TREATMENT ADVOCACY CENTER (TAC) USES DISHONEST SCIENCE TO DEFEND TRAUMATIC BRAIN INJURY CAUSED BY NEUROLEPTIC DRUGS
by Families for the Ethical Psychiatric Treatment of Patients and Prisoners
The role of Treatment Advocacy Center (TAC) in pushing for legislation to forcibly drug psychiatric patients is well established. If you access TAC’s website, www.treatmentadvocacydenter.org, you’ll find page after page of files delineating their fight for passage of these laws across the U.S. It isn’t until you get through about the tenth page of theses files that you come to a document called “Do antipsychotic drugs change brain structure?” This document, called a “backgrounder” and last edited by TAC in March, 2011, is worth looking at in some detail. (All quotations in the following analysis are taken from that document, accessed online on July 22, 2012).
Before we begin this analysis, a comment on TAC and the psychiatric industry’s use of the term “antipsychotic” to identify the drugs which are properly known by the term “neuroleptic”. The term antipsychotic is a so-called “disease specific” term coined by the marketing departments of the drug industry. “Antipsychotic”, by definition, would mean a drug that prevents, defers, or mitigates psychosis. These drugs, in fact, have many more far reaching effects on the human brain and body. To single out their putative effect on psychosis and label them “antipsychotic”, while calling the myriad other effects “side effects” is to fundamentally misrepresent the action that the drug has on the body. “Neuroleptic”, on the other hand, means to seize the brain, or to paralyze the central nervous system – a much more scientifically accurate and comprehensive drug action centered name for the way in which the drug actually affects the human body (for a more complete discussion of this issue, see “The Myth of the Chemical Cure”, by Joanna Moncrief). In other words, TAC begins with a basic deception in their discussion of this very important matter which lies at the foundation of their entire approach. By so doing, they hope to lend a powerful bias to their argument – the bias of prejudicial vocabulary. This fundamental dishonesty runs throughout their defense of their attack on civil liberties in the name of coercive medical intervention. We shall see just how scientific their representations really are as we analyze this paper posted on their website. (Note: wherever we are not quoting TAC directly, we shall use the term neuroleptic instead of the drug industry term antipsychotic).
FALSE CLAIM #1: SCHIZOPHRENIA AND BIPOLAR DISORDER CAUSE STRUCTURAL CHANGES TO THE BRAIN
The article begins by making the statement, “Changes in brain structure are caused both by the disease process of schizophrenia and bipolar disorder and by the antipsychotic drugs used to treat these diseases” (emphasis added). This first half of this statement is not true, while the second half is true. There is no scientific evidence that the conditions labeled schizophrenia and bipolar disorder are caused by or accompanied by structural changes in the brain. On the other hand, there is much scientific evidence that neuroleptic drugs do cause structural changes in the brain. By lumping these two claims together, one proven and one not proven, TAC lays a false basis for their defense of forced drugging as well as the theory that mental problems are caused by biochemical imbalances in the brain. We can expose this duplicity on the part of TAC by examining the evidence that TAC cites to verify both aspects of their claim.
TAC cites thirteen (13) scientific studies to back up their assertions that both schizophrenia/bipolar and neuroleptic drugs cause structural changes in the brain. Upon examination of these sources, we find that twelve (12) out of the thirteen are studies connecting brain changes to neuroleptic drugs, and only one (1) of the studies purports to show that the brains of persons labeled schizophrenic are abnormal. This is very lopsided evidence to support their thesis, so we will look at the one study that supposedly proves that schizophrenia and bipolar disorder cause structural brain changes.
TAC cites a study titled, “Hippocampal Volume Change in Schizophrenia”, published in the Journal of Clinical Psychiatry by van Haren, Cahn, et.al. in 2010. Let us look at it closely, which can be done by pulling it off the website of the Journal of Clinical Psychiatry at article.psychiatrist.com/dao.
The Objective of this paper states: “Patients with schizophrenia show reductions in hippocampal volume (no citation here, so the paper starts with a conclusion unsupported by evidence – FEPTOPP). However, the time course of these changes is still unresolved. The aim of this study is to examine the extent to which hippocampal volume change in patients with schizophrenia is confounded by effects of age and/or antipsychotic medication.” (emphasis added).
Under Method, we find the design of the experiment: “Between 1995 and 2003, two structural magnetic resonance imaging brain scans were acquired from 96 patients with DSM-IV- diagnosed schizophrenia and 113 healthy subjects within an interval of approximately 5 years. Hippocampal volume change was measured and related to age and cumulative medication intake during the scan interval” (emphasis added).
At this point, we can stop this analysis for our purposes, because it is clear that the methodology of the study is flawed if it purports to prove that schizophrenia causes structural brain changes. The study is comparing psychiatric patients diagnosed with schizophrenia to healthy persons. The psychiatric patients are being treated with neuroleptic drugs (that’s what classifies them as patients). This must be true, because treatment with neuroleptics is the standard of current psychiatric treatment for persons diagnosed with schizophrenia. The paper makes no attempt to clear up this point. Furthermore, the conclusion confirms the point:
Conclusion: “…The relationship between larger exposure to atypical antipsychotic medication and smaller hippocampal volume loss during the interval may suggest neuroprotective effects of these agents on hippocampal volume” (emphasis added).
In other words, this was a comparison study between patients diagnosed as schizophrenic who were being given neuroleptic drugs and persons without a psychiatric diagnosis who were not being given the drugs. From a scientific point of view, we must ask: How does this study prove that the difference in the brain changes between the two groups was due to schizophrenia, since all the patients were taking neuroleptic drugs? How do we know all the changes weren’t due to the drugs? The answer, of course, is we don’t know, and there is now way to tell from the design of the experiment.
If an experiment were to examine whether schizophrenia causes structural brain changes, it would have to compare a group of patients diagnosed with schizophrenia who weren’t taking (and had never been exposed to) neuroleptic drugs with a group of non-patients who also had never been exposed to neuroleptic drugs. That would be the only way to find out what brain changes might be associated with schizophrenia.
This points out the dilemma faced by TAC and all the proponents of the chemical imbalance theory of brain disorders: There is no way to test for the brain changes due solely to schizophrenia with any patients unless they (a) have never been treated with neuroleptic drugs, and (b) are left untreated by neuroleptic drugs over the time period of the study and their brain volumes, etc. measured during that time period. THIS HAS NOT BEEN DONE FOR THE SIMPLE REASON THAT, UNDER CURRENT PSYCHIATRIC TREATMENT GUIDELINES, IT WOULD AMOUNT TO MEDICAL MALPRACTICE. In fact, such a study would be cause for censure by TAC itself (since TAC advocates forced neuroleptic drug treatment), and therefore TAC would be caught in an ethical dilemma to cite such research, if it even exists. Such actions would be on an ethical par with the famous Tuskegee Experiment, wherein a group of African-American men were left to the ravages of syphilis for decades so that doctors could study the course of the disease process.
So, although we strongly disagree with the psychiatric industry and TAC that schizophrenia is related to structural brain changes (because it hasn’t been shown by the evidence), we also point out that in order to prove their assertion, they must perform studies involving persons diagnosed with schizophrenia who have not been exposed to neuroleptic drugs. There is simply no other way for their thesis to be tested. (Unfortunately for them, mice apparently do not suffer from schizophrenia, so animal experiments cannot by used to test their theory).
We also note, at this point, that in addition to the fact none of the research cited by TAC confirms their assertion that schizophrenia causes structural brain damage, the one study they cite in an attempt to prove their case doesn’t even mention bipolar disorder. So this leads us to another point of scientific dishonesty:
FALSE CLAIM #2: SCHIZOPHRENIA AND BIPOLAR DISORDER ARE ASSUMED TO BE THE SAME IN TERMS OF THEIR STRUCTURAL EFFECT UPON THE BRAIN.
TAC presents no evidence even attempting to link bipolar disorder to structural brain changes, and apparently assumes that the reader will not notice this major omission. Indeed, it is clear that TAC must assume that no one follows their assertions in this matter very closely at all (or they don’t care), because they continue on to even greater false constructions.
FALSE CLAIM #3: STRUCTURAL CHANGES TO THE BRAIN CAUSED BY NEUROLEPTIC DRUGS ARE BENEFICIAL.
To buttress this claim, the article states:
“For example, levodopa, a mainstay in treatment for Parkinson’s disease, has been shown to produce some changes in the cellular mitochondria and neuronal degeneration. Phenobarbital, widely used for many years to treat some forms of epilepsy, has been shown to produce ‘lasting effects on fine structure of cells’ in the cerebellum. And diphenylhydantoin, also commonly used to treat epilepsy, has been shown to produce ‘marked dystrophic changes in the Purkinje cell axaons; and to interfere with the formation of neuronal processes. Drugs used to treat diseases of other parts of the body (e.g., heart, joints) also may cause structural changes to those parts.”
The dishonesty here lies in the mixing apples and oranges. Levodopa is an amino acid produced naturally in the body, not a synthetically manufactured chemical. It is one of the natural building blocks of dopamine, one of the neurotransmitters in the brain. Parkinson’s disease is a real disease with a real pathology that leads to death and can be identified in autopsies, unlike schizophrenia or bipolar disorder. Therefore, to compare the action of neuroleptic drugs to the action of levodopa is not scientifically sound – the pathological mechanism of schizophrenia and bipolar disorder is only alleged and theorized – not proven, as in Parkinson’s disease.
As for the barbiturate Phenobarbital, its action on the body is sedative and hypnotic, as well as anti-convulsive. Its use is no longer part of the treatment of epilepsy in the industrialized countries, and it has never been approved by the Food and Drug Administration. It was also used by the Nazis as part of their extermination program. Again, it was used to treat a real disease, epilepsy, not mental disorders.
This is the dishonest misrepresentation of science. It depends on the reader either not being familiar with the process of scientific studies, or not checking the underlying research as it is represented. Unfortunately, this dishonesty prevails in the entire field of mental health treatment today. CAVEAT EMPTOR!