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Biopsychiatry Illuminated

THE CANDLELIGHT PROJECT
by Bob Collier

24 November 2003
Issue 69

Pseudo-Science Among Us
by Dean Blehert

Part 1

INTRODUCTION:

Increasingly one sees articles about the overprescription of psychiatric drugs like Ritalin and Prozac among school children. Even the New York Times got into the act recently, despite its bias towards the large pharmaceutical companies who pay so much for ad space and would prefer to pretend the controversy doesn't exist. When even the Times decides that this news is fit to print, the issue is getting too hot to ignore.

In the following article, I want to shift focus from debates about how much of a drug is too much to the basic scientific validity of the psychiatric labels -- alleged disorders - that lead to the drugging of millions of children in the United States. I want to remove from the discussion some assumptions that make it difficult for us to see what's before us. The main assumption is that because a great deal of science (especially chemistry) is involved in psychiatric medication, the psychiatric programs are, themselves, scientific. By analogy, if a mass murder killed millions of people by use of highly "scientific" weaponry designed in advanced laboratories (a la Lex Luthor), one would conclude that the killing of millions of people was part of a "scientific program". That sounds absurd, but prominent Nazi psychiatrists running experiments in the death camps tried, with considerable success, to persuade themselves and their colleagues that the killing was the extension of a "valid" scientific program (euthanasia of the insane and handicapped).

And in particular, I'd like to make it clear exactly what is meant when someone argues that various alleged psychiatric conditions (for example, Attention Deficit Hyperactive Disorder, ADHD) do not exist. Obviously children can be found who manifest the symptoms attributed to ADHD. How then can it be argued that ADHD does not exist? No one denies that some people are tired, but we would probably not be willing to call "tiredness" a psychiatric disorder. Why not? And what would happen if we did? And is the psychiatric classification (ADHD, for example) liable to lead to trouble? I've tried to answer these questions below.

Finally, it is my intention to provide an overview, not a scholarly study full of references to studies, but a view of the logic -- the science or lack thereof -- behind the current scene in psychiatry. Most articles on the subject concentrate on horror stories, pro and con: Mother fears her child won't get the Ritalin that has helped him so much (how much? No scientific assessment available), or mother claims her son has been ruined by Ritalin. Such stories impinge, but tend to paralyze thought and observation. First of all, we know that many people with ADHD and other conditions get huge gains when given placebos (pills that are known to do nothing). Often, in the tests submitted to the FDA (Food and Drug Administration) to prove the effectiveness of new drugs, people given placebos (e.g., sugar tablets) show nearly as much improvement as those given the new drugs. Often the drug companies must nurse the statistics considerably to be able to claim a significant difference.

And many of the drugs now in use were tested with inactive placebos. That is, the "control group" is not supposed to know it is receiving a placebo. It is supposed to think it is receiving a potent drug. When sugar tablets are used as placebos, the people taking them, noticing that there are no obvious physical side effects, know they are receiving placebos. Studies have shown that when people are given active placebos -- pills that are known to have no effect on the disorder being treated, but that have noticeable side effects (e.g., itching or dry mouth) -- they give a much higher rate of "improvement" than do sugar tablets, because the control group is convinced it is receiving a potent drug. The point is, the fact that some people claim gains from, say, Ritalin, is meaningless in the absence of statistics on the gains themselves and on what proportion of users receive them and over what period of time. And even then, gains must be closely defined: What a teacher calls a gain (child sitting still in class) may have little to do with the welfare of the child, but may please the parents, since the child is given a glowing grade.

Similarly, stories of horrors (suicides, children taken from parents who won't let the children be drugged, etc.) are moving, but hard to evaluate without knowing how many others are helped by the drug. And in most cases the pharmaceutical companies have pat, almost indisputable answers to any claimed bad side effects, one or more of the following:

1. You can't prove it was caused by our drug.

2. Of course he killed himself; he was depressed to begin with. That's why he was taking our drug. He simply came to us too late.

3. He shouldn't have stopped taking the drug.

4. Yes, there are bad side effects, but they occur in only a tiny percentage of cases.

The last answer is particularly clever, because, though doctors are supposed to report bad side effects they observe, surveys of doctors in recent years have shown that few of them know they are supposed to do this or know how to do it. What the drug companies really mean is "...in only a tiny percentage of cases, so far as we know, based on the few reports we get and based on our eliminating from the statistics any bad effects that we feel can't be PROVEN to be connected with our drug." Where people have sued pharmaceutical companies because someone has, for example, taken Prozac, then gone berserk and killed people, the companies nearly always try to settle out of court on the condition that the settlement be kept confidential, then claim that it has not been proven that their product was at fault.

Similarly, where children have shot up their schools, psychiatrists and the pharmaceutical company agents are always on the scene to ensure that the medical records of the shooters are sealed under medical privacy laws, so that it is difficult to ascertain whether the shooters were under psychiatric treatment or on psychiatric drugs. In most cases, we've eventually learned that they were, but the information came from relatives or friends. In the case of Eric Harris (the Colorado shooting), we learned about his psychiatric medication (Luvox) from the Army, where he'd tried to enlist.

It is hard, perhaps impossible, to get all the data needed to weigh the anecdotes. It is easier to find statistics on the abuses than on the gains, which is suggestive, since one would think that pharmaceutical companies, earning billions and claiming their drugs are safe and effective, would be able to produce proofs of their long-range effectiveness - long-range since children are expected to take these drugs for years -- but no such proofs exist.

The battle of anecdotes is no doubt worth fighting, but here my intention is to get behind the anecdotes to the scientific basics: What is it that psychiatry calls a disorder? How does it determine this? What science is behind this? How are the medications developed? When we debate the effectiveness of Ritalin in treating ADHD, is this analogous to debating whether a particular anti-biotic can subdue a known microbe? Or is it more like debating whether to cure an invasion of evil spirits by throwing pepper over one's right shoulder or one's left shoulder. (And my apologies to the witch doctors for this analogy, since studies exist that show they have as high a cure rate as Western psychiatrists and psychologists.)

I simply want to put the debate in the correct perspective: Are we debating about science, and should we defer to people who call themselves scientific authorities and who know much more than most of us know about brain chemistry and symptoms of disorders? If not, let's find out what it is we're debating.

A final note: Little in what follows is new or original. Much of it can be found in longer, more detailed works by Thomas Szasz and others. I am trying to simplify and highlight a few key points and make them as clear as I can for as many people as possible.

DSM IV:

DSM IV: that is, edition 4 of the Diagnostic and Statistical Manual -- sounds scientific. What is it? It's a list of conditions, including various supposed types of anxiety, depression, phobia (fear of flying, coffee, colors, women, etc. -- over 500 fears), bad handwriting, difficulty with mathematics, too much religious belief, too active, too inactive, angry, upset after pregnancy, upset before or after menstruation, difficulty reading, etc. -- thousands of fears, angers, beliefs, emotions, attitudes. It is the Bible of organized psychiatry and the envy of organized psychology.

Each condition is described by a list of symptoms (each such list being a "syndrome") that one is supposed to use to diagnose the condition. Each condition is said to be a disorder, a lapse of mental health. Statistics accompany these lists that purport to say what percentage of the population of the United States suffers from each disorder. (Someone put the statistics together and concluded that in the United States, many times the number of people there are in the United States suffer from one or more mental disorders.) The statistics are alarming, but shouldn't be, since they have no scientific basis. They are simply pulled out of a hat. The current figure -- if it hasn't increased as I write -- tossed about by the media as being an estimate from the American Psychiatric Association (APA) is that 50,000,000 Americans need psychiatric help. Years ago (in the 50's), the announced statistics were "one in 25". A decade later they were "one in 10" and later "one in 3". The sources of these statistics have never provided evidence for them, nor have the sound-byte-hungry media ever demanded evidence. After all, they are statistics, and they come from the authorities on mental health.

The definitions of the various conditions often overlap. No objective tests for the presence or absence of these conditions is given. Definitions are loose enough and conditions numerous enough that it is possible to find a description that will fit ANYONE. Thus, by use of DSM IV, any person can be found to suffer from a mental health disorder requiring treatment. Any person can be said to be either too active or too inactive, too anxious or too serene, too religious or too cynical -- whatever you happen to be is (or may easily be made to seem) a disorder (or dysfunction, a sexier term). There are even disorders that apply to a person who disagrees with the validity of such diagnoses. In other words, if you think the DSM is bunk, you are, per the DSM, mentally ill.

Who compiled this manual? A committee of psychiatrists on behalf of the APA. How did they compile it? By proposing new disorders (the manual expanding greatly with each edition) and voting them into the manual. One member of the committee later vented her disagreement with the process publicly, stating that she was astonished at the lack of scientific discussion and scientific evidence. She said it seemed as though they were voting on whether to order Chinese or Italian for lunch, not creating a standard list of mental illnesses.

The development of this manual from edition to edition has mostly consisted of the creation of new conditions, but where politically expedient, conditions have been removed. For example, early editions included homosexuality, but when this became politically incorrect (and with no scientific justification either for the inclusion or the exclusion), homosexuality was removed from the DSM. Remember those words, "politically expedient". They answer a lot of questions. If women's organizations (e.g., NOW) raised enough stink about conditions like Post Menstrual Syndrome being listed as a mental disorder, it would vanish from the next edition -- with no new studies to justify the change.

Scientific Basis:

What, then, is the scientific basis for defining these conditions as disorders, diseases, syndromes? To begin with, what constitutes "scientific basis?" Most people confuse "science" with anything scientific sounding. Thus, when medical wisdom called for the bleeding of sick patients to rid them of excess "humors" (a theory in vogue with the very best authorities for centuries), this seemed quite scientific to the general populace, because it was propounded in big words (like "propounded") by recognized medical authorities, and because it was associated with all sorts of scientific trimmings. For example, to bleed someone, a surgeon had to know where to apply leeches, how the circulatory system worked, etc. Similarly, lobotomies (which cut out or sliced up frontal lobes and made vegetables out of people to cure them of depression) were extremely scientific: It takes surgical knowledge to slice up a brain without instantly killing a body or badly disfiguring it. It takes enough knowledge of the brain to know which slices will leave the motor controls intact (so that one gets a vegetable that can still walk), and so forth. Doesn't the word "lobotomy" sound more scientific than "torture" or "slicing up brains"? And it's done by people in white lab coats on operating tables.

In this sense of the word "scientific", everything to do with psychiatry and DSM IV is thoroughly scientific. The scientific trimmings are gorgeous: Every psychiatrist is an MD, and most can talk persuasively about double-blind studies and chemical imbalances. (Note: "Double-blind study" is one where neither the people dispensing the drugs nor the people receiving the drugs know which are receiving the "real" drug and which are receiving the "fake" drug or placebo. That way the psychiatrist isn't biased by his knowledge so that he "sees" improvement only in the subjects receiving the "real" drug.)

But the sense of "scientific" we usually mean when we speak of a scientific basis for something is a great deal more than jargon and trimmings. For example, in traditional (that is, non-psychiatric) medicine, a disorder or disease is typically defined as follows: First a set of symptoms is observed repeatedly. Then research is conducted to locate the cause of the symptoms -- for example, a germ, a nutritional deficiency, a toxin. Then a remedy is found. Such a set of symptoms is not labeled a "disease" until the various similar sets of symptoms have been linked to a common cause.

Why not? First, because it is dangerous to equate similar symptoms to a single illness, for example, to assume that because two people suffer from headaches, they must both have the same illness. What if one person's headache derives from a vitamin deficiency, while another's derives from a brain tumor? The second person may die of his tumor while being treated with vitamins to remedy a non-existent deficiency. The first person may die under the knife (for surgery to remove his non-existent tumor) because his immune system is weakened by the unremedied vitamin deficiency. They have similar symptoms, but until these symptoms are found to be from the same cause, it is dangerous, possibly fatal, to assume that they are the same disease.

The cause is that which, when remedied, eliminates the illness. Medicine defines a condition tentatively, then searches for the cause, then the remedy. Medicine proves out a proposed diagnosis by verifying that every time the symptoms that are supposed to define the condition are present, the identical causes are also present. Thus, if a man has a headache and cramps, since several different causes may lead to these symptoms, the doctor must look for other symptoms to better diagnose the condition. There are, then, objective tests (observable, repeatable, with predictable results) for a medical condition, once it is understood. A person either has the condition or does not. Any treatment of a condition not thus understood is experimental at best. (By that standard, all psychiatric treatments and medications are experimental at best.)

Second, inventing names for "syndromes" in the absence of such understanding creates the illusion that something is known about the cause of the supposed condition when nothing is known, only a list of symptoms. This creates a medical elite exalted by medical jargon, their status having no basis in useful expertise. It substitutes a superstition (Scientism?) for science.

The Scientific approach, then, would be (and I know I'm repeating this ad nauseam, but it's a key point, if we're to have scientists, not high priests) to identify a possible illness (set of symptoms), find (by verifiable experiments) a cause, then develop a cure that handles the known cause. A non-scientific approach might be to chant spells over patients, and if one of the patients gets better, use the spell that apparently worked on every patient. Since many conditions are entirely or partly psycho-somatic, this will often work, just as a placebo will often work as well as the "real" medicine. One highly effective treatment is to have Mummy kiss it and make it well. And there are many other non-scientific approaches.

Some are perhaps more scientific than we think. That is, studies not yet done may one day show us the scientific basis of having Mummy kiss it and make it well. (Or the studies may have existed for years but not found publication in professional journals. After all, how would 12-year-educated experts make money if any mother had as much expertise as they?)

Copyright Dean Blehert

PART 2 OF 'PSEUDO-SCIENCE AMONG US' NEXT WEEK

Visit 'Words & Pictures', the website of Pam and Dean Blehert, artist and poet, at:
http://www.blehert.com/



 
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