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DSMV reviewed as a work of dystopian literature

Michael sez, "The American Psychiatric Association recently released a new version of its Diagnostic & Statistical Manual - basically a catalogue of the categories into which they divide suffering. This entertaining review treats the text as a sprawling dystopian novel."

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Rare footage of a "normal person" given LSD in 1950s clinical research

In this video, Sidney Cohen (author of The Beyond Within: The L.S.D. Story, administers LSD under clinical conditions to an unnamed "normal person" (her description), some time in the 1950s. Her description of her experience is really wonderful -- you can tell she's going through something profound and amazing. As Reason's Jacob Sullum wrote in 2011,

The experience she describes includes familiar themes such as gorgeous colors, geometric patterns, microscopic particles suddenly visible, and a sense of transcendence, oneness, and ineffability:

"I can see everything in color. You have to see the air. You can't believe it....I've never seen such infinite beauty in my life....Everything is so beautiful and lovely and alive....This is reality...I wish I could talk in Technicolor....I can't tell you about it. If you can't see it, then you'll just never know it. I feel sorry for you."

Today all this may sound hackneyed, but what's striking about this woman's account is that her expectations were not shaped by the huge surge of publicity that LSD attracted in the next two decades. Although she had not heard what an LSD trip was supposed to be like, her experience included several of the features that later came to be seen as typical—a reminder that, as important as "set and setting" are, "drug" matters too.

Despite the similarity between this woman's description of her experience and testimonials from acid aficionados of the '60s and '70s, her presentation is so calm and nonthreatening that it is hard to imagine how anyone could perceive this drug as an intolerable danger to society.

'I Wish I Could Talk in Technicolor' (Thanks, Fipi Lele!)

A suicide draws attention to the ethics of psychiatric drug testing

This is a really important long read that we all need to pay attention to. It concerns how we treat people with who are suffering from paranoid delusions — and how we treat people whose families worry that they are a threat to others. It concerns the relationships between doctors and the pharmaceutical industry. It concerns the ethics of clinical trials — the risks we run as we test potential treatments that could help many, or hurt a few, or both. If we want to reform mental health care, this needs to be part of the discussion.

In 2004, Dan Markingson committed suicide. The story behind that death is complicated and depressing. At the Molecules to Medicine blog, Judy Stone documents the whole thing in three must-read chapters. Many people find help in psychiatric drugs, and credit those drugs with making their lives better. (Full disclosure, I'm one of them. I have used Ritalin for several years. I am temporarily on an anti-depressant.) But we have to pay attention to how those drugs get to us. This isn't just about treating people. It's about the process that gets us there. Because, if that process is compromised, the treatments we get won't be as effective and lives will be lost along the way.

Markingson began to show signs of paranoia and delusions in 2003, believing that he needed to murder his mother. He was committed to Fairview Hospital involuntarily after being evaluated by Dr. Stephen Olson, of the University of Minnesota. He was subsequently enrolled on a clinical trial of antipsychotic drugs—despite protests from his mother. This study was a comparison of atypical antipsychotics for the treatment of first episodes of schizophrenia (aka the CAFÉ study), sponsored by AstraZeneca. The study’s structure was that of a Phase 4 randomized, double-blind trial comparing the effectiveness of three different atypical antipsychotic drugs: Zyprexa (olanzapine), Risperdal (risperidone) and Seroquel (quetiapine), with each patient to be treated for a year.

After about two weeks on study treatment in the hospital, Markingson was discharged to a halfway house—again over his mother’s objections. Over the coming months, Dan’s mother, Mary Weiss, continued to express concerns about her son’s deterioration, even asking if her son might have to kill himself before anyone else would take notice…then, in fact, her son violently committed suicide on May 7, 2004, mutilating himself with a box cutter. The University of Minnesota and their IRB have maintained that the study was conducted appropriately and that they have no responsibility for Dan’s death. Dan’s mother and bioethicist Carl Elliott believe otherwise.

We’ll explore some of the major issues of contention in this case over several posts, as illustrative of basic clinical research principles, including adequacy of informed consent, IRB oversight, conflicts of interest, and coercion, including threats to a bioethicist whistleblower.

Read the first part of the story

Read the second part: How clinical trials should be done and how they were done in this case.

Read the third part: Conflicts of interest between the researchers and the pharmaceutical industry.

Image: Pills (white rabbit), a Creative Commons Attribution (2.0) image from erix's photostream

Temper tantrums considered for addition to DSM

The American Psychiatric Association is set to add "disruptive mood dysregulation disorder" to the Diagnostic Statistical Manual (DSM), the bible of psychiatric disorders. A kid has "DMDD" if she or he has "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation... at least three times a week."

As Wired's David Dobbs notes, this describes basically all kids ("No, I don't want to wear my rain boots!") at some time or another. So why is this being considered? Here's Neuroskeptic's explanation:

DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?

Well, the back-story is that in the past ten years, many American kids and even toddlers have got diagnosed with ‘child bipolar disorder‘ – a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn’t even achieve this dubious goal.

The possibility of just going to back to the days when psychiatrists didn’t diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.

Psychiatry Set to Medicalize Hissy Fits

It's time for psychiatrists to stop being so friendly with pharmaceutical companies

Psychiatry is "committing professional suicide" because psychiatrists are far too willing to accept gifts, food, trips, and free samples from the pharmaceutical companies that push psychiatric drugs, says psychiatrist David Healy. Worse, he says, those same drug companies have been caught hiding dangerous results from the FDA and doctors, covering up that malfeasance, and attempting to silence critics (including Healy himself). At Time's Healthland blog, Maia Szalavitz shows that Healy makes a persuasive case against the pharmaceutical giants and in favor of patients, doctors, and the federal government doing more to hold these companies accountable. Maggie