Dr Caroline Leaf – Howling at the moon

The night is darkest just before the dawn, so says the age-old phrase.  It’s funny how we just accept these old adages as true, but when you actually think about it, they’re nothing more than a concoction of the imagination.  The night isn’t darker just before dawn – it’s just as dark when the sun goes down as it is before the sun comes up again.

In the same way, we so often accept things said by ‘experts’ as truth when in reality, they’re also just some particularly imaginative concoctions.

Take, for example, Dr Leaf’s latest e-mail newsletter and blog for June 2017.  In it, she merrily gloated about how a recent UN Human Rights report “exposed the current failings of diseased-based psychiatry” and “challenges the dominant narrative of brain disease and its overreliance on psychoactive drugs”.  The smugness is palpable – she finally has something more authoritative to try and back up her psychiatric antagonism than just the collective ranting of an outspoken, ill-informed fringe group.

Dr Leaf is a communication pathologist (essentially an academic speech pathologist) though she continues to delusionally claim that she’s a cognitive neuroscientist.  She also grandiosely believes her training in speech pathology make her a mental health expert, above psychiatrists with actual medical training and decades of real clinical experience.  She might feel vindicated by this report and her ill-formed friends, but her view is naive and her narrative is based on inaccurate statistics and logical fallacy.

For example, this paragraph encapsulates Dr Leaf’s statistical errancy and general self-deception: “Several of my previous blogs, as well as some of my FAQs, deal with the current state of mental health care, which has crippled so many lives, led to countless deaths, and left millions of people thinking that there is ‘something wrong with my brain.’ Indeed, an estimated 20% of the American population take psychiatric drugs, which amounts to a staggering cost of $40 billion, as mental health advocate Robert Whitaker points out (a 50-fold increase since the late 1980s).”

It’s a “see-I-told-you-so” attempted justification, except that modern mental health care has not “crippled so many lives” or “led to countless deaths.”  It’s actually untreated mental illness which really cripples people’s lives, or ends them.  Suicide is an unspoken epidemic that is so often the end result of undiagnosed or untreated mental illness.  Suicide is the major cause of premature death among people with a mental illness and it’s estimated that up to one in ten people affected by mental illness die by suicide.  Up to 87% of people who die by suicide suffer from mental illnesses. There are more deaths by suicide than deaths caused by skin cancer and car accidents.  Up to three percent of adults have attempted suicide within their lifetime and it’s estimated that for every completed suicide, at least six other people are directly impacted in a significant way [1].

On the flip side, the use of any anti-psychotic medication for a patient with schizophrenia decreased their mortality by nearly 20% [2]. In another study, the mortality of those with schizophrenia who did not take anti-psychotics was nearly ten times that of the healthy population, but taking anti-psychotic medication reduced that by a factor of five! [3]  Dr Correll and colleagues summarised the literature, noting that, “clozapine, antidepressants, and lithium, as well as antiepileptics, are associated with reduced mortality from suicide. Thus, the potential risks of antipsychotics, antidepressants and mood stabilizers need to be weighed against the risk of the psychiatric disorders for which they are used and the lasting potential benefits that these medications can produce.” [4]

As for her example taken from the equally prejudiced Robert Whitaker that “an estimated 20% of the American population take psychiatric drugs, which amounts to a staggering cost of $40 billion … (a 50-fold increase since the late 1980s)”, even if it were true, it’s simply misleading and ill-informed.  Twenty percent of the US population might be taking “psychiatric drugs” but some of them might be taking them for different reasons.  For example, tricyclic anti-depressants are no longer used primarily for depression but have found a niche in the treatment of chronic and nerve-related pain.  And so what if there’s been a 50-fold increase in the use of psychiatric medications since the 1980’s, that doesn’t mean they’re being used inappropriately.  Her analogy is like saying that because there has been a 900-fold increase in the number of road deaths since the turn of the century [5], cars are being used inappropriately and we should all start travelling by horse-back again.

It’s the height of arrogance for Dr Leaf to sit in her ivory tower and condemn modern psychiatry based on her utopian fantasy, but mental illness affects real people and causes real suffering – like the two heart-broken parents told a Parliamentary Enquiry in Australia a few years back, “We would rather have our daughter alive with some of her rights set aside than dead with her rights (uselessly) preserved intact.” [6]

Dr Leaf may smugly think the sun is shining on her, but she’s still in the darkness of night, barking and howling at the moon like a rabid dog.  If she really wants to step into the light, she should try looking at the mountain of scientific evidence supporting modern psychiatry and if that’s not enough for her, then she should at least look at all those afflicted and distressed because the mental illness they or their loved one suffered from was ignored in favour of an ideology that claims to support human rights but which ignores the most basic human right of all, the right to life.

References
[1]        Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. Am J Prev Med 2007 Jun;32(6):474-82.
[2]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[4]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[5]        “List of motor vehicle deaths in US by year” https://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in_U.S._by_year Accessed 18 June 2017
[6]        “A national approach to mental health – from crisis to community – First report” 2006 Commonwealth of Australia http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/c03 Accessed 18 June 2017

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3 thoughts on “Dr Caroline Leaf – Howling at the moon

  1. Dr Pitt, the peak risk time for people with mental illnesses committing suicide is on the day of release from a psychiatric ward and in the following three months. As mental health staff know, the mental health systems of the world are inhumane. It’s important for mental health staff, as soon as possible, to advocate and demand rights for people with mental illnesses and start to work in ways that support them. At present, the health toll on mental health staff is also far too high. Mental health systems are bad for everyone – both patients and staff. God bless you.

    • Hi Lisa,

      Thanks for sharing your opinion. I’m not ignorant to the complications inherent to modern mental health systems. They’re certainly not perfect, and they can always be improved.

      However, just because modern mental health systems can improve doesn’t mean that they’re inhumane. The treatment of mental illness is complex, time-consuming and resource-intensive, and is constricted by societal stigma and fiscal cachexia. The majority of mental health staff do an amazing job with very challenging presentations in spite of the limited resources, and the lack of the recognition or rewards that they deserve.

      I’ve not heard the statistic that you quoted, that the greatest risk of committing suicide is on the day of release from a psychiatric ward and in the following three months, but even if we take that as a given, there are alternative explanations. Patients who have been in a psychiatric ward are at the severest end of the disease spectrum which, in and of itself, places them at a higher risk of suicide, and the movement from intensive supports to more basic supports creates an extra layer of vulnerability.

      The suggestion that the increased suicide rate after discharge is related to the care itself is a post hoc fallacy. It’s like saying that the increased risk of death after surgery must be because of the quality of the surgery, or that people die after being read their last rites so it must be the last rites that are causing their deaths.

      You may feel that “mental health systems are bad for everyone”, which I also think is an overgeneralisation, but again even if that’s true, the answer isn’t to reject the model but to improve on it. Dr Leaf and her ilk would all have us believe that simply thinking better, holding hands and singing Kum By Yah, will somehow magically alleviate all the distress that mental illness brings to our world. That’s naive. The mental health systems of the world will never improve if we listen to such stigma-inducing ignorance.

      For me, the answer lies in the prevention and early treatment of mental illness through good primary care and appropriate social supports. At the moment, governments are putting all the money at the end of the mental illness spectrum and not at the beginning. Mental health systems will improve as the science of mental health and illness is further elucidated, and as governments put more money into prevention and effective early management – to stop as many people as possible from progressing into full blown mental illness, to then free up the resources for those who do find themselves at the pointy end of the mental illness spectrum.

      Thank you for sharing your perspective on this very important topic. All the best to you.

  2. Pingback: Where are all the shepherds? | Dr C. Edward Pitt

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