Monday, May 18, 2015

APA Annual Meeting in Toronto

For the second year in a row, the APA gave me a huge discount off the price of admission to their annual meeting, for being an advocate with an organization that they would certainly consider to be part of the fearsome "anti-psychiatry movement". (I love the irony in that... although mentioning it here may cost me in the future. I'm not sure if they're magnanimous with known enemies, or just incapable of evaluating freely available information.)

The Toronto convention was huge. It was all over the downtown portion of this beautiful city. When I arrived at Canadian immigration on my way in, the officer said she could tell what conference I was there for because I didn't look very happy about it. She added that she had overheard some very interesting conversations.

I'll just summarize a couple high points, and perhaps write more later....

My first class was on "Treatment of Schizophrenia". I'm actively litigating right now for two different clients who are diagnosed with schizophrenia, involuntarily confined and/or forcibly drugged.

One of the four presenters in this class was Rajiv Tandon, MD, who was part the DSM5 committee that dictated the newest definition and "reality" of schizophrenia itself. Dr. Tandon was surprisingly forthcoming. Among his admissions:
  • there is "incredible heterogeneity in schizophrenia;"
  • there appear to be hundreds of genetic causes and, "We don't know what this means;"
  • "We still have not defined what exactly is wrong;"
  • treatments are empirical and experimental only; the drugs are clearly not well targeted, or targeted at all for that matter, to any known specific brain pathology, thus they can cause more trouble than they're worth;
  • prophylactic treatment of any "prodrome" should be with omega-3 fatty acids, definitely not with anti-psychotic drugs.
At the end of his presentation, a young Canadian psychiatrist asked Dr. Tandon whether it was actually unfortunate that the DSM5 committee had elected to retain "schizophrenia" at all as a diagnosis. Between the "incredible heterogeneity" and the clear threat of stigma, shouldn't the concept be abandoned as both meaningless and damaging?

Dr. Tandon implied surprising agreement with this, but claimed that it was really a World Health Organization issue, after all. The APA must avoid being accused of "American imperialism" by the rest of the world, for taking so radical a step as to abolish schizophrenia. He added that, "Changing the term would imply that we know something about why it should be changed, which we don't."

So I guess the bottom line from the APA on treatment of schizophrenia (whatever that is) in 2015 equals something like, "We have no idea what we're doing, even after 100 years of trying to figure it out with billions of dollars from the public fisc. But we are very concerned about public relations..."

My second class was "Evaluation and Treatment of Behavioral Emergencies." Despite the fact that the most time was spent discussing the details of drugs new and old, there was also a prevailing opinion that the magic factor in emergency psychiatry is "de-escalation". There was much common sense in this, and some fascinating statistics. Apparently psychiatry works far better with the least possible amount of coercion (what do you know!): all five speakers agreed with the principle.

The problem of course, is that so-called "treatment of behavioral emergencies" remains essentially a euphemism for police action. There's no way to fundamentally separate it from coercion. An explicit point was made that chemical restraint, defined as treatment with drugs not to ameliorate any medical condition but only to control a person's movement, violates civil and human rights.

The disingenuous solution... and none of the speakers had any problem posing it with a straight face... was to call "agitation" a medical condition. This is no less arbitrary than the idea that all human problems of thinking, feeling and behaving are medical conditions, which is of course a central tenet of orthodox American psychiatry.

However, what was most impressive here was the apparent lack of all insight that merely presuming any agitation to be a medical condition was a semantic trick. Even Jon S. Berlin, with whom I was quite positively impressed, had no comment indicating awareness of this. 

I think it just worked too well to get these guys off the hook for chemically restraining people.