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Tuesday, 18 April 2023

ON THE HISTORY AND FUTURE OF PSYCHIATRY

 





Here is an excerpt from my book (in preparation), Lavender Rising; An Intersectional History of the Queer Struggle


Psychiatry

Psychiatry is the branch of medicine that is supposed to be concerned with the study, diagnosis, and treatment of mental illness.

There is ever-increasing concern in the psychiatric survivor movement as to how many so-called mental illnesses can be beneficially treated using a medical model, whether they can be responsibly diagnosed, and as to how many mental health issues are created by socio-economic and working environments rather than underlying chemical imbalances or medical deficiencies.

My selective history of psychiatry focuses, in part, on its the history in London and Edinburgh, but also on international material collated during my twelve or so years campaigning against problematic twenty-first century psychiatry (beginning around the end of 2011). The seminal work on depressive disorders by Professor Joanne Moncrieff at UCL has relatively recently epitomised the urgent need for, albeit belated, change to, or replacement of, the entire discipline of psychiatry. See Moncrieff (2022).

Knapton (2023) reports that anti-depressants raise the risk of suicide while also giving people the means to kill themselves. Psychologists at the University of East London, lead by the pioneering Professor John Read, analysed media reports of nearly 8000 coroners’ inquests in England and Wales between 2003 and 2020 in which antidepressants were mentioned. They found that the drugs [doubtlessly including the already notorious imapramine, Prozac, and Seroxat]were linked to 2718 cases of hanging and 2329 overdoses, of which 933 people had overdosed on the antidepressants themselves. A further 2083 had been struck by a train, tube, lorry or other vehicle, had jumped or fallen to their death, drowned, shot themselves , or been involved in a fire or electrocution. Experts said that the figures were likely to be just the tip of the iceberg, because many suicides and inquests are not fully reported in the media,


Psychiatry has frequently been used to damage native populations. For example, Dr. Selwyn Leeks used electric shocks without anaesthetic from an ECT machine to torture over 300 children between 1972 and 1977 in the Lake Alice psychiatric hospital in New Zealand (Smale, 2022, Ellingham,2022). Most of the tortured children had been sent to Lake Alice from state-run welfare homes and around half were Maori boys.

The children received electric shocks or were injected with paralysing drugs (e.g. paraldehyde) as punishments and many were sexually or psychologically abused. The Crown and the psychiatric profession reportedly protected Leeks and he was never held to account for his heinous sadism. He lived for another 45 years while his surviving victims suffered from their horrific childhood experiences.

Psychiatry has been used to damage or destroy many queer people’s lives e.g by imposing courses of aversion therapy for ‘sexual perversions’ (Davison, 2020). Even when a psychiatric maltreatment damages people regardless of their gender or orientation, it injures a disproportionately large number of queer folk, simply because queers are more likely to have mental health issues.

For Martin Harrow’s empirical investigations that help to invalidate the cruel treatment or non-treatment of schizophrenia by anti-psychotics, see Whitaker (2023). The ‘optimal’ dynamic treatment regimes proposed by Shortreed and Moodie (2012), where patients are switched from one harmful medication to another, are absolutely disgusting, because of the miscellaneous collection of debilitating side effects (including tardive dyskinesia and neuroleptic malignant syndrome) that the patients could and often do suffer.


Mystification

I will, for example, refer to this terminology in section 2.2 when I discuss transphobic people. Rather than using Karl Marx’s definition, I refer to


Definition Epseilon: The practice and experience of ‘mystification’ is a process by which a person or group of people A exert or exerts significant influence over another person B, functionally changing B’ s sense of identity, understanding and experience of emotional and cognitive states, and sense of reality, in order to serve A’ s purposes.


As a simple example, A and B could be lovers, where A influences B into believing that B is a ‘top’, when in reality neither of them are tops. As a more disconcerting example, psychiatrists A frequently inappropriately influence and mystify their patients B into thinking that their mistreatments are actually beneficial.

Subjective Probability Assessments

As an interdisciplinary Bayesian statistician, I refer to my philosophy:

Most statistics are potentially misleading, but some can be useful for making qualitative assessments.

To give three examples:

(A) It is very difficult to use a census to count the number of individuals in a population, since undercounts can be quite sizeable and related, in particular, to social deprivation. Furthermore, the population may itself be undefined or time varying, e.g. because of migration, birth or death.

(B) Kinsey’s 1948 ‘estimate’ or ‘guess-timate’ that 10% of the American male population were at that time gay is at best a ball-park figure owing to (a) lack of replicated randomisation at the experimental design stage (b) lack of a precise definition of gayness, and (c) the quite reasonable propensity of gay men to be economical with the truth when posed with the question, owing to well-grounded fears of possible repercussions.

(C) Subjective assertions of the type

LBG people are twice as likely to have a mental health problem than non-LQBTQI+ people

or

TQI+ people are four times more likely to have a mental health problem than non-LGBTQI+ people

cannot be precisely validated in numerical terms for a host of the same sorts of reasons. They can nevertheless provide us, in qualitative terms, with useful working hypotheses. [I am idealising the situation for the sake of simplicity. In practice, I would try to make separate assessments for T, Q, I and the different types of ‘+’ people].

Suppose that 25% of the population of Freedonia have mental health problems, and that 8% of the entire population are LGB and a further 5% are TQI+.

Then, assuming the truth of the two propositions in (C) we could base various calculations on either Venn diagram logic or on Bayes Theorem and the Law of Total Probability. See Mathsfun [1] and pp76-77 of Leonard and Hsu (1999)

Under the assumptions stated, my calculations indicate that among members of the population with mental health problems:

13.01% are LGB

16.26% are TQI+

70.73% are not LGBTQI+

Suppose that the head psychiatrist Dolly in Holy Name Hospital decides that all people with mental health problems in Freedonia should be prescribed with the potentially harmful treatment Hard Hit, regardless of their gender or orientation, for the primary purpose of keeping them quiet.

Possible choices of Hard Hit include (a) brain-damaging Electro-Convulsive Therapy (ECT) or (b) a neuroleptic medication with devastating physical side effects e.g. quetiapine (Seroquel).

Under the assumptions stated, Dolly is implicitly discriminating against TQI+ people, since their percentage (16.26%) among people with mental health problems is substantially greater than their percentage (5%) in the general population.

Now assume instead that Dolly is an evil god-like eugenicist, and arranges to prescribe Hard Hit for 90% of the LGB patients, for 99% of the TQI+ patients, but for only 10% of the non LGBTQI+ patients.

Then of the patients prescribed with Hard Hit,

32.72% will be LGB

47.51% will be TQI+

19.77% will be ‘not LGBTQI+

Dolly’s prescriptions would clearly amount to cruel discrimination against LGBTQI+ people.

Such qualitative assessments can be useful in many of the situations described in this intersectional book. Examples involving conditional percentages and subjective probabilities are included at the end of the research exercises at the end of each chapter. Further exercises link to

the statistical analyses of data sets. The data provide useful fodder for budding statisticians.

See Zellner (2019) for a history of the International Society for Bayesian Analysis (ISBA), and Leonard (2014) for a history of Bayesian Statistics


References (for Introduction)

Nick (2018) The Myth of Sexual Attraction. On pp 176-7 of Come Together:The Years of Gay Liberation 1970-73, edited by Aubrey Walter. London: Verso Press.


Jane Coaston (2019) The Intersectionality Wars (Vox) https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination Accessed 11 April 2023


Chris Donald (2017) Kate Tempest and the voice that won’t be silent (Sputnik)

https://sptnk.co.uk/2017/10/10/kate-tempest-and-the-voice-that-wont-be-silent/

Accessed 1 April 2023


Kahn Academy [1] Lesson 4: Independent versus dependent events and the multiplication rulehttps://www.khanacademy.org/math/ap-statistics/probability-ap/probability-multiplication-rule/a/general-multiplication-rule Accessed 7 April 2023


Morgan Lev Edward Holleb (2009). The A-Z of Gender and Sexuality. London: Jessica Kingsley Publishers


Neil Vallelly (2021) Futilitarianism:Neoliberalism and the Production of Uselessness London: Goldsmiths Press


Lizzy Fone (c2023) Lizzy Fone on Linkedin https://www.linkedin.com/in/lizzyfone/?originalSubdomain=uk Accessed 12 April 2023.


Kate Ashmore (2019) The team so far.(Rebel HR Group) https://rebelhr.group/testimonials/ Accessed 12 April 2023.


Matthew Brown (c2023) Our Story (Adding Value) https://adding-value.org/our-story/ Accessed 12 April 2023’


New Socialist (2018). You are more oppressive than our oppressors: Transphobia and Transmisogyny in the British left.https://newsocialist.org.uk/you-are-more-oppressive-than-our-oppressors-transphobia-and-transmisogyny-in-the-british-left/ Accessed 26 March 2023


Red Fightback (2020).Marxism and Transgender Liberation: Confronting Transphobia in the British Left https://web.archive.org/web/20221224084520/https://redfightback.org/read/transphobia_in_the_left Accessed 25 March 2023


Mathsfun [1] Bayes Theorem https://www.mathsisfun.com/data/bayes-theorem.html Accessed 6 March 2023


Thomas Leonard and John S.J. Hsu (1999) Bayesian Methods: An Analysis for Statisticians and Interdisciplinary Researchers. Cambridge: Cambridge University Press.


Arnold Zellner (2019) ISBA History and Meetings (ISBA) https://bayesian.org/isba-history-and-meetings/ Accessed 22 March 2023


Thomas H. Leonard (2014) A Personal History of Bayesian Statistics. WIRES Computational Statistics Vol 6, pp80-115. Wiley Hot Article of the Week, 28 April 2014


Stephen Shaffner (2022) What Genetics say about Adam and Eve (Biologos)

https://biologos.org/articles/what-genetics-say-about-adam-and-eve Accessed 12 March 2023.


Ismail Ahmed (2018) Allah’s Mercy (The Siasat Daily)

https://www.siasat.com/allahs-mercy-2118493/ Accessed 17 April 2023


Lily Ramlan (2021) Forgiveness in Islam: An essential virtue for every Muslim (Simply Islam)

https://simplyislam.academy/blog/forgiveness-in-islam-an-essential-virtue-for-every-muslim

Accessed 17 April 2023


Robert Whitaker (2019) Eugenics and Psychiatry (Youtube)

https://www.youtube.com/watch?v=k2K_APjkFAY Accessed 7 March 2023



Ann Alison Phoenix (2021)Becomings or fixity? Intersectional Challenges to Reductive Power Relations. International Review of Theoretical Psychologies 1 (2), pp 5-20 https://tidsskrift.dk/irtp/article/view/127970/174192 Accessed 7 April 2021.



Scott Forster and Tom Leonard (2019). The Forster-Leonard written submission to the Commission of Inquiry into the History of Eugenics at UCL http://thomashoskynsleonardblog.blogspot.com/2019/07/the-leonard-forster-written-submission_20.html Accessed 22 March 2022



Nathaniel Joselson (2016) Eugenics and Statistics Part 2, Reflections and Implications (Meditations in Statistics) https://njoselson.github.io/Eugenics-Reflections/ Accessed 16 April 2023

Joanne Moncrieff (2022) How to take the news that depression has not been shown to be caused by a chemical imbalance (Critical Psychiatry Network)

https://joannamoncrieff.com/2022/07/24/how-to-take-the-news-that-depression-has-not-been-shown-to-be-caused-by-a-chemical-imbalance/ Accessed 22 March 2023



Sarah Knapton (2023) Anti-depressants increase the risk of suicide for some patients, scientists warn (Telegraph) https://www.telegraph.co.uk/news/2023/04/17/antidepressants-suicide-drugs-prozac-research/ Accessed 18 April 2023


Aaron Smale (2022) Notorious Lake Alice Psychiatrist Dr. Selwyn Leeks Dies (Stuff)

https://www.stuff.co.nz/pou-tiaki/300503822/notorious-lake-alice-psychiatrist-dr-selwyn-leeks-dies


Jimmy Ellingham (2022) Lake Alice: Why psychiatrist Dr. Selwyn Leeks was never charged (RNZ) https://www.rnz.co.nz/news/national/462498/lake-alice-why-psychiatrist-dr-selwyn-leeks-was-never-charged


Kate Davison (2021) Cold War Pavlov: Homosexual aversion therapy in the 1960s History of the Human Sciences 34 (1) pp81-119


Robert Whitaker (2023). Martin Harrow: The Galileo of Modern Psychiatry (1933-2023) Mad in America https://www.madinamerica.com/2023/03/martin-harrow-the-galileo-of-modern-psychiatry-1933-2023/ Accessed 1 April 2023


Susan Shortreed and Nicola Moodie (2012) Estimating the optimal dynamic antipsychotic treatment regime: Evidence from the sequential multiple assignment randomized CATIE Schizophrenia Study Journal of the Royal Statistical Society Series C (Applied Statistics) 61 (4) pp 577-599 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475611/ Accessed 15 April 2023


Uncle [1] All about Manchester’s Gay Village

https://uncle.co.uk/blog/all-about-manchesters-gay-village/ Accessed 23 February 2023


Queer Oxford [1] Wadham https://queeroxford.info/wadham/ Accessed 22 March 2023




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