Never a good look

December 2011

Khari with LBA – July 2005 Edmonton

Interviewing Dr.Warme

Robes

Magic Moore

"I understood that everything people talk about with regard to magic is all absolutely true as long as you understand that it is happening inside peoples minds...it must be like treating the space inside our minds as a kind of territory."

A Placebo Cure?

John Livingstone is a "trained therapist, clinical hypnotherapist, and past-life regressionist," a self-avowed "spiritual counselor" and "exorcist" specializing in the neutralization and/or removal of "spirit entities (ghosts), demons, dark ETs (reptilians, greys), etheric implants, and dark portals." Payment is conducted through paypal (donations only!). Many report to have been helped through telephone lines and email. While I don't personally subscribe to this type of treatment, Dr. Gordon Warme's book Daggers of the Mind has me thinking of the profound nature of placebo cures. While I am skeptical and generally label certain folks as grifters, Mr. Livingston seems to provide a service that people are willing to pay – rather donate – their money for a cure. Especially when dealing with realms of the mind and/or the spirit of the believer; who's to say that "Curse Depowering" isn't the answer? Even though I am very confident such a treatment wouldn't have any effect on my sensibilities, isn't it possible that others might benefit?

Biobabble

A cautionary tale

Gordon Warme

More than any other medical specialty, psychiatry is prey to groundless theory; I say this as one who practises in the field. Our patients show no objective signs of abnormality, and despite our rhetoric there is no evidence that any psychiatric disorder is biological. Emotional uproar, tragedy, wild accusation and despair are still the stuff of our everyday work. And yet, being doctors, we hunger for “real” diseases to grapple with, diseases that will yield up biological causes, thus offering hope for specific treatments and definitive cures. From psychobabble, we've moved on to biobabble.

This longing to treat disorders with a physical substrate makes us vulnerable to dangerous nonsense such as insulin coma treatment, lobotomies and theories of chemical imbalance. It is this vulnerability that inspired sociologist Andrew Scull to write this cautionary tale, the strange story of Dr. Henry Cotton.

Cotton was superintendent of the New Jersey State Hospital from 1907 until 1930. During his tenure he became enthralled by the idea that madness was caused by hidden foci of infection — an idea that, although on its deathbed, was still around when I was a medical student. Diligent eradication of such infections would, Cotton thought, wipe out the scourge of mental illness. He had the support of his profession, especially his mentor, Adolf Meyer, chief of psychiatry at Johns Hopkins Medical School.

Cotton's convictions led him to radical intervention: he treated all patients by surgically removing every potential site of infection. Teeth, tonsils and the colon were his favourites, but the spleen, uterus and bladder were also suspect. His surgical death rate was scandalously high — hundreds died —and, contrary to his own claims, cures were uncommon.

Adolf Meyer was commissioned to investigate, and assigned this job to his most brilliant student, Phyllis Greenacre. Her findings were devastating. It is a sad fact that Adolf Meyer suppressed her report: medical solidarity had gone mad.

How is it that the medical establishment could have been so easily fooled? Think of bloodletting, purges, diets, mountain air, mustard plasters, magnetism, sexual abstinence — you name it, someone has recommended it. In this age of evidence-based medicine, we are presumably less vulnerable — except in psychiatry. Because we have nothing objective to study and measure, we rely on patients' opinions of whether our treatments work. But even a questionnaire (a trick that makes us think that, like real doctors, we have a “test”) leaves us at the mercy of the placebo effect. We can't produce objective proof that even our most successfully propagandized treatment, antidepressants, does anything.

This is what befuddled Henry Cotton. Some patients probably improved, but time showed he had cured no one. His discouraging long-term outcomes are echoed by modern studies that conclude that, in the long term, schizophrenic patients treated with neuroleptics do no better than those who don't get them. Never mind that many studies are flawed: if the results with and without neuroleptics aren't different enough to be easily distinguished, we know the treatment isn't doing much. But, in the short term, because they suppress unattractive behaviour, treatment with neuroleptics makes physicians and family members feel more comfortable; we feel we are doing something, even though the long- term effects should cause us disquiet.

When we are too enthusiastic, we doctors make errors: in a state of furor therapeuticus, as a precautionary measure, Henry Cotton removed teeth from members of his own family. Curb your enthusiasm, I say. Medical sobriety trumps medical passion every time. Treat yourself to Andrew Scull's new book, a fast-paced thriller that reminds us that fervour can lead us astray.

Gordon Warme Centre for Addiction and Mental Health Toronto, Ont.

Lifted from CMAJ

Kwame McKenzie

Tranquil Prisons

Erick Fabris had his book launch last night for his work Tranquil Prisons. He teaches mental health and madness history at Ryerson University. Buy a copy here...

A brave and innovative book, Tranquil Prisons is a rare academic study of psychiatric treatment written by a former mental patient. Erick Fabris's original, multidisciplinary research demonstrates how clients are pre-emptively put on chemical agents despite the possibility of alternatives. Because of this practice, patients often become dependent on psychiatric drugs that restrict movement and communication to incarcerate the body rather than heal it. Putting forth calls for professional accountability and more therapy choices for patients, Fabris's narrative is both accessible and eye-opening.

McLean's Magazine (June 2006)

The meaning of crazy

Dr. Gordon Warme argues there's no biological basis for mental illness

BRIAN BETHUNE

Dr. Gordon Warme is 73, a distinguished psychiatrist who taught at the University of Toronto for three decades, and the proud new owner of a pionus parrot from South America, a genus known for its subtle coloration and relatively quiet voice. He's also a heretic -- a psychiatrist and psychoanalyst who maintains, in a polite and muted fashion, that there isn't a scrap of evidence that mental illnesses are caused by any biological dysfunction. Warme argues in Daggers of the Mind, a humane apologia for his profession, that science, and drug-obsessed psychiatrists, are charging down the wrong track, misleading patients and forgetting that "most, if not all, of the effects of psychiatry are magical."

"Psychiatrists committed to biological explanations," Warme says in an interview, "will show me brain scans and point out tiny abnormalities in a high percentage of the brains of schizophrenia patients -- but the same range of imperfections will show up in healthy people's brains. If I push them and say, 'Show me evidence,' they'll finally say 'You're right,' but they don't want to talk about it. If you want to get ahead in our profession you have to write papers that promote this nonsense. And that's morally wrong. To tell our patients -- without any evidence -- that they have abnormal brain chemistry is just as crazy as some guy over there shuffling, grunting and staring into space."

This is heresy indeed, in an era in which the biological roots of virtually every unhappiness is an article of faith among experts and lay people alike. The sharp point of Warme's spear is aimed straight at schizophrenia -- the mental disorder most adamantly portrayed as an organic disease by those who treat it, and by the families of those who suffer it. Any textbook, any website devoted to the condition, opens with a confident statement of fact -- Warme would call it superstition: schizophrenia is a brain disease. Only further in will the reader find what Warme points to as telltale signs of pseudo-science -- researchers "do not yet understand all of the factors," or "it appears likely that."

Warme argues that psychiatrists have forgotten that illness is a metaphor for what they are observing -- a very useful metaphor, Warme agrees. The disease concept "removes the urge to fear or hate, the judgmental element." But it adds a declaration of biological abnormality -- read biological inferiority, according to Warme, who considers the label an affront to the autonomy and human dignity of his patients.

What, then, does a skeptical and infinitely curious headshrinker, a mental health professional who tosses around words like "crazy" and "mad" in exactly the same way as regular folks do, make of schizophrenia and other mental disorders? It's worth bearing in mind that heresy, too, is only a metaphor, for Warme offers no counter-church with an absolute truth of its own. "Madness," he says slowly, "is another way of life, another way of being human. Schizophrenia is stable across time and place; its roots are archetypical -- every culture provides its members with a blueprint on how to be mad."

The suffering is real, and so is the help experts provide. But what psychiatrists actually do is not far removed from the rituals of a Mayan shaman waving a chicken over a troubled patient. Even drugs, which have a success rate barely distinguishable from that achieved by sugar pills, function entirely through the placebo effect, what Warme calls the enchantment or magic of his profession. "That's where I really get into trouble," he says, "when I say all psychotherapy is a placebo, when I tell my closest associates that for all the good we can do through wise talk and encouragement, we do not cure our patients, because they never had a disease."

What do his own patients think? "For 20 years I've seen people who came to me saying they were depressed. After 10 minutes they never say the word again, even if I see them for five years. It's clear to me that 'depression' is a magic entry phrase to one of the wise men." And unhappy people have even more practical reasons for claiming depression: "Does medicare pay for you to go to a doctor to say 'I'm not getting along with my husband'?" Warme asks sardonically.

Human suffering is eternal, Warme believes -- there will never be a biological, drug-based fine tuning that will end it. Warme has no objection to any relief that can be offered without serious side effects, from drugs to electroshock to sacrificed chickens. But as a rational humanist skeptic, what he really believes in is the aesthetic cure. "In films, books and operas, we discover human nature writ large, with complexities, blemishes and perversities included. Like psychiatrists, art invites you to wrestle with ghosts. I listen to my patients and they tell me the same archetypical stories I read in Homer." His job, Warme figures, is to convince patients to become more conscious creators of their own selves, "to look over the way they have lived their lives, to tell them that the story you have lived up to now -- you might benefit from a different story."

SENT.

A typical Conspiracy pose.

August 2011 (Edmonton)

A.P.A.B.O.

July 2011 (Part II)

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July 2011