The Nature and Meaning of Psychiatry

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October 25, 2021 | 17 Comments


  1. Thank you Professor Healy for another gifted and inspirational lecture. Far from inducing hypertension, I found your presentation spiritually uplifting, and markedly hypotensive in its cardiovascular impact. Definitely a therapeutic experience.

  2. No need to pay for it – it’s free to download -see George Ikkos twitters promoting the book
    Mind, State and Society: Social History of Psychiatry and Mental Health
    edited by George Ikkos, Nick Bouras
    My review – there’s always more that could be said but here’s some-
    It may have become trendy amongst those who have books to publish but try asking the person in the street what s/he understands by ‘madness’ Those so labelled are not impressed even if there are some ‘users’ who have been brain washed into using the term which took a long time to fall into disuse . in the same way ‘spastic’ is no longer acceptable neither is labelling people as ‘mad’.For those who want an overview of the way society was greatly changed from to some extent a push towards a socialist ideal to a bureaucratic nightmare focussing on the NHS, although one of the authors also practices privately, this is a useful book. For readers who have a specific interest in a topic the key points and refs are useful . It is written from the perspectives of those who reached influential positions which always leaves a gap in historical accounts. For example The one person described as a ‘user’ has made a sucessful career It would have been useful to include a variety of authentic experiences written by those themselves who experienced mental health services Instead the book talks About others ,as others, There is no mention of the influence of Italian psychiatrists on the initial development of an attempt to bring a more humanised equalised service to Britain by people themselves who didn’t wait to be ‘allowed ‘but began activism against the system . Without them the services would have languished even further behind than they were. It is a book by academics which doesn’t reflect the lived lives of vulnerable people in UK enough but is a necessarily partial history
    Apart from the chaper by Professor David Healy which traces the beginnings during the period the book covers of over medication and the consequent harms which are still being covered up. It may be trite but a history should give the possibility of learning lessons including about the use of psychiatric medications and the propaganda allowing their use by pharma and regulators medical colleges and politicians and medical leaders and medial journals.. Few have done as much to track the history of this development than D Healy, His chaper is a warning not just an academic historical account of what is being done to psychiatry , those who work in it and those who use it. He does actually predict the demise of the practice of psychiatry Considering the history of psychiatry as led by the state ,with the collusion of leading academics ,and the very tangled networks DH describes ,many would celebrate that.

    Re George Ikkos co-editor- he is a psychiatrist-therapist member of the Inst of Group analysis and has or had a private practice in ‘prestigious’ Harley St London as well as worked in the NHS with a special interest in psychosomatic theory. aAnd of course now still works for the coll of psychs
    The IGA is one of the leading psychotherapy training organisations, The development of psychotherapy-analysis was not included in the book The internecine battles and positioning for power and prestige of certain theories of therapy would have been a useful chapter. They were of course tried out mainly on unsuspecting NHS ‘users’
    Self indulgent books and talks and the sickening mea culpas for the theories they carried on promoting when they were being told by those they practiced on that they were causing harms and deaths reveal the danger of group think and the hubris of those who reach ‘the top’

    Should anybody embark on the runaround of making complaints this is what G I suggested – designed to undermine any complainant even more so in those days but hidden in benign therapy speak.

    Psychoanalytic Psychotherapy
    Volume 14, 2000 – Issue 1
    Complaints against psychiatrists: Potential abuses
    Dr George Ikkos &Dr David Barbenel
    Pages 49-62 | Published online: 11 Aug 2006
    The presence of complaints procedures is an essential element of clinical management. We discuss diagnostic, psychodynamic and systemic factors that may lead patients and their carers to make ill-founded complaints against their psychiatrists. We argue that explicit attention to these factors is essential for effective understanding and investigation of complaints in the NHS Mental Health services.
    Using ‘citizenship’ to deal with feelings of hate in psychiatry’
    George Ikkos
    Published Online:28 Sep 2013
    Clinicians’ feelings of hate towards their patients may contribute to adverse clinical outcomes through unintended harm or intended abuse. Ideas of ‘citizenship’ may assist psychiatrists and other mental health professionals to deal with naturally arising feelings of hate, through engagement in dialogue with patients and colleagues, in a spirit of ethical encounter and fellowship.
    Should a doctor ‘hate’ us is the answer to use us for some excercise in self discovery or to have the decency to move out of the person’s life altogether …
    As for ‘hubris’ co-editor Nick Boras writes to expose the dangers of this. However he has not replied to several requests I sent for help with issues raised on the blog re suicides specifically. I pointed out that a huge problem is the hubris dispayed by regulators and the networks we are familiar with No reply. So many of those who are lauded do not recognise hubris in themselves.

  3. “Some of the rest of the stuff, well….”

    If these two, George Ikkos and just about every other psychiatrist were subject to induced akathisia by the very drugs they subject people to in their closed cultures of abuse called psychiatric ‘hospitals’, then let’s see what you lot have to say.

    Those psychiatrsts who read this blog and disagree – why don’t you do it and see for yourself. If you take the popular prescribed sertraline along with Nytol – it is not uncommon for people to take Nytol or some other natural valerian based sleep aid when they have such problems due to anxiety/depression – before they go to a GP. See how you get on, well… ?

  4. It was a blockbuster of a lecture which should be shared world wide. And hopefully will be by those who are able to do so. (A birthday gift any mother would be proud of) in that it doesn’t pull any punches, is worthy of the trust so many put in him and his work. As for Tom Burns – who many would describe as rude and obnoxious rather than modest
    and certainly not able to engage when he is certain he is right.
    At the end of the meeting Tom Burns was called on to comment on the all the lectures. I missed this at the time. He said:
    About David Healy I thought we missed a trick. We should have done a mass blood pressure test before and after, because I think I was not alone in the room at fuming a bit about some of the stuff he said. But he’s not here so we can’t thrash it out.
    Some of the rest of the stuff, well….
    Burns and everyone else were able to repond to David H – but chose not to, His choice of words is telling ‘thrash’ ? He was not able to have a civilised debate. Or even engage in the Q and A Far too important.People on the other side of his fence would not remember him as ‘modest’ but arrogant and self important and guilty of persuading politicians to bring in one of the most harmful policies of modern times ie Coercive community orders. But he’s not here so we can’t thrash it out.
    Reviews of hos eminence by people who actually met him rather than just read his self righteous books
    books -‘ 4 March 2016

    Sean Gilligan
    3.0 out of 5 stars Could do better, considering his eminence
    Reviewed in the United Kingdom on 13 April 2015
    I wasn’t all that impressed with this book, but I gave it three rather than two stars because it wasn’t as bad as I’d feared, knowing Tom Burns’s reputation and having been deeply unimpressed with some of his media appearances, including him absolutely “losing it” with psychologist and former patient Rufus May in a debate about the best way to help voice-hearers, leaving me wondering who the mad ones really were. However, this is a critique of the book, not the person, so to be fair he does acknowledge that psychiatry and its disorders are not equivalent to other branches of medicine and disputes the validity of this claim, which is often made by psychiatrists and their auxiliaries. He is also humble enough to admit that he made a mistake in his influential recommendation of preventive community treatment orders, which later research showed to be ineffective (not to mention the unwarranted infringement of civil liberties they entailed). Having said that, I think the book ultimately fails to grasp the nettle presented in its subtitle. His examination of the dark side of psychiatry is, to my mind, an attempt to illustrate “the exception that proves the rule” principle so beloved of apologists of all kinds, and leaves the “dark centre” unexplored; he touches on the elision of psychiatry into neurology without discussing its implications for patients or society; he claims to have psychotherapeutic inclinations without fully exploring them or explaining them (unless I missed it), and without realising that this tends to undercut the confident biologism that has characterised psychiatry during his years of practice; he seems to perform the usual “divide and rule” manoeuvre common in psychiatry (in the NHS, at any rate) of dividing patients into the mad/not responsible/deserving (typified by ‘schizophrenia’) and the bad/responsible/undeserving (‘personality disorders’) without examining critically the aetiology or the clinical implications of these concepts; and while he presents a reasonably good summary of the history of psychiatry, his discussion of contemporary treatments is superficial and lacks context. You might reasonably argue that all these subjects deserve books in their own right, and that this is meant to be an overview of psychiatry’s place in society; but as such, it reads less like a genuine philosophical examination of the topic (of which there are many excellent examples) and more like special pleading for a profession with an identity crisis. Considering this professor’s eminence, I might have expected better.

    1.0 out of 5 stars Tom Burns should be ashamed of himself. He was …
    Reviewed in the United Kingdom on 5 November 2016
    Tom Burns should be ashamed of himself. He was at the forefront of promoting compulsory orders against all the advice from people who would suffer from his actions and were more qualified to judge,. Despite claiming that listening is of prime importance whlst still a young psychiatrist at St #georges he was totally unable to listen and revise his opinions..which he has been forced to agree were wrong. Will he apologise especially to the black community of service users at St G~eorgesnow that his ambition has taken him to a research dept at Oxford. What do you think?!

  5. Kellogs…

    ‘Constantly irritated by the endless misrepresentation of psychiatry in public media I have been concerned to try and make my profession more intelligible to the general public.’

    Is the current epidemic of depression and hyperactivity the result of disease-mongering by the psychiatric profession and big pharma? Does psychiatry have any credibility left at all?

    But what Burns cannot quite bring himself to do is give up the drugs. In a 333 page book (complete with a glossary, a bibliography and an index), there are just three references to the most commonly prescribed psychiatric drugs: the SSRIs, or selective serotonin reuptake inhibitors (such as Prozac and Seroxat). When he does consider the SSRIs, he notes that they may indeed be overprescribed (as of 2011 46.7m prescriptions had been written in the UK for antidepressants), and in particular that they may be used to “treat” commonplace unhappiness rather than severe depression.

    What he doesn’t venture near are the systematic critiques of antidepressants – and neuropharmacology in general – that have emerged in recent years.

    Psychiatry’s cause for anxiety

    Focus on people, not technology or the DSM, to treat mental illness, Tom Burns tells Matthew Reisz

    Long before he became professor of social psychiatry at the University of Oxford, Tom Burns had first-hand experience of what was at stake. His mother had a nervous breakdown when he was 15, and he and his brother spent the next 20 years coping with the recurrences. Looking back, he believes he learned three central lessons.

    “It taught me that psychiatric treatments do work,” he says. “They make a fantastic difference. They are not trivial, they are as good as anything you see in surgery or anywhere else in medicine…I also saw that there are limits to what we can understand, limits to what can be done – you have to live with that and not keep demanding that everybody can be cured.”

    Yet Burns also could not help noticing that “some psychiatric teams were markedly better than others. The things that distinguished the better teams were not the treatments they had available in terms of drugs – they were the same for everyone – but the fact that they were able to maintain a more durable, sensitive focus on the individual.

    “The thing I took from that and that has never left me is that psychiatry is utterly based in and dependent on a relationship. It is not a secondary, luxury add-on. It is the core of the activity. What I feel anxious about in modern psychiatry is that we have become quite preoccupied with the technology and, certainly in our writings, downplay the importance of continuity of care and relationships.”

    Psychiatry, Mental Illness, and the State

    Finally, we have a definitive discussion of the discipline of psychiatry, from an insider committed to the profession but who does not shy away from its profound difficulties. In Our Necessary Shadow: The Nature and Meaning of Psychiatry, Dr. Tom Burns reveals all even while insisting that at bottom “psychiatry is a major force for good.” Psychiatry is inherently controversial since it claims to know the psyche; but this touches, as he puts it, what “is most human in us,” our being, our “soul” which we cannot be neutral about. Psychiatry is a “hybrid” of “guided empathy” and detached cure—and the profession has swung wildly between them for years.

    While he is right to defend psychiatry’s positive achievements, it is questionable whether a field of endeavor that has no theory to guide it has learned or ever can learn its lesson.

    Looking ‘inside’ …

  6. Antidepressant discontinuation trial misleading as it likely mis-interprets withdrawal effects as relapse
    Re: Half of people who stopped long term antidepressants relapsed within a year, study finds Elisabeth Mahase. 374:doi 10.1136/bmj.n2403
    Dear Editor
    Lewis and colleagues randomly assigned patients with multiple depressive episodes, stable on antidepressants, to either continue antidepressants or to stop them over 4-8 weeks.[1] The authors concluded that continuing antidepressants reduces the chance of relapse even for those patients feeling well enough to stop as 39% of patients in the maintenance arm met criteria for relapse, compared to 56% in the discontinuation arm.

    This conclusion is not warranted because the authors neglected to account for the possibility of antidepressant withdrawal effects being mis-classified as relapse, a fundamental problem in discontinuation trials.[2,3] Stopping antidepressants commonly causes withdrawal symptoms, with about half of patients experiencing them.[4] This is reflected in the current study where the average number of withdrawal symptoms was more than double in the discontinued group at 12 weeks (3.1 vs 1.3 out of 15 total symptoms).[1] Even this may have been an underestimate as the modified DESS scale used did not measure severity. ‘Dizziness’, for example, may mean different things to people in the maintenance group compared to the discontinuation group (such withdrawal symptoms can be so severe they have led to people being investigated for stroke).[5]

    Although antidepressants were, by design, discontinued more slowly than in previous trials, we now know that 8 weeks is still a relatively short taper in patients who had been on the drugs for more than 2 years (half the dose for one month, then halve the dose every second day for one month, before stopping). Although this approach was consistent with recommendations at the time the trial was set up, since then guidance from the Royal College of Psychiatrists[6] and draft guidance from NICE[7] recommends stopping antidepressants over “months or more.”[7] Also the final doses before stopping (one quarter the highest dose), although seemingly small, have large effects on target receptors and therefore cause large shifts in effect when reduced to zero.[8] Hence withdrawal symptoms are still likely to occur.

    Antidepressant withdrawal symptoms overlap with most domains of the depression scale (rCIS-R) used to detect relapse,[9] and are therefore likely to artificially inflate relapse rates in the discontinuation group.[2] The withdrawal symptoms measured by the authors include: ‘severe nervousness or anxiety’, ‘confusion or trouble concentrating’, ‘agitation’, ‘brain fog, forgetfulness or problems with memory’, ‘trouble sleeping, insomnia’, ‘fatigue, tiredness’, ‘sudden panic or anxiety.’[9] These symptoms would also register on the scales used to detect anxiety (GAD-7), depression (PHQ-9) and relapse (rCIS-R), which include the same domains.

    There are several lines of evidence that withdrawal symptoms from antidepressants were indeed mis-classified as relapse in this study. There was high correlation between mean differences at the different time points on the withdrawal scale (DESS) and mean differences on the depression scale (PHQ-9) (R2=0.97) and anxiety scale (GAD-7) (R2=0.89). The differences between the average of the groups for the DESS at weeks 12, 26, 39 and 52 were 2.2, 0.7, 0.9 and 0.1, respectively; for the GAD-7 they were 2.2, 0.8, 0.6, 0.3 and for the PHQ-9 they were 2.2, 0.8, 0.6, 0.3. Together, with the overlap of withdrawal symptoms with measures of mood and relapse, this suggests that the withdrawal symptoms may account for the increase in symptom scores and relapse rate. The reverse direction of causation would be unlikely, since withdrawal symptoms include physical symptoms that are not intrinsically related to depression, including dizziness, electric shocks and headache. Whilst it is possible that relapse and withdrawal effects could co-incide, Occam’s razor would suggest one condition causes several symptoms rather than requiring several conditions.

    Withdrawal confounding of relapse is also consistent with the finding that most relapses occurred when withdrawal effects are at their peak, within 6-12 weeks of when the drugs were stopped (at week 8). Indeed, 90% of the total difference in relapse rates between the two arms of the trial (at 52 weeks) was present at 12 weeks after the drugs were stopped (although this accounts for only 27% of the total follow-up time (12/(52-8)*100%). Furthermore, patients stopping fluoxetine, associated with fewer withdrawal effects than other antidepressants, because of its long elimination half-life, relapsed about 25% less than people stopping citalopram and sertraline again suggesting withdrawal effects.

    Moreover anxiety, and depression scores were the same for both groups at the end of the study (week 52). Although 44% of the discontinued group returned to their medication by this point, even with twice as many people on antidepressants in the maintenance group (89% were still on medication) there was no difference in symptom scores. This suggests that discontinuation of antidepressants did not worsen mood after the period in which withdrawal symptoms had settled (there were only small differences in DESS scores by 52 weeks).

    Lastly, 71% of patients in the discontinuation group correctly guessed their allocation to placebo, possibly because of withdrawal symptoms, and the expectation that they would get worse might have contributed to their worsening.[10]

    As there was no effort made to manage the potential confounding of relapse by withdrawal the current study suffers the same flaws as previous discontinuation studies and cannot provide evidence of the benefits of long-term treatment, only the difficulties of stopping it. The authors could resolve some of these concerns by analysing the correlation of withdrawal symptoms with mood scores and relapse amongst individual patients to verify if withdrawal symptoms might account for relapse. They could also re-analyse their data by excluding patients who experienced significant withdrawal symptoms (e.g. modified DESS ≥ 2) from qualifying for a diagnosis of relapse. This would provide a more robust measure of relapse, reducing the potential for the misclassification of relapse as withdrawal. They could also test whether unblinding was associated with relapse.

    Uncritical interpretation of this study may lead to the erroneous conclusion that antidepressants should be continued to prevent relapse, when in reality all they may be doing is preventing withdrawal symptoms. The more accurate conclusion would be that such symptoms are temporary withdrawal symptoms that can be minimised by stopping the drug more gradually, as recognised by the authors in media interviews, although not in the published paper.
    27 October 2021
    Mark A. Horowitz
    Clinical Research Fellow in Psychiatry
    Professor Joanna Moncrieff, Dr Beth Parkin
    Maple House, Department of Psychiatry, 149 Tottenham Court Rd, UCL

  7. 29mins 30sec

    ‘you work with the person, people are the data’

    People in psych units are treated like trash, utter rubbish. There is no pretense of care what so ever. I never stopped telling the people who trashed me with those vile drugs that they were causing my situation – they threatened me with sectioning and vehemently accused me of some crime, ‘What have you done’ they keep shouting at me. That this, what ever I had done was why I had severe anxiety and had been suicidal – I was a criminal. All about me were suffering the same, unable to keep still, running around taking their clothes off, attacking people, flooding the place out, trashing and smashing anything, climbing over the high wire fence to escape. Two people actually died after doing this, being killed on a near by motorway and stated in the trusts own public documents but seen no where in the local media. After all this – and I’m mentioning a small fraction – the CQC gave these people a ‘good’ rating.

    • update – I’ve been corrected… it was three people who died on a motorway after escaping one from another hell hole, same ‘health trust’.

  8. Certainly is ‘interesting’ Spruce. Why has it taken so long though when they have been aware of the situation as admitted for so long……..Now we need some action not another consultation or more meet ups amongst those who should have taken action years ago ‘Interesting’ that reports of the meetings described includes BMA CGP and so on but no squeaks from them
    Have sent David H’s lecture to the RSM (On David Healy blog) to -Roc Private Clinic
    Dr. Aseem Malhotra
    Location: London
    e mail

  9. Will Patrick Vallance;s behaviour be investigated…. he is a member of the club so….more days out for the chums
    Patrick Valance, worth £10m, could become even richer from … › news › article-8772503
    25 Sept 2020 — Sir Patrick Vallance, the Government Chief Scientific Adviser, … After six years at GSK his base salary as Executive Director was £780,000 …
    Great to be joined by Sir David Attenborough and
    Secretary of State
    on board the #RRSSirDavidAttenborough where we shared our aspirations for
    and marked the launch of the Statement by International Scientific Advisers #COP26 #TogetherForOurPlanet

    Climate crisis: People need to change their diet and flying habits… › story › climate-crisis-people-nee…
    21 hours ago — Speaking ahead of the COP26 climate talks, Sir Patrick Vallance said behaviour changes will be required as well as new green technology .
    Wonder if his properties worth zillions have had the boilers changed .
    Anyway happy to drag you all around a food bank when you’ve recovered from jet lag Patrick and co. The message from someone in P V’s position is insulting There’s plenty in Glasgow who never get a meal and can’t afford heating.

  10. I.m tossing up whether to rummage through their tool box as I may not have yet more months which they can drag into years using various ploys , to deal with the predictable runaroundYour GMC enquiry (The Call centre handler -sorry ‘Contact Centre Advisor ‘might have spelt my name correctly by the way – ) But worth having another concern on the GMC records along with a previous complaint by a group concerned about her practice.
    11:24 AM (1 hour ago)
    to me
    Dear Suzanne
    Thank you for your email about your concerns.
    If you have serious concerns about a doctor, you should raise them with us via our concerns tool which you will find in the concerns section of our website.
    These concerns could include:
    serious or repeated mistakes in patient care
    failure to respond reasonably to patient needs (including referring for further investigations where necessary)
    violence, sexual assault or indecency
    fraud or dishonesty
    a serious criminal offence
    abuse of professional position, eg an improper sexual relationship with a patient
    discrimination against patients, colleagues and others
    Please be advised that you will also need the doctor’s full name and GMC number in order to submit your concern to us.

    If you would like to discuss this further, please call us using the number below or reply to this email.
    Yours sincerely
    Claire Hall
    Contact Centre Adviser,
    Registration and Revalidation Directorate
    Telephone: 0161 923 6602 (+44 161 923 6602 from outside the UK)

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