The Danish Psychiatric Association has a 21-page leaflet from 2020 on its website entitled “Make Psychiatry Healthy.” Since I also think psychiatry is sick, I studied the leaflet closely. I found that the Association’s suggestions would make psychiatry sicker than it already is.
“During the last 10 years, a special focus on non-psychotic mental disorders such as stress, anxiety and depression has resulted in a marked increase in the number of psychiatric patients. It can represent serious illness, but unfortunately the economy has not kept pace with the developments … From 2009 to 2017, the number of patients in psychiatric treatment has increased from 110,000 to 151,000.”
There is no information about overdiagnosis, although it plays a major role for the growing number of people receiving a psychiatric diagnosis. The criteria for making a diagnosis are so broad that many healthy people, probably the vast majority, could get a diagnosis if they were examined for some of the many diagnoses, psychiatry operates with. This is also my experience when ask course participants to try just three different diagnostic tests on themselves.
“Literally speaking, schizophrenia, bipolar disorder and psychoses related to substance abuse tear the mind apart and deprive people of the ability to be with others and to manage on their own. Yet, too many seriously mentally ill people are left to fend for themselves in a starving psychiatric system with too few resources for the too many patients. They live significantly shorter lives than average … Some present a danger to others. Several are at risk for themselves. This is reflected in the high number of suicides and in the number of forensic psychiatric patients, i.e. mentally ill sentenced to treatment, which tripled in the period 2001 to 2014.”
The leaflet does not say that one of the main reasons why seriously ill patients live substantially shorter lives than others is the treatment the psychiatrists provide to them, often against their will. In addition, psychiatrists often deprive patients of their hope of getting well, for example when they say that medical treatment must be lifelong. The high number of suicides is partly because depression pills increase the risk of suicide, both in children and adults.
In a register study of 2,429 suicides, Danish psychiatrists showed that admission to a psychiatric ward increases the risk of suicide for psychiatric patients 44 times. Of course, one would expect patients admitted to hospital to be at greater risk of suicide than others, but the results were robust, and most potential biases in the study actually supported the hypothesis that hospital contact is harmful. An accompanying editorial noted that there is little doubt that suicide is related to both stigma and trauma, and that it is entirely plausible that the stigma and trauma inherent in psychiatric treatment—particularly if involuntary—might cause suicide. The authors believed that some of the people who commit suicide during or after an admission to hospital do so because of the conditions inherent in that hospitalisation.
The tripling of forensic psychiatric patients could be because far too many receive a treatment sentence. This has been heavily criticized in the public debate, but the psychiatrists do not write anything about that either.
The psychiatrists claim that “74 percent of the forensic psychiatric patients have received inadequate psychiatric treatment in the period before they committed the crime. Some of the crime, which affects completely innocent people, could thus have been avoided with better treatment.”
These conclusions are based on false premises, and they are not valid. In contemporary psychiatry, inadequate treatment means inadequate medical treatment. But there are no psychotropic drugs that can prevent crime unless you render the patients totally passive with excessive doses of psychosis pills, which they call becoming a zombie. It is well-documented that psychotropic drugs increase the risk of violence. That which in the eyes of psychiatrists is “better treatment” will therefore likely increase crime.
“[We] doctors are forced to discharge seriously ill patients who have not been adequately treated more than 25,000 times a year because new patients arrive at the clinics. Among other things, this is expressed in the towering readmission rates when the ‘revolving door patients’ come again and again in the hope of adequate treatment.”
There are two main reasons why patients come back, but the psychiatrists do not mention them. One is that depression pills and psychosis pills have such a small effect that it is less than the minimal clinically relevant effect, which the psychiatrists themselves have demonstrated. The other is that patients often do not like the drugs due to their harms, and if they stop abruptly or taper too quickly, they may get abstinence symptoms, also called withdrawal symptoms, which make them even worse. These symptoms often resemble psychiatric disorders, and then it is not at all strange that the patients come again. It would lead to far better long-term results and fewer revolving door patients if one opted for psychotherapy and other psychosocial interventions instead of medication.
“The diagnosis is clear: Psychiatry is sick. Very sick. Unfortunately, a deficient symptom treatment is the only treatment that psychiatry has received in the last many years. This cannot continue. Psychiatry needs a long-term political treatment plan. A treatment plan that strengthens psychiatry and the efforts for the people and families affected by mental illness. A treatment plan that ensures proper and dignified treatment for all who need it. A treatment plan that makes psychiatry healthy.”
Sure, psychiatry is very ill, but it’s the psychiatrists’ own fault, and the solution is not more of the same, which would only make matters worse. In all countries where this relationship has been studied, there is a clear correlation between how much the population is treated with psychotropic drugs and the allocation of disability pensions because of psychiatric disorders. Medicine makes it hard for people to function. How difficult can it be? The deficient symptom treatment that the psychiatrists are talking about does not apply to psychiatry, but it is precisely the kind of treatment that the psychiatrists give the patients!
“The number of psychiatric beds must be markedly increased. Seriously mentally ill people must be able to be admitted and remain hospitalized when their illness requires it, and the readmission rate in the most strained sections must be reduced. As several pilot projects have shown, more beds and more staff may reduce the use of coercion and may reduce the use of psychotropic drugs for the individual. It will cause fewer side effects and thus a more effective treatment in the long run.”
More beds may well reduce the use of coercion and medication, but it is especially important that there are enough beds that the patients can administer themselves. They may need a little rest and relief during an acute period of stress, which may prevent the condition from developing into a psychosis. A Swedish psychiatrist wrote about this: “Being treated humanely is difficult in today’s psychiatry. If you panic and seek out a psychiatric emergency room, you will probably be told that you need medication, and if you reject it and say you just need rest to gather yourself, you may be told that the department is not a hotel.”
“The capacity for outpatient treatment must be significantly increased.”
The result of this depends entirely on whether it just becomes more of the same, or a completely different psychiatry where the emphasis is on psychotherapy and other psychosocial interventions. That will hardly be the case because the outpatient clinics are run by psychiatrists.
“The waiting time for housing offers must be significantly reduced, and the quality must be increased. The waiting time can exceed 12 months for a housing offer where the seriously mentally ill in need of daily support and help are left to fend for themselves. No one with a serious mental illness should be discharged into the streets.”
You can only agree with that. But the efforts at the housing facilities must change radically. Many residents are unable to function because they are on too much medication.
“Treatment courses for the mentally ill must be based on the individual patient’s difficulties and resources. Significant individual differences in disease courses and needs make treatment packages and treatment guarantees ineffective. ”
Yes, to a great extent. Treatment guarantees can be useful if you have broken a leg or had a blood clot and need to be treated and rehabilitated without undue delay. But mental disorders are so individual that they are not at all suitable for treatment packages.
On 15 November 2016, I was invited to a meeting in Parliament, “Hearing about children without pills,” which was introduced as follows: “More and more children end up in psychiatry. That is right for some children, but many could have been helped much better earlier and with other efforts. We will jointly develop recommendations for this.” The child and adolescent psychiatrists agreed that treatment packages are completely unsuitable. It is incredibly important to prevent an incipient mental illness from developing into something much worse, and some children need a far greater effort than others. It could save a lot of money, also for early retirement later, if resources were provided to give these children the support they need, which is not drugs, but psychosocial interventions.
“The national guidelines for the treatment of severe psychotic diseases and depression need to be updated … National guidelines will strengthen both patient rights, patient safety and the quality of treatment in psychiatry.”
The most important issues in relation to patient rights, patient safety and the quality of treatment are not mentioned. Denmark has ratified the United Nations Convention on the Rights of Persons with Disabilities, which stipulates that mentally ill patients must not be discriminated against: “States parties must abolish policies and legislative provisions that allow or perpetrate forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using mental health systems who have experienced deep pain and trauma as a result of forced treatment.”
It is also not mentioned that benzodiazepines (sleeping pills or sedatives) in randomized trials have shown better effect than psychosis pills in acute psychosis. In 14 trials that had compared them, the desired sedation occurred significantly more often on benzodiazepines, and almost all patients report that they prefer to get a benzodiazepine if they should become acutely psychotic again. However, the psychiatrists do not respect the patients’ wishes. Via the Freedom of Access Act, we got access to documents in 30 consecutive cases where patients had complained about the forced medication to the National Board of Appeal. We showed that the law had been violated in every single case.
“Specifically, the Danish Psychiatric Association recommends that psychiatry should be evaluated based on:
- Life expectancy for patients corresponding to the rest of the population.
- Retention in education or in the labour market.
- Decrease in number of suicides.
- Decrease in use of coercion.
- Decrease in number of forensic psychiatric patients.
- Decrease in number of mentally ill homeless people.
- Decrease in use of police resources for psychiatric patients.
- Strengthening the clinical databases.”
These are really good effect measures. If used on contemporary psychiatry, you will have to conclude that it does not work but makes matters worse for the patients due to the excessive use of medication and coercion.
“Psychiatry must become a more prominent part of basic medical education. The number of teaching weeks in psychiatry must be increased substantially … A better understanding among doctors in general of psychiatric diseases will also contribute to increasing the life expectancy of psychiatric patients.”
Under the current psychiatric paradigm, this is not correct. It will lead to even more psychiatric diagnoses for people who have difficulty sleeping, family problems, sweetheart troubles, stress, are irritating (also called ADHD), or who just have a temporary low in life; and it will lead to even more use of medication that will lead to even more lost life years and lost good life years for psychiatric patients. I have estimated, based on the most reliable research I could find, which were randomized trials and good cohort studies with a control group that did not receive psychiatric drugs, that psychiatric drugs are the third most common cause of death, after heart disease and cancer. It may not be quite as bad, but there is no doubt that psychiatric drugs are a very common cause of death.
The basic medical education must therefore be changed radically, with far greater emphasis on psychosocial interventions in psychiatry. Psychiatric drugs should only be used in acute situations, only with the patient’s acceptance, and only with a plan for subsequent slow phasing out.
“More public research in psychiatry.”
That is a good idea. It is well-documented that we cannot trust at all the industry-sponsored trials of psychiatric drugs. They are deliberately flawed by design, which gives a false idea of what the drugs can accomplish and what the harmful effects are. Moreover, more than half of the deaths and half of the suicides in psychiatric drug trials have been omitted from the published articles. The psychiatrists therefore do not know how dangerous and ineffective psychiatric drugs actually are. But the population knows this. A survey of 2,031 Australians showed that people thought that depression pills, psychosis pills, electroshock and admission to a psychiatric ward were more often harmful than beneficial. The social psychiatrists who had done the survey were dissatisfied with the answers and argued that people should be trained to arrive at the “right opinion.”
Since the perceptions of the population agree with what the most reliable part of the research literature shows, it is time for psychiatrists to be educated by teachers who know what they are talking about so that they can be cured for their many misconceptions, which are so harmful to their patients. The leaflet from the Danish Psychiatric Association can be summarized with these words: “Send more money.” But it is not a good idea to get more of the same.
Psychiatry must be changed radically. And psychiatrists need to listen to the patients and the rest of the population and take what they say seriously. This would not only benefit the patients but also provide greater job satisfaction for the psychiatrists.
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.