Well, surely we can trust all the research from NIMH, right?

Conflicts of interest at the National Institute of Mental Health (NIMH)

Well, it seems that drug companies have been paying researchers in the same way they have been funding NAMI. Let’s take the case of Dr. Charles B. Nemeroff, author of more than 850 research articles. According to the NY Times, Dr. Nemeroff:

earned more than $2.8 million in consulting arrangements with drug makers from 2000 to 2007, failed to report at least $1.2 million of that income to his university and violated federal research rules [...] Dr. Nemeroff is a charismatic speaker and a widely admired scientist who has written more than 850 research reports and reviews. He was editor in chief of the influential journal Neuropsychopharmacology (Harris, 2008).

And the Chronicle of Higher Education writes:

In the case of Dr. Nemeroff, a pattern of accepting undisclosed corporate payments goes back at least a decade. In 2003, [...] Dr. Nemeroff used an article in Nature Neuroscience to praise treatments for depression in which he had an unreported financial interest. In 2004, Emory issued a report citing him for multiple "serious" violations of its conflict-of-interest policies for protecting patients (Basken, 2010).

And Bernard Carroll (past Chairman of the Dept of Psychiatry at Duke University Medical Center) writes how Dr Nemeroff stayed silent as a junior presenter falsified parts of a Continuing Medical Education (CME) class:

[...] the video presentation one of the junior presenters stated very clearly that there was "significant improvement in both response and remission with both doses" of Seroquel. That is a falsification of the scientific record. [...] Dr. Nemeroff was required to correct this false statement made by his junior assistant, but Dr. Nemeroff failed to do so. (2009)

Other instances of failure to disclose drug company payments

And the failure to report all drug company money was not limited to Dr. Nemeroff:

The Congressional inquiry, led by Senator Charles E. Grassley, Republican of Iowa, is systematically asking some of the nation’s leading researchers to provide their conflict-of-interest disclosures, and Mr. Grassley is comparing those documents with records of actual payments from drug companies. The records often conflict, sometimes starkly. "After questioning about 20 doctors and research institutions, it looks like problems with transparency are everywhere," Mr. [Senator] Grassley said. (Harris, 2008).

What does this have to do with the credibility of the NIMH?

Dr Thomas Insel’s relationship with Dr. Charles Nemeroff

To answer that we have to examine the relationship of Dr Thomas Insel (director of the NIMH from 2002 through 2015) and his relationship with Dr. Charles B. Nemeroff. Let’s start with more from the Chronicle of Higher Education article:

Dr. Nemeroff began offering help to the now-director of the NIMH in 1994, when Dr. Insel was facing the nonrenewal of his research job at the NIH, Mr. Carroll said, bringing him to Emory to serve as a professor of psychiatry and director of the Yerkes Regional Primate Research Center. Dr. Nemeroff also led a lobbying effort that helped ensure Dr. Insel's appointment in 2002 as NIMH director, Mr. Carroll said.

Mr. Carroll, who supervised Dr. Nemeroff for six years at Duke, describes the career assistance for Dr. Insel as part of a strategy in which Dr. Nemeroff would "put people in debt to him, and then call in the chips later." (Basken, 2010).

So, the same person who reportedly accepted millions from drug companies, who was silent when a CME class was falsified and failed to make required conflict of interest disclosures, also helped Thomas Insel become director of the National Institute of Mental Health.

A deeper look into Thomas Insel, director of NIMH from 2002 - 2015

Helping Dr. Nemeroff get work

Again, from Bernard Carroll (how Dr. Insel helped Dr. Nemeroff get a job at the Univ of Miami):

What message does it send for Insel, a well known crony of Nemeroff, to blithely assure Pascal Goldschmidt at Miami that Nemeroff is "absolutely in fine standing" with NIH and that he "not only could begin applying for NIH grants as soon as he arrived in Coral Gables, but that he could also continue to serve on the NIH's expert panels that help decide on which grant applications win federal financing?" (2010).

Dr Insel’s blog post suggests that we should medicate more children

1. Dr. Insel exonerates the pharmaceutical industry with one line "And drug companies, while frequently maligned, have reduced, not increased, their marketing budgets in the US" (Insel, 2014) and cites a single source. That press release says that pharmaceutical company spending on marketing is flat, not "reduced". (FiercePharma, 2014).
2. Dr. Insel states "In light of the evidence that about 1 in every 12 youth suffer from a severe developmental, behavioral or emotional disorder, under-treatment remains a serious problem." (Insel, 2014). So, 1 in 12 kids have "severe" disorders that requires them to be medicated? More documentation should be presented to support such an extreme and dramatic claim.
3. Dr. Insel states "In fact, evidence from nationally representative surveys of youth in the U.S. challenges recent concerns regarding widespread overmedication and misuse of medications, at least in adolescents." and cites 3 sources. Let’s have a look.
• The first is an NIMH funded study done in 2013 (Dr. Insel is director of the NIMH at the time). It agrees with Dr. Insel's thesis, relying heavily on this "Only 14.2% of youth with a mental disorder during the past year reported psychotropic use, and the majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings, had a mental disorder with severe consequences and impairment, functional impairment, suicidality, or associated behavioral and developmental difficulties." (Merikangas, K, He, JP, Rapoport, J, Vitiello, B, Olfson, M, 2013)

  So much can be said about this, including how "severe" was assessed, whether these "specialty mental health settings" were regularly visited by drug company reps. When this author interned at a "specialty mental health setting," we had regular visits and free lunches from drug reps as part of the $20 billion they spend a year to "market" to health care professionals (Schwartz, Woloshin, 2019). When I casually mentioned the side effects of Risperdal, it was met with a distinctly hostile response from the clinical director.

• And then there’s the fact that the study was funded by NIMH, an agency with a track record of conflict of interest relationships with drug companies (Fava, 2007, Nature.com, 2012).
4. The other 2 studies do not appear to support Dr. Insel’s contention that adolescents should be medicated at a higher rate at all.
• The CDC study is descriptive of adolescents who use psychotropics.(Jonas, Gu, Albertorio-Diaz, 2013).
• The other study is supportive of more engagement of (and not necessarily medicating) adolescents (Hacker K, et al. 2014).

What Dr Insel’s blog post failed to mention about the overmedication of children

Dr Insel’s blog post made a weakly supported, exculpatory argument that the drug companies are largely innocent.

What facts did he ignore while extolling the benefits of medicating more kids? The substantial side effects from using psychotropic drugs.

From the 2012 book "Drugging our children: How profiteers are pushing antipsychotics on our youngest, and what we can do to stop it." [Note SGAs = second-generation antipsychotics]:

1. "When investigators [...] surveyed their juvenile patients with exposure to SGAs, they found that more than 50 percent were overweight or obese. This weight gain [...] may also cause pediatric patients to become depressed and suffer from low-esteem." (Olfman, Robbins, 2012, p. 12)

   Note the irony of giving adolescents medication to help reduce psychological problems where the medication itself may cause additional psychological problems.

2. "Endocrine dysfunction Several news stories reported on teenage boys prescribed Risperdal who have grown breasts and even begun lactating." (Olfman, et al., 2012, p. 13)
3. "SGAs can also cause an array of emotional and cognitive problems. In the TEOSS study, 26 percent of the patients reported being anxious. Other common side effects include irritability, depression, emotional lethargy, and decreased concentration." (Olfman, et al., 2012, pp. 13-14).

   Again, note the irony of drugs meant to treat psychological problems possibly causing additional cognitive/psychological problems.

4. The book also mentions "poor global health [...] long term brain damage [...] early death" (Olfman, et al., 2012, pp. 14-16)

Nothing illustrates "the undermedication of children" better than Rebecca Riley

At age 28 months (a toddler), Rebecca was diagnosed as having "bipolar disorder" and ADHD. By age 4, Rebecca was dead from an overdose of psychotropic drugs and her mother charged with murder.

Was this a case of child abuse or was there more involved? This is what the Alliance for Human Research Protection had to say:

Boston residents are jolted by news reports detailing the drug-induced death of 4 year old Rebecca Riley who had been "diagnosed" as suffering from both ADHD and Bipolar disorder at the tender age of 28 months. She was prescribed three powerful psychotropic drugs whose toxic effects have never been shown to be safe or appropriate.

[...]

Neither the ADHD/ Bipolar diagnosis nor the toxic drug cocktail which the child was prescribed — Seroquel, an antipsychotic drug; Depakote, an equally powerful mood medication; and Clonidine, a blood pressure drug–are backed by medical-scientific evidence. However, the four year old’s treatment reflects the prevailing practice in U.S. psychiatry, the pharmaceutical industry’s most lucrative specialty. (2007).

What’s your opinion of this? Should a psychiatrist be able to diagnose a 28 month old toddler with bipolar disorder and then prescribe Seroquel, Depakote and Clonidine?

Last, Dr Insel’s TED talk "Toward a new understanding of mental illness"

First, faulty analogies

To begin, this talk is a textbook faulty analogy, as it attempts to compare early interventions with physical diseases (cancer, heart disease) to early intervention in psychological issues (in this case, the highly controversial diagnosis of childhood onset schizophrenia).

Presenting COS [childhood onset schizophrenia] without important disclaimers

Dr Insel talks about childhood onset schizophrenia. So let’s address that first. From Health Psychology and Behavioral Medicine:

"COS [childhood onset schizophrenia] is a very rare illness and as such is poorly understood. This lack of understanding makes it difficult to accurately diagnose and, as a result, children with schizophrenia are often misdiagnosed. [...] and as such many clinicians are reluctant to do so. One of the key difficulties in making this diagnosis is distinguishing between true hallucinations and delusions and a child's imaginative play" (Bartlett, 2014).

Dr Insel has no such hesitation, though, in presenting COS as fact. And in his drive to portray a biological "illness", he ignores contradicting studies. From the article titled "Childhood stressors and symptoms of schizophrenia":

There are many psychiatric disorders for which severe adverse events in childhood have been shown to be significant risk factors. This is particularly true for schizophrenia." (Gallager, Jones, 2013).

And this one, 'All That Glitters Is Not Gold': Misdiagnosis of Psychosis in Pervasive Developmental Disorders - A Case Series" which states:

This article looks at problems arising from overdiagnosing psychosis in those with PDD. Four case examples of misattributed diagnosis of psychosis are described. The features that were mistaken for psychotic phenomena are described and explained and successfully treated in the context of a diagnosis of PDD. (Dossetor, 2007).

Dr Insel later shows some brain scans, showing abnormalities (Insel, 2013). Based on the research just presented, those brain scans might have indicated PDD. That possibility was not accounted for.

The research that Dr Insel does cite (again, funded by the NIMH) states "unusual psychological trauma, do not appear to account for the earlier age at onset on a clinical basis." (Rapoport, 2000, p. 177). This is directly contradicted by the research just cited in "Childhood stressors and symptoms of schizophrenia." But no matter, let’s move on to the scare tactics.

Dr Insel refers to heart attacks and arrhythmias "either one would kill you"

And compares that to early intervention with a controversial diagnosis like COS. Advocating for "early detection, early intervention" sounds like we should medicate more children. Well, look at how "early intervention" worked out for Rebecca Riley

Is "mental illness" a misleading misnomer?

Should it be called an "illness" or a syndrome?

Imagine a man is rushed to the ER and the attending doctor diagnoses him with PAI (Perforated abdomen illness). While the diagnosis does accurately describe his physical condition, it does not identify a cause. Might it be more accurate to call it a gunshot wound to the abdomen? This connects an experience (getting shot) to the physical symptom (a perforated abdomen). The problem with the term "mental illness" is that is there is no definable illness, only a syndrome. This is detailed in the 1999 report, "Mental health : a report of the Surgeon General":

The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion,- laboratory test, or abnormality in brain tissue that can identify the illness. The diagnosis of mental disorders must rest with the patients’ reports of the intensity and duration of symptoms, signs from their mental status examination, and clinician observation of their behavior including functional impairment. These clues are grouped together by the clinician into recognizable patterns known as syndromes (p. 44).

A suggestion for a better description

A more accurate description would be "PTANS" or post trauma/abuse/neglect syndromes, clearly specifying the experiences that cause (based on research noted above) psychological problems. In other words, no more "Perforated abdomen illness" used to describe gunshot wounds to the abdomen.

Why is "mental illness" so prevalent a description?

Doing a google search of the NAMI website finds the phrase "mental illness" mentioned about 11,000 times (search done Sep 15, 2019). This organization, with extensive funding from drug companies, used to promote the idea of a "brain based biological disorder" (a phrase no longer used, apparently due to lack of evidence) and now uses the "mental illness" moniker. NAMI and other "patient advocacy groups" have testified before congress, lobbied, put out "educational materials" and as I mentioned earlier, sent speakers to schools.

So the repetition of the "mental illness" meme, makes it seem obviously true. This is known as the "illusory truth effect," explained in Advances in Consumer Research:

Repetition does not seem like a sound basis for determining truth, but researchers have consistently found that people rate repeated statements as more true than non-repeated statements. This effect is known as the illusory truth effect and appears to be quite persistent. (Cronley, Kardes & Hawkins, 2006)

A story...

Sometimes, individual testimony can help make sense of this subject more than any statistics. A client (who suffered with anxiety and depression) gave permission to share one experience from their childhood (this is not a literal account but a paraphrased account of the story).

My mother screamed that she was leaving and my father followed her to the garage door. I knew where this was going when he shouted "you’re not going anywhere." I ran down stairs to find that he had started to strangle her. I couldn’t believe my eyes, I could not fathom what was happening in front of me. I started screaming and crying "please stop, please stop." I pulled my hair as hard as I could, fell to the ground and began rocking, begging him to stop "please Daddy, please stop, please." He kept strangling her and eventually she went limp and dropped to the ground.

When she came to, he still would not let her leave, so she called 911 (one of many such calls). When the police came, my mother was sitting at the top of the stairs, my father at the bottom. They immediately saw the necklace of bruises around her neck and asked if she wanted to press charges. She smiled in a strange way and said "no." They advised her that it was her right to press charges, and she still refused, still smiling oddly. They turned their attention to my father, who was staring down, blankly. "Sir, she has the right to leave if she wants to." My father kept staring down, unresponsive. The police looked at each other, visibly unnerved. "Sir, your wife has the right to leave. You can’t stop her." Still, no response.

At this point, I am pacing behind the 2 officers and I can see each of them slowly raising their right hand, one reaching for his gun, the other for his baton. I didn’t know what a panic attack was then but I was in full panic. "What am I going to do? I can’t let them shoot my father. What am I going to do?" raced through my mind. I decided that if the officer pulled his gun, I was going to grab his arm. Finally, my father said "OK."

I was 11 years old and I went to school the next day, as if nothing happened.
The incident was never spoken of again.

So it is possible that this client had a "biologically based brain disorder" (NAMI website, 2004), a "chemical imbalance" or a "genetic" problem. Or, maybe, just maybe, being exposed to life threatening episodes of domestic violence was the proximate cause of the anxiety and depression.

This case was one of many, many stories of trauma, abuse and neglect that I have heard in over a decade of practice. And what all these stories have in common is that they can logically (and intuitively) account for the psychological problems of the person who experienced them.

Cui Bono (who benefits)? A closer look at drug company influence

Alan Brandt succinctly sums it up "the best public relations work left no fingerprints" (2012).

But eventually, fingerprints (conflicts of interest) did show up for tobacco corporations in the 1950’s, for sugar corporations in the 1960’s and now, for the pharmaceutical industry. Let’s recap:

• NAMI describes itself as "the nation’s largest grassroots mental health organization," (NAMI website, undated) yet received 75% of its funding from drug companies in 2006-2008 (Harris, 2009). That is one reason why the Citizens Commission on Human Rights International called NAMI "a Pharma front group" (2009).
• NIMH research has been tainted by undisclosed conflicts of interest and an ethically compromised director, who ran the agency for over a decade. Thomas Insel, acting as an apologist for drug companies, stated that "[...] drug companies, while frequently maligned, have reduced, not increased, their marketing budgets in the US" (Insel, 2014). According to Schwartz and Woloshin (2019), that is a patently false statement. In the research that I have reviewed (funded by NIMH), there is a pattern of ignoring or marginalizing the role of trauma, abuse and neglect.
• Drug companies have almost DOUBLED their marketing spending, going from $17.7 billion to $29.9 billion in the last 20 years. Marketing to health care professionals now totals over $20 billion. (Schwartz, Woloshin, 2019).
• The repetition of the genetic/biological/"disease"/"illness" narrative by NAMI and NIMH (via Dr Insel) has caused it to gain the illusory truth effect.
• "Mental illness" is a misnomer because "there is no definitive lesion,- laboratory test, or abnormality in brain tissue that can identify the illness" (DHHS, 1999).
• There is extensive evidence that trauma, abuse and neglect results in both physical and psychological (cognitive & emotional) damage (Perry, et al., Mikulincer M, Shaver P, Felitti, et al., Perry, Pollard).
• Generous, sometimes undisclosed drug company payments to speakers known as KOLs

The former sales representative Ms Elliott says drug companies desperately need key opinion leaders. "There are a lot of physicians who don’t believe what we as drug representatives say. If we have a KOL [key opinion leader] stand in front of them and say the same thing, they believe it." (Moynihan, 2008).

So who does benefit from the conflict of interest laden research, highly compensated "KOLs" and "grassroots organizations" who proclaim (often with no basis) that "mental illness" is a biological/genetic/chemical imbalance issue?

Who benefits from marginalizing the research documenting how therapy can be effective in treating the after effects of trauma, abuse and neglect?

Fingerprints?

You decide

Occam’s razor suggests that the explanation that requires the least speculation is likely the correct one. So, it is possible that you did not actually read this article. Instead, aliens captured you, implanted the memory of the article and then erased your memory of the capture. It is a possibility and it would be hard to disprove. Of course, it is more likely that you just read the article. While admittedly an extreme example, it illustrates why speculation can easily lead one astray.

Appendix A: a note on statistics

Have you ever read that eating XYZ is bad for and then a month later, you read that it’s good for you. Welcome to the world of statistics.

Statistics are based on correlation and correlation is not proof of causation. Correlations are always vulnerable to what is called a "lurking variable" which "a variable that is unknown and not controlled for; It has an important, significant effect on the variables of interest." ("Lurking Variable: Simple Definition, Examples", 2018).

Here is an example of how correlation can be misleading. There is a 99% correlation between margarine consumption per capita and the divorce rate in Maine (Fletcher, 2014). Should people stop eating margarine to prevent divorce? Of course not, but that is how correlations can be misleading, creating connections and relationships where there are none. Go to http://www.tylervigen.com/spurious-correlations to see hundreds of absurd correlations.

So be wary of federal agencies with a history of compromised research, industry funded "consumer advocacy groups" and especially skeptical of research that is funded by for profit corporations (e.g., tobacco, sugar and pharmaceutical).

And don’t worry, you can still eat margarine without causing divorces in Maine.

Appendix B: Does this mean that parents should feel guilty?

For the vast majority, no. Most parents raise their children the way they were raised, coupled with some informal learning (Miller B, Myers­-Walls J, 1983). Parenting is a stressful, demanding job and occasional issues are to be expected.

However, if someone’s parenting included sexual abuse, damaging levels of physical abuse or severe emotional abuse, then yes, guilt is appropriate. The best use of this guilt would be to seek counseling to understand what motivated the negative behaviors and then to offer remorse and amends to the children harmed.

Appendix C: the parting words of President Eisenhower

Warning against the enormous power and influence of the military industrial complex, he says:

This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence -- economic, political, even spiritual -- is felt in every city, every State house, every office of the Federal government.

[...]

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.(Eisenhower, 1958).

Can the same be said of the enormous power and reach of the drug companies?