADHD drugs: 'Children treated with stimulants often develop atrophy of the brain...Furthermore there is evidence that these stimulants lead to growth supression in children...No long term benefit for children of any kind has ever been demonstrated for any stimulant drug' (Breggin). Breggin's view is that the use of psychiatric drugs on children should be prohibited by law (even if the parents wish their children to take them).
Antidepressants: 'They are no better than placebo for mild depression, only slightly better for moderate depression, and benefit only one out of 10 with severe depression. In around half of all patients, they cause sexual disturbances. The symptoms include decreased libido, delayed orgasm or ejaculation, no orgasm or ejaculation and erectile dysfunction. Studies in both humans and animals suggest that these effects may persist long after the drug has been discontinued.' (Gotzsche)
'I've been practising psychiatry for 20 years, and in my experience antidepressants don't do any good at all. I wouldn't take them under any circumstances - not even if I were suicidal.' (Moncrieff).
Antipsychotics: 'There is substantial evidence that both the old and the new generation of antipsychotics cause irreversible neurological damage in the form of tardive dyskinesia, shrink the size of the brain, cause people to put on weight, disrupt the body's metabolic processes, heighten the risk of heart disease and stroke, and cause premature death...' (Moncrieff)
People who have been labelled as schizophrenic or bipolar die about 25 years earlier than the rest of the population in the UK. Given that there is no known physical difference between the brains and bodies of those with these labels and everyone else (prior to taking the drugs), the suspicion must be that this is due to the antipsychotic drugs they take. Gotzche has estimated that Zyprexa (olanzapine) alone has killed 200,000 worldwide. Scandalously, increasing numbers of people are forced by law to take these toxic drugs.
What will future historians make of this period in our history? I fear that the verdict may be the same as on Aktion T4, the eugenics programme carried out by the National Socialists in the thirties and forties:
'In some places doctors and psychiatrists co-operated with families to have patients discharged, or, if the families could afford it, had them transferred to private clinics where the reach of T4 did not extend...For the most part, however, doctors co-operated with the programme, either from ignorance as to its true nature, agreement with Nazi eugenicist policies, or fear of the regime' (wikipedia)