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Ethical Issues Related to Treatment Induced Harm

Posted Sep 08 2012 2:06pm

Many people come into the mental health system often after being betrayed and traumatized in a number of ways:  too often, the mental health system ends up betraying these people again, causing more harm than help.  I believe the system has been too slow to respond to criticism, and to take seriously all the ways it can cause harm and how things could be changed to reduce harm.

Anyone interested in such issues may want to check out some of the resources listed below. I developed this list for some seminars I am currently presenting (along with Pam Birrell PhD) – we just finished presenting to a good group of 62 people in Eugene Oregon yesterday, and will be presenting in Portland Oregon on 9/14/12, more at  http://ethicspdx.eventbrite.com/   I also hope to make this into a webinar, with ethics CEUs for professionals, by next spring.

The resource list for the seminar:

Many of the articles listed below are available for free at the included links.

Learn to think critically about psychiatric medications, while also earning up to 12 free CE credits, for free: http://www.criticalthinkrx.org/ (This site was funded through a settlement for drug company misbehavior.)

How to help people who might want to reduce or get off medications:  One source is Ron Unger’s guide http://recoveryfromschizophrenia.org/therapists-guide-to-reducing-medications/   This source references a number of other sources which are written to be given directly to consumers, such as http://comingoff.com/  or the Coming Off Medications Guide – Second Edition – http://wp.me/p5nnb-7dS Or consider going to the seminar presented by Will Hall, the author of the Coming Off Medications Guide, Understanding Psychiatric Medications: A Harm Reduction Approach   Sunday, October 21 2012 10:00 am – 5:00 pm in Portland OR.

One place to find out more about medications and risks, that is professionally run but not drug company funded: Rxisk.org .  This site offers the ability to search for a drug and see all the available data from fda’s medwatch, organized in an easy-to-understand manner, with charts, graphs, leaflets, and other information that may not be available anywhere else, and it’s all free.  A number of psychiatrists, including David Healy, are the creators of this site.

There are two sources in particular that you might want to check in on frequently to make sure you have access to critical information about biopsychiatric claims.  One is Mad in America , a website organized by Robert Whitaker but also featuring many others, that includes both easy to read blog posts by a number of authors, plus references to the most recent research.  Another is which is a facebook group that describes its purpose as “To be clear, this group is absolutely not anti-pharmacology. It is decidedly anti-pharmaceutical corruption, including perpetuation of pharma myths, concealing iatrogenic effects, under-representing and concealing side-effects, and exaggerating clinical efficacy.”

A Straight Talking Introduction to Psychiatric Drugs by psychiatrist Joanna Moncrieff is a short, clearly written book that can help both professionals and lay people understand psychiatric drugs in a balanced way.

Pharmageddon – A book by psychiatrist David Healy, in which he documents step by step how drug companies increasingly market drugs of little or no real value which covering up evidence of serious harm.  This is a problem not just in psychiatry but also in general medicine.  For a couple articles discussing these problems in general medicine, see Anemia drugs made billions, but at what cost?  and All Routine PSA Tests For Prostate Cancer Should End, Task Force Says

Paula Kaplan’s site that goes into detail and tells stories about harm as a result of diagnosis, as well as proposes some solutions, is at http://psychdiagnosis.net/default.htm

One thing that makes informed consent for medications difficult is the fact that people come in with lots of untrue expectations about the ability of professionals to really know what is wrong with them and what will safely fix it.  Advocates Inc. developed an informed consent form that really addresses these issues, in a way that empowers the people receiving the medications while fully disclosing the limits of professional knowledge.  You can access this form at Http://bit.ly/NmNlix

Web article by Ron Unger, It’s Not Just the Drugs; Misinformation Used to Push Drugs Can Also Make Mental Problems Worse

Another web article by Ron Unger: How to reduce deaths associated with “anti-psychotic” medications   This article examines how a deliberate campaign to rely on alternatives to antipsychotics where possible could likely prevent many deaths.

The Triumph of Bad Science is a blog post by Robert Whitaker that explains the history of the false claim that black box warnings about antidepressants are increasing rates of suicide.  For access to lots of articles that document reasons to doubt the long term usefulness of all the types of psychiatric drugs, broken down by drug category, go to the Anatomy of an Epidemic website and look at the sidebar on the lower left.

David Healy explains how to methodically evaluate whether drugs may be causing particular problems.  For problems associated with going onto a medication, see Pharmacosis: trigger algorithm , and for problems associated with withdrawal from a medication, see Pharmacosis: terminator algorithm .

Insight into how pharma manipulates research evidence: a case study by Jon Jureidini, Professor of Psychiatry at University of Adelaide  Reports on the Paxil study in adolescents.  For an update on controversy about this case, see Ghost-Written Article at Heart of Pharma Fraud Case

Bahrick, A., & Harris, M. (2009). Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap . Journal of Contemporary Psychotherapy, 39(2), 135-143.  You might also be interested in this collection of information on Post-SSRI sexual dysfunction or this article on the effects of SSRIs on love and romance .

British Journal of Psychiatry editorial,  Antipsychotics: is it time to introduce patient choice?   The article summarizes how the effectiveness of these drugs has been much less than we had heard, while the risks are much higher.

Psychiatric drug-induced Chronic Brain Impairment (CBI): Implications for longterm treatment with psychiatric medication , by Peter R. Breggin.  International Journal of Risk & Safety in Medicine 23 (2011) 193–200  This article reviews how the drugs themselves may impair a person’s ability to rate whether or not the drugs are helping more than hurting.

See page 40 of Sandra Bloom’s HUMAN SERVICE SYSTEMS AND ORGANIZATIONAL STRESS for more on “risky risk avoidance.”

For a review of reasons to believe the evidence of influence of genes on mental and emotional problems has been vastly overstated, see Richard Bentall’s book Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? ” or “ The Missing Heritability’’ of Psychiatric Disorders:  Elusive Genes or Non-Existent Genes? ” by Jay Joseph.

Some current trends in therapy are moving away from both a focus on diagnosis and even on the “symptoms” that underlie the diagnosis:  for an introduction to one of them, see this video introduction to the Method of Levels, which has also been called a “transdiagnostic” form of CBT.  The focus is simply on helping the person work out conflicting purposes.

Lots of articles are available online for those interested in the Open Dialogue approach.

Eleanor Longden tells her story on the DVD Knowing you, knowing you .  Eleanor has also been lead author for an article that challenges us to rethink our understanding of voice hearing:  see Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing.

Marit, B., & Kristjana, K. (2004). Recovery-oriented professionals: Helping relationships in mental health servicse . Journal of Mental Health, 13(5), 493-505.  Discusses the possible value of professionals stretching their professional role in assisting recovery.

The Cryptonite Of Behavioral Health: Making Mistakes   This is a blog post by Scott Miller that looks at how wanting too much to come across as “expert” makes us afraid to notice our mistakes, and how that fear of noticing can make us fail to learn.

Psychiatrist Pat Bracken speaks on the current “crisis of legitimacy in psychiatry,” and the growth of the international “service user” movement at the Forum for Existential Psychology and Therapy. The root cause of the crisis is not attributable to psychopharmacology or “a few mistakes in the DSM” that more research would get right, he argues; the root cause lies deep in the dominant paradigm; a “modernist” agenda to frame all human problems in scientific and technological terms.  http://tinyurl.com/cw2f3xp

Articles by Pamela Birrell PhD:

  • Birrell, P.J. & Freyd, J.J. (2006). Betrayal trauma: Relational models of harm and healing. Journal of Trauma Practice , 5(1), 49-63.
  • Birrell, P. J. (2006) Ethics of Possibility: Relationship, Risk and Presence. Ethics and Behavior , 16(2), 95-115.
  • Birrell, P.J. (2006) Schizophrenia Under Siege: The Unmaking of a Disease. [book review] Journal of Trauma and Dissociation , 7(2), 91-95.

 

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