Tuesday, 28 June 2016

NHS Scotland needs a Sunshine Act: The Guardian 28Jun16: Dr Peter J Gordon

Scotland's NHS needs a Sunshine Act to make pharma links transparent 
28 June 2016, The Guardian, Dr Peter J Gordon, Consultant Psychiatrist, NHS Lothian, Scotland

PE1493: A Sunshine Act: Scottish Parliament
"There is a longstanding joke about the lack of sunshine in Scotland.

Three years ago, I began the process of raising a petition with the Scottish parliament to urge the Scottish government to introduce a Sunshine Act.

A Sunshine Act makes it a statutory requirement for all payments from commercial interests made to healthcare workers and academics to be declared publicly. The metaphor is that sunshine brings full light. Both the US and France have introduced a Sunshine Act. 

While a junior doctor in around 2000, a consultant handed me a several-hundred page document entitled Behavioural and Psychological Symptoms of Dementia. The consultant told me: “This is the way forward.” Some years later I realised that this document had been developed, funded and disseminated by the pharmaceutical industry.

After the dissemination of this document, the prescription of antipsychotics, sedatives and antidepressants for dementia patients in Scotland has been rising year on year. This mass prescribing is often long-term. Yet the evidence to support such prescribing is poor.

There is much promotion of partnership working between industry and healthcare. Yet we must remember that these two partners have different aims, and it is the responsibility of healthcare workers to follow the ethical approaches central to their professions. The General Medical Council is clear about what is expected of doctors in its Good Medical Practice document. The potential for conflicts of interest is recognised, and doctors are advised: “You must be open about the conflict, declaring your interest formally.”

Scottish government guidance has been in place since 2003 allowing the declaration of financial interests of NHS staff to their health boards. As a result of my petition, the Scottish government has confirmed that this guidance is not being followed.

One key area of concern is the mandatory continued professional education of healthcare professionals. In at least two NHS Scotland boards, continuing medical education relies entirely on the financial support of commercial interests.

National and international conferences may also form part of continuing professional education. Because of the Sunshine Act in the US, we know that a keynote speaker at a recent UK conference has been paid more than $3m (£2.3m) by the pharmaceutical industry since the Sunshine Act was introduced. There is currently no way of knowing the scale of any payment made to a UK speaker sharing the same platform.

My experience of trying to establish whether there is transparency about financial payments to healthcare professionals in Scotland has been revealing. I have encountered significant defensiveness from individuals and organisations. 

For instance, there has long been a body of evidence that prescribing behaviour is influenced by commercial interests, but doctors find it hard to accept this. This collective denial would suggest that the forthcoming (voluntary) ABPI (Association of British Pharmaceutical Industry) register is unlikely to work, as many will opt out, regarding it as inapplicable to them.

As part of its consideration of my petition, the Scottish government commissioned a public consultation exercise on whether a Sunshine Act is needed or not. The majority of participants believed that it should be mandatory for all financial payments to be declared on a single, central, searchable register. The outlook for Scotland may be cloudy for the moment, but there’s a chance of sunshine in the longer-term forecast."


Monday, 20 June 2016

Forced “Treatment” is Torture: Peter Breggin 19Jun16 @Mad_In_America

Forced “Treatment” is Torture: Peter Breggin, 19 June 2016, on Mad in America

"Torture often has a straightforward goal—to break the victim’s will and to intimidate others who fear that torture will also be inflicted on them.  Anyone who has worked or been a patient on a psychiatric ward has witnessed daily attempts to break the will of patients by limiting their freedom and activities, treating them like children, making threats, using physical restraint and isolation, and ultimately inflicting drugs and electroshocks that render the individual helpless. The most profound impact of neuroleptic (antipsychotic) drugs is to render the individual indifferent, apathetic and docile; but the drugs commonly continue to inflict physical and mental torment.

In my decades of clinical experience, many if not most victims of involuntary treatment experience it as torture.  They know it aims at breaking their will and they physically and mentally resist, resulting in even more dire consequences.  Involuntary treatment humiliates and demoralizes people, reinforcing their feelings of being worthless, powerless, and helpless.  It leads to outrage, which is then crushed by psychiatric drugs.  The neuroleptic drugs cause a confusing combination of emotional numbing and apathy along with feelings of acute physical discomfort and agonizing akathisia and agitation; but they inevitably produce docility with a chemically lobotomizing disruption of the brain.

I have opposed involuntary treatment for my entire career and first began criticizing it in the medical literature in 1964.  As Thomas Szasz originally taught, involuntary psychiatric treatment is unconstitutional and an assault on basic human rights.   I am also against it on scientific grounds, because after hundreds of years, this violation of human rights has generated no scientific studies to show that it benefits its victims.

I am encouraged by the excellent blog by Peter C. Gøtzsche on MadinAmerica.com, which inspired me to put a new section, Psychiatric Coercion and Involuntary Treatment, on my website, and to compose these further observations of my own.

Since finishing my training, I have never treated or incarcerated anyone against his or her will.  During this period in private practice extending back to 1968, no patients in treatment with me have committed suicide or a perpetrated a serious act of violence.  Any good psychiatrist or therapist could have a patient commit suicide or perpetrate violence; but coercion, drug treatment, and hospitalization increases the likelihood.  I believe that my refusal to coerce patients, my efforts to prevent hospitalization, and my practice of not starting patients on psychiatric drugs have contributed to the good fortune that my patients have not committed suicide or extreme violence. People in deep distress do not need incarceration or the inevitable drugs that follow; they need caring help from friends, family, and professionals.

Someone in an out-of-control manic episode or someone threatening to do harm in a psychotic episode presents difficult problems to civil libertarians and to those of us who wish to help people in distress while protecting others from them. There are no easy solutions, especially when some of these people reject all offers of voluntary help.  However, there are many reasons not to use these examples as a justification for laws that allow involuntary treatment—locking up people on the say-so of judges and healthcare professionals.  In addition to the human rights and Constitutional reasons, here are some further reasons to do away with involuntary treatment:

First, very few people labelled “mentally ill” actually become violent.  Rates of criminal violence in this group do not exceed the general population.  Those who do become violent are usually reacting against the oppressive, antagonizing conditions on hospital wards.  As described in my book Medication Madness, when patients do commit extreme violence, it is usually the result of psychiatric drug-induced brain dysfunction and/or drug withdrawal.   Psychiatric drugs frequently cause irritability, hostility, aggression, disinhibition and mania, leading to violence, especially when starting or during drug dose changes.

Second, there is no evidence that psychiatrists, judges, or others empowered to commit or certify people have any reliable knowledge or skill for determining who is acutely dangerous and who is not, and when they have recovered.

Third, there is no scientific evidence that psychiatrically incarcerating people reduces their violent tendencies or protects the public from them.  In my clinical experience and study of violent perpetrators, involuntary incarceration increases the likelihood of future violence by adding the humiliation and abuse of forced treatment to the individual’s list of reasons to feel humiliated, outraged and retaliatory.  In addition, they become exposed to psychiatric drugs, many of which can cause or worsen violence. [Moore et al., 2010]

Fourth, fear of involuntary treatment hangs over the head of everyone labelled a mental patient. Going to a psychiatrist, or to other healthcare providers, exposes the already distressed individual to the risk of incarceration and forced treatment with little or no due process.  When feeling helpless and overwhelmed, seeking psychiatric treatment can turn into the most dangerous mistake of a person’s life. People often avoid seeking help for fear of being locked up and/or forced to take drugs, when voluntary psychotherapeutic interventions can be lifesaving.

Fifth, psychiatry’s capacity to force treatment upon its most challenging patients means that psychiatrists have little motivation to develop genuinely helpful treatments.   Psychiatrists can and do get away with compulsively repeating the same old oppressive approaches—hospitalization, mind-numbing drugs, and ECT—without any evidence for their effectiveness.  Why explore better approaches, when they can simply lock up people, while making believe they are doing the best that they can do?  Involuntary treatment becomes the easy way, without the necessity of psychotherapeutic interventions that require thoughtfulness, empathy, hard work, and devotion.

We know that there are excellent treatment interventions for even the most distressed people, acutely disturbed people having breakdowns diagnosed as schizophrenia.  Robert Whitaker, Loren Mosher, as well as myself and many others, have described them.  Yet these approaches remain outside the psychiatric establishment because it is so easy to lock up people who “do not respond to treatment.”

Sixth, even if involuntary treatment could prevent a few instances of violence, the cost is too high.  The use of psychiatric coercion for centuries has led to the wretched incarceration and horrendous abuse of millions of people throughout the world.   All the most violent treatments, such as neuroleptic drugs, electroshock and lobotomy, grew out of unethical, unprincipled mass experimentation on involuntary inmates.  Many of the worst abuses I continue to witness as a medical expert have been perpetrated upon helpless, incarcerated patients.

Today in America, while long-term psychiatric incarcerations have gone down, civil commitment of people in the community is escalating.  Imagine someone forcing you to take long-acting injections of neuroleptic drugs like Risperdal and Zyprexa while living at home?   Imagine refusing to go the clinic for your shots, so that the police or other agents of the state come knocking down your door?

Undergoing forcibly injected psychiatric drugs is worse than drug-free imprisonment in jail where at least your mind and spirit are free.  The neuroleptic drugs crush the mind and spirit, in the extreme producing a zombie–like existence.   Your will can be so broken by the drugs that you cannot find the strength or motivation to resist, or to run away and hide from the authorities.

There is a reason for the complex, cumbersome protections of the criminal justice system.  People in authority, such as judges, prosecuting attorneys, psychiatrists and police officers need the restraint of Constitutional protections, especially the Bill of Rights.  Civil commitment bypasses these protections, resulting in devastating outcomes for the individual and society. As cumbersome as the criminal justice system can be, we are better off as a society if we rely upon it, rather than coercive psychiatry, to protect us from violence.  If an individual cannot forcibly be detained under existing criminal laws, then we must tolerate their freedom, if only to protect our own.  If they are jailed, they must still have the right to refuse psychiatric treatment that imposes shackles on the brain, mind and spirit.

The call to abolish involuntary treatment has become more controversial and threatening since the mass shootings perpetrated by individuals who at times seem emotionally disturbed, including some who are ideologically and religiously motivated.  As I discuss in my book Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime, organized psychiatry and involuntary treatment has not protected society from them.  Nearly all of the non-Jihadists have been through the mental health system, which has failed to respond to their threats of violence. Many have received psychiatric drugs that have worsened or even caused their violence.  On the other hand, the psychiatrist system will never get hold of most Jihadists, and if and when it does, it will provide us no protection, while continuing to trample on individual rights.

Practical experience demonstrates that involuntary treatment does not protect society while it abuses many innocent people.  Many of the mass murderers, especially Jihadists, could have been deterred by the current criminal justice system if they had been investigated and prosecuted more rigorously.

Abolishing involuntary treatment is easily justified under the Bill of Rights, including sections that pertain to due process, protection from cruel and unusual punishments, and the protection of freedom of speech.  Involuntary treatment has no place in a society that values the rights of the individual.  Nor is it “humane” or “kind” to lock up and drug people against their will.   If these people thought psychiatric treatment was humane and kind, they would have chosen it.  To superimpose upon them the will of professionals devoted to psychiatric theories and practices that do more harm than good is neither human nor kind; it is simply oppressive."

Friday, 17 June 2016

Attachment and Psychosis 2016 BABCP Keynote from Andrew Gumley

Dr. Peter Gøtzsche: Forced Psychiatric Treatment Must be Abolished

"Published on Jun 10, 2016
This is the video of Dr. Peter Gøtzsche's June 2, 2016, talk in Anchorage, Alaska on Forced Admission and Treatment in Psychiatry are Violations of Basic Human Rights and Must be Abolished. A little under an hour is the talk with the rest being the question and answer period.

The talk runs a little under an hour and then there is about an hour of questions and answers.

This talk was sponsored by the Law Project for Psychiatric Rights (PsychRights) with a grant from the Alaska Mental Health Trust Authority.

For more information go to http://www.deadlymedicines.dk/

Thursday, 16 June 2016

Working with the marginalised: Formulating beyond the mainstream 5July16 #BPS London

The Minorities in Clinical Psychology Training group's Third Annual Conference; Working with the marginalised: Formulating beyond the mainstream 

Tuesday 5th July 2016 at BPS Offices, Tabernacle Street, London

"We are extremely pleased to be hosting our third annual conference! For this event we are focusing our attention onto alternative ways to formulate clinically which may better serve needs which clinical psychology may have been complicit in silencing. Indeed, mainstream psychotherapy models are often criticised because they take little account of social and cultural forces and of their effect upon psychological functioning and relational processes. This is a significant limitation in terms of working in ways that are more 'culturally competent' and socio-politically informed. Many marginalised groups continue to see mainstream therapy and mental health services as irrelevant and there is an on-going need to deliver interventions and formulations that take better account of the lived experience of 'minorities', of the political and of the social realities of those who are disadvantaged. For our third annual conference, the 'Minorities Group' aims to encourage a dialogue on some of the above issues by concentrating on formulation. The day will aim to make more visible the power of social and historical contexts, their related traumas and, propose ways these may become integrated within formulations."

Speakers & Facilitators

Monday, 13 June 2016

Faith-fuelled pensioner: WordLive 13Jun16

"Prepare: ‘Your word is a lamp that gives light wherever I walk’ (Psalm 119:105). ‘Lord, light up not only this moment in your Word, but my day, my week, my life.’

Bible passage: Joshua 14:6–15

Hebron Given to Caleb
 6 Now the men of Judah approached Joshua at Gilgal, and Caleb son of Jephunneh the Kenizzite said to him, "You know what the LORD said to Moses the man of God at Kadesh Barnea about you and me. 7 I was forty years old when Moses the servant of the LORD sent me from Kadesh Barnea to explore the land. And I brought him back a report according to my convictions, 8 but my brothers who went up with me made the hearts of the people melt with fear. I, however, followed the LORD my God wholeheartedly. 9 So on that day Moses swore to me, 'The land on which your feet have walked will be your inheritance and that of your children forever, because you have followed the LORD my God wholeheartedly.'  10 "Now then, just as the LORD promised, he has kept me alive for forty-five years since the time he said this to Moses, while Israel moved about in the desert. So here I am today, eighty-five years old! 11 I am still as strong today as the day Moses sent me out; I'm just as vigorous to go out to battle now as I was then. 12 Now give me this hill country that the LORD promised me that day. You yourself heard then that the Anakites were there and their cities were large and fortified, but, the LORD helping me, I will drive them out just as he said."
 13 Then Joshua blessed Caleb son of Jephunneh and gave him Hebron as his inheritance. 14 So Hebron has belonged to Caleb son of Jephunneh the Kenizzite ever since, because he followed the LORD, the God of Israel, wholeheartedly. 15 (Hebron used to be called Kiriath Arba after Arba, who was the greatest man among the Anakites.)
      Then the land had rest from war. 

Explore the Bible

An incredible example
What do you expect to be doing when you hit 85? You may not expect to be as strong as when you were 40 (v 11) but the incredible Caleb was preparing to take possession of the hill country (v 12) that he had been promised by faith 45 years previously (vs 6,9). Think about that for a moment: Caleb did not let go of God’s promise to him – through Moses – for 45 years.

Caleb is to us an incredible example of positive, tenacious belief in God’s character and word. Back in his 40s, Caleb had viewed the land of Canaan with ‘eyes of faith’. Despite the scepticism he met, Caleb had spoken compellingly to his people to convince them of God’s promise and empowering presence (see Numbers 13:30). 

To the glory of God
How can we become like Caleb? Verse 8 reveals his determination to follow God ‘wholeheartedly’. Ask God for that kind of determination.

In all of our weakness, temptation and struggles with sin, the Holy Spirit will empower us to take small (or large) steps to develop ‘Caleb character’. No matter how young or old we are, it is possible to live a life of significance and meaning, to the glory of God."


Family photos



Thursday, 9 June 2016

photos of me taken by my Dad c1963; tweeting about my breakdown last year & surviving

Photos taken by my dad, of me at our Pomarium, Perth, flat, when I was about 11, c1963: 

after school, impatient to get out & play


dressed in my play clothes

my Dad c1963 aged 34


Tuesday, 7 June 2016

#StayingWellAfterPsychosis Ch5 "sealing over"

#NewMentalHealth @PickersgillM Edinburgh 6Jun16: wider perspectives & survivor voices

Thursday, 2 June 2016

invitation to view video of new £4.4m IPCU Stratheden @nhsfife 7Jun16

I received this letter by Email today from the PA of Paul Hawkins, Chief Executive, NHS Fife, signed by the Deputy Chief Executive:

I have contacted Dr Reid's secretary and a meeting to view the video has been arranged for Tuesday 7 June 2016 at 3.30pm in Stratheden Hospital.

I will prepare a list of questions to ask Dr David Reid who is the Clinical Director of NHS Fife and the PT Consultant Psychiatrist in charge of the new IPCU, as I understand it.