Debunking Denialism

Fighting pseudoscience and quackery with reason and evidence.

Tag Archives: antidepressants

Mailbag: Anti-Psychiatry Misinformation About Clinical Significance

Mailbag

It is time for another entry in the mailbag series where I answer feedback email from readers and others. If you want to send me a question, comment or any other kind of feedback, please do so using the contact info on the about page.

Anti-psychiatry is a form of pseudoscience that is based on at least three false core beliefs: the denial of the existence or severity of metal illness, the rejection of mainstream treatments for mental illness (including medication and therapy) and the demonization of psychiatrists. There are many different kinds of anti-psychiatry activists. This includes some religious extremists who deny the intimate connections between the mind and the brain, some new age believers who wrongly think that it is just a matter of positive thinking, some alternative medicine proponents who falsely claim that it is due to eating too much acidic foods and so on.

In particular, anti-psychiatry activists spread misinformation and hate about psychiatric medications in much the same way that anti-vaccine and anti-GMO activists fearmonger about vaccines and genetically modified foods. Many anti-psychiatry researchers make obvious statistical errors (by wrongly calculating standardized effect sizes) and create smokescreens about the clinical significance of antidepressants by selecting outdated and arbitrary cutoffs, when clinical significance should be based on the totality of evidence and the scientific context.

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How Anti-Psychiatry Researchers Attack Antidepressants With Faulty Statistics

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Anti-psychiatry is a pseudoscience that downplays or rejects the existence and severity of psychiatric conditions, denies the efficacy of established treatments and demonizes medical doctors. Not all anti-psychiatry activists are committed to all of these three positions, but they are common beliefs within the movement. It is thus very reminiscent of anti-vaccine activists who wrongly think that vaccine-preventable diseases are natural and not very harmful, reject vaccines and demonize pediatricians. In terms of debating tactics, anti-psychiatry activists make use the same standard denialist toolkit: quoting scientists out of context, cherry-picking data, misunderstanding basic science and so on.

A recent paper by Jakobsen and colleagues (2017) claims to have shown that the antidepressant class SSRI has questionably clinical efficacy. It turns out that they base this claim on a piece of highly deceptive statistical trickery: they erect an arbitrary and evidence-free effect size threshold for clinical significance and then reject all treatments that do not fulfill it.

Because the threshold they picked was so large, they would be forced to reject both psychotherapy and a considerable portion of medications used in general medicine as well. The researchers cite National Institute for Health and Care Excellence (NICE) as support for their criteria, but NICE dumped this criteria as flawed around eight years ago. In the end, SSRIs are effective and a useful treatment for depression (but do not work perfectly for everyone) and clinical significance is a spectrum and not a black-and-white issue.

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The Anti-Psychiatry Propaganda of Nathan Shachar

The Anti-psychiatry propaganda by Nathan Shachar

Dagens Nyheter (the largest morning newspaper in Sweden) continues to promote pseudoscience. Last month, the newspaper decided to publish a full-page anti-immigration ad with flawed equivocations, ignorance of confounders and the deceptive framing of published statistics. Out of the ashes into the fire, Dagens Nyheter decided to publish a column filled with anti-psychiatry propaganda by Nathan Shachar. He has previously come under fire for his ignorant ADHD denialism, where he fear mongered about the side-effects of ADHD medications, butchered the complex etiology of ADHD and misrepresented scientific reports on ADHD rating scales.

In his latest pseudoscientific screed, Shachar continues to recycle common anti-psychiatry myths. He claims that the FDA and the Swedish counterpart (Medical Products Agency) is bought by pharmaceutical companies, but the FDA charges pharmaceutical companies to ensure fast and high-quality drug review process. He asserts that modern psychiatry holds that all psychiatric conditions are caused by “chemical imbalance”, when the scientific consensus position is that they result from a complex interaction between biological, psychological and social factors. Shachar makes a false comparison between “pure amphetamine” and ADHD medication, completely without insight that it differs in chemical nature, dosage and release rate. He bases his case against modern psychiatry on the writings of Janne Larsson, a member of the Scientology-based organization Citizens Commission on Human Rights (CCHR). Counter to the myths promoted by Shachar, several large-scale meta-analysis has found that antidepressants are more effective than placebo even when you take publication bias into account. He continues by showing that pharmaceutical companies sometimes behave unethical, but that is an issue of corporate ethics, not the science of psychiatry or the efficacy of psychiatric medication. Finally, he dismisses ADHD as merely a “maturity” issue, despite the well-known biological underpinnings of the condition. Read more of this post

Scientific Reality Versus Anti-Psychiatry: Once More Unto the Breach

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Why should scientific skeptics care about refuting anti-psychiatry? Compared with other forms of pseudoscience, such as creationism or climate change denialism, anti-psychiatry has received considerably less skeptical attention. Yet anti-psychiatry is a dangerous pseudoscience that causes real harm. Like alternative medicine quacks, anti-psychiatry exploits vulnerable people and by denying the existence of psychiatric conditions or dismissing them as harmless, proponents of anti-psychiatry deny the suffering of human beings.

After debunking the claims made by the anti-psychiatry proponent Tin, this person continued to make a long list of assertions about psychiatry. When your opponent blasts you with multiple, long texts, it is very difficult to ensure that you responded to every single assertion (I am sure I accidentally missed some in this post, and I’m sure I will be hearing about it too). To a certain extent, that is the goal of this kind of shotgun approach (sometimes called the Gish Gallop in honor of the young earth creationist Duane Gish who frequently used this technique): make as many flawed and unsupported assertions as possible in an attempt to overwhelm the opposition. If any claim is forgotten or not decisively refuted due to time or space, declare victory. This is also related to what is known as the asymmetry of pseudoscience: it takes a few seconds to make a pseudoscientific claim, but anywhere from ten minutes to several hours to research and refute one of the claims in detail. In that sense, scientific skepticism is always an uphill battle. However, once the refutation is out there online, anyone who comes across a similar claim can find it with a search engine and review the material in the references. So although I have little hope that the arguments and evidence I present will convince a ingrained anti-psychiatry proponent, it is still worth doing. Read more of this post

Responding to Incoherent Anti-Psychiatry Drivel

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A person going by the name of Alan David Anderson decided to post a few comments loaded with anti-psychiatry drivel on an older blog post I wrote. It is a garbled mix of assertions, such as that I am stupid and an ignorant fool, that psychiatrists have worthless educations, that anti-psychotics and anti-depressants are used to euthanize elderly that lack a balanced diet and that people with mental conditions are just obese.

Normally, I would have responded in the comment section of that blog post or just deleted his crap. However, it is the holiday season, I am feeling particularly charitable. Not that I think this will change his mind, but hopefully will give my readers something informative and perhaps something to chuckle at. Also, it is free blogging material for me at a time when I have more important things to do. Therefore, I will give his assertions a fair hearing in a new blog post. As we will see, they do not fare well.

The first comment

Mr. Anderson started his objections to psychiatry by posting the following:

wonderful sight thanks for leting me clear up the fact that you have no education that is legit it in this subject. psychiatrists have worthless educations. psychiatrists drugs are not needed under any circumstances. they give synthetic drugs that resemble things that are naturally produced. why would we need them? you simply do not need them at all. you ignorant fool. you cannot win an argment with me. you HAVE NO EDUCATION ON THE SUBJECT.

Mr. Anderson is correct in that I am not a psychologist, psychiatrist or psychotherapist. I have no formal training in any of these subjects. However, that says nothing about the credibility of the arguments I put forward. Arguments stand on their own evidential and logical merit and their truth does not depend on who puts them forward.

Throughout his three comments, Mr. Anderson makes no effort to engage in the arguments I actually do put forward. This shows an unwillingness to have an honest discussion about the reasonableness of those arguments. Mr. Anderson does not appear interested in a reasoned debate, but rather to spread his bare assertions. Nowhere in his comments does he provide any empirical evidence for his assertions or links to any sources.

Contrary to what Mr. Anderson claims, psychiatrists do not have a worthless education. In the United States, a psychiatrist must first complete an M. D. and then spend four years as a psychiatric resident (American Psychiatric Association, 2012). Thus, psychiatry is like any other medical specialty in terms of educational requirements. This is hardly a “worthless education”.

While mental conditions are not quite as simple as “chemical imbalance”, treatments that modify neurochemistry in individuals with some mental conditions has shown to be very effective. I have written at length about this in other blog posts, such as here and here.

Mr. Anderson calls me an ignorant fool, yet provides no evidence to why we should believe him. He repeats his claim that I have no education on the subject and triumphantly claim that I cannot win an argument with him. Actually trying to convince someone who has sunken so deep into pseudoscience as Mr. Anderson has is very difficult and largely a waste of time. However, my goal here is not to convince him that he is wrong, but to convince fence sitters of the rationality of scientific skepticism and science-based medicine as well as giving supporters of these two concepts useful things to read. Read more of this post

Anti-Psychiatry in the Atheism+ Forum?

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I find my self slightly unsettled to watch the slow infiltration of anti-psychiatry into the various skeptical movements. This is probably facilitated by political ideology. Some left-leaning liberals have a suspicion of psychiatric medication because they are provided by large multinational corporations. Some libertarians are susceptible to anti-psychiatry because the government helps to finance psychiatric care. This is the kind of situation that made me have careful qualifications about new aspiring social movements in my post Crossing the Chasm. Even though there is a broad agreement on social values, there can be a strong disagreement on what empirical methods are best used to fulfill these values. I am carefully optimistic about Atheism+ and I support many of its values, but I first want to see where the movement is going in practice.

Recently, a thread appeared on the Atheism+ forum discussing mental health issues. Right now, it is just one thread and we should not overestimate the size of the problem. We should also not approach the ideas of a few as if they were a majority position. I am not saying that any particular forum poster is necessarily anti-psychiatry and I am also not saying that Atheism+ has been corrupted by anti-psychiatry. After all, anti-psychiatry proponents can probably be found in every movement. I am also not telling marginalized people to stop telling their stories. With those qualifiers out of the way, I do note that arguments commonly put forward by anti-psychiatry proponents has started to appear on the Atheism+ forum. I do not want to make accusations against any individual poster, but I feel it is important and worthwhile to address the claims being put forward. I could have done it the forum thread itself, but as anti-psychiatry is a topic that this blog covers, I thought I might as well make a blog post about it.

The thread is called Mental Illness Support. It starts out completely reasonable where the opening poster is inviting others for discussing things like how mental conditions affect group participating in the atheist movements and what can be done to help those coping with mental conditions become more involved in the movements. I think these questions are highly relevant. In passing, the opening poster apfergus mentioned that a new medication had been beneficial for him or her. For those of you experienced with debating anti-psychiatry proponents, you know what happens next. Read more of this post

Antidepressants, Psychotherapy and Emergent Suicidality

A while back, I cam across an interesting study published in the American Journal of Psychiatry. Bridge et. al. (2005) looked at the number of new cases of emergent suicidality during a clinical psychotherapy trial for depression in adolescents and what important predictors were at play. Emergent suicidality can be defined as an increase in the rate of suicide, suicidal attempts, preparation for suicide and suicidal thoughts during the early stages of treatment, although definitions sometimes varies across studies (Meyer et. al. 2010).

The general message of the Bridge et. al. study was that the rate of emergent suicidality in the drug-free psychotherapy trial was 12.5% (this was not attributable to the therapy itself). They also found that the strongest predictor of emergent suicidality was the level of self-reported suicidal thoughts at the baseline rather than what was recorded during the intake interview. So the more suicidal thoughts you have at the start of psychotherapy, the more likely you are to experience suicidality during the psychotherapy treatment.

In this clinical trial, which enrolled subjects similar to those enrolled in pharmacotherapy clinical trials, rates of emergent suicidality in patients receiving psychotherapy but no pharmacotherapy were comparable to rates observed in antidepressant trials. Self-reported suicidality in the week before intake predicted the onset of emergent suicidality to a much greater extent than did interview-rated suicidality, indicating that self-report may be a necessary component to the assessment of adolescent suicidal risk.

This is an important finding, because it casts a shadow of doubt over studies purporting to show an increase level of suicidality during treatment with antidepressants. Read more of this post

Stefan Molyneux’s Unfortunate Spiraling into Anti-Psychiatry

Stefan Molyneux is an atheist and anarchist philosopher. He is the host of Freedomain Radio, which is one of the most popular podcast series on philosophy on the internet. He is an author of many books such as “Universally Preferable Behavior: A Rational Proof of Secular Ethics”, “Against the Gods” and “How (Not) To Achieve Freedom”. He is also a popular speaker on many libertarian festivals and gatherings such as New Hampshire Liberty Forum, Libertopia and many others. His arguments about religion, problems with many government programs and peaceful parenting are very persuasive and worth taking a look at. However, dark clouds appeared on the horizon back in early August.

I explored some of the problematic claims that Molyneux put forward on the topic psychiatry a while back in a post entitled A Critical Examination of Stefan Molyneux’s Claims about Antidepressants, where I attempted to correct what I thought where flaws in his arguments about medical psychiatry. While I did not consider him to be anti-psychiatry at the time, one of his latest videos on the topic has made me reevaluate that stance. In a video spanning almost 50 minutes called There Is No Such Thing As Mental Illness, he lays out his case against psychiatry, arguing not only that there is no such thing as mental illness, but that medications against these mental conditions (such as antidepressants and anti-psychotics) are not only ineffective, but actually harmful. He finishes off by asserting that psychiatry is a pseudoscience and should not be taken seriously.

Let us get one thing straight at the start, Molyneux is not claiming that the conditions that the scientific establishment labels as mental conditions, such as depression and anxiety, do not exist. On the contrary, he admits that the anguish and suffering is very real. His problem lies in the notion that these are classified as mental illnesses. He rather thinks it is a reaction to a sick and harmful society. He makes a large number of other claims, that I will be examining in this blog post, one by one.

I also just want to emphasize, yet again, that I am not a doctor, psychologist or psychiatrist. I am just a guy on the internet. Because of that, I fully accept that I can be completely mistaken in everything I say. But hopefully I can present persuasive evidence for the arguments and claims I make in this entry. I will also list the timestamps for the specific claims made so that readers can make sure that I did not falsely characterize his arguments and positions. With that said, let’s get started. Read more of this post

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