jc

"The purpose, then, of the new DSM is to convince clinicians and the public that unvalidated, hypothetical biological markers prove the validity of psychiatric diagnoses." ARTICLE LINK: madinamerica.substack.com/p/dsm-6-will-b…

Psychiatrists should be more transparent that antipsychotics are frequently used for behavioral management rather than to treat or cure an underlying disease. By implying that an antipsychotic fundamentally “treats” psychosis rather than acknowledging that it bluntly blocks dopamine receptors, we have created a catch-22. It is not surprising that individuals are rightfully upset when these medications are prescribed in what appear to be alternative or off-label ways. I suspect that if the field had been more honest, it wouldn’t seem like such a leap to use antipsychotics to address agitation in other situations. This means acknowledging that a significant reason we use them in schizophrenia is to manage the severe agitation that often accompanies the condition, rather than to “cure” it. This transparency, however, does not negate the very real problems associated with their use. Antipsychotics are at times inappropriately prescribed merely for the convenience of overburdened staff in inadequate facilities. Yet this is not always the case. Even in well-run facilities or homes with particularly caring family members, all involved often reach the difficult conclusion that antipsychotics genuinely improve the patient’s living conditions. When accompanied by thorough informed consent, these medications can sometimes be a tool that allows a patient to safely remain at home longer. How, then, does one differentiate the well-intended use of antipsychotics as a compassionate last resort from their lazy use for convenience? Not easily. Failures such as lack of informed consent, erroneous diagnoses, chronic understaffing, and poor clinical evaluation make inappropriate use easier to identify. The WSJ is right to point out these failings. However, the broader public conversation about the role of these medications needs to be more honest and nuanced. For context, people should revisit the landmark case of Clites v. Iowa (1982). Timothy Clites, an 18-year-old with developmental delays, was committed to a state hospital. There, he was prescribed antipsychotics specifically to manage behavioral disturbances stemming from his developmental delay, rather than for psychosis. His medical care was particularly poor, exemplified by the fact that he was not seen by a physician for three entire years. After Clites developed severe and permanent side effects from the antipsychotics (tardive dyskinesia), his father sued the state. The court ultimately found that the hospital failed to meet the standard of care because it used the medications not for the patient’s benefit, but for institutional convenience.

this poor woman was put on anti-psychotics because she kept saying there was a man in her loft. one problem: there actually was a man secretly living in her loft this is a plot to a horror novel i’m horrified lbc.co.uk/article/man-hi…

@jill_d35 MH providers should be aware of and actively avoid condescending comments.

Any post from a mental health bod that starts with the words "You clearly don't understand...." gets my back up. Like they have any idea about wtf I understand or don't. Don't go there. Seriously, it's ridiculous.

Except: "Despite being subject to stringent controls and patient monitoring, Clozapine has in fact been linked to more than 7,000 deaths since it was licensed to treat schizophrenia in 1990." cebm.ox.ac.uk/news/news-arch…

This is the product of a broken educational system - when most psychiatrists get their knowledge of medication from the British Association of Psychopharm which has long played down the risks of these drugs it leads to preventable harm to patients.

U.S. nursing homes are fabricating schizophrenia diagnoses to hide their use of dangerous antipsychotic drugs to subdue dementia patients, a government watchdog report found. The drugs increase risk of falls, strokes and death. wapo.st/4tfSUsr

George Kirov helpfully notes that almost every psychiatric diagnosis and treatment is associated with premature mortality. (He is wrong about anxiety disorders btw).

Akathisia is caused by psych med withdrawal but is also a side effect from a number of pharmaceuticals, not just withdrawal. Hell. The fact this fairly common reaction is hidden by pharmaceutical companies and renamed things like “restlessness” is criminal.

"Research" in psychiatry is just hilarious. Read this summary of the research on treating akathisia with beta blockers: A Cochrane review found 3 RCTs with a total of 51 participants. Two of the trials lasted 48 hours 😂. Didn't bother to document adverse effects.

I wrote for @PsychToday on a new study showing how the biological approach to depression can undermine healing. Grateful for the work of @JDaviesPhd, @joannamoncrieff and @markhoro. Link below.

"Biological beliefs can create a sense of a lack of agency, or what psychologists call an external locus of control. This is the idea that I’m helpless to change my depression on my own; I need a doctor to “fix” me."

Are the clinically useful biomarkers in the room with us right now?

If this is the case, why did psychiatric institutions promote the myth, and stand by as the myth grew & enabled the mass pharmaceuticalisation of contemporary society. Psychiatry has never offered apology for this, only new myths, excuses (like this one 👇) & denial.

I'm reluctant to intervene here, but I must speak out. I genuinely believe that appointing Howard as @rcpsych president would be detrimental not only for harmed patients, but for progressive thinking in psychiatry & for the profession's public standing ... 1/2

A nurse practitioner in Illinois prescribed psychiatric drugs to nearly 4,000 Medicaid children in one year. Her reimbursement for ADHD drugs alone: $203,711. She has been the state's top prescriber for six consecutive years. No investigation. No interruption. No consequence. I published the full investigation. Link in comments.

I don't think people realize quite how much psychiatry is still in the Dark Age of medicine, having never adopted evidence-based medicine as anything other than a marketing tool. Nice when they broadcast it publicly like this.

Look at the opening line in this recent post by @PsychiatristCNS It is the PATIENT who has failed, not the things they have been prescribed. The message is the "SSRIs, antipsychotics and mood stabilizers" are ordinarily miracles but the patient is not: the patient is the failure. Also, the patient IS their disorders ("bipolar-OCD patient"). If you ever want an example of something that epitomises how psychiatry is inherently a self-serving, dehumanising, anti-patient field, this one line is it. (From 3 March 2026, from an outlet whose X bio boasts of being "peer-reviewed leaders informing clinical practice and patient care.")

Just a reminder that Lexapro (Escitalopram) was approved for kids as young as 7 years old despite a 6- Fold Increase in Suicide Risk compared to the placebo. The study's conclusion, inexplicably, boldly asserts that "Lexapro is well tolerated in pediatric patients with Generalized Anxiety Disorder." Yes, you read that right—a disturbing six-fold increase in suicidality… AND ITS WELL TOLERATED!

"Anti-med cult" Psychiatry is by every measure a pro-med cult. No matter how poor the outcomes, or how trivial the efficacy, their only reaction is to prescribe more and more psychotropics to ever escalating portions of the population.