Seeing Stars

(List of abbreviations at end).

This week's edition of the American Journal of Psychiatry (AJP) was devoted to psychedelic drugs in psychiatry. There was a review article followed by seven letters commenting on it, which means the letter-writers saw the article before publication. Two of the authors of the lead article caught my attention: Profs. Guy Goodwin and Charles Nemeroff. The article is free to access; go to the end and check the "declarations of interest" (i.e. conflicts of interest).

Nemeroff in particular has been paid by practically every drug and other company making money from mental disorder in the US. In about 2007 or so, he was investigated by his university for not declaring payments from drug companies and was forced to resign but it didn't worry him, he moved to Florida and is now in Texas where he is clearly still raking it in. There were millions involved but he definitely wasn't the only one on the take - then or now.

Nemeroff trained as a neurobiologist (PhD) before he switched to medicine and then to psychiatry, so his orientation is pretty clear. According to his Wikipedia page, at the age of 18, in his first year of biology at junior college, he visited the Manhattan State (mental) Hospital, a classic Stalinist wedding cake structure that housed thousands, and decided he wanted to study mental disorder. That is, at the age of 18, with no knowledge of mental disorder, he had already decided it's all biology, and has pushed that barrow ever since, becoming very wealthy in the process. This is much the same as Thomas Szasz, of anti-psychiatry fame (which he disputed) who, at the age of 16, while still at school and with apparently zero knowledge of mental disorder, decided there's no such thing, that all "mental patients" and psychiatrists are frauds. He got half of it right but still he made heaps of money.

But back to the Nemeroff article: they have announced that what is now called "psychedelic-assisted therapy" is wrong. This was the basis of having these drugs approved for psychiatrists to treat depression: patients are given controlled doses of powerful psychoactive drugs that, in higher doses, mimic psychosis. The drug gives them a warm fuzzy and they are more open to talking (as in blabbing) and hugging people. After a couple of trips, their "chronic, treatment-resistant depression" goes away and they're fine and able to get on with life. There was a slight problem in that nobody specified what sort of "therapy" they were to receive but in the excitement to get a "breakthrough" in treating mental disorder, that small point was overlooked. Unfortunately, after shuffling the figures, Nemeroff and his group concluded that it's all a drug effect and "psychotherapy" has nothing to do with it: the psychological support assists the drug rather than the other way around. The immediate answer is: "Well, they would say that, wouldn't they," but we mustn't forget all the "therapists" who thought they were going to make heaps of cash out of this. Poor dears, what are they going to do now? Don't worry, once it's approved, nobody will ever be able to get rid of it. Only the theory will change.

Meantime, after about 13 years of investigation, it seems the wheels have finally fallen off the STAR*D wagon. The what? This is the "Sequenced Treatment Alternatives to Relieve Depression," which, at $35million, was the largest and most expensive study in the history of the NIMH. There were 23 psychiatric centres and 18 general practices involved in treating ordinary people for depression. If they failed to respond to one antidepressant, they were given another, and another, until they got better. Results were first published in 2008 and were proclaimed from on high as proving that antidepressants were wonderful and could relieve the world of the scourge of the disease of depression. University departments of psychiatry made the study compulsory reading and drug companies, or course, were ecstatic.

However, it wasn't long before the critics started circling. In 2010, psychologist Edmund Piggott and his associates raised serious questions about the methodology of the STAR*D study, arguing that the results were much worse than had been published. Where the researchers had claimed about 70% "cure" rate for depression, the actual figures were closer to 35%. A long and vituperative battle ensued, with Piggott, and later Bob Whitaker on Mad in America, insisting the research group had fiddled their results and, essentially, made up the story about antidepressant efficacy. However, the research group kept quiet until just recently, but their defence has been shown to be false, and the term "scientific fraud" is now being tossed around.

As far as anybody knows, Nemeroff wasn't involved in the STAR*D study but he trained the then-director of NIMH, Thomas Insel, who approved the vast expenditure (it's only vast to us; Insel doled out about $1.5billion a year). Insel, in case you didn't know, built his reputation on his research on social bonding in voles, little animals like mice. What this says is that people with a particular vision of mental disorder are running the show - to suit themselves. The original STAR*D study was published in the American Journal of Psychiaty. How come they didn't pick up the glaring faults with STAR*D themselves? When the first critiques were published, how come the AJP didn't tell the STAR*D people to write a response? For that matter, why didn't they publish the critiques themselves? And why did they wait until December 2023 to publish a response? Answer: "Well, that's what they do, isn't it."

It has to be understood that the STAR*D project was and still is A Very Big Deal. There was the money, of course, but there were something like 100 research papers published during and after. The main paper in AJP was a commissioned summary, but that's the one everybody quotes. Here, at last, was the evidence to crush the nay-sayers (like me, who hardly prescribed antidepressants). "Antidepressants work..." from which followed "...which proves it's all biology." The Nemeroffs and Insels of the world were thrilled to see such strong support for their convictions, and rushed to tell the politicians to spend more on biological research, to spend more so more people could get more drugs, the drug companies were in clover and, critically, the money flowed back to the psychiatrists who were pushing the biological barrow. Hundreds of millions. Not to neutral or independent researchers, and certainly not to critics, only to True Believers in the biological cult of psychiatry. That's how it's done. It's the same model as has been used by the tobacco industry, the asbestos industry, and now the fossil fuel industry: find "researchers" whose opinions can be bought, flood them with money, create doubt and confusion and then sit back and enjoy the profits.

Psychiatry as it exists today is very firmly in the grip of a bunch of ideologues. They do not have a theory of mind or a model of mental disorder. They have a belief system which hasn't been developed by one word since 1871, when British psychiatrist Henry Maudsley announced it: "All mental disease is brain disease." Vast sums of money have been spent searching for possible causes, to no avail. Thomas Insel admitted (after he left NIMH) that he had sprayed about $20billion on basic biological research but it hadn't found anything and, more to the point, hadn't made life any better for the tens of millions of mentally-troubled Americans.

The one item of research they will never fund is this: Is mental disorder the sort of thing that can be studied through a microscope or fixed with a pill? You would think this is fairly elementary but the grip of the biological ideologues is so strong that they can stop those questions being asked. Just as the AJP made sure no criticisms of the STAR*D program were published for well over ten years, so the great and the good of psychiatry make sure only one voice is heard: theirs. Is that corruption? I believe it is. Bob Whitaker's article on STAR*D this week leaves no doubt there is dirty work afoot, and my paper on the corruption surrounding the "biopsychosocial model" is getting some attention [1]. But one thing is clear: the people who hold power in the world of psychiatry, the academic and political psychiatrists and their financial backers, the drug companies, will not give up their power without a fight. From long experience, I know one thing: they fight dirty. Don't ever expect them to "do the right thing," e.g. publish criticism of their ideology, because they won't. Their response to criticism is always the same: shoot the messenger and keep pretending.

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References:

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

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This material is copyright but can be copied or quoted on condition the author is acknowledged.

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Abbreviations:

OPCAT: Optional Protocol to the UN Convention Against Torture

NIMH: National Institute for Mental Health, Bethesda, Maryland, USA.

RANZCP: Royal Australian and New Zealand College of Psychiatrists

RCPsych: Royal College of Psychiatry (UK).

UNCAG: UN Convention on the Prevention and Punishment of the Crime of Genocide.

UNCAT: UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.

UNCRPD, or just CRPD: UN Convention on the Rights of Persons with Disabilities.

WHO: World Health Organisation.