Psychiatrists as Gardeners

Until about the late 1950s, and much later in many parts of the world, mental hospitals were huge, terrifying places on the outskirts of cities, usually hidden by high walls and dense trees. People went in and very often didn’t come out alive. For a variety of reasons, including TB, pneumonia and general neglect, the death rate among long-term patients was much higher than the rest of the population [1]. Since then, a lot has changed. Most of the really big hospitals have now gone or are being allowed to fall to ruin so the government can bulldoze them and sell the land. Mentally-troubled people are supposed to be “mainstreamed,” meaning assessed and managed within normal hospitals as just another medical specialty, before being discharged to the “community.” All too often, especially in the US, that means discharged to the streets where they are seriously at risk, or ending up in prisons. One thing, however, hasn’t changed: they still die young.

According to figures from WHO and other sources, people with psychiatric diagnoses and treatment die, on average, about 19 years younger than their undrugged peers [2, 3]. In the US, where people are given more drugs in higher doses for longer but with less care and support, that figure is 25 years. As I said last week, it’s a lot of life to lose but nobody seems to care much. While we constantly hear about how mental disorder affects your life and career, you will rarely hear about how it lops up to a quarter off your life span. Compare that with amyotrophic lateral sclerosis, or motor neurone disease, which affects about 2 people per 100,000 per year. The life span after diagnosis is very variable but, on average in Australia, sufferers lose something like 23 years of life, amounting on average to under 50 person-years of life lost per 100,000 per year. For people with major mental disorder, say 100 new cases per year per 100,000, losing 20 years on average is about 40 times the human burden of ALS, yet nobody talks about it.

On the face of it, nobody cares but I think the reason is that hardly anybody actually knows. If you go into a public toilet, you’ll usually see a sign that says “Feeling down? Feeling worried? See your doctor.” What it won’t say is: “… who will put you on drugs that could lop 20 years off your life.” Of about a hundred thousand papers published each year in psychiatric journals, hardly any talk about serious side effects of drugs. I became aware of this many years ago when I bumped into somebody who had worked for years at a mental hospital where I had trained about 18 years before. Naturally enough, I asked him about some of the patients I had known there. Every name I put to him, the patient was dead. These were not old people, they would then have been in their 40s yet the half dozen I could recall had all died. Why? He didn’t know. It wasn’t suicide, they just “up and died,” as they say.

It seemed to me very strange that people are forced into hospitals and compelled to take drugs in order to save their lives, when it clearly had the opposite effect. This was pre-internet. I couldn’t find much on the topic in the limited medical library we had, but one thing was obvious: psychiatric drugs caused massive weight gain and, as we all know, obesity is dangerous. However, it wasn’t called “drug-induced morbid obesity,” it went with the cutesy name of “metabolic syndrome.” It was a cluster of obesity, high blood pressure, high cholesterol and triglycerides and high blood sugar, all of which lead to major complications such as heart disease, stroke, fatty liver, type 2 diabetes, sexual dysfunction, sleep apnoea, gout, varicosity, blood clots and, of course, early death.

The term seemed to become popular in the early 1980s or maybe later, and it was always known that if people lost weight by exercise and a proper diet, all their blood and liver abnormalities went back to normal. Except if the “syndrome” was caused by psychiatric drugs, it was impossible to lose weight while taking them. That was very clear: the weight gain started within two weeks of commencing them and persisted as long as they took them. Some drugs were worse than others but the impression is that modern drugs, both antidepressants such as mirtazapine and antipsychotics such as olanzapine and quetiapine, are worse. It seemed that the more sedating drugs were worse than those that caused a bit of alertness (not many).

The weight gain can be dramatic: a 53kg woman actually doubled her weight, to 106kg. A 17yo boy weighing 65kg who was prescribed olanzapine went to 164kg and repeatedly crushed his mattress or broke his bed. A young man finally reached 180kg while taking quetiapine and clozapine. In each case, the hospital staff blamed the patients for eating too much and not exercising. However, people taking the drugs describe an overwhelming urge to eat even though they know it’s no good for them:

I come to at 2.30am, standing in front of the open fridge, stuffing everything into my mouth. I know it’s bad, I know I’m not hungry but I can’t stop it.

I can’t have anything sweet in the house, if I see it, it will go straight into my mouth. It drives my family mad but I can’t resist.

Icecream. I never used to eat icecream but now I get through 2 litres of icecream in a minute or two then look around for more. Look at me, I used to be fit and healthy. I tell the doctor and she just says I should eat less. That doesn’t work, it’s their drugs.

I have to admit that when it came to patients’ physical health, I was a real nag: “Get regular exercise, eat properly, cut out the smokes and weed, lay off the booze…” but it didn’t have much effect. They smoked because they were bored (“What else can I do in this place?”), ate because the drugs made them and didn’t have the energy to exercise. The only way to deal with it was to reduce the drugs, but then you run into resistance from the hospital who are simply incapable of understanding that life with less drugs may be preferable.

As a result, when I saw a notice of a lecture on physical health in psychiatry, I watched it. It was sponsored by the local college of psychiatrists and presented by a group in Sydney called mindgardens Neuroscience Network as part of the area mental health service. Their website has the usual pictures of radiantly happy people having a great time in lovely surroundings, which has nothing to do with the reality of mental trouble or of government mental health services. Their job is to get people with mental disorders to adopt healthy lifestyles, to get rid of the weight and high cholesterol caused by the drugs. They gave a few figures: in the first twelve weeks, people commenced on antipsychotic drugs in the normal "first episode psychosis” program gain about 8kg in weight and 7cm in girth. That’s bad, but remember, it doesn’t stop. The longer they take the drugs, the more the weight stacks on and the worse they feel, physically and mentally. For their program, the figures were 0.5kg gain and 1.0cm girth.

The program is run from an elegant old mansion in what appeared to be an expensive part of Sydney not far from Bondi Beach. People are referred by the local mental health service for a well-organised program that has been copied in a few other places. They have lots of staff running a range of programs: dietician, exercise physiologist, drug and alcohol counsellors, family and relationship counsellors, group counsellors and even something called a motivational speaker. There is plenty of space for meetings and activities, including a large room stuffed with new gym equipment. The speakers showed lists of brightly coloured forms setting out the activities and it was all delivered in a racy and rather breathless style that one of them called “inspiring.” All that was lacking was figures: who pays for this, how many people go there, how much does it cost, what’s their outcome? And something that concerns me: what about all the people in the country or in working class areas of the city? No mention of them.

Something else wasn’t mentioned, too: the cause of the explosion in “metabolic syndrome” over the past 30 or 40 years. Ther was one table where weight gain was shown for each drug: olanzapine was top of the pops, but that was the only indication that the problem was drug-related and not, as was passively but clearly implied, due to “mental illness” per se. It is a drug effect but the problem is that psychiatrists don’t believe it. In early 2018, Danish professor Peter Gotzsche visited Australia and New Zealand to talk about the damaging effects of psychiatric drugs. There’s no question: he knows as much about this topic as anybody. If he says they’re dangerous, they are. As part of his talk, he said antidepressant drugs have a lot of adverse side effects and should not be prescribed by general practitioners, if they are used at all. Immediately, the college of psychiatrists leapt into action. In a press release dated March 6^th, the RANZCP said:

The prescription of antidepressant or antipsychotic medications is something that a psychiatrist only ever does in partnership with the patient and after due consideration of the risks and benefits.

A few weeks later, I sent a long letter to the then president of the college showing how their statement was false at no less than seven points. False. Not mistaken or a bit exaggerated. Within a day, they had taken down the press statement but they were too late as I had a copy (see the letter). The president wrote back, repeating this manifestly false claim but I was never able to get anybody to agree that it was a fabrication. Everybody, the college board, the Medical Board, the Ombudsman and something called the National Health and Privacy Commissioner all said it was fine to make this kind of claim and then refuse to justify it.

We’re left with a choice: was the then president of RANZCP lying, or was she deluded, or was she a fool? Fools are people who, confronted by evidence that contradicts their opinions, discard the evidence, and I think that’s the case. If this were the only incident, we could perhaps get over it but it’s not. It’s part of a systematic program of deception, starting with self-deception as to the safety and efficacy of their treatment, and directed at deceiving the general public, governments and regulatory agencies, insurers, patients, medical students and training psychiatrists. From top down, psychiatrists believe their own propaganda.

We saw yet another example recently in a paper published by a group who re-analyse treatment trials conducted by drug companies [4], an international collaboration called Restoring Invisible and Abandoned Trials (RIAT). This concerned an important and widely-quoted trial, the “Treatment for Adolescents with Depression Study” (TADS). This very expensive trial concluded that antidepressants are safe and effective in young people, “…establishing fluoxetine internationally as the mainstay ‘evidence-based’ treatment for adolescent (depression).” After careful study of the original research data, which had been concealed, the RIAT team concluded:

Our reanalysis confirms the original reported findings that superiority over placebo was not demonstrated for fluoxetine. Contrary to original TADS Team’s reporting, we have uncovered a higher, clinically significant level of harm, including eleven additional suicide-related adverse events [4, p17].

That’s about 10% of the people taking it, and the omission was not an accident. If those figures had been included, the drugs would never have been given such massive support nor so widely prescribed. That is, the drug companies wouldn’t have made so much money, nor the researchers get such praise and status. And that’s the problem: the whole enterprise of modern psychiatry, of satisfying the very real human need for alleviating mental disorder, is powered by twin lusts for money and for prestige. Tough luck for the patients but they wouldn’t have enjoyed old age anyway.

It's almost grounds for despair. Psychiatry deals with the most vulnerable people in the community, the great majority of whom have not broken any laws, yet they are treated worse than even convicted murderers. They cop it from three directions. The first are governments, all of whom know they can win no votes from being nice to mental people but they certainly can lose votes if they seem too lenient. Consequently, pressures are ratcheted up and up. The second group are the drug companies who are there to make money for their shareholders. That’s their job and duty as dictated by the companies act. It’s competitive so they are all constantly exploring ways to make more, to get ahead of the others, and to see if they can slip around some of the rules. The RIAT team repeatedly bang heads with their ethically dubious behaviour (see [5] for some background on this particular project).The so-called opioid epidemic in the US is emblematic of the shady ways drug companies operate, with one foot over the line and one hand dialling their friends in government to keep them on side.

Finally, there is the institution of psychiatry which operates hand-in-glove with the drug industry. Their conflicts of interest are legendary but my main concern is the morality of a profession that claims to have a solid basis in established science when, as a matter of demonstrated fact, they don’t. They prattle on about genes and neurotransmitters and brain scans and so on but with no concept of how this relates to normal or to abnormal mental function. As a starter, they don’t have a theory of mind. Trainees (residents) are not taught anything on the philosophy of mind but are simply led to believe that psychiatry has something called “the biomedical model” which explains all. They don’t have that, it doesn’t exist [6]. What they have is an aspiration that mental disorder will some day be explained but they have no clues as to how this will come about. The same goes for their fall-back position, “the biopsychosocial model.” Despite anything the current and immediate past presidents of RANZCP have to say on the matter, that also doesn’t exist and any person who claims it does is repeating a falsehood [7].

So back to the nice people with all the government money running their “mindgarden Network.” Mind garden? What’s that mean? Does it mean growing minds, or maybe it means tending to all the drug-soused people they’ve turned into vegetables? Either way, there’s a quicker and more effective path to preventing early death from drug side effects: stop prescribing so many drugs. Put a bit of effort into sorting out the psychosocial causes of mental disorder, and provide tailored human-centred treatment programs. It’s not rocket science, and it’s a lot cheaper. Of course, there isn’t as much money in it, but we’re not in it for the money, are we?

References:

1. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.

2. Firth J, et al. (2019) The Lancet Psychiatry Commission: A blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry 6: 675–712

3. Goldfarb M et al (2022). Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J. Amer. Coll. Cardiol. 80: 918-933.

4. Aboustate N et al (2025). Restoring TADS: RIAT reanalysis of the Treatment for Adolescents with Depression Study. Int J Risk Saf Med. N/S, p1-20. DOI: 10.1177/09246479251337879

5. Aboustate N, Jureidini J (2022). Barriers to access to clinical trial data: Obstruction of a RIAT reanalysis of the treatment for adolescents with depression study. Int J Risk Saf Med; 3(3):299-308. doi: 10.3233/JRS-210022.

6. McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon.

7. McLaren N (2023). The Biopsychosocial Model and Scientific Deception. Ethical Human Psychology and Psychiatry, 25: 106-118.doi:10.1891/EHPP-2023-0008.

My critical works are best approached in this order:

1. The case against mainstream psychiatry:

McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. ISBN 978-1615998227. Amazon (also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).

2. Development and justification of the biocognitive model:

McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

3. Clinical application of the biocognitive model:

McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press.

ISBN 978-1-61599-410-6. At Amazon.

4. Testing the biocognitive model in an unrelated field:

McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.