Dan Carlat MD has just come out with a book on American psychiatry that has got a lot of people talking. In Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About a Profession in Crisis Dr. Carlat describes the practices of the typical psychiatrist. In order to generate the most income, most of the appointments are 15 minute “med checks,” and the treatments are based on psychopharmacology and the biological psychiatry model. Patients are fed the pharma marketing explanations of how psychotropic medications work, providing solace for all involved, although there really isn’t good evidence for the explanations. Meanwhile, psychiatrists have farmed out therapy to the other professions, and have adopted a herd em through mentality toward their patients.

A July 13, 2010 interview about the book with Dr. Carlat on NPR’s “Fresh Air” show (which you can listen to here) has evoked some controversy. Giovanna Pompele wrote a critique on the Beyond Meds blog that takes him to task for his comments. She feels that by describing these practices and not apologizing for them, or implying that they still go on, that he is committing an offense. He also had some people throw some rocks about the implication that psychiatric training did not place a high value on therapy training.

I’m not sure I really see it that way. I think it is good that he is bringing this stuff out into a public discussion. I too used to give “drug talks” (see “Confessions of a Psychnetter“) but at the time I deluded myself into thinking that I was providing a useful “education”. However when they wouldn’t let me pick my own slides I realized I was doing nothing more than paid ads for the drug companies, and they dropped me for being difficult. I didn’t like it anyway, because the conversations with the psychiatrist attendees were like “I gave her Zoloft, and she got sleepy, so I gave amphetamines, and she developed… what should I do now?” Years later, the situation has degenerated to the point where my academic physican colleagues openly bemoan the fact that they can’t give “promotional talks” (yes, they actively call them that now). As for clinical work, I refuse to do the 15 minute med check thing, and restrict my clinical work to doing one hour evaluations. The part about telling patients that antidepressants increase serotonin in the brain is kind of a joke, because that is just marketing PR, and researchers like myself who have spent a lot of time reading the primary literature know it is a joke. However I’n not sure how much psychiatrists in the community have read that literature.

The idea of prescription medications like psychotropics being used to treat chemical imbalances has been burned into the public consciousness. Just take the example of Lindsay Lohan, who is on trazodone, Zoloft, Adderall and dilaudid, mixed with alcohol and cocaine, just one in a string of celebrity disasters to bite the dust on these lethal combinations. And when I pointed that out on TV last night, a caller practically took my head off, and there was a general discussion about her “depression” and how she needs to keep her meds in jail. How do we know she has real depression until all those drugs get out of her system? You don’t throw prescription meds at people who are actively abusing drugs (oopes, unless they are a Hollywood celebrity, of course).

I also see a little bit of the reaction to the acadmic psychiatist speaking the truth syndrome which is like “get him!” The whole psychiatry field has been perpetuated by myths and disttortions for so long that when someone talks frankly everyone freaks out.

By way of disclosure Danny wrote thispost in my support last year. I mention this as as a disclosure of my potential bias.

I just saw this review published in Activities, Adaption & Aging by Leo Uzych. Thanks guys!
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Abstract:Reviews the book Before you take that pill by J. Douglas Bremner (2008). Before You Take That Pill critically examines a multitude of commonly prescribed medicines and alternative medicines (including vitamins and herbs) within the analytic framework of data gleaned from research studies. To the reader’s likely great edification, Bremner displays a fierce determination to unearth data embedded in the research literature germane to making scientifically valid conclusions and recommendations about potentially harmful effects of medicines. But the cascade of information flowing profusely from the book, focusing especially on the harmful effects of drugs, is a boon to the reader with any drug exposure. The book’s scientific rigor may also strongly attract the keen interest of readers with professional backgrounds tethered to medicines, including medical clinicians, scientists, and ethicists; public health professionals; health policy makers; and members of the pharmaceutical industry.

Yesterday I did an interview on twitter using #writechat with novelist Peter Fogtdal, author of the novel THE TSAR’S DWARF. which I transpose here.

THE TSAR’S DWARF – Sorine a Danish dwarf tormented by her past is given as a present to Peter Tsar of Russia.

You can follow Peter @danish_novelist and his book @thetsarsdwarf on twitter.

I first became aware of Peter’s book through #litchat which is every MWF 4-5 pm EST, where writers chat about their books, gr8 idea. I bought his book and read it and Peter agree to a Q&A.

Peter Fogtdal

DOUG BREMNER: When and how did you first get the idea to write a novel about a dwarf in 18th cent Denmark and Russia?

PETER FOGTDAL: Initially I wanted to write a novel about Peter the Great, but then I read he collected dwarfs & the novel took off

DOUG BREMNER: What interests you about the character of a dwarf in a novel? #writechat

PETER FOGTDAL: I want to say something about how we treat people who are “weird”. Novel is about human dignity, not dwarfs as such

DOUG BREMNER: What kind of research did you do for the book? Were dwarves really called nonhuman in 18th century?

PETER FOGTDAL: Dwarfs were called “it”, not he/she in the 18th century. They were considered toys and at best treated like lap dogs

DOUG BREMNER: Your MC Sorine leads a tragic life but somehow “even she” emerges as human. Did you spend a year in the head of a dwarf?

PETER FOGTDAL: I spent a year in the head of a funny, dark FEMALE dwarf who despises the world but end up accepting it. Another important theme: If you’ve been harassed by everyone, how is that gonna effect your view of God?

DOUG BREMNER: What is your view of Peter the Great Tsar of Russia? Did your view change after the book? Was he flawed? Typical King?

PETER FOGTDAL:Russia’s Peter the Great was a brilliant genius & psychopath, ruthless, energetic, intuitive, eclectic, I love him!

DOUG BREMNER: OK thanks for taking questions.

My bottom line? I found THE TSAR’S DWARF to be a fascinating tale of the capacity for human redemption. Good job Peter and good luck with the book!

I think most people would agree with the fact that corporations are sucking the life out of individual expression and freedoms, whether is it oil companies, tobacco, drug companies, or Toyota. With their teams of corporate lawyers and lobbyists and powerful financial resources they control the stream of information and effectively block or even ruin and destroy anyone who gets in their way.

And how do we counteract that? Well, reading is one way. But the fact is that the corporations have gobbled up all of the publishers, so now there are only four publishing companies that can get their books into book stores, and one of them is owned by Rupert Murdoch, so, well, you know what I mean.

That is why it is good that there is one individual typing away in rural County Kerry in Ireland who will “take the piss out of” the corporate masses as they say there and reaffirm the dignity of the individual through her writings. Marcella O’Connor, is part of a small collective of writers based called the YearZeroWriters collective who have decided to bypass corporate publishing and take their wares directly to the people. I have read their books which are consistently excellent. These include Daisy Anne Gree with Babylon, as well as others. Marcella recently wrote a wonderful story (“Prick Uniforms”) on the YearZero website. It described the anger of an Irish person who encounters an outsider using the Irish tongue to impress his girlfriend. The scene evoked the rage associated with the rape of cultures (and women) by foreign oppressors as well as the personal meanings of native tongues. Marcella is working on a book called The Emptying about a scientist who has donated eggs for IVF and then the children later come back to find her. She tells me that that character was based in part on a friend of hers who is the lead in a rock band.

Keep an eye on this up and coming group of writers.

21 Feb 2010. This blog was corrected from the original version which mentioned checkpoints and the bloody English.

I have been reading books on a website called authonomy.com where readers and writers get together to vote on which books they like best. At the end of each month the publisher HarperCollins takes the top five and gives them and editorial review, and if they like it, a contract. Unfortunately there are no “rules” and that causes some of the sociopaths who run amok on the site to say “Hey there are no rules” as if that gives them an opportunity to play out their bizarre fantasies like they are characters in Lord of the Flies as has been observed by a writer who recently left the site and to lie and cheat in their effort to climb over bodies on their way to the top. Once they get there, their books are appropriately judged as shite (as the Brits who dominate the site say) and promptly dropped in the garbage can. It just goes to show you that most people will act like rats unless they have someone to publicly shame them. JD on the other hand has consistently given great feedback to others, has been honest, and he has a great book that I want to promote. You see, I think writers who are not honest are shite, cuz they don’t describe real emotions, and if you don’t talk about real emotion, who the hell would you want to read your book?

Revene’s book Appetites is described thus:

Days that are going to change your life should come with a warning attached. James Harford misses the signs when he feeds his wife’s desires.

James is a modern man, defined by material successes. Approaching forty he has everything, and it’s not enough. Sal, his younger ex-model wife, is a stay-at-home mum. With the kids at school, her days are beginning to drag.

The day that changes their lives starts normally. They take time without the kids, enjoying a sultry Sydney day. Time for each other.

Then they pick up a charming stranger in a strip club, and one thing leads to the other.

Sal and James both crave something more, but that night changes everything. Yearnings become all consuming. While Sal seeks fulfillment from more and more men, James gets closer and closer to another woman, and gnawing jealousy eats away at what they share.

Can their appetites be sated or will they remain empty?

[WARNING Contains sexually explicit adults only material: readers who would prefer no sex are advised to consider chapters 2, 11,22, 37 or 46.]

i.e. don’t forget to get extra batteries for your vibrator.

I read appetites and I thought it was great. The use of the situation of introducing outside sexual partners into a monogamous relationship and the effect that has on the relationship and the motivations and self deceptions involved were compelling in my opinion as a psychiatrist.

Read more of Appetites here. Join the facebook cause “Get JD to the Editor’s Desk” here.

The title of the book in question was originally Men ON Women but as author Barbara Silkstone got into interviewing over 500 men on their opinions about women, sex, and relationships, the men relaxed in her one on one chats and became emotionally naked with her, hence she changed the title to 527 Naked Men and One Woman: Adventures of a Love Investigator, which you can buy here.

Barbara Silkstone

I found the book fascinating (as a psychiatrist) for the wide range of nuttiness found in the men’s attitudes about love and sex, which seemed to boil down to either I am looking for my life partner and that one wasn’t it, or she just stayed at home with the kids and had no goals and I want a woman with goals, and on and on. Men shared their confusion about what they thought they wanted and how unhappy they were when they actually got it.

I recently interviewed the author through email and here are some snippets:

DOUG: How did you come up with the idea of the book?

BARBARA: I was just coming off of a second divorce and felt like I was taken financially by my ex. I was sure he had a hidden agenda. I have a lot of really great guy friends and I thought there must be some guys out there who marry for true love and don’t just worry about the money. I started with a list of eight guys willing to be interviewed about their relationships. When the word got out that there was a woman who wanted to hear about their thoughts on relationships and wasn’t judgmental, the word spread through the guy-network and then around the country. I traveled for six years just listening to men. Can you imagine?

DOUG: Was there anything that surprised you about the interviews?

BARBARA: Some of the men’s attitudes about relationships were a lot worse than I had expected. It got pretty hard to listen to after a while. It took a toll on me emotionally.  There were many days went I spent the mornings with men who were having mulitiple affairs and justified them and then afternoons with single men who were helping married women cheat and those single guys had all sorts of justifications. Few of the men ever  used the word love.

DOUG:  Was there a certain answer that ran through all the interviews?

BARBARA:  I would ask the men if they would be willing to die for the woman they claimed they loved. Only 14 men out of the 527 said yes and yet half the men were married.  Their response was usually…’You’re not gonna use my name, right? Then, ‘Of course I wouldn’t lay down my life for my wife. She has no goals. I still have things to do with my life.’

It got me wondering whatever happened to those romantic guys from days of old who marched off to defend their women folk? How did we lose them?  Where did they go?

DOUG: I was surprised at how many men looked at relationships from primarily a self centered perspective, or that worried about things like not getting bogged down with a ’stay at home mom’. And yet they were so unhappy.

BARBARA: Yes it is pretty remarkable. I started out with a plan to interview 1000 men in one year. But after six long years and a couple of melt-downs I had to stop at 527 guys.  I had no more emotional strenght left – and I’m a pretty storng lady.

DOUG: Has this affected your own view of dating?

BARBARA:  I haven’t dated since I finished the last interview. I’m a perfect example of biting off more than you are trained to digest. Since I finished the interviews. I became THE WOMAN WHO KNEW TOO MUCH.  What I did was an excellent job of biting off more than I could chew. I had no way to put all this knowlege into prospective. I am my own collateral damage.

DOUG: What are you working on now?

BARBARA: I’ve just completed a novel titled THE SECRET WORLD OF ALICE IN WONDERLAND, AGE 42 AND THREE-QUARTERS. I discovered that we all live in some version of Lewis Carroll’s reality. If we can just learn to laugh at ourselves we’ll survive and get a few giggles along the way.  My Alice has some crazy quirks – she suffers from Alice in Wonderland Syndrome and nibbles on little pink pills to keep her cool. She’s dying to live in England and almost does. Gangsters pursue her and she runs into the arms of a charming British conman. It’s a bit like A Fish Called Wanda.
 
DOUG: Barbara has agreed to hang around and answer questions about love and relationships on the comment section. Thanks for agreeing to being interviewed!

BARBARA: Thanks for having me!

The Beach Beneath the Pavement, is a quirky novel by a first-time English writer named Roland Denning. I first came across Roland when I was reading a thread on authonomy about finding an agent. He posted a link to a hilarious video he made that showed a bunch of robots (author, agent, publisher, friend, etc) acting out the plight of trying to get a novel published. I figured I should get the book, just as a way of showing appreciation for his video.

The book itself is about a guy named Bernard (I always thought of him as Roland, but whatever) who is a journalist in London and gets pulled into a series of bizarre events. These involve a woman named Animal who is apparently a terrorist, a mysterious person named “JJ” who noone is really sure is real or just a myth generated by internet buzz, something called the Tranquillity Foundation which promised “serenity with security”, and a bunch of other New Age hilarious characters. There is also a group of theater performers who are trying to “break down the barriers between audiences and theater” who carry out a series of bizarre productions that confuse and involve the audience. The novel itself has the feeling of continued confusion which the author appears to induce deliberately. I found it interesting for some of the ideas conveyed (a monologue by “JJ” about the age of “post-credibility”, amongst others). So I would definitely recommend it for someone looking for something different than a Tom Clauncy or Dan Brown novel.

Backed!

Originally posted on Doug Bremner’s blog

http://www.beforeyoutakethatpill.com/index.php/2009/11/28/the-beach-beneath-the-pavement/

Book Review: Is It You, Me, or Adult ADD? by Gina Pera (Alarm Press, 2008)

I know someone with childhood attention deficit hyperactivity disorder (ADHD) whom I describe as Jack in my book in order to describe all of the possible side effects you can get with drugs like Adderall. However I didn’t know much about Adult Attention Deficit Disorder (ADD) before I started reading Gina Pera’s well written and highly informative book.

For starters, of course, Mrs. Bremner had to take that survey of Adult ADD partners to see if I qualify. Here is how it went (maybe you can take it too):

• Scatter-brained or absent minded: check
• Immature: check
• Dysfunctional family background: check
• Selfish: check
• Passive, lazy or introverted: (last one, check)
• “Free spirit” or eccentric: check
• Passive-aggressive: not really
• “That’s how men are”: (confused look, not in Italy)
• Deceptive/sneaky: No
• “Hyper” high strung or extroverted: No
• History of bad luck: check
• Thrill seeker: No (writing a blog can be thrilling, I say)
• “That’s how creative people are”: I guess
• Workaholic: No (at least not compared to Mrs. Bremner)
• Rebel: check
• Past/current substance abuse: No (didn’t inhale)

I had to take my Dad off of my email list because of #3 (sigh).

Anyhoo two thumbs up for this book!

Gina also writes an entertaining blog related to Adult ADD called ADHD Roller Coaster.

by Neil Shulman MD

I was having some pain in the esophagus while swallowing this weekend and started to freak out about it a little. Being a doctor myself I naturally didn’t want to go to a doctor about it so I grabbed Your Body’s Red Light Warning Signals by fellow MD author Neil Shulman. Fortunately I found out that I wasn’t going to die right away and I got better with some OTC Prilosec and Mylanta. That is why I was glad to see a new revised and updated version come out that got great reviews this weekend in the local AJC paper. Here is an excerpt.

When the little red light on your car’s dashboard flashes, you know to check the oil or battery. But if one of your eyelids droops and your vision gets blurred, you might not know what to do —- or react as quickly. Atlanta physician Neil Shulman, who penned the book that became the 1978 hit movie “Doc Hollywood,” is out with a new volume that aims to help you decode your body’s codes.

In the newly revised and updated edition of Your Body’s Red Light Warning Signals (Delta, 496 pages), the Emory University professor provides an owner’s manual-style overview of the body and explains how to read the signs of potential health danger. Shulman helps explain the differences between simple conditions and immediate health threats, such as when a pain in the tummy is more than indigestion and could be an ulcer.

Health care is a two-way street, and the best way to make the system work better is to make people more medically literate and empower them to advocate for themselves, he said. “You shouldn’t just turn over your body to a doctor and say, ‘Take care of me,’ ” said Shulman, who describes himself as obsessively compulsive about patients.

I am reading Alison Bass’s book Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial. Overall it makes for a good read, a story about distortion of study results related to SSRI antidepressants, and the corruption of leaders in the academic psychiatry field for the purposes of promoting profit for pharma.

My only criticism is that at times it seems like there is too much narrative detail about taxi rides and other things that slowed the story down and are not directly relevant to the story flow.

However I have to admit that the part I found most fascinating was the part about Martin Teicher, MD, a psychiatrist I know personally, have had dinner with, read his papers and grant applications, and whose research interests overlap with mine (i.e. effects of childhood abuse on the brain).

You see, Marty Teicher had the guts to say that Prozac could make some people (emphasis mine) suicidal, back in about 1990, at a time when we were all “listening to Prozac”, or maybe drooling over Prozac, or whatever.

The “miracle drug” results in a two point increase over placebo on a 56 point scale, which pharma now acknowledges, because it is off patent and they want to promote their new miracle drug Abilify (which is actually an antipsychotic, which will literally make you drool).

I actually skipped chapters to read the accounts of Dr. Teicher. You see I had heard that Eli Lilly had used rumors that he had had sex with a patient to silence him in expressing his views that SSRI antidepressant medications could increase suicidal thoughts. Not very good PR when they were launching their drug as the miracle cure for depression.

And they were pretty effective. Most of Dr. Teicher’s recent research is on the effects of childhood abuse on the brain (NOT Prozac and suicidality).

I know that tune.

It’s kind of hard to do research when your data gets subpoenaed before you have had a chance to go over it and fact check it. I know from experience.

In the schools I came from they call that bullying.

In Alison’s book she gives a compelling narrative about an attorney for Eli Lilly named Nina Gussack who “softened up” Dr. Teicher and then hit him with accusations of a patient that he had had sexual relations with her. She spent two days deposing him after which he decided that he wouldn’t testify again. Eli Lilly hired his ex-wife (leading her to move to Indiana for four years THE VERY DAY they deposed him, taking with her his kids), only to dump her when they had no further use for her.

Congratulations, attorney Nina Gussack, counsel for Eli Lilly, I hope you can sleep at night (try some Ambien).

From my reading of the book and my personal interaction with Dr. Teicher I think the whole thing is a bunch of bullshit, Eli Lilly manipulating someone with borderline personality disorder for their own interests. In fact the Massachusetts Medical Board found no evidence of any sexual relationship.

The only “evidence” they had was that Dr Teicher had given the patient a card saying “love marty” on her birthday and a pair of ear rings valued at $3.50.

I write cards to my kids saying “love dad”. That doesn’t mean I am having sex with them. Give me a f**king break.

Here is my card for Eli Lilly: “Thanks for making us suicidal! Love, Doug Bremner MD”