#joanna moncrieff

[triviareads]

#LMAO #I don't.... think he understands his own appeal #he could absolutely be the dirty duke of My Dirty Duke #by Joanna Shupe #or Moncrieffe from Julie Ann Long's What I Did for a Duke #bridgerton #richard armitage

[transmutationisms]

i think you do a really impressive job balancing comprehensive/concise while referencing a lot of complex frameworks(contexts? schools of thought? lol idk what to call that. big brain ideas) but if you have any readings specifically on the institution of psychiatry topic that you would recommend/think are relevant, I'd be interested. it's absolutely not a conversation that's being had enough and I want to be able to articulate myself around it

yes i have readings >:)

first of all, the anti-psychiatry bibliography and resource guide is a great place to start getting oriented in this literature. it's split by sub-topic, and there are paragraphs interspersed throughout that give summaries of major thinkers' positions and short intros to key texts.

it's from 1979, though, so here are some recs from the last 4 decades:

overview critiques

mind fixers: psychiatry's troubled search for the biology of mental illness, by anne harrington

psychiatric hegemony: a marxist theory of mental illness, by bruce m z cohen

desperate remedies: psychiatry's turbulent quest to cure mental illness, by andrew scull

psychiatry and its discontents, by andrew scull

madness is civilization: when the diagnosis was social, 1948–1980, by michael e staub

contesting psychiatry: social movements in mental health, by nick crossley

the dsm & pharmacy

dsm: a history of psychiatry's bible, by allan v horwitz

the dsm-5 in perspective: philosophical reflections on the psychiatric babel, by steeves demazeux & patrick singy

pharmageddon, by david healy

pillaged: psychiatric medications and suicide risk, by ronald w maris

the making of dsm-iii: a diagnostic manual's conquest of american psychiatry, by hannah s decker

the myth of the chemical cure: a critique of psychiatric drug treatment, by joanna moncrieff

the book of woe: the dsm and the unmaking of psychiatry, by gary greenberg

prozac on the couch: prescribing gender in the era of wonder drugs, by jonathan metzl

the creation of psychopharmacology, by david healy

the bitterest pills: the troubling story of antipsychotic drugs, by joanna moncrieff

psychiatry & race

the protest psychosis: how schizophrenia became a black disease, by jonathan metzl

administrations of lunacy: racism and the haunting of american psychiatry at the milledgeville asylum, by mab segrest

the peculiar institution and the making of modern psychiatry, 1840–1880, by wendy gonaver

what's wrong with the poor? psychiatry, race, and the war on poverty, by mical raz

national and cross-national contexts

mad by the millions: mental disorders and the early years of the world health organization, by harry yi-jui wu

psychiatry and empire, by sloan mahone & megan vaughan

ʿaṣfūriyyeh: a history of madness, modernity, and war in the middle east, by joelle m abi-rached

surfacing up: psychiatry and social order in colonial zimbabwe, 1908–1968, by lynette jackson

the british anti-psychiatrists: from institutional psychiatry to the counter-culture, 1960–1971, by oisín wall

crime, madness, and politics in modern france: the medical concept of national decline, by robert a nye

reasoning against madness: psychiatry and the state in rio de janeiro, 1830–1944, by manuella meyer

colonial madness: psychiatry in french north africa, by richard keller

madhouse: psychiatry and politics in cuban history, by jennifer lynn lambe

depression in japan: psychiatric cures for a society in distress, by junko kitanaka

inheriting madness: professionalization and psychiatric knowledge in 19th century france, by ian r dowbiggin

mad in america: bad science, bad medicine, and the enduring mistreatment of the mentally ill, by robert whitaker

#sorry this is SO MANY things lmao #i wld recommend starting with harrington or scull as an intro and then maybe look at one of the more topic-specific texts #depending on what interests you specifically #book recs #psychiatry

[maaarine]

The Cause of Depression Is Probably Not What You Think (Joanna Thompson, Quanta Magazine, Jan 26 2023)

"A literature review that appeared in Molecular Psychiatry in July was the latest and perhaps loudest death knell for the serotonin hypothesis, at least in its simplest form.

An international team of scientists led by Joanna Moncrieff of University College London screened 361 papers from six areas of research and carefully evaluated 17 of them.

They found no convincing evidence that lower levels of serotonin caused or were even associated with depression.

People with depression didn’t reliably seem to have less serotonin activity than people without the disorder.

Experiments in which researchers artificially lowered the serotonin levels of volunteers didn’t consistently cause depression. (…)

Although serotonin levels don’t seem to be the primary driver of depression, SSRIs show a modest improvement over placebos in clinical trials.

But the mechanism behind that improvement remains elusive.

“Just because aspirin relieves a headache, [it] doesn’t mean that aspirin deficits in the body are causing headaches,” said John Krystal, a neuropharmacologist and chair of the psychiatry department at Yale University.

“Fully understanding how SSRIs produce clinical change is still a work in progress.”

Speculation about the source of that benefit has spawned alternative theories about the origins of depression. (…)

Repple warns, however, that another explanation for the effects his team observed is also possible: Perhaps the depressed patients’ brain connections were impaired by inflammation.

Chronic inflammation impedes the body’s ability to heal, and in neural tissue it can gradually degrade synaptic connections.

The loss of such connections is thought to contribute to mood disorders.

Good evidence supports this theory.

When psychiatrists have evaluated populations of patients who have chronic inflammatory diseases like lupus and rheumatoid arthritis, they’ve found that “all of them have higher-than-average rates of depression,” said Charles Nemeroff, a neuropsychiatrist at the University of Texas, Austin.

Of course, knowing that they have an incurable, degenerative condition may contribute to a patient’s depressed feelings, but the researchers suspect that the inflammation itself is also a factor.

Medical researchers have found that inducing inflammation in certain patients can trigger depression.

Interferon alpha, which is sometimes used to treat chronic hepatitis C and other conditions, causes a major inflammatory response throughout the body by flooding the immune system with proteins known as cytokines — molecules that facilitate reactions ranging from mild swelling to septic shock.

The sudden influx of inflammatory cytokines leads to appetite loss, fatigue and a slowdown in mental and physical activity — all symptoms of major depression.

Patients taking interferon often report feeling suddenly, sometimes severely, depressed.

If overlooked chronic inflammation is causing many people’s depression, researchers still need to determine the source of that inflammation.

Autoimmune disorders, bacterial infections, high stress and certain viruses, including the virus that causes Covid-19, can all induce persistent inflammatory responses.

Viral inflammation can extend directly to tissues in the brain. Devising an effective anti-inflammatory treatment for depression may depend on knowing which of these causes is at work.

It’s also unclear whether simply treating inflammation could be enough to alleviate depression.

Clinicians are still trying to parse whether depression causes inflammation or inflammation leads to depression. “It’s a sort of chicken-and-egg phenomenon,” Nemeroff said.

Increasingly, some scientists are pushing to reframe “depression” as an umbrella term for a suite of related conditions, much as oncologists now think of “cancer” as referring to a legion of distinct but similar malignancies.

"And just as each cancer needs to be prevented or treated in ways relevant to its origin, treatments for depression may need to be tailored to the individual."

#article #health

[miyuecakes]

curated list of scholarly articles

i asked if people would like a curated list of scholarly articles i’ve read throughout my last year of university and the people (on instagram) said yes

these are largely discursive/conceptual readings because if i included my area study articles ... it would be really long

Post-colonialism

Denevan M. William. “THE “PRISTINE  MYTH ” REVISITED”

This is a critique of the narrative that the Americas prior to colonization was “virginal” and “untouched”. Such narrative contributes to the erasure of Indigenous presence in the region and falls into the idea of the “noble savage”. I really recommend this and think it can be applied to other parts of the world (Central Asia comes to mind for me, personally).

Nixon, Rob. “Environmentalism and Postcolonialism”

Recommend reading this with the Denevan article.

Oyěwùmí, Oyèrónkẹ́. “Colonizing Bodies and Minds: Gender and Colonialism”

A revelating piece on how colonization not only established a global hierarchy based on race but also made widespread the patriarchy. Utilizing the Yoruba as an example, Oyěwùmí describes the material consequences of these effects and the psychological ones. A good primer in understanding colonialism as both gendered and racialized. 

Sajed, Alina.“Fanon, Camus and the global colour line: colonial difference and the rise of decolonial horizons”

Sajed provides a comparative analysis of Albert Camus, an Algeria-born French philosopher (part of the settler population, essentially), and Frantz Fanon, an Afro-Martinican scholar, on their narratives surrounding the Algerian War of Independence. This comparison serves to highlight some of the “blind spots” of Camus’ framing – that being the titular “colonial difference” and its specificity of enacting violence.

Spivak, Gayatri. “Can the Sub-Altern Speak?”

A fundamental text within postcolonial studies that touch upon the need for intersectionality and nuance within academic discourse (particularly in regard to women and the disprivileged classes). This is an extremely difficult text, in my opinion, due to the amount of academic jargon – but its significance within the field and message makes attempting to read this worth it. 

Simon  Granovsky-Larsen   and  Larissa  Santos. “From the war on terror  to  a  war  on  territory: corporate counterinsurgency at the Escobal mine and the Dakota Access Pipeline”

A case study of two infamous examples of corporations utilizing violence in order to pursue their goals and how this method may become popularized amongst extractivist companies.

Global Health

Hickel, Jason. “The contradiction of the sustainable development goals: Growth versus ecology on a finite planet”

An illuminating critique not just of standard global health efforts but also of the myth of economic development. 

Moncrieff, Joanna “The Political Economy of the Mental Health System: A Marxist Analysis”

Provides an overview of the history and function of mental health asylums in early English society and how the medicalization/creation of mental health illnesses maintains yet reveals the limitations of capitalism. Highly recommend this reading, it is quite fascinating.

Muntaner, Carles, et al.“Precarious Employment Conditions, Exploitation, and Health in Two Global Regions: Latin America and the Caribbean and East Asia”

#not art #disk horse #NOT REALLY LOL #scholarly academia

[rabbits-of-negative-euphoria]

I feel like "unscientific myth" is a bit of strong words? It's more of a half-truth, isn't it? Environmental causes exist, yes. And Depression isn't synonymous with "existential despair". But these things at least operate THROUGH brain chemicals do they not? It's easy to get dismissive about chemicals when you've never had yours manipulated directly

brain chemicals exist of course, but the serotonin “chemical imbalance” theory is not the cause of depression, and it is not the reason SSRIs work for some people (researchers straight-up don’t know why they seem to work in some cases and not in others).

“The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants.” 2022

while this is news to some people, it was not news to my mother, who had studied the studies years before and knew the serotonin claims were baseless. it is far and away more likely that our brain chemistry is reactive rather than causal.

this 2-part podcast may also be helpful/ more in-depth regarding the relationship between the pharmaceutical companies, doctors, and chemical imbalance propaganda:

#- HK #mobile #x

[beguines]

. . . it is necessary to utilise the existing evidence to more accurately theorise the real vocation of the psy-professions in capitalist society. As the faulty knowledge claims of the DSM are summarised by Burstow, "reliability cannot legitimately function as a validity claim and no studies have established validity"; therefore, "it follows that . . . no foundation of any sort exists for the DSM categories. This is a serious issue that calls into question the power vested in psychiatry." It necessarily leads us to consider such institutions as moral and political enterprises rather than medical ones because psy-professionals make historically and culturally bound judgements on the "correct" and "appropriate" behaviour of society's members. This is a point summated by Ingelby when he states that (emphasis added): "what one thinks psychiatrists are up to depends crucially on what one thinks their patients are up to; and the latter question cannot be answered without taking an essentially political stand on what constitutes a “reasonable” response to a social situation."

In the same manner, British psychiatrist Joanna Moncrieff agrees that a "psychiatric diagnosis can be understood as functioning as a political device, in the sense that it legitimates a particular social response to aberrant behaviour of various sorts, but protects that response from any democratic challenge." Even Shorter accepts that the profession is responsible for policing social deviance when he remarks that "[p]sychiatry is, to be sure, the ultimate rulemaker of acceptable behaviour through its ability to specify what counts as 'crazy.'" Likewise, the concept of "health" within the mental health system is understood as whatever counts as "normal" within a specific historical epoch and cultural setting. Sayers states of this relative concept of "health" that: "[t]he society and the individual's role within it are assumed to be normal (that is to say, 'healthy': 'normality' is a common synonym for 'health' in psychiatry as in other areas of medicine). Indeed, the prevailing social environment is made the very criterion of normality, and the individual is judged ill insofar as he or she fails to 'adjust' to it."

Bruce M.Z. Cohen, Psychiatric Hegemony: A Marxist Theory of Mental Illness

#bruce m.z. cohen #psychiatric hegemony #psychiatry

[brostateexam]

https://www.quantamagazine.org/the-cause-of-depression-is-probably-not-what-you-think-20230126/

A literature review that appeared in Molecular Psychiatry in July was the latest and perhaps loudest death knell for the serotonin hypothesis, at least in its simplest form. An international team of scientists led by Joanna Moncrieff of University College London screened 361 papers from six areas of research and carefully evaluated 17 of them. They found no convincing evidence that lower levels of serotonin caused or were even associated with depression. People with depression didn’t reliably seem to have less serotonin activity than people without the disorder. Experiments in which researchers artificially lowered the serotonin levels of volunteers didn’t consistently cause depression. Genetic studies also seemed to rule out any connection between genes affecting serotonin levels and depression, even when the researchers tried to consider stress as a possible cofactor.

“If you were still of the opinion that it was simply a chemical imbalance of serotonin, then yeah, it’s pretty damning,” said Taylor Braund, a clinical neuroscientist and postdoctoral research fellow at the Black Dog Institute in Australia who was not involved in the new study. (“The black dog” was Winston Churchill’s term for his own dark moods, which some historians speculate were depression.)

The realization that serotonin deficits by themselves probably don’t cause depression has left scientists wondering what does. The evidence suggests that there may not be a simple answer. In fact, it’s leading neuropsychiatric researchers to rethink what depression might be.

#long reads

[protoslacker]

Patients should not be told that depression is caused by low serotonin or by a chemical imbalance and they should not be led to believe that antidepressants work by targeting these hypothetical and unproven abnormalities. In particular, the idea that antidepressants work in the same way as insulin for diabetes is completely misleading. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.

Joanna Moncrieff quoted in an article by Christopher Lane in Psychology Today. A Decisive Blow to the Serotonin Hypothesis of Depression

An exhaustive new review debunks the “chemical imbalance” theory of depression

In Nature.  The serotonin theory of depression: a systematic umbrella review of the evidence

#depression #medicine #science #belief #metaphor

[dissociacrip]

just posting this for reference irt "the brain is an organ therefore all psychiatric disorders are physical in nature:"

In contrast to the mainstream position, I and other critics suggest that mental health problems are not equivalent to general medical conditions (Valenstein, 1998; Szasz, 2000; Whitaker, 2002; Moncrieff, 2020). Although human beings are embodied creatures, and all human activity depends on biology, none of the situations we call mental disorders have been convincingly shown to arise from a biological disease, or, putting it another way, from a specific dysfunction of physiological or biochemical processes.

(...)

The abundance of research into the biological basis of mental disorders means it is difficult to challenge every new claim or theory, yet fundamental flaws have been identified in key areas of research. For example, genetic research with families and twins has overlooked important confounders and positive findings have been highlighted while negative ones have been buried (Rose et al., 1984; Joseph, 2003). More recent genome wide studies produce negligible evidence for any relevant genetic effects (Latham and Wilson, 2010; Moncrieff, 2014). The most consistent finding in biological psychiatry is that people diagnosed with schizophrenia have smaller brains and larger brain cavities than people without, and this has recently been shown to be due, at least in part, to the effects of antipsychotic treatment (Fusar-Poli et al., 2013). Any remaining differences are likely accounted for by intellectual ability and other uncontrolled factors (Moncrieff and Middleton, 2015). Biochemical research also fails to support widely held beliefs that mental disorders are caused by abnormalities of specific neurotransmitters (Valenstein, 1998). The hypothesis that depression is caused by serotonin deficiency is not supported by evidence from any of the principle areas of research into depression and the serotonin system (Moncrieff et al.). Evidence on dopamine also fails to confirm the dopamine hypothesis of schizophrenia or psychosis, though dopamine is known to be involved in arousal mechanisms that are likely to be awry in someone who is acutely psychotic (Moncrieff, 2009; Kendler and Schaffner, 2011).

from "The Political Economy of the Mental Health System: A Marxist Analysis" by british critical psychiatrist, joanna moncrieff

#j #community

[neuroscotian]

Dr. Joanna Moncrieff—a founding member of the Critical Psychiatry Network, a group for psychiatrists who are skeptical of the mental-health establishment—believes that’s because some antidepressants don't work the way they're advertised. For decades, researchers theorized that depression stems from a shortage of mood-regulating neurotransmitters, particularly serotonin, in the brain. Blockbuster antidepressants like Prozac, which hit the U.S. market in the 1980s, are meant to boost those serotonin levels. But Moncrieff’s research, as well as other scientists’ work, suggests that depression isn’t caused by low serotonin levels, at least not entirely. And if serotonin isn’t the main problem, Moncrieff says, taking these drugs is “not correcting a chemical imbalance. It is creating a chemical imbalance.” So why do some people feel better after taking antidepressants? They clearly have some effect on the brain, potentially improving mood, but Moncrieff isn’t convinced they’re really treating the root cause of depression. To do that, she believes, clinicians need to help people solve problems in their lives, rather than simply prescribing a pill. “Lots of people would disagree with that,” Moncrieff admits. But studies, including the 2019 research review on psychiatric treatments, do show that “problem-solving therapy,” a modality that teaches people how to manage stressors, can work.

#Therapy #Antidepressants #critical psychology

[shadowfromthestarlight]

Way back in 2008, I wrote an article called “The ‘Chemical Imbalance’ Myth,” which challenged the dominant idea that depression is caused by a chemical imbalance in the brain and changes in serotonin levels. As you can imagine, it was a pretty controversial article. It probably received more comments than just about anything else I’ve ever written, along with quite a lot of hate mail and pretty strong attacks, despite the fact that the article was very well-referenced and included many links to peer-reviewed evidence.

And since then, that theory has only fallen apart further, most recently with a landmark paper that was published by Dr. Joanna Moncrieff and colleagues. It was a review of meta-analyses that had been published on this topic, and it just systematically debunked the idea that depression is caused by a chemical imbalance and changes in serotonin levels. 

#medicine #depression #health

[transmutationisms]

Long time listener first time caller (well not really I'm pretty sure we've talked about Succession before). I wanna read up more on anti psychiatry but I'm fucking shithouse at reading, are there any like videos or podcasts or audiobooks you'd recommend, because that would make my life ten times easier

yes great question honestly. i haven't heard all of these podcast episodes, but i curated the list based on knowing the speakers' work (not necessarily the podcast hosts/shows!), and i think these are good places to start.

"Debunking the Myth of the Chemical Imbalance with Dr. Joanna Moncrieff" interviewed by Dr. Caroline Leaf

Revolution Health Radio: "Reviewing the Evidence on the Serotonin Theory of Depression, with Dr. Joanna Moncrieff"

Mad in America Radio: Lucy Johnstone on the Power Threat Meaning Framework

NPR Fresh Air: Anne Harrington on psychiatry's "troubled search" for a biological understanding of mental illness

New Books Network: Mical Raz on her book "What's Wrong With the Poor: Psychiatry, Race, and the War on Poverty"

The Mental Breakdown Morning Show: "Bruce Cohen and Psychiatric Hegemony" (Cohen, unlike most on this list, explicitly aims for a marxist explanation and understanding of mental illness)

Madness Radio: "Bipolar Medication Myths" (Joanna Moncrieff interviewed by Will Hall)

What Your GP Doesn't Tell You: "David Healy Discusses SSRI Drugs, Suicide and Sexual Dysfunction"

Coming From Left Field: "The Political Economy of Mental Health Systems with Joanna Moncrieff"

States of Mind: "Mental Illness in America" (includes segments with Katherine Bankole-Medina, Jonathan Metzl, Allan Horwitz, Jamie Cohen-Cole, and Elyn Saks)

Jesse Meadows's podcast on ADHD, "Sluggish" (haven't listened to this one, but have read a lot of their writing; they're challenging the psychiatric view of ADHD as a person who struggles with the symptoms and behaviours the diagnostic label describes)

audio books: i'm honestly not sure where's the best and cheapest place to actually download these from, but i know there are audio books of 'mind fixers' by anne harrington (narrated by joyce bean) and 'desperate remedies' by andrew scull (narrated by jonathan keeble). uh, if anyone has a good list of audiobooks on this lmk :-)

#psychiatry

[triviareads]

can you recommend historical romances (regency era up until 1900 vibes) that are “realistic”? i know you make a point in your charlotte bridgerton fic that eventually all the bridgerton make respectable marriages. all of them are conventional but that’s something i act—i enjoy that both main character and love interest are of the same social standing and therefore don’t have to “struggle” to get married. do you have any books recs (series would be preferable but i’m good with standalones!) like that?

also love your writing!! really want to know how charlotte reacts to clairmonts proposal lol - your charlotte is probably one of my favourite characters because she has that perfect understanding what it means to be a woman in that era which i just love

Sure! Here's are some recs I have for historical romances where the heroine and hero are of a similar social standing. Obviously, this is HR and what's "realistic" is still pretty.... not, because that's the genre, but I get what you mean.

What I Did for a Duke by Julie Anne Long: Genevieve is the daughter of a wealthy gentleman, and Moncrieffe is a duke, so no social obstacles there. Moncrieffe wants to seduce Genevieve out of revenge for her brother sleeping with his fiancée but obviously, his quest for *revenge* is thrown out the window within 20 seconds of meeting her. Also, you get the sense that both characters are not only deeply aware of one another, but they're very socially aware.

The Bride Goes Rogue by Joanna Shupe: Set in Gilded Age America so you'll still get your balls (including a French ball!) and whatnot. Katherine and Preston are both a part of the Upper Ten Thousand and are actually betrothed. But Preston refuses to honor it and Kat goes a little off the rails (in a fun way) as a result, they're both conducting a "no-strings" (ha as if) affair. Also, Preston is deffo trying to get *revenge* on Katherine's dad, so there's a pattern here.

Marquess of Meyham by Scarlett Scott: Leonora is the daughter of an earl, and Morgan is a marquess. This is another *revenge* book since Morgan's grand plan is to ruin and marry Leonora and make her miserable out of revenge for her half-brother Alessandro (possibly?) having tortured him during the Peninsular War. I don't talk about Morgan enough, and honestly I should because he goes HARD on the "whose pussy is this" bit during sex. Him and Alessandro (or Sandy, as I affectionately call him) are hot messes and I love them both.

The Truth about Cads and Dukes by Elisa Braden: Jane's the daughter of an earl, Harrison is a duke. He marries her to save her "honor" after his fuck-up brother fucks up. The best thing about his book is how Jane slowly breaks Harrison using her "wiles" after they're married and how much Harrison is OBSESSED with her hands, her tits (in that order!), and eventually, her.

And I'm glad you enjoy Charlotte/Clairmont- they're my babies. I'm trying desperately to get the next chapter across the finish line. I will say, I think Charlotte has an imperfect understanding of what it means to be a woman in that era because her understanding only goes so far as aristocratic womanhood. But my dream in the future is to a) write a fic or maybe even a novel with a more expansive notion of womanhood in the Victorian era, and b) the ultimate dream which is to somehow incorporate a Charles Hamilton Houston-esque legal strategy to overturn Plessy, but in this case, for women's rights in the Victorian era with HR heroines somehow spearheading the effort. Basically, a systemic, strategic plan to attain rights one by one without jumping straight to suffrage which is what I've seen a lot of HR writers do. Which annoys me a little.

#historical romance #book recs #julie anne long #joanna shupe #scarlett scott #elisa braden #bridgerton #charlotte bridgerton #ask

[d33-alex]

Depression and Serotonin

A Popular Hypothesis About the Cause of Depression Is Rebuffed

How most medicines work their magic is understood. But for some it remains a mystery. Among the most mysterious are a group of widely used antidepressants called selective serotonin reuptake inhibitors (SSRIS), the best-known of which is Prozac.

For decades, doctors believed ssris operated by boosting levels of serotonin, a chemical which carries signals between neurons in the brain. This supposition was based on the hypothesis that a lack of serotonin causes depression. But a growing number of investigations suggest that theory does not hold water—a conclusion hammered home by a round-up of reviews of such work just published in Molecular Psychiatry.

This uber-study, led by Joanna Moncrieff of University College, London, covers several strands of research on the link between serotonin and depression. One looks at levels of serotonin and its breakdown products in blood and spinal-cord fluid, taking these as proxies for the amount in the brain, which it is unsafe to measure directly in living people. Work in this strand, the review concludes, shows no difference between the clinically depressed and the healthy.

Neurons reabsorb serotonin after it has done its job. ssris block this, leaving more of the molecule available. Another body of work thus examined the receptor proteins which respond to serotonin, and the transporters through which it is reabsorbed. This occasionally found indications of higher serotonin activity in people with depression, the opposite of what might be expected. Dr Moncrieff reckons that may actually result from antidepressant use, something not always taken account of when those with and without depression are compared.

A third line of research depends on the fact that serotonin is made from tryptophan, a substance the body cannot synthesise, and so must ingest from food. In these experiments participants’ serotonin levels are lowered by depriving them of tryptophan. Dr Moncrieff’s team concluded that lowering serotonin in this way did not produce depression in hundreds of healthy volunteers.

Last, the researchers looked at big genetic analyses. These found no differences between genes that regulate the serotonin transporter in those with depression and those without it.

If serotonin is not the cause of depression, that raises questions about SSRIS. These do help some new patients, but not others. And they come at a cost and with side-effects including loss of libido and inability to reach an orgasm. They can also be hard to stop taking, leaving some who recover from depression dependent on them for life.

Already, clinical practice is changing to emphasise dealing with environmental triggers of depression, such as adversity and poor coping skills, rather than deploying drugs. But it would still be good to understand upfront who will benefit from ssris and who won’t. Without the serotonin hypothesis, doctors are, in this regard, back to square one.

#medical science #medicine #health

[viscountmelbourne]

“[The paper] doesn’t undermine the efficacy of antidepressants for those people for whom they work,” says Comaty. “But we just don’t know the biochemical theory of depression.” Such ambiguity may be unwelcome to those looking for definitive answers one way or the other about SSRIs. Uncertainty is an inevitable aspect of the scientific process, Comaty says, and one that should be welcomed rather than cited as evidence of psychiatric medication’s uselessness, as some on the right have done.

#science #scientists #medicine #antidepressants #health medical pharma #clinical depression

[nicklloydnow]

“One need not be a Marxist to acknowledge the logic behind Karl Marx’s observation: “The ideas of the ruling class are in every epoch the ruling ideas.” It is especially important for the ruling class that the general public’s ideas about our emotional suffering and behavioral disturbances be the ideas of the ruling class.

Twenty years ago, one would have been labeled as “anti-psychiatry” for acknowledging that: (1) psychiatry’s treatment outcomes are “abysmal” and “not getting any better”; (2) the serotonin imbalance theory of depression is untrue; and (3) psychiatry’s diagnostic manual, the DSM, is scientifically invalid. Yet today, these acknowledgements—which don’t threaten the ruling class—are stated by the psychiatry establishment and reported by the mainstream media.

There are, however, critiques that continue to be too taboo for the mainstream media to report. Such critiques are existential threats to establishment psychiatry, and these critiques are financial threats to both Big Pharma and a mainstream media dependent on Big Pharma advertising dollars. Even more importantly, these critiques are political threats to the ruling class which prefers medical “individual defect” explanations for emotional suffering and behavioral disturbances rather than explanations that challenge the societal status quo.

(…)

In 2011, Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015, acknowledged: “Whatever we’ve been doing for five de­cades, it ain’t working. When I look at the numbers—the number of suicides, the number of disabilities, the mortality data—it’s abysmal, and it’s not getting any better.” In 2017, Insel told Wired: “I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.” In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.” While twenty years ago, it would have been radical to state that psychiatry is making no progress, today it is not taboo to report that our collective mental health has gone in “the wrong direction” despite increased treatment.

(…)

In 2022, CBS reported: “Depression is Not Caused by Low Levels of Serotonin, New Study Suggests.” Receiving widespread attention in the mainstream media was the July 2022 research review article “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,” published in the journal Molecular Psychiatry. In it, Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: “We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.” Leading establishment psychiatrists, rather than disputing these finding, tried to convince the general public that Moncrieff’s findings were not newsworthy.

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What remains taboo is criticism of psychiatry that calls into question its fundamental paradigm of care. Specifically, this means it is taboo to ask this question: Has viewing our emotional suffering and behavioral disturbances as medical disorders and illnesses been helpful or harmful? Thus, the mainstream media rarely reports the empirical research that challenges psychiatry’s essential paradigm—its so-called “medical model.”

In psychiatry’s medical model, mental illnesses and their symptoms are voted in by the American Psychiatric Association (APA), and then listed in the DSM, published by the APA. DSM mental illnesses such as attention deficit hyperactivity disorder (AHDH) and schizophrenia are—like gonorrhea and cancer—seen as pathological conditions. While psychiatry generally views mental illnesses as biological in nature—be it chemical imbalances (now a discarded theory) or other theories involving brain and genetic defects—its medical model, as in much of the rest of medicine, does not preclude the effect of psychological and social factors on biological functioning. (Just as oncologists embrace the idea that genetics predisposes a person to cancer but recognize that psychological and social variables can trigger it, so too does psychiatry’s medical model recognize that psychosocial variables can trigger DSM mental illnesses.)

In contrast to psychiatry’s medical model, other models of emotional suffering and behavioral disturbances don’t assume that a medical illness is causing emotional suffering or disturbing behaviors. Non-medical models conclude that there are many reasons that have nothing to do with medical illness as to why, for example, a child does not pay attention and is disruptive; and such non-medical models conclude there are many reasons that have nothing to do with brain defects as to why an individual may be hearing voices and having bizarre beliefs. Before examining the research that casts doubt on the neurobiological validity of psychiatry’s medical model, first the empirical research that examines whether or not the medical model creates more or less stigma.

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Published in the journal Neuron in 2022, Raymond Dolan—considered one of the most influential neuroscientists in the world—co-authored “Functional Neuroimaging in Psychiatry and the Case for Failing Better,” concluding, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.” Reflecting on the more than 16,000 neuroimaging articles published during the last 30 years, Dolan and his co-authors concluded: “It remains difficult to refute a critique that psychiatry’s most fundamental characteristic is its ignorance. . . . Casting a cold eye on the psychiatric neuroimaging literature invites a conclusion that despite 30 years of intense research and considerable technological advances, this enterprise has not delivered a neurobiological account (i.e., a mechanistic explanation) for any psychiatric disorder, nor has it provided a credible imaging-based biomarker of clinical utility.”

What about genetic correlates to “serious mental illnesses”? A 2020 study in Schizophrenia Bulletin reported that no genetic variants have been found to predict schizophrenia; as no significant difference was found in the genetic variance of people with a diagnosis of schizophrenia and people without such a diagnosis. Similarly, examining mood disorders, a 2021 investigation published in the Journal of Affective Disorders (that included 5,872 cases and 43,862 controls, and examined 22,028 genes), reported that the study “fails to identify genes influencing the probability of developing a mood disorder” and “no gene or gene set produced a statistically significant result.”

Thus, despite the fact that researchers have not found any neuro-chemical-biological-genetic evidence for any psychiatric condition, it remains taboo to challenge psychiatry’s medical model and brain disease ideas about emotional suffering and behavioral disturbances.

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While it is not taboo to report psychiatry’s poor treatment outcomes, it is taboo to blame these poor outcomes on psychiatry. Former NIMH director Insel has repeatedly acknowledged psychiatry’s poor treatment outcomes, but he does not blame psychiatry for it in his 2022 book Healing. He states, “First, most people who would and should benefit from treatment are not receiving care.” However, more people are in treatment than ever, and as the New York Times reported in 2021, outcomes have gone in the “wrong direction.” Insel also tells us that “although individual treatments work, they are rarely combined to provide the kind of comprehensive care that most people need.” However, nobody, including Insel, argues that such “comprehensive care” has worsened, yet outcomes have worsened with more treatment. Why is it not taboo for the mainstream media to report treatment outcome failure, the jettisoning of the serotonin imbalance theory of depression, and the invalidity of psychiatry’s DSM diagnostic manual? The public is simply being prepared for new treatments, new theories, and new diagnostic manuals—none of which fundamentally threatens the ruling class and ruling institutions of society.

However, it remains taboo to challenge whether or not medicalizing our emotional suffering and behavioral disturbances is the best model of care. Such a challenge, as noted, is not only an existential threat to establishment psychiatry but a financial threat to Big Pharma and a mainstream media dependent on Big Pharma advertising dollars. Even more significantly, such a challenge is a political threat to the ruling class which prefers “individual defect” explanations for emotional suffering and behavioral disturbances—rather than explanations that take seriously the direct and indirect effect of an alienating and dehumanizing society. While researchers have not linked any psychiatric condition to neurobiological variables, there are many links between these conditions and socioeconomic variables. Results from a 2013 national survey, issued by the U.S. government’s Substance Abuse and Mental Health Services Administration (SAMHSA), provide extensive evidence that unemployment, poverty, and involvement in the criminal justice system are highly associated with depression and suicidality.

Moreover, in the late 1990s, the Adverse Childhood Experiences (ACE) study revealed a powerful relationship between childhood trauma (including physical and emotional abuse) with later adult emotional difficulties and behavioral disturbances. An alienating and dehumanizing society such as ours that creates extensive anxiety, powerlessness, resentment, and rage is a society that creates adults who, in their interactions with children, have little frustration tolerance; and this lack of frustration tolerance makes abuse and trauma of children more likely—resulting in the adverse childhood experiences that create later adult emotional difficulties and behavioral disturbances.

The ruling class could not care less whether psychiatric treatment consists of bloodletting, lobotomy, electroshock, SSRI antidepressants, or psychedelic microdosing. As long as the “ruling idea” of society is that our emotional difficulties and behavioral disturbances are caused by our medical defects, this keeps us diverted from just how much shit we have to eat in order to survive and how extraordinary our good luck need be for us to find joy. As Marx stated, “The ideas of the ruling class are in every epoch the ruling ideas,” and you would have to be an especially stupid member of the ruling class not to see the value of the “ruling idea” that emotional suffering and behavioral disturbances are the result of medical individual defects—and not the result of a society that is a good deal for the ruling class but is alienating and traumatizing for many of the rest of us.”

“Drug retailer CVS and health insurer Aetna announced a $69-billion merger. Walgreens made a $5.2-billion investment in primary care provider VillageMD and took a $330-million stake in home care provider CareCentrix, giving it control of both firms. Rite Aid wasn’t as aggressive, but still built up its national footprint to 5,000 stores before cutting back to about 2,100.

The companies talked about evolving into one-stop medical providers so that “patients discharged from the hospital … will be able to stop at a health hub location to access services such as medication evaluations, home monitoring and use of durable medical equipment, as needed” (according to the merger announcement by CVS and Aetna).

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That wasn’t so long ago. The CVS/Aetna merger was in 2017. Walgreens took over VillageMD in 2021 and CareCentrix just last year.

Now, however, their dream of playing a central role in a restructured nationwide healthcare system seems to be fading.

The pharmacy chains have discovered that taking a larger role in the healthcare system than simply dispensing prescriptions and selling over-the-counter notions is more complicated and costlier than they expected.

“It has taken us longer than anticipated to realize the cost synergies across the combined assets,” John P. Driscoll, the head of Walgreens’ U.S. Healthcare division, told investment analysts at the company’s fourth-quarter earnings conference call on Oct. 12.

He said VillageMD would be focusing on “our highest opportunity markets” — evidently affluent urban areas — by shutting down in five markets and closing 60 VillageMD clinics over the coming year.

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At CVS, executives paint the effort to remake the company into an integrated healthcare provider as very much a work in progress.

“If you think about what’s happening in America relative to healthcare,” Chief Executive Karen Sue Lynch told investment analysts at a Morgan Stanley healthcare conference in September, “it’s ... very hard for people to access care.”

She said the company’s goal is “to make sure that people have seamless connected experiences across the spectrum of healthcare. And I would argue that the businesses that we’re creating will enhance the value of consumer experience.”

The tendency of the American healthcare system to confound promises and expectations was underscored in 2021. That’s when billionaires Warren Buffett, Jeff Bezos and Jamie Dimon had to admit that their plan to solve the system’s problems, as if by sheer star power — well, to be fair, through “technology solutions” — had been obliterated.

The trio had announced their venture in 2018 to a blast of worldwide fanfare. If they couldn’t succeed, it was said, no one could. The idea was that there was some magic bullet for reducing healthcare costs that had evaded everyone for years, but that they could discover.

Less than three years later, they had been subjected to a ritual mortification. Their joint venture, christened Haven, shut down. For all their efforts, primary care had not become easier for millions of Americans to access, insurance benefits were as opaque and arcane as ever, and prescription drug pricing was still a public scandal.

The drug chains’ expansion strategies have exposed them to complexities in American healthcare — political controversies, Medicare regulations, issues of prescription drug pricing — that they had not faced in the their core businesses and have led to a string of unpleasant surprises.

Walgreens became embroiled in abortion politics in March, when it said it would not distribute or ship a drug used for medication abortions in at least 21 red states, including at least four where abortions were still legal.

The company made the announcement after a group of red state attorneys general threatened it with unspecified “consequences” for shipping the drug, mifepristone, the long-assumed legality of which had been challenged in federal court.

Walgreens’ national footprint made it vulnerable to the threat — and to a backlash from blue states such as California, where Gov. Gavin Newsom said he would stop the state from doing business with the company, or any other “that cowers to the extremists and puts women’s lives at risk.”

CVS ran into the buzzsaw of Medicare politics in August, when a New York state judge blocked the transfer of 250,000 Medicare patients to Aetna’s Medicare Advantage plan. The transfer was part of a contract worth $15 billion to Aetna over five years. Medicare Advantage plans provide more benefits to enrollees than traditional Medicare but have come under fire for costing the government too much for too scanty patient gains.

The company also disclosed a potential hit of $800 million to $1 billion in its 2024 operating income from a downgrade by government authorities in its Medicare quality rankings, known as “star ratings.”

The move of CVS into the pharmacy benefit manager business through its $24-billion acquisition of the Caremark PBM in 2007 also may not have worked out as it expected.

PBMs originated as middlemen to help health insurance plans process prescription claims, steer doctors and hospitals to the cheapest drug alternatives, and allow insurers to combine their customer bases for greater leverage in negotiations with drug manufacturers. Eventually they got blamed for driving up drug costs by extracting their own profits without producing sufficient discounts for their clients.

In August, Blue Shield of California rattled Caremark by cutting most of its ties with the PBM and turning over most of its responsibilities to four competitors, in a strategy aimed at cutting its prescription costs, which come to more than $600 billion annually, by as much as $500 million a year.

That was the second blow to Caremark in a year; in November managed care insurer Centene said it was turning pharmacy benefits for its 20 million enrollees over to Express Scripts starting next year, on a $35-billion contract.

The Blue Shield announcement drove the CVS stock price down by about 9%, a reaction that CEO Lynch called “overblown” at the Morgan Stanley conference. She also cast doubt on Blue Shield’s assertion that the PBM change would save it $500 million. “We’re not earning that kind of money on that account,” she said.

As for Rite Aid, that chain has problems all its own. The firm filed for bankruptcy protection on Oct. 16, citing a crushing debt load and excessive rent for underperforming stores. The company subsequently announced plans to close 154 stores, including 31 in California.

Rite Aid is also facing a federal lawsuit for allegedly filling unlawful prescriptions, mostly for opioids. It isn’t alone in being accused of complicity in the opioid crisis: In a 2022 legal settlement with state attorneys general, CVS agreed to pay as much as $4.9 billion over 10 years, Walgreens up to $5.52 billion over 15 years, and Walmart, which has become a major competitor in the pharmacy business, up to $2.74 billion within six years.

At this moment, it’s clear that pharmacy services remain overwhelmingly the drivers of revenue and profit for the drugstore chains. At CVS last year, pharmacy services and other retail sales provided $14 billion in operating profit on $275.8 billion in revenue, versus $6 billion in operating profit on $91.4 billion in revenue from healthcare benefits.

At Walgreens, retail pharmacy sales provided $3.7 billion in operating profit on $110.3 billion in revenue in the fiscal year ended Aug. 31, 2023, while U.S. healthcare generated a loss of $556 million on $6.6 billion in revenue.

One other factor stands between the drugstore chains and their ambitions to cast a wider net over American healthcare: The presence of well-heeled rivals with ideas of their own. Walmart, the nation’s largest retailer, offers customers low-priced prescriptions and telehealth services, and has been opening walk-in clinics around the country.

Then there’s Amazon, which may have felt burned by the failure of Haven, but acquired concierge care provider One Medical in February for $3.9 billion and offers its Amazon Prime members access to scores of generic medicines for a monthly fee.

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They and their rivals in retailing and clinical services may well change the course of American healthcare in the future, but it should not be forgotten that they’re all fundamentally in it for the money. Their promises of cheaper, more efficient and more effective healthcare for the average American should be treated with the all-purpose medicine of a healthy skepticism.”

“Many pharmacy employees at some of the largest U.S. drugstore chains say they’re reaching a breaking point.

On top of verifying, filling and dispensing prescriptions, pharmacists and support staff are responsible for administering vaccines, fixing insurance issues, transferring prescriptions to other pharmacies and tending to dozens of patients in stores and over the phone, among other tasks. Those workers have said they are concerned that companies like Walgreens and CVS are placing unreasonable demands on them, without providing enough staffing or resources to safely execute tasks.

Frustrated by what they describe as increasing workloads, understaffing and cuts to their hours, pharmacy staff from Walgreens locations around the country and CVS stores in the Kansas City area have walked off the job in recent weeks — and some employees are planning to walk out again from Oct. 30 to Nov. 1.

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The two companies were the biggest pharmacies in the U.S. based on prescription drug market share in 2022. Both CVS and Walgreens operate around 9,000 retail store locations across the U.S.

CVS has more than 30,000 pharmacists and 70,000 pharmacy technicians, while rival Walgreens has more than 86,000 health-care service providers, including pharmacists, pharmacy technicians and other health-related professionals.”

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