Objective: Many thousands of people still receive electroconvulsive therapy (ECT) but it remains highly contested. A recent audit of the United Kingdom patient information leaflets found multiple inaccuracies and omissions, minimizing risks and exaggerating benefits (e.g., only six leaflets mentioned cardiovascular events). This study reports efforts to improve accuracy for patients and families. Methods: Letters were sent twice to managers of all 51 United Kingdom National Health Service Trusts, (regional bodies which deliver most healthcare) detailing the audit’s findings and the accuracy of their own Trust’s leaflet, also asking what changes would be undertaken. Results: Only nine Trusts responded and three committed to improvements. The Royal College of Psychiatrists released a slightly better but still highly misleading information sheet. Efforts to engage Government and all other relevant United Kingdom bodies failed. Conclusions: Trusts are unwilling to correct misinformation/ provide balanced information.

Mainstream psychiatry is unable to decide on its model of mental disorder. While the great bulk of research is biologically oriented, many practitioners prefer a more holistic model integrating biological, psychological, and social factors. The “biopsychosocial model” attributed to George Engel appears to offer theoretical support, but the evidence is that it does not exist in any form suitable for science. This puts psychiatry in an invidious position, exposed to allegations of misconduct with no obvious defense.

In 1962, in the wake of the thalidomide crisis, a new Amendment to the Food and Drugs Act introduced Randomized Controlled Trials (RCTs) into the regulations governing the licensing of medicines. It was believed that requiring companies to demonstrate their products were effective through RCTs would contribute to safety. In 1962, RCTs were a little-understood technique. It was thought trials would produce generalizable knowledge with similar outcomes for successive trials. As a result, regulators adopted a criterion of two positive placebo-controlled trials for licensing medicine. For physicians keen to stall therapeutic bandwagons and eliminate ineffective treatments, a negative RCT result was a good outcome. When it made a gateway to the market, companies, in contrast, had an interest to transform RCTs from assessments that might throw up unexpected or negative results into Randomized Controlled Assays (RCAs) that efficiently generated approvable results. This article outlines the differences between RCTs and RCAs, the steps companies took to transform RCTs into RCAs, and the consequences of this transformation.

Medications to treat attention deficit/hyperactivity disorder (ADHD) can increase students’ ability to stay awake to cram for exams. Although popularly viewed as “academic steroids,” there is no evidence that ADHD medications promote complex cognitive functioning or scholarship. To the contrary, compelling new evidence indicates that ADHD drug treatment is associated with deterioration in academic and social-emotional functioning. Yet, ADHD diagnosis and drug treatment have risen unabated for decades. Today, ADHD medications are so prevalent on college campuses that students falsely perceive these drugs as relatively benign and freely use them for nonmedical reasons, resulting in record numbers of adverse events and deaths. This article describes the nature of the ADHD drug abuse epidemic, rules some colleges have implemented to manage risk, and actions that any educational institution may consider to combat ADHD drug abuse and to promote student health and campus safety.

The 35-million-dollar Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study is the largest antidepressant effectiveness study ever conducted. STAR*D enrolled 4,041 depressed patients and provided them with exemplary free acute and continuing antidepressant care to maximize their likelihood of achieving and maintaining remission. Patients who failed to get adequate relief from their first antidepressant were provided with up to three additional trials of pharmacologically distinct treatments. This article identifies numerous instances of apparent bias in the conduct and reporting of outcomes from this study. In contrast to STAR*D’s report of positive findings supporting antidepressants’ effectiveness, only 108 of its 4,041 patients (2.7%) had an acute-care remission, and during the 12 months of continuing care, these patients neither relapsed nor dropped out. This article also discusses the roles of the American Journal of Psychiatry (AJP) and the National Institute of Mental Health (NIMH) in promoting the biased reporting of STAR*D’s results.

Electroconvulsive therapy, also known as shock therapy and electroshock, is a psychiatric treatment that sends electricity into the brain of the patient with the purpose of inducing a seizure in that patient’s brain. A brief overview of relevant literature introduces an autobiographical narrative account of what it is to experience shock therapy. The author, a woman who had been given a diagnosis of schizoaffective disorder to explain her natural and expected responses to trauma and adversity, concludes with a critically reflective commentary on ECT.

Ongoing farmers' protests have once again brought back the spotlight on the agrarian crisis in India. Even though upstream factors that perpetuate farmers' suffering, including the role of the state in promoting agrocapitalism, have been discussed extensively by scholars and activists across the spectrum, mental health discourses almost always frame it as a mental health problem to be addressed by increasing access to psychopharmaceuticals. Drawing on developments around farmers' protests and analysis of articles published in flagship journals of largest professional bodies of clinical psychologists and psychiatrists in India, I highlight the intimate relationship between neoliberal state and farmers' distress to which the mental health system shuts its ears and eyes obscuring and downplaying socio-structural determinants of farmers' mental health.

This essay is a critical review of recent collections of articles by friends and colleagues of Thomas Szasz. Apart from the usual misunderstandings and wilful misinterpretations of Szasz's social psychology generally and critique of mental illness specifically, his friends and colleagues add a new dimension to Szaszian criticism by damning him with faint praise. Ignoring his indebtedness to social psychologist, George Herbert Mead, they interpret his work as an ideological defence of libertarianism, rather than as a logical critique of mental illness. A defence is, therefore, especially indicated.

This article develops the thesis that feelings of unhappiness and depression are an inherent and unavoidable part of being alive. Depression should not necessarily be seen as a medical illness or as a type of mental illness. Of course, frequently occurring feelings of depression that create distress and dysfunction should be properly evaluated before developing potentially effective interventions. Mainstream perspectives offered by the National Institute of Mental Health and alternative perspectives on both the nature of depression and ways of supporting individuals struggling with depression are offered in this article. Antidepressants are now the most widely prescribed drugs in the United States. Critical reviews of the value of antidepressants have found them lacking both in terms of efficacy and safety. Effective and safe interventions should be based on accurate assessments of what is contributing to disabling and recurrent feelings of depression. Appropriate evaluation of sleep patterns, exercise, nutrition, stress factors, cognitive factors, medical illnesses, and so on, need to be conducted as a foundation for developing appropriate interventions. Any effective intervention needs to be based on the well-established medical dictum, “first, do no harm.”

Psychiatrist Eugen Bleuler declared in 1911 that the primary trouble in the “schizophrenias” is the thinking disorder. Now, a century later, epidemiologic evidence shows that the prevailing disease model is misleading and that the somatic treatments are more damaging than helpful because they rapidly increase disability rates and fail to help patients achieve adaptive thinking ability crucial for fully functioning living. Schizophrenia is claimed to be a disease like diabetes although the “newer antipsychotics” can cause actual diabetes.

Empathizing with and understanding the characteristic dynamic gestalt of terror, loneliness, hopelessness, and need for witting awareness can lead to developing crucial thinking ability as terror becomes intense constructive motivation to learn. This orientation, fundamentally opposite in direction from the standard drug treatment, is illustrated with several examples of persons hospitalized for schizophrenic breakdowns. When unhampered by the prevailing drug treatment and focused on the central interpersonal issues, psychotherapy can lead to high levels of adaptive thinking ability in what were persons with severe psychosis. Consequently, persons with schizophrenia can experience for themselves that schizophrenia is neither incurable nor a disease.