Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs. In this blog, he explores the institutional betrayal of psychiatry, particularly regarding depression pill-related suicides. Each Monday, a new section of the book is published, and all chapters are archived here.
A debate at the annual meeting of Swedish young psychiatrists
In November 2016, I lectured in Stockholm and met with Joakim Börjesson, a psychiatrist in training who wanted to do research with me. He was very impressed during his medical studies when a psychiatrist told the students that the psychiatrists knew so much about the brain and the drugs that they could use drugs that were specifically targeted to work on a disorder’s biological origin, the so-called chemical imbalance. He found it so fascinating that he decided to become a psychiatrist.
Later, when Joakim worked at this psychiatrist’s department, he was asked to produce fake reports that would yield social benefits to this psychiatrist’s fellow countrymen (he was not from Sweden). Joakim was in a predicament, as this psychiatrist was the one who should approve his stay at the department as part of his education, but he found a way around this where he avoided committing social fraud.
After having read books by Robert Whitaker and me, Joakim realised that he had been totally fooled and considered leaving psychiatry. Ultimately, he didn’t, and came to see me for three months in Copenhagen where we worked on a systematic review of lithium’s effect on suicide and total mortality.8
In January 2018, Joakim arranged a session in Göteborg during the annual conference for 150 Swedish psychiatrists in training where I debated with clinical pharmacologist and professor Elias Eriksson.
Our talks were: “SSRIs have a good effect and mild side effects” and “Why SSRIs and similar antidepressants should not be used for depression,” in that order. Joakim had invested a lot of diplomacy to have this arranged, both internally and when dealing with Eriksson, who has a reputation of attacking his opponents brutally.
There were other issues. During the discussion, I mentioned that Eriksson had entered a secret agreement with Lundbeck (a company that sells three different SSRIs) against his university’s rules, which meant that Lundbeck could prevent publication of his research if they didn’t like the results.9,10
I said this because Eriksson routinely “forgets” to declare his conflicts of interest,10 but I was immediately stopped by the chair. Later, the Ombudsman criticised the university for covering up the affair.11 Eriksson stated that he could not deliver correspondence with Lundbeck to a journalist because it had taken place on a Lundbeck server, a highly unusual arrangement, to say the least, and he lied about what the Freedom of Information request had been about.9,10
The rules for the debate included that each of us should choose five articles, which would be the only ones we were allowed to discuss. Eriksson broke the rules by suddenly asking me about minute details in a meta-analysis I had published that showed that psychotherapy halves the occurrence of suicide attempts.12 Fortunately, I remembered the details and responded. Eriksson not only broke the rules, the meta-analysis was also totally irrelevant for the debate, which was about SSRIs. Obviously, Eriksson used dirty tricks in his attempts at convincing the audience that I could not be trusted. Joakim wrote to me three weeks before the meeting that,
“Elias Eriksson had your book about psychiatry on his article list. When I talked to Elias Eriksson per telephone and asked him why he had put it there (I told him that he could not possibly had found any evidence for the benefit of SSRI in your book) he told me that he had the intention to ‘reveal that Peter Gøtzsche is a charlatan’ during his lecture. We then discussed this for about an hour and I fruitlessly tried to convince him to adhere to the rules for the debate with no success.”
Eriksson claimed in his abstract for the meeting that there was no reason to believe that any of the side effects of the pills were irreversible and also that they were not addictive. He opined that criticism of the pills was “ideologically founded” and that their use, according to the critics, was the result of a world-wide conspiracy that included psychiatrists, researchers, authorities, and drug companies. Five months earlier, when I debated with Eriksson on Swedish radio, he said the pills helped dramatically and could prevent suicide in many cases.15
After the meeting, a psychiatrist wrote to me that you cannot convince religious people that there is no evidence for God’s existence but you can make them lose confidence in their priest if you can show evidence that he has used donations to the church to buy cocaine at a gay bar. He furthermore wrote: “Elias Eriksson is a simple lobbyist that has made a fortune by playing political games rather than doing honest research and he knows this himself. That is why he can lie about things he very well knows is untrue, like that there is good evidence that antidepressants work.”
I was also told that many of the psychiatrists had not understood my explanations about depression pills causing suicide. This illustrates the widespread cognitive dissonance among psychiatrists. When I present the same slides for a lay audience, they always understand them. The psychiatrists DON’T WANT to understand what I tell them, as it is too painful for them.
In 2013, when Robert Whitaker was invited to speak at a meeting in Malmö that child psychiatrists had arranged, other psychiatrists intervened and got control of the meeting. They said Whitaker should only speak about the dopamine supersensitivity theory and not present any data on long-term outcomes.
Although this was clearly a set-up, Whitaker went along with it. When he arrived, he was told that Eriksson would be his “opponent,” and he spent his time denouncing Whitaker in an unbelievably dishonest fashion. In Whitaker’s own words: “The whole thing was a disgusting set-up that stands out for its complete dishonesty, from start to finish.” Eriksson declared that he considered Whitaker to be a “charlatan who tortures patients.”
I had planned on coming, but Eriksson had declared that he wouldn’t participate if I showed up!
It is strange how psychiatry’s apologists constantly call their opponents charlatans or worse and use strawman arguments all the time. None of us has ever postulated anything about a “conspiracy” or used this word, but by so doing, the apologists associate themselves with a deplorable recent past. Nazi propaganda constantly talked about a non-existing worldwide Jewish conspiracy.
National Boards of Health are unresponsive to suicides in children
In 2018-19, I alerted Boards of Health in the Nordic countries, New Zealand, Australia, and the UK to the fact that two simple interventions, the Danish Board of Health’s reminder to family doctors and my constant warnings on radio and TV, and in articles, books, and lectures, had caused usage of depression pills to children to be almost halved in Denmark, from 2010 to 2016, whereas it increased in other Nordic countries.14
I noted that this was a serious matter because depression pills double the risk of suicide compared to placebo in the randomised trials and because leading professors of psychiatry continue to misinform people telling them that the pills protect children against suicide. I therefore urged the boards to act: “The consequence of the collective, professional denial is that both children and adults commit suicide because of the pills they take in the false belief that they will help them.”
I got no replies, late replies, or meaningless replies that looked like bullshit to me, which philosopher Harry Frankfurt considers short of lying.15 After five months, the Finnish Ministry of Social Affairs and Health responded in the typical mumbo jumbo sort of way that civil servants use when they praise a system that clearly doesn’t work, but refuses to acknowledge it and to take action: “Increased suicidal thoughts have been connected with SSRIs in some studies.” This is terribly misleading. When all studies are taken together, it is clear that depression pills increase everything, suicidal thoughts, behaviour, attempts, and suicides, even in adults (see Chapter 2).
After six months, the Swedish Drug Agency replied. It was all about processes, and I was told that the agency had issued treatment recommendations in 2016. I looked them up.16Under side effects, there was absolutely nothing about suicidality. Not a single word. Further down in the document, it was mentioned that depression pills increase the risk of suicidality slightly, but we were also told that, “they do not increase the risk of suicide, and there is some evidence that the risk is decreased.”
This information contrasts with the text in the Swedish package insert for fluoxetine, which mentions that, “Suicide-related behaviour (suicide attempt and suicidal thoughts), hostility, mania and nasal bleeding were also reported as common side effects in children.” Some of the so-called experts the agency had used, e.g. Håkan Jarbin, had financial ties to manufacturers of depression pills, but none of this was declared in the report.
After six months, in June 2019, the Icelandic Directorate of Health replied that they had asked for an expert opinion, but I did not hear from them again.
In 2020, I wrote to the boards again, this time attaching my paper about their inaction.14 The Icelandic Directorate of Health replied that they had asked the psychiatrists in charge of child and adolescent psychiatry to give their opinion nine months earlier, but that they had not responded despite a reminder, and had said a few days earlier that they simply did not have the time.
I replied: “They should be ashamed of themselves. Children kill themselves because of the pills and they don’t have the time to bother about it. What kind of people are they? Why did they ever become psychiatrists? What a tragedy for the children they are supposed to help.”
I informed Whitaker about this who replied that he always said that the inaction by the medical profession regarding the prescribing of psychiatric drugs to children and adolescents is a form of child abuse and neglect, and institutional betrayal.
I did not get any replies from Australia or the UK. An undated letter from the Ministry of Health in New Zealand said that the drug regulator had not approved the use of fluoxetine for people less than 18 years of age. However, the lack of approval of depression pills in children is no hindrance for their usage, which increased by 78% between 2008 and 2016,17 and a UNICEF report from 2017 showed that New Zealand has the highest suicide rate in the world among teenagers between 15 and 19, twice higher than in Sweden and four times higher than in Denmark.18
When I visited John Crawshaw, Director of Mental Health, Chief Psychiatrist and Chief Advisor to the Minister of Health, in February 2018, I asked him to make it illegal to use these drugs in children to prevent some of the many suicides. He responded that some children were so severely depressed that depression pills should be tried. When I asked what the argument was for driving some of the most depressed children into suicide with pills that didn’t work for their depression, Crawshaw became uncomfortable and the meeting ended soon after.
So-called experts on suicide prevention appear to be highly biased towards drug use and in the way they cherry-pick the studies they decide to quote despite calling their review systematic.19 Suicide prevention strategies always seem to incorporate the use of depression pills,19 even though they increase suicides. This was also the case in a suicide prevention programme for US war veterans.20
The title for one of the chapters in my book about organised crime in the drug industry is, “Pushing children into suicide with happy pills.”21 Can it be any worse than this in healthcare, telling children and their parents that the pills are helpful when they don’t work and drive some children into suicide?
To read the footnotes for this chapter and others, click here.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.