on 4 March 2014
I really enjoyed this book. As someone on quite a lot of medication, it affirmed quite a lot of my own experience of dealing with psychiatrists who seem to know it all, until you see another one who tells you the exact opposite with equal high-handed authority!
But some points, such as the pharmaceutical industry's payment of doctors is labored, while what for me was the book's most interesting discussion - the fact that there are significantly better outcomes for many mental illnesses in developing countries where drugs are not widely prescribed - only got a three paragraph mention right at the end.
I'd particularly single out Chapter 6, 'Mental oddities and the pills that cause them,' as flawed. After going into great detail on placebo effects in previous chapters, Dr Davies then lends great authority to comments from a review of just 38 patients and a quote from a bloke talking about how his wife, 'isn't quite the same,' on TV's Kilroy.
Presumably if people given sugar pills can mistake them for anti-depressants, people actually on medication can also report all kinds of side effects that aren't actually real. In fact, these placebo side effects and people blaming pills for other ailments are quite widely documented and one reason why just about every medication package now comes with a gigantic list of ailments that have been attributed to the medication (When was the last time you took a pill that didn't warn you that it might give you diarrhea? Do they all really do this, or is it just that people get upset stomachs all the time and blame the pills, rather than the dodgy takeaway they at the night before...)
I don't want to seem overly negative - this is a four star review after all - but authors need to apply the same rigor to evidence that supports their hypothesis as they do to picking apart the arguments behind 'conventional wisdom.'
on 29 May 2013
I liked this book - the author is clearly very knowledgeable and he writes in a balanced, even handed way. This book is not just a joust against the 'evils' of modern Big Pharm but is also a considered account of the nature and success of modern medical Psychiatry. You will probably only be reading this book if you already 'smell a rat', but on the small chance you are an admirer of modern medicine and its treatment of mental disorders, and you feel warm and friendly to the pharmaceutical industry, be prepare for some uncomfortable reading. Perhaps the most telling take-away from the book - if you or a loved one are offered or told you 'need' anti-depressants or neuroleptic drugs then - well, pause and have a good think.
Why has the prescription of antidepressant medicine roughly tripled in less than 20 years? Is it that we are indeed becoming sicker, that we are all becoming more and more stressed and psychologically unwell, is it merely that doctors and psychiatrists are much more skilled at diagnosing psychiatric conditions than they used to be, or is it that we are now medicalising (drugging) what is normal about the variety of day to day human experiences, which at times can be sorrowful, challenging or confusing?
This brilliantly clear, cogently argued, shocking and timely book by psychotherapist and anthropologist James Davies rendered me almost incoherent with rage, exposing as it did something which many of us have been aware of, but maybe have not had the tools or ability to follow to a conclusion. James Davies has those tools and abilities; he thoughtfully, knowledgeably, skilfully connects all the dots together, uncovering the horrendous duplicity, collusion and sheer unscientific snake oil peddling visited upon us by Big Pharma, in the field of mental health.
I can't urge the reading of this book strongly enough. Anyone who cares about what it means to be a fully human being, and especially anyone involved in any way in the caring professions needs to be aware of what Davies lays clear about the mental health industry. For industry it surely is.
With a carefully constructed series of explanations, revelations and arguments Davies delivers telling knock out punches to the House of Trick Cards of current mainstream psychiatry. The major punches involve
1) The increasing categorisation of VIRTUALLY ANY EMOTIONAL STATE so that it falls within a category of disorder - thus opening the way to the development of chemical coshes. This categorisation - the `Bible' used to denote syndromes, the DSM (currently DSM 5), is NOT the result of huge studies and research itself, yet it gets used as if it were the result of close scientific analyses. The result of the sort of sordid, limiting tickboxy thinking, turning us all into robots who can be managed out of our normal human pain is the crass thinking that says, for example, if after a bereavement, sleep appetite and general mood are affected for more than 2 weeks, anti-depressants may be helpfully prescribed. Crazy, insidious, crass. We have become so afraid of our suffering that the answer becomes `cosh it, flat line what it is to be in any way human'
2) Trials - various meta analysis studies have shown that antidepressants are BARELY more effective, in mild to moderate depression, to placebo. Drug companies have disquietingly low bars to climb over, in order to `prove' their products effectiveness. Davies uncovers the secrecy, the UNPUBLISHED drug trials that go against the findings Big Pharma wants and the manipulation of results. More than this, how drug companies positively USE that most powerful of tools - PLACEBO ITSELF to manipulate their own results higher - for example, the colour, the name, the advertising of the pharmaceutical - many of the effects that might be assumed to be the result of the chemistry of the drug `better than placebo' - are in fact DUE to the use of placebo!
3) There has been a change in thinking from the 60s and 70s, where psychiatric drugs were seen as altering mood (in the same way as any mind altering drug, including alcohol and street drugs alter moods) A shift occurred to thinking of psychiatric drugs as `curative'. This might not seem an important shift - however it goes along with the idea that much uncomfortable, difficult human emotion is now being seen as potentially aberrant and classifiable as a `disease' - as in the DSM - shyness becomes `social phobia'.
Medical naming encourages thinking about human beings in all their complexity as broken, and needing mending - and opens the door to the over-prescription. In fact, as one astute expert (among the many) Davies consults, points out tersely, this thinking of these drugs as `cures' is erroneous, as unlike most physiological disease there just is no hard evidence to support the biology of a lot of what is now being treated as `disease' through these medications - which alter mood. They do not `cure' shyness, (or, lets medicalise it as social phobia) any more than a glass of wine `cures' shyness - both change ways of perceiving the world, that is all.
4) Who bites the hand that feeds? There is a huge cover-up, smoke and mirrors going on in the world of funding `research' into psychiatric medicine whether in academic institutions, or with clinicians. And, gentle reader, there is even less transparency over this in the UK than there is in the States, where under the Obama administration, spearheaded by a particularly truth-and-justice campaigning Senator, Senator Grassley, some efforts to bring the Pharma hyena under the spotlight are beginning to bear fruit. But not here, where there is murk a plenty. Perhaps though, the fact that fully 56% of the panel member luminaries involved in writing the DSM-IV bible had 1 or more financial associations with the pharmaceutical industry, should begin to rip the wool from over our eyes. And, for those writing/creating the diagnostic categories, which would or course be primarily treated by pharmaceuticals, - 88% of DSM-IV panel members had drug company financial ties.from Big Pharma. And things don't have appeared to have changed for the better in terms of `arms length' involvement with the writing of the now current DSM-V.
I am not saying (nor is Davies) that all these senior clinicians and medical academicians are corrupt, merely that neutrality becomes hard to achieve when your income is dependent on a particular company who are hoping your findings will support the excellence of their product, and even to demonstrate a need for their product
I received this book as an ARC - of course, given what I have said in point 4, you may feel that my judgement is compromised. I would argue that a lowly amateur reviewer lucky enough to get offered bookie freebies through third parties does not in any way equate to some stars of the psychiatric industry who receive millions for the sterling work they do in supporting the claims of specific drugs and manufacturers. A look at some of my reviews on Amazon will show that if I think a particular book is poor I will indeed say so.
This one though gets my gold standard bookie trial award. Properly researched, properly cited, free from duplicitous cover-up. Unlike the industry is exposes.It deserves to be a best seller - indeed, needs to be so - its material is provocative, prescient, and vital to know.
I have one cavil - my ARC was a digital copy. Now I don't know if this will be any different than the standard digitise prepared for sale, but the digitisation on my ARC was poor - a lot of the useful charts and graphs do not appear and footnotes get chopped and inexplicably appear in the middle of other pages. If I were buying this book, I would definitely choose hard, over digitised, copy.
on 3 July 2013
Well researched and eminently readable for the non specialist. I felt that the author, while doing a great job of debunking psychiatry and reminding us that mental torment and anguish is in fact often a normal response to stress and distress, was wisely restrained in his criticisms of current practice as no doubt there are many excellent and thoroughly wise mental health professionals out there..... But how can we judge?
I guess, when all's said and done, what shocks me most is not the drug companies burying of unfavourable research, or even their deliberate targetting of new consumers. After all they are ultimately out to SELL a lot of drugs not matter what altruistic motives they purport to have. No what shocks me is how large numbers of highly academic medical professionals can apparently have allowed themselves to become so immersed in the medical/biological understanding of the brain that they seem to be unable to even consider other ways of thinking. Closed minds....? Now isn't that why many people consult psychiatrists? .........Because the sufferers brains seem to have got stuck in one particular groove for one reason.?
We all want instant solutions these days including instant mental health. I guess no one is allowed to prescribe simply rest and TLC these days. After all what would be the employers response to this? No better by far to put the sufferer on Prozac or it's imitators, and get them back into being an economically viable member of society ASAP! who cares if their true personality is debased. Still I think the tide is turning. More people are being offered "talking therapies"
.... As someone who has recently walked the very difficult road with a relative who became seriously unbalanced for a while due largely to stress but who is now thankfully well on the road to recovery without recourse to drugs or worse, I can testify that not only is recovery possible but that the person may emerge the stronger for their ordeal. But patience, tolerance, forgiveness and unconditional love are the key....... These are qualities that are sadly out of fashion. The carer also needs non judgemental friends with broad shoulders if they are not to crack up themselves under the strain. The brain it seems is like any other organ of the body. Put it under too much stress and it will start to perform badly. No one would suggest to someone who's ankle was broken that pain killers will solve the problem ,... No the ankle needs to be immobilised and rested so the body can do its healing job. Why do we imagine our brains are somehow different...?
All in all an important and timely book deserving of a very wide readership.
on 24 January 2015
This is an Important Book, I think.
In it James Davies sets out why he thinks Psychiatry is doing more harm than good. For someone like me, who works in the `mental health' field, it contains a lot of arguments that are familiar - but here they're drawn together and also illuminated with interesting interviews from players on both sides of the argument. For people who weren't already so familiar with the arguments, I think this book will be truly revelatory and shocking. At the same time, I think it's ultimately fair and balanced towards Psychiatry; it isn't calling for an end to Psychiatry but a more critical approach to it and a rebalancing of power (power that is built mostly on myth and money from the pharmacological industry).
(Although I feel Davies is fair and balanced throughout, very occasionally when reading his descriptions of some of the interviews my own critical senses were tingling. For example, when interviewing Professor Bailey, president of the Royal College of Psychiatrists, it's made completely clear that she's a "straight talking, no-nonsense Psychiatrist" who's mainly only interested in her own opinion. This is immediately followed by an interview with Dr Timimi, a psychiatrist who's been critical of psychiatry, who is described as responding "cooly". Of course, these may well be perfectly accurate descriptions of the protagonists, but it's important to always keep an eye out for bias - even with people you agree with.)
Beyond the critical analysis of the Psychiatric industry there were two aspects that especially appealed to me. First, there is a section about how certain symptoms come in and out of cultures over time. Some examples include a Westernised version of anorexia in China after a prominent case in the early `90s, bulimia after the highly publicised example of Princess Diana and self-harming. I think Davies sets out a good argument for why it can't simply be a case that these things were becoming better recognised by professionals, but instead that once certain behaviour is given prominence in the media and legitimised by `experts in the field', it becomes, culturally, a way to express distress. My interpretation of that argument is that while the distress is very real, the way that it is expressed can be understood as being at least partly socially constructed. One of the interesting implications of this, I think highlighted by Davies, is that campaigns to bring `awareness' to certain `disorders' may have the paradoxical effect of increasing the prevalence of those `disorders'. I think this is just as much an issue for Psychology as it is for Psychiatry and something that needs to be thought hard about.
The second thing, which is related, is Davies' exploration of our ideas about suffering have changed. I understand that he has another book ("The Importance of Suffering"), that explores this theme in a lot more detail, but I haven't read that yet. Again, I think this is just as much an issue for Psychology to address as Psychiatry. My own view, which I think lines up quite well with Davies', is that suffering is an important part of life that can teach us important things. That we should work towards accepting and embracing it. Whereas nearly all big institutions in society seem to tell us that suffering is something to avoid and get rid of (which, as with most things, has the paradoxical effect of strengthening the power of the thing you're trying to avoid).
on 9 November 2015
OK, as somebody who is qualified in science, I already knew large long-term studies demonstrated that anti-depressants were by and large useless.
I already knew that psychiatry 'medicalises' normal spectrum behaviours.
However, I did learn a lot from this book:
1) That the medical model of schizophrenia is not proven
2) That placebo ECT studies (where an electric shock is administered in people with severe depression) have demonstrated a larger placebo effect
3) That ECT is extremely damaging to the brain
Chapter 12 was the most shocking chapter for me where he convincingly demonstrates the huge cultural influences in mental health problems through the anorexia 'epidemic' in Japan, a country which saw a huge upsurge in this problem, which prior had been largely a western issue, after masses of media coverage of a single death from it. The most shocking part of the chapter was the correlation of self-harm with references to it in popular culture (please spare me the correlation doesn't equal causation phoney argument and review the history of epidemiology).
The book reads very well, and should be read by all doctors as Peter Hitchens says.
The one aspect I feel the book could have improved was giving a bigger role to the evidence around schizophrenia. He does talk about it, even has an appendix on it, but does not go into the depths he does for depression and behavioural disorders. In fact, his description of how people who hear voices fare in countries where there isn't any stigma was extremely interesting.
So, where does this leave my impressions of psychiatry? Being brutally honest, it leaves it as a specialty that seeks to be God, that is lazy in seeking drugs over prolonged counselling, that isn't really medicine in the same way neurology is, that has been thoroughly corrupted by pharmaceutical companies and that needs much greater emphasis on psychological counselling.
As if by magic, the author is a qualified psychotherapist.
And what about the patients; the disease model allowed psychiatry to brush off the 'they're just mad' put down. However, is this not true? Regardless, abandoning the false disease model means patients have more control than they ever thought of their own mental health. However, because this goes against the agenda of the times, it is unlikely to be realised.
on 7 June 2013
After 30 years as a GP, this book confirmed what I had suspected all along, that doctors are carried along on a wave of misinformation and pharmacological skulduggery.
The problem is that patients are also sitting on the same wave, looking for labels to justify sick leave, extra social security benefits and attention, and have no difficulty changing to a physician who will agree with them.
Obviously Mr Davies has an axe to grind as he is a psychologist rather than a psychiatrist but he readily admits this in this well researched book that complements the work of Ben Goldacre's lambasting of the drug industry.
on 10 May 2013
It was seeing a review in The Times magazine that made me buy this book and I found that Davies makes a convincing case - it's an intriguing and revealing read, hard to put down as it's so well written and fast-paced. It must be a book that psychiatrists certainly don't want you to read! It's absolutely fascinating and I'd totally recommend it.
on 5 July 2013
Cracked opens the lid on the closed world of psychiatry and lets us take a look inside. What we find may well shock the reader. Drug trial data being buried in order to make drugs appear to be more effective than they really are, drug companies exploiting peer review publications, doctors taking large sums of money from big pharma to push drugs that don't work, and spurious claims about the biological causes of mental illness.
None of this is really new. This has been written abut previously, but the author brings together this information in a readable form for non medical professionals.
This is NOT a hatchet job on psychiatry by some scientologist. Here we have a well researched and laid out argument of what is wrong with psychiatry and how we can put it right by basing treatment decisions on the best available evidence. The author does not argue that ALL drug interventions are bad for patients, but that drugs should not be the default treatment choice.
on 10 May 2013
I haven't been able to put this down since my copy arrived earlier this week. The interviews with the leaders of psychiatry are fascinating - it is amazing that Davies managed to secure interviews with all of these people, from Senators in America to several Presidents and ex-Presidents of Psychiatric Associations. It was so interesting to hear Robert Spitzer, the modern founder of psychiatry, admitting that there are no biological markers to most of these disorders. I was also shocked to read of the scant science behind the creation of these disorders - and not from Davies but from the mouths of the people who created them and were on the Taskforce for the DSM! The material on the close links with Big Pharma and psychiatry is appalling - I heard Davies on the radio yesterday discussing this with a psychiatrist. The psychiatrist said this does not happen in the UK but Davies then showed that this very psychiatrist had also received money from several pharmaceutical companies! Davies shows in the book how rife this is in England so I disagree with the previous review that this is only a problem in America - policy change, please! This is an excellent book, which is vividly written. I'm off to order my copy of Davies' previous book now, The Importance of Suffering!