Monday, November 19, 2007

Elderly taking some psychiatric drugs could die
St. Petersburg Times
Dementia relief, with a huge side effect

The off-label use of some drugs is helping elderly patients, but may be killing thousands.

November 18, 2007

Two years ago, federal regulators sounded a dire warning: Elderly people with dementia who take drugs like Seroquel, Risperdal and Zyprexa could suffer the ultimate side effect.

They could die.

Yet today, about one in four nursing home residents still take these antipsychotic drugs. Sales to the elderly continue to rise, generating a total of $13-billion in revenues for their manufacturers this year.

The disconnect between government warnings about the increased risk of death and physician prescribing practices led a prominent Food and Drug Administration safety expert to make a stunning estimate.

Dr. David Graham, who had blown the whistle on the dangers of Vioxx, was back before a congressional panel in February. He testified that Zyprexa and other antipsychotics kill about 15,000 nursing home residents each year.

His pronouncement did not spark any followup investigations; it did not prompt government-sponsored research for safer alternatives. Instead, there was resounding silence.

Why was there no outrage?

Barbara Hengstebeck, executive director of the Tallahassee-based Coalition to Protect America's Elders, thinks she knows.

"A lot of people feel like the elderly in nursing homes are expendable," she said. "They're old anyway, they have dementia anyway, they're of no value to society. So what's the big deal? That's a sad commentary."

But people who deal with dementia patients say it's a devil's dilemma. Yes, the drug might kill them. Then again, it might make their remaining days easier - not only for the patients but for those around them.

In nursing homes, where resources are strained and staff overworked, medication that can prevent residents from hurting themselves or others is often the only option, regardless of the risks.

"There are time restraints, financial restraints and limited resources," said Dr. Fadi Saba, a St. Petersburg internist who sees patients at several local nursing homes. "So we go to pharmaceutical intervention."

Psychosis and behavioral problems associated with dementia are the No. 1 reason people end up in nursing homes. If their behavior can be controlled with these drugs, sometimes they can stay home longer.

Robert Wager, an 89-year-old St. Pete Beach resident, was diagnosed three years ago with Alzheimer's disease, one of the leading causes of dementia. He would erupt into eye-popping rages over nothing.

"It would come out of the blue and all hell would break loose," his wife, Leora, said of the incidents, one triggered by dirty measuring spoons. "It was to the point where I was absolutely terrified."

Two years ago, Wager's doctor, David LeVine, recommended 2.5 mg of Zyprexa at bedtime. It has made all the difference.

"Now he's a pussycat," Leora said. "It's not like he's in a stupor. He's still active, walking the dog and pulling weeds. If he weren't on Zyprexa, he'd probably have to go somewhere."

LeVine, a family practice doctor and medical director at Menorah Manor in St. Petersburg, said he focuses on improving a terminal patient's quality of life.

"If it means speeding death slightly, there's some risk/benefit there," he said. "If it means being able to keep them in their homes longer, it's the quality of the time that they're here. That's why we keep prescribing these drugs."

Seroquel, Zyprexa and Risperdal are the bestselling brands in a class of drugs called atypical antipsychotics. Approved by the FDA during the 1990s, they were hailed as a major improvement over earlier antipsychotics, known as typicals.

Those drugs, including Haldol and Thorazine, could turn patients into zombies and cause severe shakes and involuntary facial tics. With atypicals, those side effects were far less likely.

The FDA approved atypicals only for bipolar disorder and schizophrenia, diseases that affect just 1 percent of all adults. But doctors can prescribe drugs for unapproved, "off-label" uses. They quickly discovered that atypicals seemed to be effective in dealing with behavioral problems associated with dementia in the elderly.

"They calm a person down," Saba said. "And when you find something that works, you stick with it."

Eager to boost sales, drugmakers began targeting family practice doctors and nursing homes. Pharmaceutical reps should have been hamstrung: By law, drug companies are allowed to promote their products for FDA-approved uses only. And few elderly suffer from schizophrenia and bipolar disorder.

But legal restrictions only meant drug reps were smoother in their sales spiels.

Doctors like Amanda Smith at the Suncoast Alzheimer's and Gerontology Center in Tampa say that the reps know just how to avoid crossing the line. "A lot of this is ridiculous charade," said Smith, who said sales reps never specifically claimed their products worked for dementia.

"They know full well that we don't see anyone with schizophrenia or bipolar disorder. But they figure if people are going to get something an atypical, they might as well get their product."

The extent of the charade at Eli Lilly & Co. can be seen in confidential marketing documents that became public late last year in response to thousands of lawsuits that claimed Zyprexa led to weight gain and diabetes in younger patients.

Buried in those documents are details abouthow the company created a 280-person "long-term care" sales force and internal memos that referred to nursing homes and assisted living facilities as an "opportunistic market."

Lilly also coached sales reps to approach family doctors, who would normally refer patients with schizophrenia to psychiatrists. During a "Viva Zyprexa" sales meeting in March 2001, company executives urged reps to build sales by using an imaginary patient dubbed "Martha."

Described as a widow who lives alone and is increasingly agitated, confused and unable to sleep, Martha was portrayed as an ideal candidate for Zyprexa.

"What's the first thing you notice about Martha?" Mike Bandick, Zyprexa's brand manager, asked the sales reps. "She's old!"

Martha's age "reinforces Zyprexa as a nursing home drug," Bandick said, but her symptoms also are commonly seen by family doctors.

"Agitation, tension, anger, hostility all show up in primary care in a variety of packages," he said.

Using the generic name for Zyprexa, Bandick told sales reps, "Olanzapine is the molecule that keeps on giving."

Marni Lemons, a Lilly spokeswoman, defended the company's sales to primary care physicians, saying they often deal with serious mental illness.

"We believe that it is absolutely appropriate to discuss Zyprexa and its indicated uses with primary care physicians in the interest of meeting a critical medical need," she said.

As it turned out, it was partly Lilly's desire to legitimize Zyprexa's use for dementia that led to the FDA's black-box warning. Lilly halted a study of the drug in the elderly population after it showed increased risk of death and strokes.

The FDA then analyzed data from 17 studies of four atypicals and found that the rate of death for elderly dementia patients treated with an atypical was 1.6 to 1.7 times that of a placebo. Most common causes of death were heart failure or pneumonia.

The FDA and researchers are not sure how atypicals increase the risk of death in the elderly, though they've long been aware of dangers with antipsychotics.

Since 1987, when medications like Haldol were widely used to control behavior, federal rules have required nursing homes to keep close tabs on the use of what are called "chemical restraints."

No physician in Florida prescribed more Zyprexa to elderly Medicaid patients last year than Dr. Laurence Petty, according to state data. A geriatrician for 17 years, his practice involves visiting more than 30 nursing homes in the Tampa Bay area.

Petty said the FDA's black-box warning on atypicals had no impact on his prescribing practices. Nor has the demand for these drugs lessened, he said, despite him spelling out the potentially fatal risk to patients and their relatives.

"I have family members asking me to put their moms and dads on something," he said. "It's hard to visit them in the nursing homes when they're screaming."

Ginny Hoar, consulting pharmacist at St. Petersburg's Bon Secours-Maria Manor, said she often suggests patients be weaned off atypicals, especially if staffers detect side effects like excessive drowsiness or falling.

Hoar recently found that 60 of 260 patients at Maria Manor were on atypicals. She recommended discontinuing the treatment for just two of them.

"The FDA can put out a black-box warning, but that doesn't mean the disruptive behavior just goes away," she said. "You have to consider the risks if we don't use the medicine. But it would be nice if there were other options."

There are other options, but they take time, money and effort.

At the Cobble Hill Health Center in Brooklyn, Dr. Louis Mudannayake decided to try to change the thinking at his 400-bed nursing home.

Ignoring naysayers and the doomsday predictions of senior nurses, 18 months ago he put together a team of pharmacists, social workers and recreational therapists to review every atypical prescription.

If a new roommate caused agitation, room assignments were changed. If a new aide was hit while dressing a patient, the aide was given special training on that patient's preferences and routine.

Though the nursing home's resources were initially stretched, Mudannayake said the quality of patients' lives improved. "Ultimately, I'm convinced financial expenditures will be diminished, because it's easier to manage a patient who is calm," he said.

Atypical use at Cobble Hill has been cut from about 25 percent of patients to about 10 percent, he said. Almost 40 percent of patients were taken off the drugs completely; 75 percent of those still on the drugs have had their dosage reduced.

"We instituted a cultural change. That's what's required to bring the numbers down," said Mudannayake, who said psychiatric hospitalizations did not increase as medication dropped.

"You'll always have doctors say there's nothing else to use but atypicals, and I agree there are a small minority of patients where you need to use these drugs. But not in the numbers we are using them."

Despite an undeniable and growing need for safer medications to control dementia, drug companies have little incentive to develop such drugs when their existing products are still bringing in billions.

Though Lilly warned doctors in 2004 that Zyprexa can cause death in the elderly, last year the over-64 age group still accounted for more than 26 percent of the drug's total prescriptions. Zyprexa had $4.4-billion in sales last year.

"There's very high risk for trying to study new drugs in older patients because it's always more complicated," said Dr. Bruce Pollock, with the Rotman Research Institute at Baycrest in Toronto.

"But what good does it do if drug trials are only conducted in healthy, middle-aged people with only one condition? It's a disservice to the biggest consumers of pharmacy that we don't have adequate data."

About the drugs

What the FDA said: Based on results from 17 trials, the agency concluded in April 2005 that the death rate for patients on atypical antipsychotics was about 1.6 to 1.7 times higher for elderly patients with dementia than for those taking a placebo.

What's a black-box warning? So named because of the black border that surrounds it on the drug label, it's the FDA-required disclosure that a drug can have serious or life-threatening side effects.

What drugs got black-box warnings? Abilify, Zyprexa, Seroquel, Risperdal, Clozaril, Geodon and Symbyax (a combination atypical and antidepressant)

Top-selling atypicals: total 2006 sales, percent of Rx to elderly
Seroquel: $3.4-billion, 19 percent to patients over 64
Risperdal: $4.2-billion, 19.7 percent to patients over 64
Zyprexa: $4.4-billion, 26.6 percent to patients over 64
Source: Company reports, Verispan

'What are some of the other red flags we should be watching for?'

Testifying at a congressional hearing, Dr. David Graham, a prominent FDA drug safety expert, was asked if he had issues with any medications already on the market.
"I would pay careful attention to antipsychotic medications. ... The problem with these drugs are that we know that they are being used extensively off-label in nursing homes to sedate elderly patients with dementia and other types of disorders.

"But the fact is, is that it increases mortality perhaps by 100 percent. It doubles mortality. So I did a back-of-the-envelope calculation on this and you have probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications.

"With every pill that gets dispensed in a nursing home, the drug company is laughing all the way to the bank."

Thursday, November 8, 2007

Don Weitz's speech about psychiatric abuse

Above is a picture of Don Weitz, an antipsychiatry activist from Toronoto

Read this powerful speech by Don Weitz:

(draft speech for Antipoverty Day of Action, September 26, 2007)
by Don Weitz

I want to thank the Disability Action Movement Now/ DAMN, particularly Loree and AJ, for giving me the opportunity to say a few words today at this historic event in our continuing struggle for human rights. Since I'm also a psychiatric survivor, I say Hi to and eagerly embrace all other survivors, people with disabilities, and antipoverty activists who are here today, who have the courage and fighting spirit and who are making common cause for justice and human rights long-delayed. NO JUSTICE-NO PEACE.

Today, we are making some very good and necessary and just demands on this corrupt McGuinty-Liberal government that specializes in breaking promises and violating our human rights. Of course, I support all our demands, particularly immediate raise in the minimum wage, an immediate 40% raise in ODSP and welfare rates, and affordable housing NOW - like a crash program of building 3000 affordable housing units a year for the next 5 years for homeless brothers and sisters. As I speak, hundreds or thousands of psychiatric survivors are homeless and on the street - homelessness drives them mad or crazy, it also kills them. So-called "mental illness" doesn't cause homelessness--governments and corporations cause homelessness.

I want to focus on one of our huge and urgent demands:
STOP PSYCHIATRIC ABUSES INCLUDING FORCED DRUGGING, ELECTROSHOCK AND COMMUNITY TREATMENT ORDERS. These are extremely destructive and dehumanizing and psychiatric procedures (not treatments) that have harmed and sometimes killed our brothers-and-sisters in the psychiatric system and community.

Forced drugging is an assault, a crime. It's administering brain-damaging antidepressants and neuroleptics to people against their will or without informed consent. There's no informed consent in psychiatry, it's a cruel sham because refusing psychiatric treatment on coercive and intimidating psychiatric wards in Ontario and other provinces is virtually impossible. Some of the more horrific, tragic and direct effects (not "side effects") of antidepressants like Prozac and Paxil are suicidal ideas, mania or agitation, and sudden homicidal violence. Some of the direct effects of the neuroleptics or so-called "antipsychotics" are neurological disorders like Parkinsonism, Tardive Dyskinesia (a grotesque and permanent neurological disorder), and Neuroleptic Malignant Syndrome (a neurological and life-threatening disorder) - they all indicate brain damage, a medical fact minimized or denied by the psychiatrists. I should also point out that proportionately more women than men are drugged.

Electroshock ("electroconvulsive therapy" or "ECT")) is a barbaric psychiatric procedure that always causes brain damage, including permanent memory loss, and other intellectual impairments including problems concentrating, reading and learning new material after a series of shocks. Women, particularly elderly women, are the prime targets of electroshock; According to ECT statistics I've collected over several years from the Ontario government's Ministry of Health, 2-3 times more women than men are electroshocked. Women diagnosed with postpartum depression and elderly women including those 80 and older have been shocked and experienced it as torture! Clearly, electroshock isn't just a human rights issue but primarily a women's issue, its time it was publicly recognized as such.

Community treatment orders (CTOs) are the more recent state-sanctioned psychiatric assaults on the mind and freedom of psychiatric survivors. Ontario's CTO law was proclaimed into law in the Mental Health Act in 2000 under the repressive Harris-Tory government, unfortunately the McGuinty-Liberal government is still enforcing CTOs. Essentially, a CTO is a doctor's order giving the psychiatrist or another doctor the authority to forcibly drug you after you've already been locked up and "treated" 2 or 3 times and after you've been released from the hospital. It's like being put on psychiatric probation in the community, a CTO is in force for 6 months at a time, it can be renewed almost indefinitely, appeals are generally useless since the psychiatrist's opinion carries more weight than the patient testimony. Psychiatric survivor-activists and other critics call CTO a leash law. It's time to outlaw CTOs. HEY-HEY, HO-HO, CTOS HAVE GOT TO GO!

Forced drugging, electroshock and community treatment orders are assaults and must be stopped. That is a big demand and challenge. I make another demand on this government: Call and hold public hearings on forced drugging, electroshock and community treatment orders. If not now, when? NO JUSTICE-NO PEACE!


Tell me your story

Tell me story. If you want me to keep it confidential I will, you can be assured.

Let me know what psychiatry did to you.

Do you want me put your story on this blog? If you want me to to I will. Keep it to two pages if you can, three maximum. No names of people involved like doctors etc. Hospitals names ok. You can put your story anonymously if you want, that is up to you.

I wanted people to have a chance to put up their stories.

If you want to have a blog of your own, go to and it easy to set up a blog for yourself.
There are countless free blogs on the internet.

Self expression is very important. Break the silence by telling your story today. Writing about what happened to you can be a healing experience, it was for me.

You can email your story to me:

Thank you. Sue Clark-Wittenberg.

Sue and Steven's ECT videos on

See all of our videos on exposing ECT as brain damaging. To see our 24 videos - go to this URL:


We are looking for someone with a good digital video camera to make our future videos. If interested, please see the contact information below:

You can email us at: or call us in Ottawa at 613-721-1833.

We welcome your feedback.

Tuesday, November 6, 2007

Psychiatric drugs can cause brain damage

Tuesday, November 6, 2007

Psychiatric drugs can cause brain damage

Book Review

The Anti-Depressant Fact Book

What Your Doctor Won't Tell You
About Prozac, Zoloft, Paxil, Celexa, and Luvox

Perseus Publishing - Cambridge, Massachusetts
copyright 2001, paperback

by Peter R. Breggin, M.D.

reviewed by
Douglas A. Smith

I thoroughly enjoyed reading this book because it says so clearly and convincingly what I have believed for a long time about the myth of biologically caused depression and about so-called antidepressant drugs and so-called electroconvulsive "therapy" (ECT).
Of the idea of biologically caused depression, the author, psychiatrist Peter Breggin, says "It is a mistake to view depressed feelings or even severely depressed feelings as a 'disease'" (p. 14) and "There is still no reason to define grief, dejection, or melancholia as a 'disease' simply because it is severe or lasting" (p. 19). He says " psychiatry, none of the problems are proven to originate in the brain" (p. 169) and that "Depression is never defined by an objective physical finding, such as a blood test or brain scan. ... Attempts have also been made to find physical markers for depression, the equivalent of lab tests that indicate liver disease or a recent heart attack. Despite decades of research, thousands of research studies, and hundreds of millions of dollars in expense, no marker for depression has been found" (pp. 18 & 22).
Of the theory behind the so-called SSRI or selective serotonin reuptake inhibitor "antidepressants" Dr. Breggin says "In reality, science does not have the ability to measure the levels of any biochemical in the tiny spaces between nerve cells (the synapses) in the brain of a human being. All the talk about biochemical imbalances is sheer speculation aimed at promoting psychiatric drugs. ... science has almost no understanding of how the widespread serotonin system functions in the brain. Basically, we don't know what it does." (pp. 21 & 42).
Of drugs used to "treat" this nonexistent disease called depression he says "The term 'antidepressant' should always be thought of with quotation marks around it because there is little or no reason to believe that these drugs target depression or depressed feelings" (p. 14). He says "Impairing our emotional awareness and our intellectual acuity with psychoactive drugs such as SSRI antidepressants [including Prozac, Paxil, and Zoloft] tends to impede the process of overcoming depression" (p. 26). About the foolishness of the beliefs of most people about psychiatric drugs he says:

Overall, we're a rather sophisticated citizenry with a fairly high index of suspicion about the products we buy and the corporations that influence our lives. But something happens to us when we are dealing with companies that make prescription medicines. Perhaps it's the aura of FDA approval. Perhaps it's the passage of these drugs through the trusted hands of our physicians. Perhaps it's the cleverness of the ad campaigns. Perhaps we just can't believe that anyone would sell poison as if it were a miracle cure. [p. 2]
That's right: He said "poison." Psychiatric drugs are poisons. In a chapter titled "Damaging the Brain with SSRI Antidepressants," Dr. Breggin says "the evidence is piling up that SSRIs cause permanent brain damage" (p. 38). Let's stop concealing or minimizing this truth as we do when we call psychiatric drugs "medications" or say they are merely "ineffective" or "harmful" or even "neurotoxic." Lawyers trying to defend us from outpatient commitment laws (as they are called in the USA) or laws authorizing "community treatment orders" (CTOs) (as such laws are called in Canada) should stop accepting the terminology of those advocating forced psychiatric drugging. Lawyers trying to defend us from forced psychiatric drugging should not go into court and say the so-called patient should not be ordered "to take his medication." Because psychiatric drugs are poisons, and because most that are administered by force cause permanent brain damage, lawyers representing people threatened with forced psychiatric drugging should tell it like it is and say, "Judge, the question presented for your decision today is whether my client should be ordered to swallow poison - poison that is known to cause permanent brain damage." Letting advocates of forced psychiatric treatment get away with calling brain-damaging poisons "medications" is hurting our cause. It has been said: Whoever controls the language controls the perceived reality of those who have it. Let's not let the advocates of forced psychiatric "treatment" and those who would persuade gullible people to take harmful drugs win because they use deceptive semantics.
In the Introduction Dr. Breggin reveals why pharmaceutical companies would do something as evil as hoodwink people into believing poisons are in fact miracle cures. He says: "In the previous year [1999], Prozac had generated more than one-quarter of the company's [Eli Lilly & Company's] $10 billion in revenue" and that "Prozac, Zoloft, and Paxil are among the top-selling drugs in the United States, with total sales exceeding $4 billion per year" (p. 1). We apparently can't expect pharmaceutical companies to bypass enormous profits just because the drugs they sell are hurting people.
Throughout this book Dr. Breggin points an accusing finger at the USA's Food and Drug Administration (FDA), which is given the responsibility of keeping harmful drugs off the market in the USA. After reviewing how the FDA had to accept misleading, manipulated data to approve SSRI antidepressants as safe and effective, and after reviewing the harm done by these drugs, he says "If the FDA had been more responsible, these continuing tragedies could have been avoided. ... When I began my review of FDA documents as a medical expert in product liability suits against Eli Lilly and Co., I was shocked and disillusioned by what I found. Until that time, I had not fully confronted the willingness of the FDA to protect drug companies, even at the cost of human life." (pp. 78-79). He says "The Food and Drug Administration (FDA) has forsaken its watchdog role. Instead, FDA officials climb like puppies into the laps of drug company executives who might some day hire them at enormous salaries" (p. 181).
One of the reasons I like this book is in it Dr. Breggin is as bold as he has been in any of his previous books when describing the pseudoscience called biological psychiatry and the harm done by its so-called treatments. For example, speaking of psychiatric drugs he says -
  • "If a drug has an effect on the brain, it is harming the brain. Science has not found or synthesized any psychoactive substances that improve normal brain function. Instead, all of them impair brain function. ... antidepressants are typically prescribed in doses that cause a wide variety of adverse effects in most patients and significantly harm a great many people" (p. 168).
  • "FDA approval by no means indicates that a drug is truly effective. ... the combined efforts of the drug company and the FDA could not come up with even one good study that unequivocally supported the value of Prozac in comparison to placebo" (p. 151).
  • "Overall, the results suggest that placebo is actually much better than an antidepressant" (p. 145).
  • "If anything, as I've already indicated, antidepressants worsen severe depression and suicidal tendencies" (p. 170).
  • "Nothing reinforces depression more than having your brain befuddled by psychiatric drugs, unless it is having your mind befuddled by false ideas about the biological or genetic origin of your suffering" (p. 189).
  • "Lithium, for example, is a toxic element that suppresses over-all brain function..." (p. 125)
  • "There are so many potential hazards involved in taking SSRIs that no physician is capable of remembering all of them and no patient can be adequately informed about the dangers without spending days or weeks reviewing the subject in a medical library" (p. 107).

Of electroconvulsive "therapy" (ECT) he says -

  • "Damaging the brain to impair brain function lies at the heart of all the physical treatments in psychiatry. Shock and lobotomy are merely the most egregious examples" (p. 155, italics in original).
  • He deplores "the willingness of psychiatry to defend its treatments no matter how obviously damaging to the brain" (ibid).
  • "In my clinical and forensic experience, patients and their families are never told the truth about how dangerous shock is; otherwise they would not consent to it. Shock advocates tend to tell patients that memory loss is temporary and surrounds the treatment time only, when in reality the memory loss can wipe out years of educational and career knowledge. ... Nurses, teachers, and other professionals may never again be able to function in their jobs. Like head injury patients from other causes, such as automobile accidents and lighting strikes, general mental function is often impaired for the rest of their lives. Advocates [of ECT] ignore this by chalking it up to the patient's 'mental illness.'" (pp. 160-161).
  • "Electroshock treatment causes brain damage and, in my clinical experience, can cause lasting depression" (p. 141). This of course is in contrast to psychiatry's claim that by some unknown means ECT relieves depression.
  • "The question is not 'Does shock treatment cause brain dysfunction and damage?' A series of shocks to the head sufficient to cause convulsions will always produce brain dysfunction and damage. The real question is 'How completely can a person recover from shock?'" (p. 162).
  • Advocates of shock claim that newer methods make it safer. ... Instead, it's more dangerous. ... modified ECT requires the use of higher amounts of electrical charge than were used in the early animal experiments that showed brain damage and cell death" (p. 163).
  • "In my clinical experience, the brain damage [caused by electroconvulsive therapy, or ECT] makes people feel more hopeless and resentful, and hence more suicidal" (p. 164).
  • "Several state legislatures have passed laws banning shock treatment for children. It's now time to ban it for adults a well" (p. 165).

This book is a fairly short (200 page), recent (2001) book that neatly summarizes many of the best arguments against biological psychiatry. I recommend it highly.
Dr. Peter R. Breggin has a huge website where all his book are listed:

Brain-Disabling Treatments in Psychiatry:
Drugs, Electroshock, and the Role of the FDA
by Peter R. Breggin, M.D.
Springer Publishing Company (1997)
Reprinted with permission of Springer Publishing Company & Dr. Peter Breggin, M.D.
Order This book now by clicking here

Chapter 1: The Brain-Disabling Principles of Psychiatric Treatment

The last decade has seen escalating reliance upon psychiatric drugs, not only within psychiatry, but throughout medicine, mental health, and even education. Nearly every patient who is psychiatrically hospitalized is encouraged or forced to take medications. There is a movement within psychiatry to make it easier to force clinic outpatients to take long-acting injections of drugs. In private practice psychiatry, it is common to give patients a medication on the first visit and then to instruct them that they will need drugs for their lifetime. Family practitioners, internists, and other physicians liberally dispense antidepressants and minor tranquilizers. Nonmedical professionals, such as psychologists and social workers, feel obliged to refer their patients for drug evaluations. Managed care aggressively pushes drugs to the exclusion of psychotherapy. Adult medications are increasingly prescribed for children.
Laypersons have joined in the enthusiasm for drugs. Because of media support for medication, as well as direct advertising and promotion to the public, patients frequently arrive at the doctor’s office with the name of a psychiatric drug already in mind. Teachers often recommend children for drug evaluation or treatment.
As a part of this overall resurgence in biological psychiatry, electroshock has become increasingly popular. Even psychosurgery once again has its vociferous advocates (reviewed in Breggin & Breggin, 1994b).
This “drug revolution” views psychiatric medications as far more helpful than harmful, even as an unmitigated blessing. Much as insulin or penicillin, they are frequently seen as specific treatments for specific illnesses. Often they are said to correct biochemical imbalances in the brain. These beliefs have created an environment in which emphasis upon adverse drug effects is greeted without enthusiasm and criticism of psychiatric medication in principle is uncommon heresy.
This book takes a decidedly different viewpoint – that psychiatric drugs achieve their primary or essential effect by causing brain dysfunction, and that they tend to do far more harm than good. I will show that psychiatric drugs are not specific treatments for any particular “mental disorder.” Instead of correcting biochemical imbalances, psychiatric drugs cause them, sometimes permanently.
The critiques in this book coincide with an alternative view that psychological, social, educational, and spiritual approaches are the most effective in helping individuals to overcome their personal problems and to live more fulfilling lives. I have described some of these approaches elsewhere (e.g., Breggin, 1991a, 1992a, 1997; Breggin & Breggin, 19941; Breggin & Stern, 1996). Many others have continued to voice strong criticism of the biological model and physical treatments from a variety of perspectives (Armstrong, 1993; Breeding, 1996; Caplan, 1995; Cohen, 2990; Colbert, 1995; Fisher & Greenberg, 1989; Grobe, 1995; Jacobs, 1995; Kirk & Kutchins, 1992; Modrow, 1992; Mosher & Burti, 1989; Romme & Escher, 1993; Sharkey, 1994). Here I want to re-evaluate the underlying assumptions used to justify drug and shock treatment in psychiatry, and to document their brain-disabling and brain-damaging effects.
The principles that are introduced in this chapter will be documented and elaborated throughout the book. Therefore, citations will be omitted in chapter 1.

Principles of Brain-Disabling Treatment

Modern psychiatric drug treatment gains its credibility from a number of assumptions that professionals and laypersons alike too often accept as scientifically proven. These underlying assumptions qualify as myths: fictions that support a belief system and a set of practices. In contrast to these myths, this book identifies principles of psychopharmacology that are based on scientific and clinical evidence, as well as on common sense. Together these form the brain-disabling principles of psychiatric treatment. While the book in its entirety provides the evidence for these principles, this chapter will summarize them:

I. All biopsychiatric treatments share a common mode of action – the disruption of normal brain function.

Pharmacologists speak of a drug’s therapeutic index, the dosage ratio between the beneficial effect and the toxic effect. The first brain-disabling principle of psychiatric treatment reveals that the toxic dose is the therapeutic effect. This same principle applies to electroshock and psychosurgery.
The brain-disabling principle states that as soon as toxicity is reached the drug begins to have a psychoactive effect, that is, it begins to affect the brain and mind. Without toxicity, the drug would have no psychoactive effect.

II. All biopsychiatric interventions cause generalized brain dysfunction.

Although specific treatments do have recognizable different effects on the brain, they share the capacity to produce generalized dysfunction with some degree of impairment across the spectrum of emotional and intellectual function. Because the brain is so highly integrated, it is not possible to disable circumscribed mental functions without impairing a variety of them. For example, even the production of a slight emotional dullness, lethargy, or fatigue is likely to impair cognitive functions such as attention, concentration, alertness, self-concern or self-awareness, and social sensitivity.
Shock treatment and psychosurgery always produce obvious generalized dysfunction. Some medications may not obviously produce these effects in their minimal dose range, but they may also lack any substantial “therapeutic effect” in that range.

III. Biopsychiatric treatments have their “therapeutic” effect by impairing higher human functions, including emotional responsiveness, social sensitivity, self-awareness or self-insight, autonomy, and self-determination. More drastic effects include apathy, euphoria1, and lobotomy-like indifference.

Higher mental, psychological, and spiritual functioning are impaired by biopsychiatric interventions as a result of generalized brain dysfunction, as well as specific effects on the frontal lobes, limbic system, and other structures. Sometimes there is a lobotomy-like indifference to self and to others – a syndrome that I have called deactivation (see chapters 2 and 4 of this volume).
Biopsychiatric treatments are deemed effective when the physician and/or the patient prefer a state of diminished brain function with its narrowed range of mental capacity or emotional expression. If the drugged individual reports feeling more effective and powerful, it is most likely based on an unrealistic appraisal, impaired judgment, or euphoria. When patients on “maintenance doses” do not experience noticeable effects, either the dose is too low to have a clinical effect or the patient is unable to perceive the drug’s impact.

IV. Each biopsychiatric treatment produces its essential or primary brain-disabling effect on all people, including normal volunteers and patients with varied psychiatric diagnoses.

Despite the deeply held convictions of drug proponents, there are no specific psychoactive drug treatments for specific mental disorders.
There is, of course, a certain amount of biological and psychological variation in the way people respond to drugs, shock treatment, or even lobotomy or an accidental head injury. However, as a general principle, biopsychiatric interventions have a nonspecific impact that does not depend on the person’s mental state or condition. For example, it will be shown that neuroleptics and lithium affect animals and normal volunteers in much the same way as they affect patients.

V. Patients respond to brain-disabling treatments with their own psychological reactions, such as apathy, euphoria, compliance or resentment.

There is some variation in the way individuals respond to drugs. For example, the same antidepressant will make one person sleepy and another energized. Ritalin quiets many children but agitates others.
It can be very difficult to separate out drug-induced form psychologically induced responses. For example, nearly all of the antidepressants can cause euphoria and mania2. At the same time, some of the people who receive these drugs have their own tendency to develop these mental states. Similarly, a variety of drugs are capable of generating agitation and hostility in patients, yet people can develop these responses without medication. The docility and compliance seen following the administration of neuroleptics can be caused by the drug-induced deactivation syndrome, but can also result from the patient’s realization that further resistance is futile or dangerous.
Later in this chapter, I will introduce the concept of iatrogenic helplessness and denial which addresses the combined neurological and psychological impact of biopsychiatric treatment. In chapter 11, I will discuss some of the criteria for determining that a drug can itself cause abnormal mental and emotional responses, including destructive behavior.

VI. The mental and emotional suffering routinely treated with biopsychiatric interventions have no known genetic and biological cause.

Despite more than two hundred years of intensive research, no commonly diagnosed psychiatric disorders have been proven to be either genetic or biological in origin, including schizophrenia, major depression, manic-depressive disorder, the various anxiety disorders, and childhood disorders such as attention-deficit hyperactivity.
At present, there are no know biochemical imbalances in the brain of typical psychiatric patients – until they are given psychiatric drugs. It is speculative an even na├»ve to assert that antidepressants such as Prozac correct underactive serotonergic neurotransmission (a serotonin biochemical imbalance), or that neuroleptics such as Haldol correct overactive dopaminergic neurotransmission (a dopamine imbalance). The failure to demonstrate the existence of any brain abnormality in psychiatric patients, despite decades of intensive effort, suggests that these defects do not exist.
It seems theoretically possible that some of the problems treated by psychiatrists could eventually be proven to have a biological basis. For example, mental function often improves when certain physical disorders, such as hypothyroidism or Cushing’s Syndrome, are adequately treated.
However, the vast majority of problems routinely treated by psychiatrists do not remotely resemble diseases of the brain (see chapters 5 and 9). For example, they do not produce the cognitive deficits in memory or abstract reasoning characteristic of brain disorders. They are not accompanied by fever or laboratory signs of illness. To the contrary, neurological and neuropsychological testing usually indicate normal if not superior brain function, and the body is healthy. There seems little likelihood that any of the routinely treated psychiatric problems are based on brain malfunction rather than on the life experiences of individuals with normal brains.
If some patients diagnosed with major depression or schizophrenia do turn out to have subtle biochemical imbalances, this would not justify current biopsychiatric practice. Since these presumed imbalances have not yet been identified, it makes no sense to give toxic drugs, including the currently available antidepressants and neuroleptics, all of which grossly impair brain function.
To claim that an irrational or emotionally distressed state in itself amounts to impaired brain function is simply false. An analogy to television may illustrate why this is so. If a TV program is offensive or irrational, it does not indicate that anything is wrong with the hardware or electronics of the television set. It makes no sense to attribute the bad programming to bad wiring. Similarly, a person can be very disturbed psychologically without any corresponding defect in the “wiring” of the brain. However, the argument is moot, since no contemporary biopsychiatric interventions can truthfully claim to correct a brain malfunction the way an electronics expert can fix a television set. Instead we blindly inflict toxic substances on a brain that is far more subtle and vulnerable to harm than a television set. We even shock or mutilate the brain in ways that would appall TV repair persons or their customers, while ruining their television sets.
It is often suggested that persons suffering from extremes of emotional disorder, such as hallucinations and delusions, or suicidal and murderous impulses, are sufficiently abnormal to require a biological explanation. However, the emotional life of human beings has always included a wide spectrum of mental and behavioral activity. That a particular mental state or action is especially irrational or destructive does not, per se, indicate a physical origin. If extremes require biological explanation, then it would be more compelling to ascribe extremely ethical, rational, and loving behaviors to genetic and biological causes, since they are especially rare in human life.
The fact that a drug “works” – that is, influences the brain and mind in a seemingly positive fashion – does not confirm that the individual suffers from an underlying biological disorder. Throughout recorded history, individuals have medicated themselves for a variety of spiritual and psychological reasons, form the quest for a higher state of consciousness to a desire to make life more bearable. Alcoholic beverages, coffee and tea, tobacco, and marijuana are commonly consumed by people to improve their sense of well-being. Yet there’s no reason to believe that the results they obtain are due to an underlying biochemical imbalance.

VII. To the extent that a disorder of the brain or mind already afflicts the individual, currently available biopsychiatric interventions will worsen or add to the disorder.

The currently available biopsychiatric treatments are not specific for any known disorder of the brain. One and all, they disrupt normal brain function without correcting any brain abnormality. Therefore, if a patient is suffering from a known physical disorder of the brain, biopsychiatric treatment can only worsen or add to it. A classic example involves giving Haldol to control emotionally upset Alzheimer patients. While subduing their behavior, the drug worsens their dementia.
After psychiatric drugs are developed and marketed by drug companies, attempts are made to justify their use on the basis of correcting presumed biochemical imbalances. For example, it is claimed that Prozac helps by improving serotonergic neurotransmission. Even electroshock and lobotomy are justified on the grounds that they correct biochemical imbalances. There is no likelihood that these intrusions correct a biochemical imbalance. Too wide a variety of brain-disabling agents are used to treat every disorder – everything from Prozac to Xanax to electroshock is prescribed for depression – and each treatment ends up disrupting innumerable brain functions. In reality, all currently available biopsychiatric interventions cause direct harm to the brain and hence to the mind without correcting any known malfunctions.

VIII. Individual biopsychiatric treatments are not specific for particular mental disorders.

It is often said that psychiatry has specific treatments for specific diagnostic categories of patients: for example, neuroleptics for schizophrenia, antidepressants for depression, minor tranquilizers for anxiety, lithium for mania, and stimulants, such as Ritalin, for attention-deficit hyperactivity. In actual practice, many individual patients labeled schizophrenic to be initially treated with neuroleptics or for depressed patients to be initially prescribed to be initially prescribed antidepressants, this is, in part, a matter of convention within the profession.
When a drug seems more effective in a particular disorder, it often depends on whether it has a suppressive or an energizing effect on the CNS. For example, if depressed patients are already emotionally and physical slowed down, giving them a neuroleptic that causes psychomotor retardation would tend to make them look worse. These patients are more likely to seem improved when artificially energized. Conversely, if schizophrenic patients are agitated and difficult to control, it would not make sense to give them stimulants. They are more likely to be judged “improved” when taking a neuroleptic that reduces or flattens their overall emotional responsiveness. These gross behavioral effects, however, are a far cry from having a “magic bullet” for a specific disease.

IX. The brain attempts to compensate physically for the disabling effects of biopsychiatric interventions, frequently causing additional adverse reactions and withdrawal problems.

The brain does not welcome psychiatric medications as nutrients. Instead, the brain reacts against them as toxic agents and attempts to overcome their disruptive impact. For example, when Prozac induces an excess of serotonin in the synaptic cleft, the brain compensates by reducing the output of serotonin at the nerve endings and by reducing the number of receptors in the synapse that can receive the serotonin. Similarly, when Haldol reduces reactivity in the dopaminergic system, the brain compensates, producing hyperactivity in the same system by increasing the number and sensitivity of dopamine receptors.
It is difficult if not impossible to accurately determine the underlying psychological condition of a person who is taking psychiatric drugs. There are so many complicating factors, including the drug’s brain-disabling effect, the brain’s compensatory reactions, and the patient’s psychological responses to taking the drug.
Because the brain attempts to compensate for the effects of most psychoactive drugs, patients can have difficulty withdrawing from most psychiatric medications. Physically, the brain cannot recover from the drug effects as quickly as the drug is withdrawn, so that the compensatory mechanism can require weeks or months to recover after the drug has been withdrawn. Sometimes, as in tardive dyskinesia, the brain fails to recover. Psychologically, individuals fear that their emotional suffering will worsen without the medication. They may have been told by psychiatrists that they require the medication for the rest of their lives. This can make withdrawal even more difficult.

X. Patients subjected to biopsychiatric interventions often display poor judgment about the positive and negative effects of the treatment on their functioning.

Generalized brain dysfunction tends to reduce the individual's ability to perceive the dysfunction. Impaired individuals not only tend to minimize their dysfunction, they often see themselves as performing better than ever. Individuals intoxicated with alcohol, for example, often show poor judgment in estimating their capacity to drive an automobile or to carry on a sensible conversation. Many individuals who chronically smoke marijuana believe that it improves their overall psychological and social functioning, but if they withdraw from the drug, it may become apparent to them that their memory, mental alertness, emotional sensitivity, and social skills have been impaired while using the drug. People intoxicated with stimulants, such as amphetamine, may feel they have superior or even superhuman capacities, when they are often seriously impaired. The same is true of all psychiatric drugs. Often the patient will have little appreciation for the degree of mental or emotional impairment until the drug has been stopped for some time and the brain has had time to recover.
In my experience as a clinician and forensic medical expert, I have seen patients remain for years in severe states of intoxication from one or more psychiatric drugs without realizing it. Attributing their condition to their own emotional reactions or to stresses in the environment, they may ask for more medication.
After shock treatment and psychosurgery, patients may also fail to understand the iatrogenic source of their mental dysfunction and instead believe that they need further interventions.
The failure to perceive the extent of treatment-induced impairment can have several interrelated psychological and physiological bases:

Psychological denial. Individuals overcome by emotional suffering are likely to deny the degree of their psychological dysfunction. They don't want to admit to being severely mentally impaired. If they are hoping to fell better with the use of a drug, their denial can be further reinforced.
Placebo effect. Patients have faith that biopsychiatric interventions will be helpful rather than harmful, encouraging them to disregard drug-induced dysfunction or to mistakenly attribute it to their emotional problems.
Compliance. To an extraordinary extent, patients will tell doctors what the doctors want to hear. If a psychiatrist clearly wants to hear that a drug is helpful, and not harmful, many patients will comply by giving false information or by withholding contradictory evidence.
Psychologically induced confusion. Emotionally upset individuals can easily lose their judgment concerning the cause of their worsening condition. They can easily mistake a negative drug effect, such as rebound anxiety from a minor tranquilizer or depression from a neuroleptic, for a worsening of their emotional problems. Typically, they blame themselves rather than the medication. This confusion is abetted when the physician exaggerates the drug's benefits and fails to inform the patient of its potential adverse effects.
Drug-induced confusion. Almost all biopsychiatric interventions can at times induce confusion, impairing the patient's awareness of the drug-induced mental dysfunction.
Drug-induced anosognosia. Anosognosia refers to the capacity of brain damage to cause denial of lost function. Anosognosia is a hallmark of central nervous system (CNS) disability (see below and chapter 5). It has physical basis in addition to a psychological one.

XI. Physicians who prescribe biopsychiatric interventions often have an unrealistic appraisal of their risks and benefits.

In recent years, doubt has been thrown on the objectivity of controlled clinical trials in which drugs are compared to placebo or to alternative medications (see chapters 6 and 11). Too often the investigators are influenced by their conscious or unconscious biases.
If clinical and scientific studies can be distorted by bias, it is even more likely that routine clinical practice will be affected by the hopes and expectations of the prescribing physician. Physicians in great numbers have prescribed drugs with unbounded enthusiasm for years before the agents have proven to be worthless or unacceptably dangerous. Amphetamines, for example, were freely dispensed for many years to millions of patients for both depression and weight control without regard for their lack of efficacy and addictive potential. Similarly, minor tranquilizers, such as Valium, were given to millions of patients before the profession recognized that they have little or no long-term benefit and can become addictive. Both psychosurgery and electroshock continue to be utilized, despite obviously devastating effects on the mental life of the patients and the absence of proven efficacy.


I have coined the term iatrogenic helplessness and denial (IHAD) to designate the guiding principle of biopsychiatric interventions. (Breggin, 1983b). It describes how the biological psychiatrist uses authoritarian techniques, enforced by brain-disabling interventions, to produce increased helplessness and dependency on the part of the patient.
Iatrogenic helplessness and denial include the patient's and the doctor's mutual denial of the damaging impact of the treatment, as well as their mutual denial of the patient's underlying psychological and situational problems. Overall, iatrogenic helplessness and denial account for the frequency with which psychiatry has been able to utilize brain-damaging technologies, such as electroshock and psychosurgery, as well as toxic medications.
Before the potential patient encounters a psychiatrist, he or she has usually been feeling helpless for some time. In my formulation, helplessness is the common denominator of all psychological failure. Helplessness is at the core of most self-defeating approaches to life (Breggin, 1992a, 1997). People who feel helpless tend to give up using reason, love, and self-determination to overcome their emotional suffering, inner conflicts, and real-life stresses. They instead seek answers from outside themselves. In modern times, this often means from "experts."
Iatrogenic helplessness and denial go far beyond relatively benign suggestion (as used in medicine and psychiatry, for example, to help overcome physical pain or addiction). First, in iatrogenic helplessness and denial the psychiatrist compromises the brain of the patient, enforcing the patient's submission to suggestion through mental and physical dysfunction. Second, in iatrogenic helplessness and denial the psychiatrist denies to himself or herself the damaging effects of the treatment as well as the patient's continuing psychological or situational problems.
Often denial is accompanied by confabulation - the patient's use of rationalizations and various "cover stories" to hide the extent of mental dysfunction. Confabulation is well understood in psychiatry and neurology, but is generally ignored in regard to treatment-induced effects. Many patients confabulate good results from drug therapy when they are obviously impaired by it.
Denial is closely linked to indifference. Sometimes it is difficult to tell if the patient doesn't care, or if the patient cares so much that he cannot bear to face up to his mental and physical dysfunction. Denial is also related to euphoria. After lobotomy or shock treatment, and sometimes during drug treatment, the patient can develop an unrealistic "high."3
Denial is one of the most primitive ways of responding to threats. The person avoids facing problems and thereby becomes unable to make headway with them. Denial as a basic defense tends to result in ineffective, impotent lives.
Brain damage and dysfunction from any cause, including accidents and illness, frequently produces helplessness and denial; but only in psychiatry is damage and dysfunction used as "treatment" to produce these disabling effects.


As I have discussed in earlier books (1991a, 1994a, 1994b), I believe that the concepts of "mental illness" and "mental disorder" are misleading, and that none of the problems commonly treated by psychiatrists are genetic or biological in origin. The terms "schizophrenia" and "major depression," for example, are based on concepts whose validity can easily be challenged. However, the brain-disabling principles remain valid even if some of the mental phenomena that are being treated turn out to have a genetic or biological basis. All of the currently available biopsychiatric treatments - drugs, electroshock, and psychosurgery - have their primary or therapeutic effect by impairing or disabling normal brain function.

1. The term euphoria as used in psychiatry indicates an exaggerated, irrational, or unrealistic sense of well-being. It can be psychological in origin but is commonly caused by brain damage or drug toxicity.

2. Euphoria is unusual in patients treated with the neuroleptics because of the suppressive effects on the CNS (see chapter 2). It is more common among patients treated with antidepressants, stimulants, and minor tranquilizers.

3. See fotnote 2, (above).