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Oh boy oh boy oh boy. The problems pointed out in this article -- which are in some degree real even if heavily editorialized -- must be understood in light of

Oh boy oh boy oh boy. The problems pointed out in this article -- which are in some degree real even if heavily editorialized -- must be understood in light of a wider context which includes: 0) The very poor standards of validity and replicability in most fields of experimental psych-whatever. The Popperian method ain't what it used to be. 1) The Viennese Waltz of bad incentives throughout the psychiatry research pipeline. Most notably, drug companies are incentivized for fraud and deceit by being rewarded for closely-guarded research, hiding negative studies and obtaining patent extensions for new applications of existing drugs. 2) Somewhat related to (1): the unfortunate drug safety model prevalent in all relevant nations in which drugs must be proven to work for some pathology. Besides incentivizing recklessness in industry-led research, this means viable off-label usages go "underground" (topiramate for dissociative disorders is a typical case where FDA-worthy testing might be impossible). It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. 3) Much related to (0): the effective failure of "talking cures" in outcompeting drugs (specially "dirty drugs" like anticonvulsants, neuroleptics and non-SSRI antidepressants) for "simple" depression, bereavement and related mental health issues of which one could whip up a "social critique" of drug use and so forth. "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects because the alternative is to go actually mad-crazy. Did I miss something?

Lxr 10y ago
> It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. The problem is that safety is not binary - it's a question of severity and probability of adverse effects vs the benefit of the drug (the risk of adverse side effects is more acceptable for a cancer treatment than a cough medicine for instance). The purported purpose of regulation is to balance risk vs benefit. Therefore the regulator needs to incorporate the indication into their decision, and so they must evaluate if it actually works.
tcj_phx 10y ago
> "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects [...] The creation and promotion of "Bipolar" as a DSM disorder is covered in Anatomy of an Epidemic, Robert Whitaker's followup to Mad in America. > [...] because the alternative is to go actually mad-crazy. The whole point of Whitaker's Mad in America foundation is to change the paradigm of our approach to mental health. nstead of trying to find the right drug to make a symptom go away, it would be much more effective to figure out non-psychotropic-drug ways to help people function better.
- KermitCole 10y ago
  Actually, speaking as an editor on "Mad in America,"I'd say that we would be interested in making a fuss about the long-term effects of lithium. We would welcome that and any other stories from the commenters posting here.
- thanatropism 10y ago
  Erm, manic depression as distinct from schizophrenia was basically established by Emil Kraepelin in the 1880s. Dr. Whitaker could be going full Foucault, but as well established by Hollywood, you never go full Foucault.
  - tcj_phx 10y ago
    > Erm, manic depression as distinct from schizophrenia was basically established by Emil Kraepelin in the 1880s. The physiological basis for scihzophrenia wasn't figured out and ignored until the 1970's. > Dr. Whitaker could be going full Foucault, but as well established by Hollywood, you never go full Foucault. Robert Whitaker is a journalist, not a doctor. He's sort of like the kid who points out that the emperor got swindled by his tailors. I like the reference to the quote from Tropic Thunder, but I'm not up to date on Foucault's contributions to philosophy.

Lxr 10y ago

> It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. The problem is that safety is not binary - it's a question of severity and probability of adverse effects vs the benefit of the drug (the risk of adverse side effects is more acceptable for a cancer treatment than a cough medicine for instance). The purported purpose of regulation is to balance risk vs benefit. Therefore the regulator needs to incorporate the indication into their decision, and so they must evaluate if it actually works.

tcj_phx 10y ago

> "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects [...] The creation and promotion of "Bipolar" as a DSM disorder is covered in Anatomy of an Epidemic, Robert Whitaker's followup to Mad in America. > [...] because the alternative is to go actually mad-crazy. The whole point of Whitaker's Mad in America foundation is to change the paradigm of our approach to mental health. nstead of trying to find the right drug to make a symptom go away, it would be much more effective to figure out non-psychotropic-drug ways to help people function better.

KermitCole 10y ago
Actually, speaking as an editor on "Mad in America,"I'd say that we would be interested in making a fuss about the long-term effects of lithium. We would welcome that and any other stories from the commenters posting here.
thanatropism 10y ago
Erm, manic depression as distinct from schizophrenia was basically established by Emil Kraepelin in the 1880s. Dr. Whitaker could be going full Foucault, but as well established by Hollywood, you never go full Foucault.
- tcj_phx 10y ago
  > Erm, manic depression as distinct from schizophrenia was basically established by Emil Kraepelin in the 1880s. The physiological basis for scihzophrenia wasn't figured out and ignored until the 1970's. > Dr. Whitaker could be going full Foucault, but as well established by Hollywood, you never go full Foucault. Robert Whitaker is a journalist, not a doctor. He's sort of like the kid who points out that the emperor got swindled by his tailors. I like the reference to the quote from Tropic Thunder, but I'm not up to date on Foucault's contributions to philosophy.