Tuesday 18th June 2024, International Congress of the Royal College of Psychiatrists, Edinburgh.
This is the third time, over the period of a decade that I have done a one-man, peaceful protest outside the International Congress of the Royal College of Psychiatrists. I retired as a psychiatrist in 2020 at the age of 51 years. I had worked for NHS Scotland for more than quarter of a century. I enjoyed my job and it was a privilege to try and do what I could to help anybody in a time of need. However, I was troubled. Why, you may ask? I was concerned about the increasing medicalisation of life and that the prescribing of psychiatric drugs was ever increasing.
Serious mental illness is awful and very real. Equally suffering due to life circumstances is very real, and few ‘escape’ it. I have always wanted, and I am sure you share this determination, to ease distress and suffering of any sort/type. However over-medicalisation is not helping . First of all, services are becoming so overwhelmed that those with serious mental illness are struggling to get the professional support, treatment and guidance that they need [this has been termed as inverse care]. Secondly, medical treatment of mental health issues – to ever increasing ‘swathes’ of the population – is supported neither by epidemiology nor by research evidence. This is true across medicine and not just psychiatry.
My training in psychiatry coincided with the Pharma-funded ‘Defeat Depression Campaign’. This campaign lasted for 5 years [1993-98] and its aims were to “educate” the public and the medical profession alike that depression is common, treatable, under-diagnosed and under-treated. This campaign was based on a theory that those who are depressed have a “chemical imbalance”. I was educated to tell patients this. I used ‘Stahl diagrams’ to explain what was ‘happening’ at the ‘neurotransmitter level’. At our weekly education meetings in Royal Cornhill Hospital, Aberdeen, we would even debate which sub-type of neuroreceptor was involved in the ‘chemical imbalance’ in any case of depression.
There are a number of influential psychiatrists who now argue that psychiatry never supported, what they now call “the trope” of a “chemical imbalance”. This is bollocks. Or bollocksology as Dr Margaret McCartney might describe it.
The Defeat Depression Campaign was based on a ‘consensus’ prevalence figure of 1 in 20 of the adult population having ‘clinical depression’.
Today, in 2024, as I write, 1 in 4 of the adult population in Scotland are taking an antidepressant. It is important to note that a significant majority of those taking an antidepressant have been taking them for considerably longer than what any available evidence would support. Psychiatric drug trials are generally short-term, 8-12 weeks, and routinely sponsored, conducted, written up and promoted by the pharmaceutical industry. These studies cannot say anything about longer term use of a psychiatric drug. Full stop.
The Defeat Depression Campaign had a number of key messages. One of these was that antidepressants were NOT dependence forming. Like the chemical imbalance theory, no robust evidence was provided by the ‘Campaign’ to support this emphatic and widely spread assertion.
Forgive me for sharing this backdrop but I feel it is necessary if you are to follow some of what I am about to share of my peaceful protest yesterday, on the pavement outside the Royal College of Psychiatrists lucrative International Congress:
18th June 2024, Edinburgh. A diary of my day.
• The 7.22 train to Edinburgh, a journey I always enjoy, travelling back to the city of my birth
• 8.20 am: arrive in Haymarket and walk up Morrison Street to the Edinburgh International Conference Centre
• Arrive at the International Congress: check with security – ask if it is okay for me to stand on the pavement outside with my banner? The senior security staff are nothing but kind: “If you have any problems, any problems at all, just say”. The sun has come out.
• 8.30 onward: fun-runners arrive back at the Conference centre. Happy, smiling faces and some sweat, but not too much
• before 9 am: Prof Femi Oyebode arrives. Introduce myself. Tell Femi how much I admire him as a ‘lad o’pairts’. We shake hands, warmly. Show Femi my banner. Ask what his thoughts on the Cumberlege Review? Prof Oyebode replies “I do not know what Cumberlege is”. A little surprised, I reply “you might want to look it up . . . . when it comes to patient safety, it is actually quite important”.
• before 9 am: spot Dr Kate Lovett, College Dean, 2016-2021. Introduce myself. Kate smiles. She is so natural. A bonny woman. I tell her that she was the best Dean the College has had. I thank her for championing values, for always being open and honest and for showing moral leadership. Kate shares with me her recent different career changes. Kate Lovett is a lass o’pairts. It is so lovely to meet her and to thank her for all that she has given to psychiatry.
• before 9 am: is that Prof David Taylor? Yes, I think so. Thinner than he looks in photos but still looks young. I feel a little anxious [given my pictograms of paid opinion leaders that, most reluctantly, I felt I had to make]. I introduce myself, offer my hand. We shake hands, warmly. I say what matters: “Thank You for writing the Maudsley Deprescribing Guidelines with Dr Horowitz”. It seems to me that Prof Taylor is both surprised and moved by this unsolicited, unexpected genuine thank you.
• before 9 am: I think I see Dr Sameer Jauhar arriving? Yes, that swarthy beard growth [like my dad used to have]. Introduce myself. Shake hands, a bit awkwardly. I don’t think Dr Jauhar has ‘worked out’ who I am. So I share more of who I am. The ‘light’ suddenly comes on. The tone of conversation seems to change. We talk about Professor Ian C Reid who I trained under in Aberdeen. Dr Jauhar then tells me – I am not sure why: “I have a photographic memory you know”. We seem to be talking at cross-purposes. I interrupt him. I apologise. This meeting is not feeling comfortable. I sense Dr Jauhar feels this too. I mention his recent widely disseminated comments relating to the Lancet meta-Analysis on antidepressants and withdrawal. Dr Jauhar says “I have done nothing wrong you know”. This seems oddly defensive. I feel more anxious. I speak too fast when anxious. I ask Dr Jauhar: “What do you think are the reasons for 1 in 4 of the adult Scottish population taking an antidepressant?” My question is side-tracked [a non-reply, if you like]. I ask – as I once did long ago with Prof Ian C Reid [my old colleague, now sadly RIP]: “how long should a patient take an antidepressant?”. . . . “6 months, 1 year, 6 years . . . ?” no real reply . . . just vagueness . . . something along the lines of ‘this is not my area’ . . . This meeting is not going well. Is my openness an issue? I think it might be. Dr Jauhar has been patient with me but understandably makes to leave. I blurt as he leaves for the Congress door [open consciousness and all that] “I think that you are in denial about the experience of many who are taking antidepressants”. Dr Jauhar replies “that’s a bit harsh” [sic]. I call back, “sorry”, but add “I do think that you are in denial”.
• 8.50 – 9 am: through the large glass front of the Conference Centre three tiers of escalators are busy conveying attendees to the auditorium to be educated. Clearly the International Congress is doing ‘rather well’! I recognise very few of the attendees. I am old now. A dinosaur!
• 8.50 – 9 am: Dr Jane Morris, Chair of RCPsych Scotland is going up the elevator. From the pavement below, I see her looking at my banner. I put my thumb up. She returns the gesture and we smile towards one another. I find myself thinking: what does Dr Morris know about the Cumberlege Review and its 9 recommendations?
• 8.50 – 9 am: Prof John Crichton is going up the elevator. Is he looking at me or my banner? Prof Crichton brought about the end of my career. I hold no bad feelings for Dr Crichton even though he used his position as Chair of RCPsych Scotland to gaslight me. I understand that he still insists that the very idea of gaslighting is a misinterpretation of his concerns for me. However, I know the truth: Prof Crichton questioned my mental health directly with my NHS employers. He did so, behind my back, because I had asked him “difficult” questions about antidepressant prescribing in Scotland [at the time he was Chair of RCPsych Scotland]. Prof Crichton is now Treasurer for the Royal College of Psychiatrists. From the pavement down below I put my thumb up to him. Time has passed. We have both moved on. From the escalator, while still going up, Dr Crichton responds with the same gesture. From this distance we smile at each other.
• 9.30 am. Most attendees have now arrived. All quiet outside. I go to buy a black coffee from a small retail shop up the road. Pass Alexander McCall-Smith’s words carved in stone: “This is a city of shifting light, of changing skies, of sudden vistas. A city so beautiful it breaks the heart again and again.” I feel so fortunate that Sandy reached out to me; encouraged me to be the artist I am, to have been an invited guest to his home on many occasions.
• 9.30 – 11 am. All quiet. Chat with security men. We have good banter! I mention to them how often I have found that psychiatrists have mistaken me [when on my protests] as a ‘Scientologist’. This is the so-called “Subjective objective divide“in action! A power imbalance where stigma lurks. This “divide” needs abandoned forthwith.
• 11.10 am. Gosh! That’s Professor Sir Simon Wessely! His casual gait and light suit mark him out. I say “hello Simon”. Initially Sir Simon acts as if he knows who I am. After a bit of chat he says “and who are you?” I reintroduce mysel’: a light bulb comes on. “Peter, you are looking well”. I reply “I am a gardener now”. I thank Sir Simon for personally communicating with me in the time that he was President of the College, but also politely say that he could have done more in relation to pharma-psychiatry and patient safety. Simon graciously replies “Yes, I guess I could”. We shake hands. This is a meeting with one of my former correspondents. In that correspondence Simon Wessely had ALL the power. He understood this. It was implicit in all his communications with me. I attempt to explain to Sir Simon how his ‘internal memo’ about me to my psychiatrist colleagues left me totally isolated [this written, as President of the College, advised caution in communicating with Dr Gordon “the one who writes to the College”].
• 12 noon. Have an early lunch a Caprese sandwich. It’s yum. The sun is out. Put on sunglasses. Just as I do, the sun hides behind the clouds!
• 12.45 pm. I think that is Prof Subodh Dave, College Dean. What great hair he has. Today, it is neatly tied up. He is chatting to pals. I gently interrupt and introduce mysel’. Prof Dave appears distracted – he is clearly very busy. I point to my banner. I ask “What is your view on the Cumberlege Report”. He gently shakes his head and looks a bit awkward. Then says “I will need to look that up”.
• 1 pm. somebody is sitting beside my banner. I jest with her “If you sit there you risk being misidentified [labelled] as a Scientologist”. She laughs. We chat. She says she is part of one of the [many] sponsorship teams for the Congress. I did not ask if she was an employee of a Pharmaceutical company. For that does not matter, she is just doing her job.
• After lunch, Prof Stephen Lawrie arrives. He is on his own. Professor Lawrie leads The Department of Psychiatry for the University of Edinburgh and is a career long paid opinion leader. He is biomedical. There can be no doubt about this. I often disagree with what he writes. He trains junior psychiatrists how to work with Industry. He does not seem to recognise over-medicalisation or iatrogenesis.
• After lunch: more paid opinion leaders arrive, such as Prof Allan Young [who featured over a decade ago on Panorama ‘Who Pays Your Doctor’]. I once gave a talk at a conference where he was the speaker before me. He did not declare his competing interests and talked about his latest drug, not yet patented, as the “Holy Grail”. He came across as pedagogical and partisan. Yet here he is today, still “educating” with Pharma’s “Ten Facts Everyone Needs To Know”. Who knows how much he has earned from pharma. A few years ago, on the same day that RCPsych published its position statement on antidepressants [finally acknowledging – after 3 decades of patient experience – that antidepressants can cause physiological adaptation, dependence and withdrawal] Prof Young stated that antidepressant dependence was “so-called” and that withdrawal is “easily managed”. This was an ‘invited’ key note lecture for the Royal College of Psychiatrists! Prof Allan Young is now marketing, with the aid of Prof David Nutt and Prof Guy Goodwin, the next generation of psychiatric drugs.
• 1.30 pm. That’s Euan! An old friend of mine! We trained together in Aberdeen. I shout his name. Euan initially does not recognise me [I am grey haired] [Euan now has little hair] He looks well. We chat as if it was only yesterday that we last met. In fact it is nearly 30 years! How life affirming to meet again and talk like yesteryear!
• 1.50 pm. It is time to go home. I head down Morrison Street to Haymarket. The sun is out. In my thoughts is an article in the Big Issue “Storytelling is the Soul of Activism”
This post is for Dr Mark Horowitz, who I met in person for the first time on the pavement outside the International Congress.
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