What's New

Firstly, my apologies for taking so long to get this back on track, we moved to our new house at the end of November so I spend my weekends barrowing dirt around the place. I've also rather foolishly agreed to work part-time for the local mental health service as they were short of staff. Now I know why they're short of staff. Actually, it's good experience, I've been out of the government for nearly twenty years. If anything, government mental health services are worse than they were back then.

Stimulants in Childhood

The medicalisation of childhood proceeds apace. A report from the US Center for Disease Control, published in the Journal of the American Academy of Child and Adolescent Psychiatry (November 2013) showed that the numbers of American children taking stimulants continues to rocket: "11% of 4-17yr olds were reported by their parents to have received an ADHD diagnosis from a healthcare provider, a 42% increase from 2003-04 to 2011-12." This translates as 6.5million children, with over half of them (3.5mln) taking highly addictive drugs during their formative years. Needless to say, the rates of this "genetic disease" vary quite dramatically, from as low as 4% in Nebraska to 15% in Arkansas and Kentucky. In 1977, there were 400,000 children in the US taking these drugs; I remember that figure because in that year, there were 400 children in the Netherlands taking them. By 1990, it was 600,000 and the numbers just keep going up. Fortunately, it is starting to dawn on some of the experts that this isn't necessarily a good thing. One of them,

In fact, genetic diseases don't increase by 900% in one generation, so something else is happening. For an example of that "something else," look no further than this gem: a New Disease. Not satisfied with snagging 15% of the juvenile population and putting them on drugs, at a national cost of about $9billion a year, the bounds of pathology are to be stretched again, further eroding the concept of normality. Psychiatrists and psychologists have decided that the quiet little day-dreamers in school are mentally ill: "Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers' estimates, it is present in perhaps two million children." 

It's just another example of psychiatrists needing to invent a new disease if they want to get fame and lots of research grants from the drug companies.

Second point: in the US, drug prices are protected by the Medicaid amendments pushed through by the Bush Administration. This blocked government agencies from using their purchasing power to get lower prices of drugs, as happens everywhere else in the world. Those prices are much higher than anybody pays in Australia, Canada, the UK etc, but the profits are still outrageous. Also, all consumer prices of drugs in Australia are capped at $37.50 per prescription, so it doesn't matter how much it costs the government, the patient pays only that amount. Pensioners pay a maximum price of $6.20 per script regardless. I've put more of these details in an article in Truthout (and don't tell me about the error in the title, I know).

The Question of ECT 

"The statement asks a series of questions such as whether it is safe (generally) and effective (in the short term) or who should do it but the one question it does not pose is this: Is ECT necessary? It must be understood that many psychiatrists do not use it at all, that its use varies dramatically from one hospital to another, or one part of the country to another. Some practitioners use it so commonly that it is almost routine; others, practicing in the same setting seeing a similar if not identical population of patients, never use it."

I have practiced psychiatry in some of the most difficult parts of this country for 37yrs without using ECT. In two hospitals to which I was appointed chief psychiatrist, one for five years and one for three, ECT was used prior to my taking up my appointment. It was not used for the time I was in charge, then it was started again some time after I left. This says that while ECT is a treatment option, it proves emphatically that ECT is not "(an) essential treatment option that should be available to all patients in whom its use is clinically indicated."

"For some practitioners, ECT is close to the first treatment option considered. For many others, treating the same types of cases, its use is never "clinically indicated." It is of interest that in both hospitals, during my total of 8 years as chief, the admission rates, bed occupancy rates and duration of stay all dropped, only to rise again after I left. This is despite the lack of use of ECT. The notion that ECT achieves some therapeutic goal not available by other means is simply not true in my experience.

The RANZCP statement on ECT says that patients should give informed consent. Strictly, this should include patients being told that some psychiatrists use ECT a great deal, while others rarely or never use it, and it is a matter of chance to which psychiatrist the patient has been referred.

"Parliaments should impose more restrictions on ECT, not loosen them."

You might expect that the college would start whining about disrespect or some such rubbish but they usually know when to shut up and say nothing. Pity.