Mad in America: Rethinking Mental Health

This week, MIA Radio presents the fourth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team. Over the past three weeks, we have published interviews with many of the leading voices in this debate. Immediately following the release of the report and the beginning of the Summit, on World Mental Health Day, psychiatric epidemiologist, Dr. Melissa Raven, was on the MIA podcast. She questioned the evidence base of the movement, pointing to statistical issues in the prevalence rates of mental disorders internationally, and called for a focus on addressing barriers to health rather than on individualized treatment. Mental health service-user activists, Jhilmil Breckinridge, of the Bhor Foundation in India, and Dr. Bhargavi Davar, of Transforming Communities for Inclusion (TCI) Asia Pacific were also on the podcast. Each discussed the lack of involvement of service-user and disability rights groups in the UK Summit and Lancet report and laid out alternative frameworks for addressing distress in ways that are sensitive to culture and social context. Next, Dr. China Mills, a critical psychologist and author of Decolonizing Global Mental Health, spoke to my colleague, Zenobia Morrill, about her experience attending the UK summit and the lack of attention that has been given to the ways in which austerity policies in Britain have contributed to the increased demand for mental health interventions. You can find these earlier interviews at the links below: 10/10/18 - Interview with Dr. Melissa Raven, psychiatric epidemiologist - The Global ‘Mental Health’ Movement – Cause For Concern 10/20/18 – Interviews with mental health service-user/psychosocial disability rights activists Jhilmil Breckenridge and Dr. Bhargavi Davar - Global Mental Health: An Old System Wearing New Clothes 10/24/18 – Interview by MIA research news editor Zenobia Morrill with Dr. China Mills, a critical psychologist and prominent critic of the global mental health movement – Coloniality, Austerity, and Global Mental Health Today I am very pleased to announce that we are joined by Dr. Derek Summerfield. Dr. Summerfield is an honorary senior lecturer at the Institute of Psychiatry in London and former Research Associate at the Refugee Studies Centre at the University of Oxford and consultant and Oxfam. He was born in South Africa and trained in medicine and psychiatry at St. Mary’s Hospital Medical School in London. Dr. Summerfield has published hundreds of articles in medicine and social science and has contributed widely to understanding the impact of war-related trauma and torture on people around the world. He has been an outspoken critic of the global mental health movement for several years, criticizing the medicalization of trauma through PTSD, the exaggerated prevalence rates in the epidemiological data, and the lack of awareness of the different cultural experiences and understandings of distress.

Today, we bring you the third in our series of podcasts on the topic of the global mental health movement. Part one of the series featured Dr Melissa Raven and part two featured Jhilmil Breckenridge and Dr Bhargavi Davar. These interviews are led by our Mad in America research news team. In this episode, we interview Dr China Mills. China participated in organizing the open letter in response to The Lancet Commission on Global Mental Health and Sustainable Development. In this interview, China shares her concerns and reactions to the Lancet’s proposal, elaborating on deeper issues related to the framing of global mental health as a “burden” and the underlying implications of coloniality, technology, and medicalization. In addition, China tells us about her insider perspectives after attending the Global Mental Health Ministerial Summit hosted by the UK government. In her recent piece for Mad in Asia about the summit, she writes: “It was ironic to listen to a range of UK Government minsters talk about the importance of mental health whilst sat in a room just over the river from Westminster, where governmental decisions to cut welfare, and sanction and impoverish disabled welfare claimants has so detrimentally impacted people’s mental health and led to suicide. It felt like arrogance on the part of the UK Government to position themselves as world leaders in mental health when in 2016, the UN found that the Government’s austerity policies had enacted ‘grave’ and ‘systematic violations of the rights of persons with disabilities’ . It was equally jarring, given the cuts to social security under austerity, to be transported by boat about 2 minutes away, to an evening drinks reception at the Tate gallery.” China Mills is a Lecturer in the School of Education, University of Sheffield, UK. Her research develops the framework of psychopolitics to examine the way mental health gets framed as a global health priority. In 2014, she published the book ‘Decolonizing Global Mental Health’ and has since published widely on a range of topics including: the inclusion of mental health in the sustainable development goals; the quantification of mental health and its construction as a technological problem; welfare-reform, austerity and suicide; and the intersections of psychology, security and curriculum. She is Principal Investigator on two British Academy funded projects researching the social life of algorithmic diagnosis and psy-technologies. China is a member of the editorial collective for Asylum magazine and for the journal, Critical Social Policy; and she is a Fellow of the Sheffield Institute for International Development (SIID).

Today, we bring you the second in our series of podcasts on the topic of the global mental health movement. These interviews are led by our Mad in America research news team. On October 9th and 10th, 2018, World Mental Health Day, the UK government hosted a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement mental health policies globally. In the same week, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal for “scaling up” mental health care globally. In response, a coalition of mental health activists and service-users have organized an open letter detailing their concerns with the summit and report. The response has attracted the support of policy-makers, psychologists, psychiatrists, and researchers. In our last episode, we were joined by Dr Melissa Raven, a critical psychologist and epidemiologist, who discussed problems with the scientific evidence base used by the global mental health movement. She also emphasized the need to consider responses to the distress and suffering of people globally that address the social determinants of mental health, including poverty, education, and healthcare. Today we turn our focus to the concerns raised by mental health activists in response to the UK summit and the Lancet report. To discuss these issues, we are joined first by Jhilmil Breckenridge, a poet, writer and mental health activist and later by social science researcher Dr Bhargavi Davar. Jhilmil is the Founder of Bhor Foundation, an Indian charity, which is active in mental health advocacy, the trauma-informed approach, and enabling other choices to heal apart from the biomedical model. Jhilmil also heads a team leading Mad in Asia Pacific; this is an online webzine working for better rights, justice and inclusion for people with psychosocial disability in the Asia Pacific region. She is currently working on a PhD in Creative Writing in the UK and, for the last three years, she has also been leading an online poetry as therapy group for women recovering from domestic violence. She is working on a few initiatives, both in the UK and India, taking this approach into prisons and asylums. Her debut poetry collection, Reclamation Song, was published in May 2018. For our second interview, we are joined by Dr Bhargavi Davar. She identifies as a childhood survivor of psychiatric institutions in India. She went on to train as a philosopher and social science researcher at the Indian Institute of Technology in Bombay and has published and co-edited several books, including Psychoanalysis as a Human Science, Mental Health of Indian Women, and Gendering Mental Health, while also producing collections of poems and short stories. Dr Davar is an international trainer in the Convention on the Rights of Persons with Disabilities (CRPD) and the founder of the Bapu Trust for Research on Mind and Discourse in Pune, India. This organization aims to give visibility to user/survivor-centred mental health advocacy and studies traditional healing systems in India.

This week, we present the first in a series of interviews on the topic of the global ‘mental health’ movement. These interviews will be led by our Mad in America research news team and today’s interview is hosted by our lead research news editor, Justin Karter. In this episode, Justin interviews Dr Melissa Raven, who is a psychiatric epidemiologist, policy analyst and postdoctoral research fellow in the Critical and Ethical Mental Health research group at the University of Adelaide, South Australia. Originally qualified as a clinical psychologist, she then worked as a lecturer and researcher in public health and primary health care. Her current mental health research and advocacy is informed by a strong social determinants perspective and a strong critical orientation, which she applies to a range of topics, including suicide prevention, workplace mental health, (over)diagnosis, (inappropriate) prescribing, and conflicts of interest in mental health and the broader health/welfare arena. On October 10th, 2018, World Mental Health Day, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal to “scale up” mental health care globally. At the same time, the UK government is hosting a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement these mental health policies globally. In response, a coalition of mental health activists and service-users have organized an open letter detailing their concerns with the summit and report. The response has attracted the support of critical professionals, psychologists, psychiatrists, and researchers.

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.