Mad in America: Rethinking Mental Health

Sharna Olfman Ph.D interviews Zach Bush MD One of the few triple board-certified physicians in the country, with expertise in Internal Medicine, Endocrinology and Metabolism, and Hospice/Palliative care, Dr. Zach Bush abandoned his prestigious academic career in cancer research, and his conventional medical practice a decade ago, after coming to terms with the fact that not only were his pharmaceutically based research and treatment protocols ineffectual; they were making his patients sicker. He then opened a clinic in the middle of a food desert in rural Virginia, where he swapped out pharmaceutical interventions for the medicinal properties of plants. Now based in Charlottesville, Dr. Bush has assembled an outstanding group of scientists and clinicians who are at the forefront of research on the microbiome and epigenetics. He has developed an impactful approach to healthcare which directly challenges ‘big farming, ‘big pharma’ and conventional medicine.  https://www.madinamerica.com/2018/10/healthy-planethealthy-mind-zach-bush-md/    

This week on MIA Radio we turn our attention to Electroconvulsive Therapy (ECT) or Electroshock as it’s known in the US. On Wednesday, September 19th, this emotive and controversial intervention was discussed at the 57th Maudsley debate, held at Kings College London. The motion proposed was: “This house believes that ECT has no place in modern medicine”. Supporting the motion were Professor John Read who has undertaken several scientific reviews of the literature supporting the use of ECT and Dr Sue Cunliffe. Dr Cunliffe was a paediatrician until she herself underwent ECT, after which she became cognitively impaired and found herself unable to continue working. She now campaigns for the risks of ECT to be made more explicit and to directly address the professional denial of the damage that ECT can cause. Speaking against the motion were Professor Declan McLoughlin and Dr Sameer Jauhar. Both John and Sue took time out to talk about the debate and the wider issues surrounding ECT. Professor Read kindly shared his debate notes, which are provided below. Thank you to the Institute for bringing us all together. Let us first remind ourselves tha thistory is littered with procedures which people believed in- just as strongly as some psychiatrists believe, today, in electrocuting people’s brains to cause seizures - but which turned out to be ineffective or damaging. The list includes spinning chairs, surprise baths, standing people next to cannons, and, more recently, lobotomies. It was 80 years ago, in 1938, that Ugo Cerletti administered the first ECT, to a homeless man in Rome. After the first shock the man called out ‘Not another – it will kill me’. The theory back then was that people with epilepsy didn’t have schizophrenia so the cure for schizophrenia was to cause epilepsy. So Cerletti was driven by the genuine belief that causing convulsions by shocking the brain really might help people, by the genuine hope that we might finally have come up with an effective treatment. The story of ECT illustrates, yet again, however, what happens when our beliefs and good intentions are not tempered with good science. ECT quickly spread from Rome across Europe and America. Finally, an effective treatment! People who received it were discharged earlier….… by the doctors who gave it. But there were no studies for 13 years, by which time everyone just knew it worked, and their belief may have been very helpful to some patients. The first study on depression (which became the main target for ECT), in 1951, found that those who had ECT fared worse than those who had not had it. It made no difference. I have co-authored four reviews of the ECT research, most recently last year. There are only ten depression studies comparing ECT and placebo; placebo meaning the general anaesthetic is given but the electric shock is withheld. Five of those 10 found no difference between the two groups. The other five found, compared to placebo, a temporary lift in mood during the treatment period, among about a third of the patients. One of these five found that this temporary improvement was perceived only by the psychiatrists, but not by the nurses or the patients. Most reviews and meta-analyses assert, on the basis of these temporary gains in a minority of patients, that ‘ECT IS EFFECTIVE’ But none of them have ever identified a single study that found any difference between ECT and placebo after the end of the treatment period. There is just no evidence to support the belief that ECT has lasting benefits, after 80 years of looking for it. Similarly, there are no placebo studies to support another genuinely held belief: that ECT prevents suicide. There is nothing wrong with treatments working because of hopes and expectations. But passing 150 volts through brain cells designed for a tiny fraction of one volt causes brain damage. Indeed, autopsies quickly led to a new theory about how ECT works. In a 1941 article entitled ‘Brain damaging therapeutics’, the man who introduced ECT to the USA, wrote ‘Maybe mentally ill patients can think more clearly with less brain in actual operation’. In 1974 the head of Neuropsychology at Stanford wrote: ‘I’d rather have a small lobotomy than a series of ECT….I know what the brain looks like after a series of shock’. All ECT recipients experience some difficulties laying down new memories and in recalling past events. What is disputed is how many have long-lasting or permanent memory dysfunction, which might reasonably be called brain damage. Findings range from one in eight to just over half. A review of studies that actually asked the patients, conducted here at the Institute, found ‘persistent or permanent memory loss’ in 29 to 55%. Yet another belief is that ECT used to cause brain damage, in the bad old days, but not any more.  But a recent study found one in eight with ‘marked and persistent’ memory loss, …..  and also found much higher rates among the two groups who receive it most often, women and older people. The same study also found that the memory loss was not related to severity of depression. This is important because another belief about ECT is that the memory loss is caused by the depression, not the electricity. Psychiatric bodies in the UK and USA recite the belief that only ‘one in 10,000’ will die from having ECT, without producing a single study to support that belief.  Our reviews document large-scale studies with mortality rates between one in 1400 and one in 700, several times higher than the official claims, typically – unsurprisingly - involving cardiovascular failure. ECT in England has declined, from 50,000 a year in the 1970s to about 2,500. The number of psychiatrists who still believe, despite all the evidence, is dwindling fast. It may have been understandable for the psychiatrists of the 1940s to believe that ECT worked and was safe. They didn’t know any better. But if psychiatry wants to be an evidence-based discipline, to be part of modern medicine, it must acknowledge that, despite all its honourable intentions, it has got this one, like lobotomies, woefully wrong. Thank you. Links and Further Information To watch the debate on YouTube, click here. To read a report on the first ever Maudsley Debate, held in January 2000, which also discussed ECT, click here. ECT Accreditation Service (ECTAS) MECTA The effectiveness of electroconvulsive therapy: A literature review, John Read and Richard Bentall Is electroconvulsive therapy for depression more effective than placebo? A systematic review of studies since 2009  

This week on MIA Radio, we discuss the UK Royal College of Psychiatrists representation on a Government-led review of Prescribed Drug Dependence. Professor Sami Timimi, a fellow of the Royal College of Psychiatry, and 30 other mental health experts, have formally asked the College to ‘replace Professor David Baldwin as its representative on The Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry’. In this podcast, we hear from Professor Timimi, Psychiatrist Peter Gordon and campaigner Stevie Lewis. Both Peter and Stevie are people who have experienced withdrawal effects from antidepressant drugs. Conflicts of Interest Questioned in Royal College of Psychiatry’s Participation in Government-Led Mental Health Medication Review August 17, 2018 From: James Moore, antidepressant withdrawal sufferer, on behalf of the 30 other signatories to today’s letter.   London, UK – A fellow of the Royal College of Psychiatry, and 30 other mental health experts, have today formally asked the College to ‘replace Professor David Baldwin as its representative on The Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry’. The Public Health England review1 was set up to examine a growing problem with patients becoming dependent on psychiatric drugs including antidepressants. In the UK, four million people are long-term antidepressant users2, with many of those unable to come off their drugs without debilitating and protracted withdrawal symptoms. Signatories to the complaint include 10 people whose withdrawal experiences have lasted between one and ten years, plus 11 psychiatrists and 8 mental health professors. In the Public Health England (2018) document ‘PMR ERG members declarations of interest’, Prof­essor Baldwin reports having received ‘personal honoraria for lecture engagements organised by AstraZeneca, Bristol-Myers Squibb, Eli Lilly Ltd, Glaxo-SmithKline, Janssen, H. Lundbeck A/S, Pharmacia, Pierre Fabre, Pfizer Ltd, Servier, and Wyeth Ltd’. In addition, he reports attendance at advisory boards of five companies and research funding from twelve. The signatories are worried that he could be unduly influenced by the large number of pharmaceutical manufacturers he has received income from. This concern is exacerbated by Professor Baldwin’s having already publicly minimised the withdrawal effects of antidepressants (Times 24.2.18), which was described as ‘misleading’ the public in the House of Lords3and led to a formal complaint against him4. Lead author of the letter, psychiatrist Professor Sami Timimi, a fellow of the Royal College, said: “DESPITE THE INCREASED AWARENESS OF THE PERNICIOUS INFLUENCE OF THE PHARMACEUTICAL INDUSTRY IN ALL SPHERES OF MENTAL HEALTH, THE RCPSYCH DOES NOT APPEAR TROUBLED BY THE POTENTIAL FOR MISLEADING THE MEDICAL COMMUNITY AND THE PUBLIC AND SOILING THE GOOD NAME OF THE PROFESSION OF PSYCHIATRY. WE FEEL THE NEED TO MAKE PUBLIC OUR OPPOSITION TO SOMEONE SO CONNECTED WITH THE PHARMACEUTICAL INDUSTRY BEING THE RCPSYCH’S REPRESENTATIVE ON A PUBLIC BODY APPOINTED WITH THE TASK OF WORKING FOR THE PUBLIC GOOD.” Another signatory, psychiatrist Dr Peter Gordon said: “EVIDENCE HAS REPEATEDLY FOUND THAT COMPETING FINANCIAL INTERESTS CAN LEAD TO DOCTORS RECOMMENDING WORSE TREATMENTS FOR PATIENTS5. IN THE UK, THE PHARMACEUTICAL INDUSTRY SPENDS OVER £40 MILLION A YEAR ON DOCTORS AND ACADEMICS WHO MARKET AND PROMOTE THEIR PRODUCTS6. I HAVE BEEN COMMUNICATING WITH MY COLLEGE FOR MANY YEARS ON THIS, YET IT REMAINS THE CASE THAT THE ROYAL COLLEGE OF PSYCHIATRISTS STILL HAS NO SINGLE, SEARCHABLE REGISTER THAT RECORDS FULL DETAILS OF INDUSTRY PAYMENTS MADE TO ITS MEMBERS. IT IS THEREFORE IMPOSSIBLE TO DETERMINE THE SCALE OF PAYMENTS THAT MAY HAVE BEEN MADE TO COLLEGE MEMBERS WHO ARE INVOLVED IN DEVELOPING POLICIES AND GUIDELINES OR EDUCATING ON THE PRESCRIBING OF PSYCHIATRIC MEDICATIONS.” Antidepressant withdrawal sufferer James Moore, also a signatory, said: “THERE ARE MANY PEOPLE OUT THERE LIKE ME, WHO HAVE FOUND THEMSELVES IN SEVERE DIFFICULTY AFTER TRYING TO COME OFF PRESCRIBED ANTIDEPRESSANT DRUGS. IN ORDER TO PROPERLY INVESTIGATE THIS ISSUE, IT IS VITAL THAT THE INFLUENCE OF THE PHARMACEUTICAL MANUFACTURERS IS NOT ALLOWED TO CORRUPT AN EVIDENCE-BASED AND HONEST APPRAISAL OF A PROBLEM POTENTIALLY AFFECTING MILLIONS OF PSYCHIATRIC DRUG USERS.” References 1. https://www.gov.uk/government/collections/prescribed-medicines-an-evidence-review 2. https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants 3. http://bit.ly/2BgyzxX 4. https://www.madinamerica.com/2018/07/30-mental-health-experts-write-secretary-state-unprofessional-conduct-uk-royal-college-psychiatry/ 5. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000352 6. https://www.bmj.com/content/360/bmj.k1380 © Mad in America 2018

This week on MIA Radio we interview Dr Julia Rucklidge. Dr Rucklidge is professor of clinical psychology at the University of Canterbury in New Zealand and she leads the Mental Health and Nutrition Research Group. Originally from Toronto, Canada, Julia completed her PhD at the University of Calgary followed by a post-doctoral fellowship at the Hospital for Sick Children in Toronto. In the last decade, she and her lab have been running clinical trials investigating the role of broad-spectrum micronutrients in the expression of mental illness, specifically ADHD, mood disorders, anxiety and stress. Julia has over 100 peer-reviewed publications and book chapters, has been frequently featured in the media and has given invited talks all over the world on her work on nutrition and mental health. We discuss: What led Julia to her interest in nutrition and how it may have a role in responding to mental disorders, particularly Attention Deficit Hyperactivity Disorder (ADHD). Why using the Recommended Dietary Allowance (RDA) of vitamins and minerals may not be the best approach when responding to psychological difficulties. How Julia went about setting up a Randomised Controlled Trial to investigate the effect of micronutrients and minerals on behavioral problems. That the most consistent finding of the study is that the individuals taking micronutrients improved more in their general functioning and impairment when compared to those just taking a placebo. That it’s hard to move away from the conception of mental illness as a chemical imbalance in the brain, partly because of the vested interest in keeping it alive. That there is no opportunity to patent nutrient therapies, so there is little incentive for research and limited commercial interests. Why a single nutrient response might not be the best approach for someone who wanted to use nutrition to improve their mental health and wellbeing. How a dietary deficiency of Niacin during the 1930s led to a condition called Pellagra which often manifested as psychotic symptoms. What led to the flagging of a 2014 TEDx talk Julia gave entitled “The surprisingly dramatic role of nutrition in mental health”. How Julia felt about her talk being flagged by TED. How many historical medical advances, now accepted as the standard of care, at the time flew in the face of conventional scientific thinking. How difficult it has been to communicate with TED about the flagging of the talk. How Julia hears from many people who get in touch to share that they are struggling with psychiatric medications and instead want to look to nutritional solutions. That the best advice is often simple, eat more fruits and vegetables and reduce the amount of processed food. Relevant Links: Mental Health and Nutrition Research Group Vitamin-mineral treatment of ADHD in adults: A one year follow up of a randomized controlled trial. Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients A double-blind randomised, placebo-controlled trial of a probiotic formulation for the symptoms of depression TEDx Christchurch: The Surprisingly Dramatic Role of Nutrition in Mental Health TED Betrays Its Own Brand By Flagging Nutrition Talk Contact the Mental Health and Nutrition Research Group Mad Diet by Suzanne Lockhart

This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 2 of the podcast, we interview Mad in America founder, Robert Whitaker. For many of us, Robert needs no introduction as he is well known for his award-winning book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, which was released in 2010. Robert has been a medical writer at the Albany Times Union newspaper, A journalism fellow at the Massachusetts Institute of Technology and Director of publications at the Harvard Medical School. Besides many papers, journals and articles, Robert has written five books which include Mad In America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001, Anatomy of an Epidemic in 2010 and Psychiatry Under The Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform published in 2015. We discuss: What took Bob from writing as an industry insider covering clinical trials to founding Mad in America. How writing a story about the botched introduction of laparoscopic surgery led to an interest in how commerce was corrupting healthcare. How Freedom of Information requests led to an understanding of the corruption in the clinical trials of antipsychotic drugs. What led to writing the book Mad in America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001. That, when you look at the science, you see an enduring theme in psychiatry of treatments that are full of promise, but ultimately can lead to harm. That Bob came to these issues as a journalist who felt a sense of public duty to be an honest reporter of the facts and the science. The extraordinary history behind the revival of the market for benzodiazepines. How Valium became the western world’s most prescribed psychiatric drug during the late 1960s. How, in the 1970s, it became apparent that people were struggling to get off the drugs. That women’s magazines started to write about the experiences of women addicted to Valium, and it was recognised as a bigger issue than heroin addiction. That the reaction by the pharmaceutical manufacturers was to reconceptualize anxiety-related distress as depressive distress and move patients on to SSRIs. How in 1980, in the third version of the Diagnostic and Statistical Manual, a new disorder is named: Panic Disorder, leading the maker of Alprazolam, Upjohn, to get it approved specifically for the treatment of panic disorder. How the study published showed that the reduction in panic attacks in the medicated group over four weeks was greater than the unmedicated group, but the study actually ran for eight weeks, by which time there was no difference between the medicated and unmedicated groups. That in the six-week withdrawal phase of the study, 44% were not able to stop the drugs. How newspapers reported that Xanax (Alprazolam) was an efficacious, safe and non-addictive treatment for panic disorder. That what you see in the heart of the Xanax story is a betrayal of the public. The reasons why doctors often don’t review the papers that would lead them to conclude that benzodiazepines are highly problematic drugs. A paper from a new International Task Force on Benzodiazepines which seems to be a statement of intent to increase benzodiazepine prescribing. That people should keep on telling their stories of withdrawal and iatrogenic harm. The attempt in Massachusetts to pass a bill requiring informed consent. The problems inherent in using the language of withdrawal when the symptoms are protracted and that it would be more appropriate to describe this as a neurological injury. That the benzodiazepine community is doing an incredible service by alerting the public to what should be seen as a public health crisis. Relevant links: Revival of the market for Benzodiazepines Malcolm Lader: It is more difficult to withdraw people from benzodiazepines than it is from heroin International Task Force on Benzodiazepines    

This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 1, we chat with W-BAD Lead Operations Volunteer and Virginia Representative Nicole Lamberson who talks about the events being held for W-BAD. We hear from psychiatrist Dr Josef Witt-Doerring, who talks about a recent paper he co-authored entitled “Online Communities for Drug Withdrawal: What Can We Learn?”. We also hear from therapist and campaigner Chris Paige who discusses his own experiences taking and withdrawing from benzodiazepines. Finally, in part 2 of the interview, we get to chat with Robert Whitaker, science journalist and author of the books Mad in America and Anatomy of an Epidemic. First, I am very fortunate to have had the chance to talk with Nicole Lamberson. Nicole is Lead Operations Volunteer and Virginia Representative for W-BAD and she has kindly taken time out of her busy preparations to talk about how she became involved with W-BAD, some of the events and campaigns being held around the world and how people can get involved. Nicole has an immense passion for benzodiazepine awareness and its victims and hopes that her efforts ultimately spare many others from taking this painful, senseless, and totally preventable iatrogenic “journey”. We discuss: How Nicole first became involved with W-BAD. How discovering personal testimonies encouraged her to reach out to find out more about an awareness day held on the birthday of Dr Heather Ashton - July 11. What it feels like to be part of the benzodiazepine community. How there is is still no medical consensus about the effects of both taking and withdrawing from benzodiazepines. The W-BAD T-shirt campaign, which was organised in partnership with the Benzodiazepine Information Coalition and As Prescribed, an in-production documentary by Holly Hardman. Pamphlet distributions happening in Auckland, Paris, Boston and Torrington. That Wayne Douglas, W-BAD founder is on the Dr Peter Breggin hour on July 11 at 4pm New York time. That people can visit W-BAD events to find out more. That on social media, people can follow events using @WorldBenzoDay and the hashtag #WorldBenzoDay. That people can participate in many ways and that one of the most important ways to participate is to submit reports of adverse effects and withdrawal reactions to the appropriate regulator, links to which can be found on the W-BAD website. How important it is to share stories and personal experiences. That W-BAD is for anybody, not just those who are damaged by the drugs but also for families and friends and those recovered too. Relevant links: W-BAD [IN]VISIBLE T-shirt campaign How to participate in W-BAD Benzodiazepine Information Coalition As Prescribed by Holly Hardman (documentary film in production) International Task Force on Benzodiazepines Dr Heather Ashton The 2017 W-BAD podcast featuring Professor Malcolm Lader, Jocelyn Pedersen and Barry Haslam. Next, we chat with psychiatrist Dr Josef Witt-Doerring. Josef trained in Queensland, Australia before becoming a psychiatric resident at Baylor College of Medicine, Houston, Texas. He co-authored a paper published in Psychiatric Times entitled “Online Communities for Drug Withdrawal: What Can We Learn?” which received praise for openly addressing the issues of dependence and withdrawal and identifying the support activity that goes on in forums like Benzo Buddies and Surviving Antidepressants. We discuss: What led Dr Witt-Doerring to become a psychiatric trainee after attending medical school in Queensland, Australia. How reading Anatomy of an Epidemic led to an awareness of some of the consequences of psychiatric drug use from a critical perspective. What led to his research into online support forums for those who are seeking support for psychiatric drug withdrawal. That Josef was surprised at the amount of support activity in online forums like Benzo Buddies and Surviving Antidepressants. How the paper that Josef co-authored on learning from online communities found a great deal of support both amongst colleagues and patient advocacy organisations. How he feels that there is a general lack of awareness of dependence and withdrawal issues because the messages can be drowned out by more strident communications in marketing or promotional material. That the idea of ‘treatment resistant’ conditions is probably much more on a general doctors mind than adverse reactions or protracted withdrawal experiences. How Josef’s experiences have influenced his approach to prescribing central nervous system drugs. That he would like to think that if a doctor and patient can talk frankly and openly about the pros and cons of treatment, then that is likely to lead to a better relationship and a better outcome. That there is a dearth of support services for people struggling with the drugs, particularly at the end of treatment. How academic detailing programmes could help raise awareness and disseminate information that would lead to doctors being more confident about de-prescribing. How the language of addiction and dependence can sometimes be a barrier to recognition of drug withdrawal issues. That it may be better to look through a neurological injury lens rather than an addiction lens both in terms of understanding experiences but also to enable better treatment and support options. That the community of those affected should continue to share their stories and to raise petitions with professional organisations, such as the boards that licence psychiatrists and OBGYN’s. How, because of the huge variation in patient experience, it would be very difficult to mandate short-term prescribing. Relevant links: Online Communities for Drug Withdrawal: What Can We Learn? Benzo Buddies Benzodiazepine Information Coalition Surviving Antidepressants Malcolm Lader: Anxiety or depression during withdrawal of hypnotic treatments Our next guest is Chris Paige. Chris has a bit of an 'inside' perspective to add to the conversation for World Benzodiazepine Awareness Day in that he is a licensed therapist of over 20 years who was iatrogenically injured by a prescribed benzodiazepine. Chris has practised in a variety of settings including hospitals, schools, and foster homes and has taught at the undergraduate and graduate level. He has presented papers at national and international conferences, appeared on Dateline NBC for his work with children of divorce and had his own national magazine column called 'On The Couch with Chris Paige'. Chris is on the board the Benzodiazepine Information Coalition, a non-profit organization that advocates for greater understanding of the potentially devastating effects of commonly prescribed benzodiazepines as well as prevention of patient injury through medical recognition, informed consent, and education. Chris currently resides and practices in Florida. We discuss: How Chris first came to be prescribed a benzodiazepine in 2000. His recollections of being prescribed Klonopin (Clonazepam) for anxiety, taking between 1 and 2 milligrams per day. How, after three years use, he started to notice tremors and memory loss. That a neurologist explained that his symptoms may be medication related and advised a taper but gave no specific instructions. How Chris came off the Klonopin fairly rapidly but didn’t find it too difficult at the time. How, some years later, he was given an antibiotic for a prostate infection but rapidly developed psychiatric symptoms including anxiety, agitation and insomnia. That this led Chris to consult a doctor for some Klonopin tablets to manage this and that he took a total of 16 milligrams over the next 10 weeks. That he understands now that the antibiotic and the Klonopin compete at the same receptor in the brain, leading immediately to a tolerance to the drug. That because of this tolerance he became more sleepless, more agitated and more anxious and working was becoming increasingly difficult. How he came to be in a five-day detox programme in Vermont, where they took him off one and a quarter milligrams of Klonopin in just five days. How Chris realised that the detox approach was not right and wanted to leave. How the detox programme decided to replace the Klonopin with four different psychiatric drugs, two of which he has now ceased with two still to taper. That he felt that his brain and nervous system were severely shocked by making such rapid medication changes. How this led to Chris being admitted to psychiatric hospital which he describes as “possibly one of the most humiliating experiences he has ever endured.” How Chris felt when experiencing akathisia which was a relentless compulsion to move and gave him a feeling as if his whole body was being electrocuted and that he had been lit on fire. That he initially felt supported by friends and family but that quickly eroded when he didn't get better or accept harmful and dangerous treatment advice. That this led to the misunderstanding of his injury and it being mislabeled as an addiction problem. That ultimately the only places he found validation and support were online support forums. The losses that Chris endured during his struggles including his health, his psychotherapy practice and even his reputation. That Chris’s message is that there is hope for the future and the importance of reconnecting with the simple things in life. The lack of acknowledgement of the impact of trauma on a person’s life. Relevant links: Benzodiazepine Information Coalition Chris's profile at BIC In part 2 of this podcast, we will hear from science journalist and author Robert Whitaker.

On MIA Radio this week, Akansha Vaswani and Dr Peter Groot discuss Tapering Strips, a novel and practical solution for those who wish to taper gradually from a range of prescription drugs. Akansha is a doctoral candidate at the University of Massachusetts, Boston and her dissertation research will involve interviewing psychiatrists in the US about their experiences helping people stop or reduce their dose of antidepressant medication. Dr Groot is a researcher and geneticist who has led the development of Tapering Strips. In a recent study, published in the journal Psychosis, Dr Groot, together with Jim van Os, reported on the results of their trial which recorded the experiences of people using Tapering Strips. In this episode we discuss: What motivated Peter to be interested in and study the effects of coming off antidepressants drugs. That the observational study reported in Psychosis was based on questionnaires completed by users who had made use of tapering medication (Tapering Strips) to slowly reduce their medication dosage. How the questionnaire asked about withdrawal symptoms and the ease of tapering using the strips and whether people had tried to withdraw previously using conventional methods. That Tapering Strips offer a flexible and necessary addition to standard doses that have been registered by the pharmaceutical companies. That current guidelines advise doctors to let patients start on the same recommended dose of an antidepressant, without taking into account large differences that exist between patients (weight, sex, etc). How we would be surprised if, when we came to buy shoes or clothes, our choices were limited to only a few sizes, but we don’t question this limitation with our medications. How current guidelines are based on group averages and do not help a doctor to determine how a given individual patient should taper. How shared decision making, in which the patient and the doctor work in a collaborative way, can make tapering easier. How shared decision making has contributed to the success of the use of tapering medication and the availability of tapering medication makes shared decision making practically possible. How shared decision and the availability of tapering medication makes life easier for the doctor as well as for the patient. How working initially as a volunteer to develop Tapering Strips brought Peter into contact with Professor Jim van Os and the User Research Centre of Maastricht University. That, in the study, 1,750 questionnaires were sent, with 1,164 received, a response rate of 68%. Of those returned, 895 said their goal was to taper their antidepressant drug completely and 70% succeeded in this goal. That the median time taken for people in the study to withdraw from Venlafaxine was 56 days or two Tapering Strips. There were a variety of reasons reported for those who didn’t reach their goal, including the fact that some of the patients were still tapering. Other reasons reported for not withdrawing completely were due to the occurrence of withdrawal symptoms, relapse of an original condition or even issues related to reimbursement of the cost of the tapering medication by insurance companies. That 692 patients reported that previous attempts to withdraw had failed in comparison to the successful use of Tapering Strips. That people using multiple drugs should only ever taper one medication at a time and in discussion with a medical professional. That Peter’s goal for Tapering Strips is to make sure that people that want to withdrawal gradually can access Tapering Strips and have the cost reimbursed by health insurers. That Tapering Strips were not developed to get everyone off their antidepressant drug but to enable patients to get to a dosage that provides benefit for them (which can be zero) while minimising adverse effects. That people outside the Netherlands can get Tapering Medication, but only with a prescription signed by a certified doctor, instructions and receipt/order forms can be found at taperingstrip.org. That Tapering Strips are also available for antipsychotics, sedatives (benzodiazepines), analgesics and for some drugs other than psychotropics, like some anti-epileptic drugs, which are currently being developed. That Peter warns against tapering by taking doses on alternating days, particularly for drugs like paroxetine or venlafaxine that have a short metabolic half-life, because this will lead to more severe withdrawal symptoms. Relevant Links: Tapering Strips (website of the User Research Centre of Maastricht University) Treatment guidelines for the use of tapering strips Summary of the tapering study in the journal Psychosis (blog) Tapering Strips study from the journal Psychosis Peter Groot interviewed on Let's Talk Withdrawal Claire shares her experience with Tapering Strips (YouTube) Petition requesting use of Tapering Strips in the UK Mad in America report on Tapering strips study Prime Time for Shared Decision Making Mandatory Shared Decision Making © Mad in America 2018

This week on MIA Radio we provide an update on a complaint made to the UK Royal College of Psychiatrists by a group of thirty academics, psychiatrists and people with lived experience. We hear from both Professor Sami Timimi and Professor John Read who discuss recent events including the latest response from the Chief Executive Officer of the College. Relevant Links: Read the latest update on Mad in America Formal Complaint to the UK Royal College of Psychiatrists Royal College Of Psychiatrists Challenged Over Potentially Burying Inconvenient Antidepressant Data Professor John Read: The Royal College of Psychiatrists and Antidepressant Withdrawal UK Royal College Dismisses Complaint © Mad in America 2018

This week, we interview Dr Peter Gordon. Dr Gordon describes himself as a gardener with an interest in medicine. He trained in both medicine and landscape architecture before specialising in psychiatry and now works with older adults in Scotland. In addition, he is an activist and campaigner and has a range of creative interests including filmmaking, photography, writing and poetry. In this interview, we walk about Peter’s own experiences of psychiatric treatment and how we need to address the divide that exists between the arts and the medical sciences. In this episode we discuss: What led Dr Gordon to have combined interests in the arts and the sciences, training both in architecture and medicine. How Peter was interested in the plurality of thinking required for psychiatry as opposed to general medicine. How he feels that his training in both the arts and the sciences led to a more rounded appreciation of why purely biological approach might miss opportunities to help people. How Peter became an activist, partly in response to the commonly taught subjective/objective diagnostic approach. How we should be focussed on the potential of any medical intervention to cause harm and should consider this carefully alongside any potential benefit. How we need to take account of all experiences to ensure we provide the maximum benefit and minimum harm to people. Peter’s own experiences with the mental health system, taking antidepressant drugs and experiencing treatment within a psychiatric hospital. How stopping his antidepressant drug resulted in withdrawal effects and led to Peter’s only episode of severe depression. Why Peter is concerned that we seem to be downplaying the experiences of people who have struggled with psychiatric drugs. How Peter’s experiences have influenced his approach to prescribing. The dominance of the biological approach and why it should not dictate how we respond to individual experiences. How the evidence is starting to show that diagnosis can often disempower and bring about ‘otherness’. Peter’s plea for people to be kind to one another and work together to maximise well-being. Relevant links: Peter’s blog: Hole Ouisa The caption is wrong Paroxetine tablets [Film-coated] Peter’s films on Vimeo Mary Midgley Nathan Filer, The Shock of the Fall Raymond Tallis To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018

This week on MIA Radio we interview Sera Davidow, a psychiatric survivor and prolific activist for the human rights of people labeled mentally ill. Sera serves as the Director of the Western Massachusetts Recovery Learning Community and is a founding member of the Hearing Voices USA Board of Directors. Through her work, she has gained a range of experiences including starting up a peer respite, opening resource centers, and producing educational materials on non-coercive, non-pathologizing alternatives to the traditional mental health system. Sera is a regular blogger for Mad in America and has written extensively on the topics of forced treatment and sexual violence. In this interview, we discuss the parallels and intersections between coercive psychiatric care and sexual assault. In this episode we discuss: Sera’s lived experience as a psychiatric survivor and survivor of sexual violence. The similarities between sexual violence and forms of psychiatric abuse including forced drugging, forced intubation, forced catheterization, strip searches, restraint, and containment How even seemingly minor or routine parts of psychiatric hospitalization, such as regularly monitoring patients, can be violating The role that victim-blaming and gaslighting play in both sexual violence and psychiatric coercion That the language and terminology of the mental health system such as “mental illness,” “noncompliance,” and “anosognosia” serve to perpetuate violence That people’s discomfort with big emotions and taboo topics often prevent trauma survivors from speaking about their experiences within psychiatric settings How we can help providers and the general public understand the trauma and violence of psychiatric coercion Relevant Links: Sera Davidow A World That Would Have Us Doubt: Rape, the System, and Swim Fans Us, Too: Sexual Violence Against People Labeled Mentally Ill Feminism 101: What is Gaslighting? To get in touch with us email: podcasts@madinamerica.com © Mad in America 2018