Stop mislabelling labels.

The last time I looked through the supermarket, I bought some baked beans. How did I know the can I took off the shelf was full of baked beans and not freshly harvested sheep’s innards? Because the label on the can said so.

Labels aren’t perfect of course. Every now and then, a can of something has the wrong label applied in the factory. Usually it’s nothing too sinister – no accidental swaps of some goat entrails instead of your tinned salmon. Instead, it’s usually something similar – tuna gets labelled as salmon and vice versa, and the worst that happens is that the tuna mornay you’ve just made had an unexpected flavour.  Even these sorts of mild mix ups are rare. Overall, we trust that the labels are guides and the information they provide us helps us make an informed decision about what do to with that particular can and its contents.

It would be pretty silly for some random person to preach out the front of the supermarket, ranting about how all labels for a particular thing are all wrong.

“Uh, just because the occasional can of tuna was accidentally filled with cat food doesn’t mean to say that all labels are wrong. And just because one person had a bad experience with the wrong label, the supermarket shouldn’t stop using them … otherwise how else is anyone supposed to manage their cans effectively without labels? Honestly, stop looking like a fool by preaching about labels and let the rest of us finish our shopping.”

Dr Caroline Leaf, communication pathologist, self-titled cognitive neuroscientist, and a self-elected champion of irrelevant mental health advocacy, has come out all guns ablazin’ over ADHD labels again. She needs to give it a rest – she’s just like the crazy person standing in front of the supermarket.

“Labels for ADHD are bad”, she says. “Look at Avery Jackson, who was labeled ADHD but did not accept the label. He went on to earn multiple degrees and become one of the top neurosurgeons in the U.S!”  The underlying message – labelling a child with ADHD will lock then into a life of pathetic excuses and they won’t ever reach their full potential until they renounce the curse of their ADHD label.

For every scary anecdote about the evils of ADHD and the mental prison that everyone with such a label is supposed to find themselves in, there are ten more where the ADHD label helped them.  There are so many more people where the ADHD label helped them to finally understand their condition and receive the correct treatment, enabling them to reach their potential and improve their life in leaps and bounds.

Take, for example, one of my patients called Little Jimmy (not his real name). When Little Jimmy was in the early primary school grades, he was a bit of a fidgeter and couldn’t concentrate well enough at school or at home to complete his homework tasks. His mother took him to a naturopath who told him he had a disorder of “pyrolles disease”. Thankfully, mum brought him to see me, and after a careful history and a long chat, Little Jimmy went to see a specialist who diagnosed him with ADHD and commenced him on stimulant medications. Before his label, Little Jimmy’s reading levels were languishing at the bottom off his class after two years of stagnation.  He was more than a year behind in reading levels and going nowhere fast.  Two weeks after getting his label and the right medication, he went to the top three reading levels in the class.  His mother told me of the massive gains he made, and the flow-on effect this had to his self-esteem and confidence in other areas of his school work and school life. She cried as she recounted his story, and then I cried too.

So perhaps Avery Jackson became an orthopaedic surgeon because he chose to ignore his label of ADHD and worked hard anyway.  Good for him.  Little Jimmy got a label of ADHD and because of it, he learnt to read. Now he’s got the chance to follow in Avery Jackson’s footsteps, BECAUSE of his label.

Labels are important. Without them, we wouldn’t know how to know who needs which treatment. Labels can help people overcome some of the strongest barriers and connect with others for support.

And let’s face it, if someone really wanted to, they don’t need a label of ADHD to find excuses in life.

So labels are not a hinderance, but rather, they are a guide to help you know what’s going on so informed choices can be made. In Dr Leaf’s mind, those kids with ADHD are just naughty children, with bad parents, who are using the label of ADHD to cover their poor parenting and their bad behaviour. Clearly all they need to do is to stop their toxic thinking and they wouldn’t need their medications, but they would be cured.

Dr Leaf is wrong … she can stand and scream blue murder about labels and ADHD all she wants.  But just like the crazy random person screaming about labels in front of the supermarket, it means very little. It’s not helping her cause, and if anything, it’s sewing distrust in an system that, despite it’s flaws, works very well, and has helped thousands of children and adults alike to achieve their potential.

That’s the power of labels, and Dr Leaf would do herself and all her followers a favour if she stopped mislabelling them.


Dr Caroline Leaf – Inside Out and Back-to-Front

Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, put this up on her social media pages this morning:

“Never feel bad for being sad. Emotions should not be kept inside because that will only make things worse. Talk to someone, cry, scream… whatever helps you feel better. One of my favorite movies is Inside Out because it really highlights the importance of letting yourself feel sad as part of the healing process. I really encourage all of you to not keep emotions bottled up. Let it out!”

Inside Out is one of my favourite movies too.  It is a rich layering of some complex psychology, told through a wonderfully relatable narrative that is beautifully told.

Inside Out is about the emotions that live inside us. Riley, an 11-year-old girl, moves from Minnesota to San Francisco, and the movie tells the story of her emotions as they deal with all of the conflicts and chaos that comes with adapting to such a big change.

The main characters are Joy and Sadness, which share “headquarters” with Anger, Fear and Disgust.  Each character has its own role to play, which Joy, as the main narrator of the movie, explains:

“That’s Fear.  He’s really good at keeping Riley safe.”
“This is Disgust. She basically keeps Riley from being poisoned, physically and socially.”
“That’s Anger. He … cares very deeply about things being fair.”

And Sadness?  “And you’ve met Sadness.  She … well, she … I’m not actually sure what she does …”

Dr Leaf explained that Inside Out, “… really highlights the importance of letting yourself feel sad as part of the healing process.”

Well, that’s one way of putting it, but Inside Out is actually much much deeper.  The story of Inside Out demonstrates that all of our emotions are needed in order to be a healthy human being.

Joy thinks of herself as the primary emotion, and does her best to keep Sadness away from the control panel.  Over the arc of the story, Joy learns that Riley needs Sadness too – that some problems can’t be solved with distraction or a pop-psychology pep-talk and positive attitude.

By the end of the movie, Joy allows Sadness to take over, helping Riley to process all of the things she had been struggling with after the major life change of her move to San Francisco.

This is what Dr Leaf was referring to, I think.  Yes, sadness is part of healing from any major life change including grief.

What Dr Leaf didn’t discuss was the role of the other emotions in Riley’s life.  Yes, Joy and Sadness are important, but the movie demonstrated all the way through that Fear, Anger and Disgust were all just as important, and the end of the movie showed that Riley’s core memories, which each formed a different aspect of her personality, were various combinations of all of the emotions.

But that’s not what Dr Leaf teaches.  For decades, her teaching has been back-to-front, claiming that emotions like anger and fear are toxic, and that toxic emotions cause damage to your brain and damage to your health.  She tells her followers not to think toxic thoughts or to have toxic emotions, but to take control of your thought life.

“Toxic thoughts are thoughts that trigger negative and anxious emotions, which produce biochemicals that cause the body stress.” [1] (p19)

“Hostility and rage are at the top of the list of toxic emotions; they can produce real physiological reactions in the body and cause serious mental and physical illness.” [1] (p30)

“There are two groups of emotions that are polar opposites: positive, faith-based emotions and negative, fear-based emotions. Each has its own set of molecules and performs as spiritual forces with chemical and electrical representation in the body. Faith-based emotions are love, joy, peace, happiness, kindness, gentleness, self-control, forgiveness and patience.  These produce good attitudes and thoughts.  Fear-based emotions include hate, anxiety, anger, hostility, resentment, frustration, impatience and irritation. These produce toxic attitudes and create a chemical reaction in the body that can alter behavior.”

“When you think a toxic thought, or make a bad choice, or you hang on to anything that is negative—anger, bitterness, hurt, irritation, or frustration—it impacts the production of those chemicals.”
“Through an uncontrolled thought life, we create the conditions for illness; we make ourselves sick! Research shows that fear, all on its own, triggers more than 1,400 known physical and chemical responses and activates more than 30 different hormones. There are INTELLECTUAL and MEDICAL reasons to FORGIVE! Toxic waste generated by toxic thoughts causes the following illnesses: diabetes, cancer, asthma, skin problems and allergies to name just a few. Consciously control your thought life and start to detox your brain!”

So it’s really interesting to see Dr Leaf discuss a movie that promotes the exact opposite of her teaching.  Perhaps she’s finally coming around to what real neuroscientists and researchers have been saying for ages, that “adaptive coping does not rely exclusively on positive emotions nor on constant dampening of an emotional reaction … Adaptive coping profits from flexible access to a range of genuine emotions as well as the ongoing cooperation of emotions with other components of the action system.” [2]

If Dr Leaf is finally coming around to real science, then that’s great, but she can’t have it both ways … she can’t promote expressing your emotions on one hand and then suppressing them on the other.  If she wants to come back to the fold of real science, then she’s going to have to renounce her previous teaching, and take it down from her website.  Otherwise it ends up being conflicting and hypocritical as well as being downright confusing.

So, Dr Leaf, you’re welcome to use movies like Inside Out to illustrate good psychological principles, but if you want credibility, you should work on some consistency.

[1]       Leaf CM. Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. Grand Rapids, Michigan: Baker Books, 2013.
[2]       Skinner EA, Zimmer-Gembeck MJ. The development of coping. Annual review of psychology 2007;58:119-44.

Dr Caroline Leaf – stop spreading ADHD stigma and ignorance

“Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.” ~ Martin Luther King Jnr.

Sincere ignorance … conscientious stupidity – I’m struggling to know which category to put Dr Leaf’s latest e-mail newsletter into.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist and self-titled mental health expert.  She is not a doctor.  She is not a psychologist.  She does not work for a university.  She hasn’t published any peer reviewed medical papers for two decades.  She is not accountable to any peak professional body.

Yet the Christian church gives her unfettered access to their pulpits despite the ignorance and stigma she enthusiastically promotes.

Take the “Mental Health News” e-mail that she posted today for example.  Dr Leaf seamlessly moves from one misrepresentation to another, weaving a narrative that unfairly undermines scientifically proven treatments for mental illness, eroding confidence and destroying hope.

She starts with the story of Michelle and Carter, although it wasn’t Michelle and Carter as her e-mail newsletter stated. It was Michelle Carter and Conrad Roy, something which Dr Leaf got right in her blog post dated 1 August 2017 (see the image at the bottom of the page), but then got wrong in her e-mail newsletter on 30 August 2017. Dr Leaf says that Michelle texted Conrad to kill himself, and he did. Michelle and Conrad were on “brain-disabling” (psychiatric) drugs. Therefore, psychiatric drugs killed Michelle and Conrad. In my opinion, that Dr Leaf would stoop so low as to use the suicide of a teenager to try and push her own ideological barrow says much about her character, but then I shouldn’t be surprised as she did the same thing when Carrie Fisher died earlier this year. It’s sick, and it’s low, and it’s something that Dr Leaf should apologise for.

It’s also incredibly disingenuous, drawing a conclusion from incomplete evidence. Dr Leaf has no experience with the case. Instead, the source of this information is Dr Peter Breggin, himself an outspoken and discredited critic of psychiatric medication with a penchant for cherry picking and bias. Dr Leaf has used the story of Michelle and Conrad based on the tainted recall of half a story. She has no idea what really contributed to Michelle and Conrad’s tragedy. Her statement, “Yet, as is often the case, there is a large and dreadful disparity between what actually happened and what we are told happened” is therefore sadly ironic.

Dr Leaf then moves on to ADHD and drugs. Dr Leaf treats the concepts of ADHD and its treatment with the same respect as she gave Michelle and Conrad. She makes statement after misleading statement which do nothing but demonstrate her myopic bias.

Let’s just take one sentence: “These drugs create, rather than cure, chemical imbalances in the brain, are difficult to come off and can have terrible side-effects that last for years, including suicide and homicide.”

ADHD is often misunderstood and almost always stigmatised.  ADHD is more than just being an active child who likes to play.  ADHD is a dysfunctional lack of control that’s abnormal compared to other children the same stage of development, is long standing and affects their entire lives.

ADHD is caused by an abnormal pattern of genes, the expression of which are triggered by environmental conditions in pregnancy and early childhood, resulting in slower maturation of the brain and an uncoordinated network of “connectomes”, which disrupts the attention and planning processes of the brain.

We know that children with ADHD have slower maturation of the grey matter [1] and structural changes in the frontal regions and deeper parts of the brain [2].  In more recent times, modern brain imaging techniques have been able to show differences in the way that the regions of the brain link together to form networks.

Think of the brain networks as a tug-o-war team.  When all the members of a tug-o-war team work in unison, they increase their collective strength, but if the different team members don’t co-ordinate their efforts properly, the strength is lost.  The same goes for the brain.  Modern neuroscientists have discovered that the function of the brain relies on physical networks within the brain, called “connectomes” and how these connectomes co-ordinate with each other.

In the ADHD brain, the connections between the different connectomes are immature [3].  These immature connections weaken the collective strength of the network, because they aren’t synchronously “pulling” together.

What’s better understood is that the neurotransmitter called dopamine is crucial to the ADHD disease process [4].  Medications such as Ritalin which enhance the dopamine signals in the brain significantly reduce the symptoms of ADHD [5].

So Ritalin and other drugs like it actually balance the neurotransmitters in the brain.  Dr Leaf’s argument that they “create … chemical imbalances in the brain” is as misleading as trying to argue that diabetic treatments are creating an “insulin imbalance”.

“These drugs … are difficult to come off” is also misleading.  Once the brain eventually matures as it does in most children with ADHD, the drug is simply weaned.  Dr Leaf doesn’t seem to understand that some children with ADHD will grow into adults with ADHD who will still need medication.  This isn’t because the drugs are hard to come off, they are simply treating an ongoing condition.

“These drugs … can have terrible side-effects that last for years, including suicide and homicide.”  Actually, the effects of Ritalin last less than a day because the drug is rapidly metabolised, and ‘homicide’ is not listed anywhere in the official product information.  Suicide has been reported in patients taking the Ritalin although the official product information notes that, “Adverse events reported since market introduction in patients taking methylphenidate include suicide, suicide attempt and suicidal ideation. No causal relationship between methylphenidate and these events has been established.”  Even so, medications like Ritalin are not meant to be given to people who have severe depression, anorexia, psychotic symptoms or suicidal tendency, just in case Ritalin might worsen these conditions.

Indeed, a Cochrane Review as recently as November 2015 said, “The evidence in this review of RCTs suggests that methylphenidate does not increase the risk of serious (life threatening) harms when used for periods of up to six months. However, taking methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.” [6]

So “these drugs” don’t have side effects for years, don’t make people homicidal, don’t make people addicted and don’t unbalance their brain chemicals.  It’s amazing how much profound mistruth Dr Leaf was able to pack into one littlesentence.

Then Dr Leaf goes on to attack the concept of ADHD itself – “Unfortunately, there is little scientific evidence for these labels … the very idea of ADHD, which includes vague operational definitions such as ‘often fidgets with hands or feet or squirms in seat,’ is subjective and defined by what society currently deems as ‘normal’ or ‘abnormal’”.

Denying the existence of ADHD is an old trick used by medication critics and the ignoranti for decades, but it’s like denying the existence of rain so you don’t have to buy an umbrella.  Dr Leaf’s assertion that the diagnosis of ADHD includes ‘vague operational definitions’ is just a strawman, because ADHD diagnosis is rigorous and relies on more than just a single characteristic like fidgeting.  I have listed the diagnostic criteria for ADHD at the end of this post, or you can look it up here:

In all of Dr Leaf’s railing against medications for ADHD, she fails to cite the evidence that shows that medications for ADHD improves the lives of those with ADHD [6], more than restrictive diets or cognitive retraining or neurofeedback [7].

Dr Leaf may like to think of herself as an expert, but her claims on ADHD and it’s treatment do not hold up under scrutiny.  She may think she’s acting benevolently but the promotion of her Dunning-Kruger style ignorance erodes the enormous hope that medications like Ritalin give to people who, without it, are held back by the mental and physical chaos that ADHD causes.

Dr Leaf, please, stop spreading the ADHD stigma and ignorance.  We already have to put up with enough suffering from the disease itself and the social stigma without you adding to it.


[1]       Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Archives of general psychiatry 2006 May;63(5):540-9.
[2]       Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[3]       Cao M, Shu N, Cao Q, Wang Y, He Y. Imaging functional and structural brain connectomics in attention-deficit/hyperactivity disorder. Mol Neurobiol 2014 Dec;50(3):1111-23.
[4]       Wu J, Xiao H, Sun H, Zou L, Zhu LQ. Role of dopamine receptors in ADHD: a systematic meta-analysis. Mol Neurobiol 2012 Jun;45(3):605-20.
[5]       Reichow B, Volkmar FR, Bloch MH. Systematic review and meta-analysis of pharmacological treatment of the symptoms of attention-deficit/hyperactivity disorder in children with pervasive developmental disorders. Journal of autism and developmental disorders 2013 Oct;43(10):2435-41.
[6]       Storebo OJ, Ramstad E, Krogh HB, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews 2015 Nov 25;11:CD009885.
[7]       Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89.

ADHD Diagnostic Criteria

The current criteria that must be matched to qualify for a diagnosis of ADHD is:

(1) Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
* Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
* Often has trouble holding attention on tasks or play activities.
* Often does not seem to listen when spoken to directly.
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
* Often has trouble organizing tasks and activities.
* Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
* Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
* Is often easily distracted
* Is often forgetful in daily activities.

(2) Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
* Often fidgets with or taps hands or feet, or squirms in seat.
* Often leaves seat in situations when remaining seated is expected.
* Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
* Often unable to play or take part in leisure activities quietly.
* Is often “on the go” acting as if “driven by a motor”.
* Often talks excessively.
* Often blurts out an answer before a question has been completed.
* Often has trouble waiting his/her turn.
* Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
– Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
– Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
– There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
– The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
– The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Where are all the shepherds?

In “The Myth of Icarus”, Icarus, full of the folly that comes with pride, flew too high and the sun melted his wings.

Dr Caroline Leaf is the modern day Christian version of Icarus, foolishly flying higher and higher, deluded by her self-importance and unaware of the weakness and fissuring of her presumed competence.

But unlike the myth of Icarus where only Icarus himself paid the ultimate price, Dr Leaf isn’t the only person flying too close to the sun, but she is encouraging the church to follow her lead.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  Unfortunately, despite no training or experience whatsoever in psychiatry, psychology or even basic counselling, Dr Leaf has assumed the role of a mental health expert for the church.

Having the untrained Dr Leaf lecture Christian congregations on mental illness is an absolutely absurd proposition – it’s like having a plumber give a public lecture about coronary bypass surgery.  Yet the uncredentialed Dr Leaf continues to speak at church after church after church about mental health and illness, given a free license as if she were a psychiatrist with decades of experience.

And my question is “Why”?

Why do pastors and church leaders give Dr Leaf a free pass to speak from their platforms on a subject that she is objectively unqualified to speak on?  Where is the public process of due diligence? Where is public demonstration of accountability that undergirds the reverence, the sacred gravitas, of the church pulpit? Why do our church leaders stay silent when unqualified preachers poison their congregations with saccharine subterfuge?

Where are all the shepherds?   Why aren’t they shepherding?

Dr Leaf’s latest e-mail newsletter aptly demonstrates what the church needs protecting from – an entire e-mail encouraging people to withdraw from psychiatric medications.  Her bias is clear – psychiatric medications are harmful and you can withdraw from them if you want to.  If you do, you’ll feel better.

This might as well be unsolicited, unlicensed medical advice.  There’s no discussion about the nuances of psychotropic medication, or the proven benefits.  She then encourages people to look for more information by reading books or visiting websites that are known to be unhinged or, at best, clearly biased against medications for mental ill-health.

In the past, Dr Leaf has clearly shown her ignorance when it comes to psychiatric medications.  She has accused them of everything from being poisonous to being unspiritual.  Never once has she acknowledged the scores of research papers that confirm the judicious use of psychiatric medications saves lives and extends the lifespan of those who take them.

Now, she has advised people that they can stop their medications and promotes unscrupulous and biased sources of information to help.  This isn’t just ignorant, this is dangerous. [1]

Will it take the untimely death of one of their congregation before our church leaders say ‘enough is enough’?  It will be all too late then.

It’s time for our church leaders to stand up for the congregations they lead and denounce the teaching of Dr Caroline Leaf.  Her ignorance and her arrogance are becoming a dangerous mix.  Our pastors can’t wait until blood is on their hands before they’re forced into action – they need to act now, before it’s too late.

~ ~
If you are concerned about the medications you’re taking or you think you don’t need them any more, for heaven’s sake don’t just stop taking them or try and wean yourself.  Go see your doctor for advice specific to your medication and your situation.

Don’t believe me?

DISCLAIMER: Just in case anyone was wondering about my motives, I declare that I have no connection with any pharmaceutical company. I do not accept gratuities of any form from any sales representative. I don’t eat their food, I don’t take their pens, and I don’t listen to their sales pitches.

References and bibliography

[1] Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry 2009 Aug;70(8):1069-77.

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.

[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” Accessed 18 June 2017
[6]        “A national approach to mental health – from crisis to community – First report” 2006 Commonwealth of Australia Accessed 18 June 2017

Anti-psychotics, damn lies and statistics

Today, I was asked to clarify some information surrounding an earlier post about Carrie Fisher and the role that anti-psychotic medications may or may not have played in her death from a heart attack.  I appreciated the question which was about whether I’d seen the statistics put up by the Mad In America (MIA) blogger who wrote about Carrie Fisher (the blog which, incidentally, Dr Leaf had then uncritically decided to slyly try to regift it in the form of her newsletter article).

In the opening of her post, the MIA blogger said, “There’s an important question here. Is she one of the cases in point to explain why our community has a 25 year lower life expectancy?” and then threw in a table plucked out of context from a journal article.  At least, unlike Dr Leaf, the MIA blogger was intellectually honest enough to attach the source of the table, which was an article published in the European Heart Journal in 2012.

While the MIA blogger is certainly entitled to her opinion, I thought it was worth discussing the statistics in a bit more detail, if for nothing else than to give some context to the whole “anti-psychotics kill you” trope that keeps getting around.

First, there needs to be the proper context.  No one is denying that there’s a higher mortality rate amongst people with schizophrenia and other forms of psychosis, though I don’t see exactly where she got her “25 year lower life expectancy” line from. To me, that seems excessive.

Then to the study itself.  The paper that the table is extracted from is Honkola et al [1]. The study specifically examines the association between the use of different classes of psychiatric medications with the rate of sudden cardiac death during a coronary event (a heart attack, or angina).

In her post, the MIA blogger throws around a lot of numbers but she was loathe to put her numbers in the right context.  For example, she claimed that “smoking is four times safer than the older types of antipsychotics. And it’s twice as safe to smoke as it is to take any antipsychotic, including the newer ones”.  Except, her comparison is a fallacy of conflation – she’s comparing the all cause mortality of smoking (which is more like three-fold rather than two-fold, just FYI [2]) with the highly specific ‘sudden cardiac death during a heart attack’ mortality of the study she’s referencing.  It’s apples and oranges – the groups aren’t directly comparable.

Besides, even if her numbers were directly applicable, the positively immoral sounding four-fold increase in the rate of death sounds is just an association, not a cause.  There is a dictum in science, “Correlation is not the same as causation.”  Just because two things occur together does not mean that one causes the other.  There may be other explanations beside the medication that might explain that number, including but not limited to, statistical anomalies and lifestyle factors, and other factors not considered in the analysis.

There are other problems with relevance too.  Most of the numbers in the table were small and not statistically significant (that is, could have been related to chance alone).  The only strong numbers were for old anti-psychotics, phenothiazines, tricyclic antidepressants and butyrophenones, none of which are first line medications for psychosis or depression anymore.  Newer anti-depressants and the newer atypical anti-psychotics did not have a statistically significant association.

And, like I said before, this study is looking at the association between sudden cardiac death in people having a heart attack, which is a very specific form of mortality.  It’s not particularly applicable to everyone on the medications, so even if the 4- or 8-fold increase is rock solid, you can’t translate that statistic to everyone on anti-psychotic medications or anti-depressants, or Carrie Fisher for that matter since no one really knows how she died other than she had a heart attack.  The rest is just disrespectful speculation.

For me, rather than trying to take a table full of weak and inapplicable statistics and beat a conclusion out of them, a more useful thing would be to know the benefit or harm of anti-psychotics on all causes of death.  If anti-psychotics were really as poisonous as Dr Leaf and the MIA blogger portrayed, then all-cause mortality would be much higher in those exposed to the drugs versus those who were never exposed to the drug, which is why this study by Torniainen and colleagues [3] is particularly interesting, and in particular, this graph –

In this study, the chance of dying from any cause was significantly higher in those people with schizophrenia who were never treated with anti-psychotics compared to those who were treated.

Does this answer the question why there is a lower rate of mortality? Not really, because in fairness, this study also showed just an association between no anti-psychotics and a higher death rate.  It doesn’t specifically prove causation one way or another.

Does it show that we should throw anti-psychotics around like lollies, or that they are wonder drugs without any associated harm? No, they are medicines and need to be used responsibly.

It does show there’s a general benefit to anti-psychotics for people with schizophrenia so they’re not the toxic killers Dr Leaf and the MIA blogger try and make them out to be.

Anyone can cherry-pick weak statistics and bend them to suit their self-interested propaganda.  The remedy to damn lies and statistics is to look more broadly and consider the strength of the numbers and their context.  When we do that with the studies on anti-psychotic medications we see that they aren’t the evil killers that some people would like to make them out to be.

[1]        Honkola J, Hookana E, Malinen S, et al. Psychotropic medications and the risk of sudden cardiac death during an acute coronary event. Eur Heart J 2012 Mar;33(6):745-51
[2]        Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. The New England journal of medicine 2013 Jan 24;368(4):341-50
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63

Dr Caroline Leaf and the power of prayer

If you’re a Christian, then you believe in the power of prayer.  It’s pretty fundamental … prayer is fundamental to our relationship with God and our daily life with him, and even salvation itself.

So where does the power of prayer come from?  Does it come from the words we speak like some ritual incantation? Does it come from the power of our minds?  Or does the power of prayer rest solely in God and his power when he answers our prayers?

One gets the impression from reading Dr Leaf’s e-mail newsletter today that the power of prayer is less about God and more about the power of the human mind.

Dr Leaf starts by saying that “12 minutes of daily focused prayer over an 8 week period can change the brain to such an extent that it can be measured on a brain scan. This type of prayer seems to increase activity in brain areas associated with social interaction compassion and sensitivity to others. It also increases frontal lobe activity as focus and intentionality increase.”

That may well be true, but the effect isn’t related to prayer itself, it’s simply what happens when the brain does things over and over.  This same effect occurs in people who perform Buddhist meditation [1], or jugglers learning to juggle [2], or London taxi drivers memorising the streets of London by rote [3].  Indeed, the brain has been shown to change simply with hormonal fluctuations that occur throughout the menstrual cycle [4].  Prayer might change the brain, but so do a lot of other things that have nothing to do with prayer.

Not that these pesky facts stop Dr Leaf from going on to state that, “As well as changing the brain, another study implies that intentional prayer can even change physical matter. Researchers found that intentional thought for 30 seconds affected laser light.”  To start with, this study [5] that Dr Leaf refers to was nothing to do with Christian prayer, and all to do with Buddhist-type meditation … to use this ‘experiment’ as support for prayer is misleading.  It’s also misleading because the results were essentially the interpretation of the experimenter.  The same experimental design performed by independent laboratories showed no effect of thought on laser light [6] (see also “Dr Caroline Leaf – Where Angels Fear To Tread“).

So intentional thought doesn’t change physical matter, and why should that be any surprise?  Prayer might change things, but the effect of prayer has nothing to do with us.  We don’t change physical matter, only God does, since He created matter in the first place.

Dr Leaf is simply setting up a false premise so she can solve it – ‘You cause brain damage by your toxic thinking, but you can heal your brain damage by your non-toxic thinking’.  But toxic thoughts do not cause brain damage, so there is no brain damage from toxic thinking for prayer to reverse.  The pathetic excuse for ’science’ that Dr Leaf relies on to support her ministry doesn’t show any effect for the power of prayer.  As Christians, the power of prayer is a matter of faith and reliance on the power of God, not our own strength.

[1]        Desbordes G, Negi LT, Pace TW, Wallace BA, Raison CL, Schwartz EL. Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in human neuroscience 2012;6:292
[2]        Scholz J, Klein MC, Behrens TE, Johansen-Berg H. Training induces changes in white-matter architecture. Nature neuroscience 2009 Nov;12(11):1370-1.
[3]        Maguire EA, Woollett K, Spiers HJ. London taxi drivers and bus drivers: a structural MRI and neuropsychological analysis. Hippocampus 2006;16(12):1091-101.
[4]        Hagemann G, Ugur T, Schleussner E, et al. Changes in brain size during the menstrual cycle. PloS one 2011 Feb 04;6(2):e14655.
[5]        Radin D. Testing nonlocal observation as a source of intuitive knowledge. Explore: The Journal of Science and Healing 2008;4(1):25-35.
[6]        Alcock JE, Burns J, Freeman A. Psi wars: Getting to grips with the paranormal: Imprint Academic Charlottesville, VA, 2003.