http://www.bbc.co.uk/programmes/b047zk6q (scroll to 39 mins: 15 secs)
Sir Simon Charles Wessely is a British psychiatrist. He is Professor of Psychological Medicine at the Institute of Psychiatry, King’s College London and Head of its department of psychological medicine, Vice Dean for Academic Psychiatry, Teaching and Training at the Institute of Psychiatry, as well as Director of the King’s Centre for Military Health Research. He is also honorary Consultant Psychiatrist at King’s College Hospital and the Maudsley Hospital, as well as Civilian Consultant Advisor in Psychiatry to the British Army. He was knighted in the 2013 New Year Honours for services to military healthcare and to psychological medicine. In 2014 he was elected president of the Royal College of Psychiatrists.
(Quite impressive ‘credentials’ you’d have to agree?)
In a recent radio discussion (see above) from the BBC, psychiatrist Simon Wessely complains that anti-depressants are under-prescribed. James Davies (senior lecturer in Psychology) author of ‘cracked’ (why psychiatry is doing more harm than good) disagrees. He points out that most people would favor talking therapy – not pills, that unfortunately the waiting lists often don’t facilitate this option and it is mostly pills that are prescribed for a myriad of different difficulties that people are struggling with. Davies thinks this situation doesn’t help the majority who seek mental health treatment, because he believes mental health problems stem mainly from psycho-social situations (poverty, unemployment etc)…
Despite a very strong argument from Davies, and also the alarming fact that 53 million prescriptions for anti-depressants are written every year in the UK alone– astoundingly- psychiatrist Simon Wessely still remains adamant that depression is under-diagnosed.
In this radio discussion-
James Davies says:
“We need greater transparency and accountability with respect to the financial ties between the pharmaceutical industry and psychiatry”
…”The research does suggest that doctors who receive these payments from industry are more likely to be biased in their clinical activities and beliefs”..
Simon Wessely responds:
‘I’m your worst nightmare here James, because..
I’ve never worked for Pharma’
Why does Simon Wessely say that he has never worked for pharma when according to this 2004 article from medscape (detailing a study of SSRI’s from JAMA and an editorial from Wessely)
“Dr. Wessely has received funding from Pierre Fabry Pharmaceuticals and from Eli Lilly and Co. to attend academic meetings and for speaking engagements.”
Why did Simon Wessely -on BBC radio- say that he has never worked for pharma when he has received funding from Fabry pharmaceuticals and Eli Lilly for academic meetings and speaking engagements? How much ‘funding’ did he receive? And how many ‘meetings’ , ‘speaking engagements’ and so on has he attended over the years? Has the influence of industry skewed Wessely’s views somewhat? Why did he not disclose this?
The SSRI study itself (from 2004) was funded by GlaxoSmithKline :
“This study was funded by the Boston Collaborative Drug Surveillance Program, which in turn received funding from GlaxoSmithKline for consultation by the authors regarding the principles of study design for a possible company study on antidepressants and suicidal behavior.”
Simon Wessely, commenting on the results of the Glaxo-funded study on comparing
“Risk of Suicidal Behavior Similar With Amitriptyline, Fluoxetine, and Paroxetine”
..goes on to say…
“But the hypothesis being tested is that over and above the known association of antidepressant prescribing and suicidal behavior (in which the confounder is the presence of depressive disorder), there is also a specific link in which one class of antidepressants, the SSRIs, increases that risk further. The results do not offer much support for the hypothesis,”
Dr. Wessely writes. “There was no evidence for the alleged withdrawal phenomenon, which is another of the concerns that have been raised about the SSRIs. Stopping medication did not lead to an increased risk, as postulated by some….”
Granted, the study was reported 10 years ago and in that time a lot has changed. We certainly know nowadays that anti-depressants can cause suicide and that Seroxat in particular has an extremely debilitating withdrawal syndrome- but what I would like to know is, does Simon Wessely still think that there is no evidence for the ‘alleged’ withdrawal phenomenon with SSRI’s? Have his opinions changed in light of the last ten years (and more) of evidence? Does he think that paroxetine (Seroxat) is a safe SSRI? How many links does he have to industry? and most importantly- why did he not disclose his links to Pharma (Eil Lilly and Pierre Fabry Pharmaceuticals) in the recent debate on anti-depressants with James Davies on BBC radio?
Why did he say that he has never worked for pharma?
Personally, I think patients with mental (emotional) health difficulties have a right to know which psychiatrists are linked to industry and which ones aren’t because at the end of the day without patients (service users) people like Sir Simon Wessely wouldn’t have careers (and very lucrative ones they are too).
Considering, Wessely is (apparently) closely connected to Ben Goldace and the Sense About Science agenda (of which I and others have written about recently) I won’t hold my breath for any kind of useful response- but discussions, comments and observations are, of course, always welcome…
An alternative perspective on mental disorders | PHILIP HICKEY, PH.D.
Psychiatry Still Doesn’t Get It
On 3-4 June, the Institute of Psychiatry in London hosted an international conference to mark the publication of DSM-5. On June 10, Sir Simon Wessely, a department head at the Institute, published a paper called DSM-5 at the IoP. The paper is a summary of the conference proceedings, and also, in many respects, a defense of DSM-5. The article touches on many issues that are central to the current anti-psychiatry debate, and for this reason, I thought it might be helpful to take a close look at the piece.
WHY IS DSM-5 CONTROVERSIAL?
Sir Simon expresses surprise that DSM-5 has been so controversial. He discusses this matter from various perspectives, but in my view he misses the essential point.
He writes: “The DSM is nothing more than a list of psychiatric disorders, accompanied by descriptions of disorders and explicit criteria for their diagnosis.”
It might be argued that this statement is true in the literal sense of the term, but it ignores the fact that the DSM is also (and perhaps more importantly) the primary source of legitimacy for the unproven assumption that all serious human problems are in fact illnesses, and are best “treated” by medical methods.
The contention that the DSM is nothing more than a list of psychiatric disorders is a bit like saying that Malleus Maleficarum (1487) is nothing more than a list of signs by which witches can be identified, and ignoring the fact that it was also the authoritative confirmation that witches really did exist and really did cause a great deal of mischief. For almost three centuries, Malleus Maleficarum served as the justification for murdering eccentric and otherwise unpopular women. In the same way, today DSM is used throughout America and other countries to justify and legitimize the drugging (sometimes forcibly) of millions of people, frequently with horrendous side effects.
But Sir Simon doesn’t seem to be aware of any of that.
Nor is this aspect of the DSM’s identity an accident. In 1952, when the first DSM was published, I don’t think it would be an exaggeration to say that psychiatry was a laughing stock among medical specialties. As the latter increasingly aligned themselves conceptually and practically with science, psychiatry wallowed in the decidedly unscientific notions of psychoanalytic theory and the brutal unvalidated “treatments” of the asylums.
Psychiatry desperately needed to get its act together and establish that it was a real medical specialty. It is arguable that this may have been a secondary agenda in 1952, but by 1968 – the year DSM-II was published – this aspect had become more urgent. There were two reasons for this. Firstly, the pharmaceuticals were coming on stream, and psychiatrists needed bona fide illnesses for which to prescribe these products. Secondly, behavior therapy was experiencing a great deal of success in the mental hospitals, especially with the more “challenging” cases, and was beginning to pose a significant challenge to psychiatric hegemony. By unequivocally medicalizing the presenting problems, psychiatry legitimized the widespread drugging of its clients, re-established its supremacy, and at the same time marginalized and subordinated behavior therapy.
The notion that all problem behaviors and emotions are illnesses is a spurious and unproven assumption, but it is an assumption that has served psychiatry (and incidentally their pharmaceutical allies) well for over four decades.
And that is why there has been so much controversy surrounding the publication of DSM-5. The negative press has arisen, not because there is anything strikingly new or different about DSM-5. The criticism stems rather from the fact that it is just more of the same. It’s the same lie being trotted out: that depression, misbehavior, mania, disruptiveness, temper tantrums, anxiety, etc., are real illnesses – just like diabetes. And that this lie is still being promoted despite four decades of failed research looking for the biological etiologies that would save this sorry theory.
In the meantime, the concept of mental illness is just another spurious assumption which would have been scrapped long ago but for the fact that it serves the interests of psychiatrists and their pharmaceutical allies.
The IoP conference could have addressed this – the central issue of the debate. And Sir Simon could have written about this. But instead, the matter was ignored.
EXPANSION OF DIAGNOSTIC ACTIVITY
Instead, Sir Simon wrote about the fact that the number of diagnoses has been quietly increasing, but that thankfully DSM-5 has reversed this trend. Does he seriously imagine that fewer people will be assigned psychiatric “diagnoses” under DSM-5 than under DSM-IV?
Sir Simon also concedes that there has occurred what he calls “psychiatric mission creep” – “the medicalization of the normal, the eccentric and the odd.” Bravo! But it’s still not the main issue. Medicalizing severe problems is just as spurious as medicalizing trivial problems.
Sir Simon goes on to reassure us that: “Concerns that the DSM-5 would continue in the inexorable march of medicalization by adding grief and bereavement to the list of human emotions that now required treatment were misplaced.” I find myself at a loss as to how he can possibly know that. Grief and bereavement are already being widely medicalized under DSM-IV, and this trend is almost certain to expand, given the specific easing of criteria in DSM-5.
Continuing on the topic of diagnostic expansion, Sir Simon writes:
“For most psychiatrists, claims that we are embarked on emotional world domination, seeking to extend our boundaries, populations and wallets further and further sounds hollow and frankly laughable when most face the most stringent cuts to services in a lifetime.”
This quote warrants some scrutiny. What Sir Simon is saying here is:
1. Our critics contend that we are pursuing emotional world domination. Ha, ha.
This is essentially an attempt to ridicule the opposition. Addressing our concerns openly and honestly would have been more productive.
2. The opposition say that we are seeking to extend our boundaries, populations, and wallets.
Psychiatrists have been, are, and apparently plan to continue extending their boundaries, populations, and wallets. And, with the help of pharma dollars, have been remarkably successful in these areas. Juxtaposing this statement with the world domination quip is a standard spin doctor trick, well-known to politicians.
3. The contentions of our opponents are hollow and laughable, because … get this … because our budgets are being cut due to governmental finance restrictions.
The fiscal restraints or otherwise of governments have no bearing on whether or not psychiatry has been pursuing an expansionist agenda. In fact, the psychiatry-pharma alliance has been consistently and successfully pursuing an expansionist agenda for the past 40 years, regardless of the state of the public coffers.
MARGINALIZING THE CRITICS
Sir Simon laments the fact that the media, “fired up” by DSM-5, are “dominated by a radical critique, questioning the legitimacy of psychiatry.”
Note the terms “fired up” and “radical”. Instead of responding in a rational and considered way to our criticisms, he’s attempting to portray us as revolutionary hotheads. And we have the audacity to question the legitimacy of psychiatry! Imagine!
Sir Simon also laments the fact that a UK psychologist used the occasion of the DSM-5 launch to say that all psychiatric diagnosis is wrong, and – listen to this – was not “shouted down,” but was actually allowed to air her views on a radio program! Can you imagine that? Daring to criticize psychiatry! And actually given air time!
COMMANDEERING THE CRITICISM
One of the basic tactics in political spin is commandeer-the-criticism. What’s involved is taking the opponent’s point, accepting it as if it were one’s own idea, but altering it just enough to work to one’s own advantage.
Here’s a nice example that comes near the end of Sir Simon’s article:
“No one can, and no one does, deny that the need to be kind, empathetic and understanding, to see all illness in its social context, to understand all illness as to how it affects the person. Far from being a “radical critique” let alone a mandate for the inevitable “paradigm shift” that our critics are calling for, that is merely a description of good psychiatry.”
The first sentence doesn’t close – but the meaning of the quote is clear: we’re good guys; we’re kind, empathetic, and understanding. We see all illness in its social context and in the effect it has on the person. This isn’t a radical critique. This doesn’t warrant the paradigm shift that these bounders are demanding. This is just good psychiatry.
So all the criticisms which we mental illness deniers direct at psychiatry are just nonsense; just so much wasted effort because … psychiatry is already there! Psychiatry doesn’t need to change!
But notice how the word “illness” got sneaked in twice. And that, as Sir Simon should know, is where the paradigm shift is needed: the recognition that the problems psychiatry is “diagnosing” and drugging are not illnesses. If he has proof to the contrary, this might have been a good place to set it out.
Sir Simon’s final paragraph is a gem of irrelevance. I must quote it in full:
“The reception afforded DSM-5 has reminded us how we sometimes look to the outside world and it is not always pretty. The charge that DSM itself is a Big Pharma fuelled exercise to open new markets for the sale of drugs is not helped when it becomes clear that some of the biggest names in psychiatry have been less than transparent in their financial dealings. Sadly the APA only gives further ammunition to the critics when it charges an exorbitant price for an almost unreadable book of marginal relevance to the mental health challenges facing most of the world. But the public relations disaster could still be turned into a triumph if the APA joined the open access movement sweeping across the world of scientific publishing and agreed to make if not DSM-5, then at least DSM 6, free to all. But I am not holding my breath.”
He mentions the accusation that the DSM is essentially a pharmaceutical instrument to sell more drugs. Now there’s an interesting thought that might have warranted some debate. But no, we move on.
Then he mentions that some of the “biggest names” in psychiatry have been “less than transparent” in their financial dealings. Some of us might have said “corrupt.”
And while we’re on the subject of corruption coupled with big names in psychiatry, let us remember the Sir Simon’s own Institute of Psychiatry honored Charles Nemeroff, MD by inviting him to speak at the opening of their new Centre for Affective Disorders on June 17. In case you’re not familiar with Dr. Nemeroff’s history, here’s an extract from Wikipedia.
“Nemeroff’s undisclosed ties to drugmakers and under-reported incomes from them have raised questions about conflict of interest. Following a Congressional Investigation led by Senator Charles Grassley of the Senate Finance Committee, Nemeroff was found to be in violation of federal and university regulations and resigned as chair of the psychiatry department at Emory University. He was also forbidden by Emory to act as an investigator or co-investigator on National Institutes of Health grants for at least two years. Nemeroff has moved to Florida and become the chair of psychiatry at the University of Miami.
According to the Annals of Neurology, the court documents released as a result of one of the lawsuits against GSK in October 2008 indicated that GSK ‘and/or researchers may have suppressed or obscured suicide risk data during clinical trials’ of paroxetine. ‘Charles Nemeroff, former Chairman of the Department of Psychiatry at Emory University, was the first big name ‘outed’ … In early October, Nemeroff stepped down as department chair amid revelations that he had received over $960,000 from GSK in 2006, yet reported less than $35,000 to the school. Subsequent investigations revealed payments totaling more than $2.5 million from drug companies between 2000 and 2006, yet only a fraction was disclosed’.”
Any reputable profession, I suggest, would have ostracized, and probably disbarred, Dr. Nemeroff. But not psychiatry. In psychiatry, that kind of corruption draws honors and accolades. Sir Simon might have written about that.
He might also have explained to us why his institute hosted a conference to mark the publication of DSM-5 if it is – as he claims – “…a book of marginal relevance…”
Then the insult to end all insults. The APA, Sir Simon writes, has given ammunition to psychiatry’s opponents by over-charging for DSM-5.
Does he seriously imagine that whether DSM-5 costs $10 or $200 makes a nickel’s worth of difference? Does he imagine that if DSM-5 had been less expensive that these protests would not have happened? Is he so out of touch with the fundamental flaws in his chosen profession that he believes that the cost of this book is even on our radar?
And – he tells us – the public relations disaster could have been turned around if the APA had distributed the book free!
And remember, dear readers, Sir Simon is an eminent psychiatrist.
June 26, 2014
Professor Sir Simon Wessely is a British psychiatrist who works at the Institute of Psychiatry, King’s College, London. He is also the new President of the Royal College of Psychiatrists, and in that capacity, he recently wrote his first blog, titled, appropriately enough, My First Blog (May 24, 2014). The article is essentially a perusal of, and commentary on, the program for the RCP’s Annual Congress, about which Sir Simon expresses considerable enthusiasm. He also engages in a little cheerleading.
” . . . We [the RCP] are the most democratic of colleges. We welcome the views of patients and carers . . . “
This statement struck me as odd, because it’s not so long ago (December 20, 2013) that I read a post by British psychiatrist Joanna Moncrieff, Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics. In this article, Dr. Moncrieff describes how she approached the RCP 2014 Conference planning committee, and asked that a symposium on “Re-evaluating antipsychotics – time to change practice” be included in the program. To her surprise, this proposal was rejected on the grounds that there were too many competing suggestions.
Dr. Moncrieff’s proposal was based on two ground-breaking studies (Ho, BC, Andreasen, NC, et al; and Wunderink L, et al.), both of which, at the very least, raise serious concerns about psychiatry’s current use of neuroleptic drugs. This certainly seems important, but in fairness to the RCP, perhaps there were topics of even greater moment, and Dr. Moncrieff’s suggestion simply couldn’t be accommodated.
Curious as to what these topics might be, I took a look at the conference schedule, and found a few entries that might conceivably have been nudged aside for Dr. Moncrieff’s proposed symposium. These include:
- Developing your teaching portfolio
- Succeeding as a new consultant
- Leadership development for the jobbing psychiatrist – what we all need to know
- Private practice
- Advanced communication skills for public engagement
- Making parity a reality
- How to get into Academic Psychiatry
And just possibly:
- Debate – Hamlet’s Ophelia: was it suicide?
In fairness to Prof. Wessely, he probably didn’t have much hand in the design of the program. (He’s the incoming President.) But he must have been aware of the College’s rejection of Dr. Moncrieff’s suggestion, and he might have expressed some regrets about this matter rather than asserting platitudinously that the RCP is the “most democratic of colleges,” that welcomes the ” . . . views of patients and carers.”
Anyway, there’s lots more cheerleading in Prof. Wessely’s post, including:
” . . . Psychiatry, like all branches of medicine . . . “
“We do not shy away from controversy . . . “
“[Attenders] will be left in no doubt about the prevalence and public health impact of the illnesses that lie at the heart of psychiatry.”
” . . . The endless fascination of psychiatry.”
” . . . The state of psychiatry is good.”
” . . . The importance of psychiatry in the modern health service.”
This is the kind of thing that we’ve come to expect from organized psychiatry in recent years, and it adds little to the current debate. But there was one statement in Dr. Wessely’s article that I would like to address in more detail:
“Any lingering doubts that psychiatry is not scientific will hopefully be dispelled, since the science of psychiatry is on constant display from the start to the finish of the conference.”
I think it would be accurate to say that the most fundamental principle in modern psychiatry is that all significant problems of thinking, feeling, and/or behaving are illnesses, caused by chemical imbalances or other putative neurological anomalies. The first part of this principle has been enshrined explicitly in the DSM’s definition of a mental disorder since DSM-III, and implicitly since DSM-II. The second part has been promoted vigorously by psychiatry for decades. This proposition is fundamental in the sense that from it, everything that psychiatry does, and stands for, flows.
The statement is also an assumption, proof of which has never been provided. Nor is the assumption self-evident. In fact, as those of us on this side of the issue have contended for decades, there are more parsimonious, and more helpful, ways to conceptualize these problems. The inattention, hyperactivity, and impulsivity characteristic of the condition labeled ADHD, for instance, can be conceptualized simply as a failure on the child’s part to acquire certain skills and habits that are considered appropriate for his age. Depression can be conceptualized as a normal response to loss, or to an unfulfilling, treadmill kind of life. And so on.
In science, of course, it’s perfectly OK to start off with an assumption (scientists call them hypotheses), and to design and execute experiments/studies to test their truth or falsity. But psychiatry has never established the truth of its core assumption. In fact, all attempts in this area have failed! So – instead of debunking this cherished assumption, as real scientists would have done, they have simply assumed it to be true, and have steadily promoted its acceptance through endless repetition, manipulation of the media, and vigorous condemnation of critics.
Then, to create the impression of science, they have conducted vast numbers of studies and trials, all designed to test various peripheral matters, but all ultimately depending for their validity on the core assumption. This isn’t science. It is nonsense, dressed up as science.
To illustrate this, let’s consider another assumption that is nonsensical: that all criminal activity is ultimately the result of alien abduction during infancy. Let’s suppose that I, basking in the narcissistic, error-prone grandiosity of which supporters of psychiatry sometimes accuse me, subscribe to this belief. Let’s further suppose that, to promote and study this core assumption, I start a new scientific discipline, which for want of a better term, I’ll call E.T.ology.
So I build a website, and attract a following, and we set about conducting E.T.ology studies to support our contention. We produce numerous papers showing that crime is most prevalent in areas where UFO sightings are most frequent. We demonstrate, through various statistical analyses, that criminals received less than average parental supervision during infancy, rendering them more vulnerable to alien abduction. And so on. And we publish these studies in our very own Journal of E.T.ology. We also speculate as to what the aliens actually do to their victims to instill the seeds of future lawlessness, and in this regard our scientists use colorful pictures of criminals’ brains to demonstrate chemical imbalances, neural circuitry anomalies, and other evidence of tampering. We develop and publish a manual for the early detection of abduction victims. The manual lists items like: failure to conform to age-appropriate social norms, deceitfulness, impulsivity, irritability and aggressiveness, recklessness, spitefulness, defiance, etc.
We have impressive-looking graphs and tables in our journal articles. We use statistical terms like correlation-coefficient, standard deviation, confidence interval, risk ratios, etc., with an easy familiarity, and we dismiss the protests of dissenting voices as the bigoted railings of anti-science deniers. We construct a sophisticated propaganda apparatus, and in our annual conferences, we have sessions on “advanced communication skills for public engagement” and related topics. We develop close ties with politicians from all branches of government, and from all corners of the political spectrum, and we advocate relentlessly for the creation of “space-shields” to protect infants from these alien invaders, who are robbing our children of their future.
We also, and entirely coincidentally, receive considerable financial support from the manufacturers of space-shield technology.
In this analogy it’s easy to see that what we have created is not science, but a travesty. It is a travesty because we will not subject our core assumption to serious scrutiny, and because we routinely allow our commitment to this assumption to direct and taint our discussions and our research efforts. What we have built is a sandcastle which, however impressive it may seem, has no defense against a flowing tide, and must ultimately collapse.
Similarly, psychiatry, despite decades of failed attempts at validation, continues to cling to its core assumption – that all significant problems of thinking, feeling, and/or behaving are illnesses. This spurious assumption underlies, drives, and ultimately invalidates everything they do, and stand for.
It is also the fundamental justification for their existence as a profession. If the core assumption were to go away, as eventually it must, then psychiatry, as it presently operates, will cease to have any relevance or purpose, and will simply collapse. In fact, it would have collapsed long ago, but for the massive, ongoing financial support that it receives directly and indirectly from its symbiotic, and incidentally corrupt, relationship with pharma.
So when Professor Wessely writes that ” . . . the science of psychiatry is on constant display from the start to the finish of the conference,” he’s referring to the sandcastle. He’s admiring the well-sculpted towers and turrets, the arched windows, and the pennants streaming in the sea breeze. But he’s ignoring the fact that the edifice, of which he is so proud, has no foundation. And he also, apparently, hasn’t noticed that the tide is coming in.
* * * * *
This article was first published on Philip Hickey’s website, Behaviorism and Mental Health