Written Testimony – Mandated School Mental Health Curricula

Written Testimony on SF 261 – Mandated School Mental Health Curricula
Karen R. Effrem, MD
President – Education Liberty Watch

Thank you, Senator Torres-Ray, for your concern for children and youth and for the mentally ill.  Although the intentions are good, Education Liberty Watch has many concerns with SF 261, including dilution of academic curriculum content, loss of local control and cost for already strapped districts, our biggest ones are the subjectivity of mental health diagnosis, controversies in treatment, huge potential for political bias in diagnosis and treatment, and conflict of interest of the pharmaceutical industry, none of which are discussed in the national health education standards.  We believe that this bill would create a biased and potentially dangerous curriculum for students. Here are a few examples:

• Even the top echelon of experts in psychiatry admit that diagnosis is very subjective:

Dr. Dilip Jeste, president of the American Psychiatric Association, in a statement on the completion of the new about to be published edition of the bible of psychiatric diagnosis, the Diagnositc and Statistical Manual (DSM-V), said last December:  “At present, most psychiatric disorders lack validated diagnostic biomarkers, and although considerable advances are being made in the arena of neurobiology, psychiatric diagnoses are still mostly based on clinician assessment.”  In plain English, that means that all psychiatric diagnosis is an educated guess.

Dr. Allen Frances, chief editor of the current edition of the DSM put it much more bluntly in a 2010 interview:  “…there is no definition of a mental disorder. It’s bull****. I mean, you just can’t define it.”

• The DSM-5 committee debated adding extreme racism and homophobia as a new diagnosis in the most recent version of the diagnostic manual set to come out this Spring (2013).

“Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs. ‘We treat racism and homophobia as delusional disorders,’ said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. ‘Treatment with antipsychotics does work to reduce these prejudices.’” (Vedatam, 12/10/05, Washington Post, emphasis added)

“As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.  Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.” (Vedatam, 12/10/05, Washington Post, emphasis added)

• The latest changes in the DSM are very controversial and according to experts like Dr. Frances and others will lead to even more over-diagnosis and more over-treatment with medications that have very limited efficacy and severe or fatal side effects

The decision to create a pediatric bipolar diagnosis in the current DSM-4 led to a 40 fold increase in that diagnosis in children, affecting African-American children most severely.  This is probably because Medicaid is the largest purchaser of antipsychotic medications used to treat those labeled with this disorder.

In the new DSM, about to be published this year, temper tantrums are now to be labeled as Disruptive Mood Dysregulation Disorder and the manifestations of the normal process of grief are now considered symptoms of Major Depressive Disorder.

• The side effects of medications used to treat mental illness are very significant and severe:

To varying degrees,  all psychiatric drugs are associated with both increased suicidal thoughts and ideation as well as akathesia, an extreme inner sense of agitation, which can and has been associated with at least 64 incidents of violence at schools, including mass shootings like Columbine, Red Lake, and as it appears, Newtown.  There are at least two reports that have not been discredited that Adam Lanza was on some type of medication.  Here is a chart showing the gun related incident resulting in deaths in the US derived from www.ssristories.org:

Antipsychotics (Zyprexa, Seroquel, etc.) – 25 year shorter life span, brain shrinkage, severe neurological problems in 60% of children that take them, more severe metabolic problems than in adults that include diabetes, weight gain, male breast development, as well as heart attack and stroke in young people.

Antidepressants (Prozac, Paxil, etc.)– For young people under 24, these drugs carry the FDA’s black box warning, the most severe warning short of a ban because of suicidal thoughts and attempts.  They also cause akathesia, even more so than the antidepressants.

ADHD Drugs (Ritalin, Adderall, etc.) – Associated with psychosis, hallucinations, sudden cardiac death and weight loss

• Psychiatric drugs do not have a great track record of effectiveness:

Antidepressants – “Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.” http://jama.amassn.org/cgi/content/abstract/303/1/47

Antipsychotics – “40% of patients diagnosed with schizophrenia who were NOT on antipsychotic drugs showed periods of recovery and better global functioning compared to only 5% of patients taking antipsychotics (p=.001). ‘These analyses indicated that in addition to the significant differences in global functioning between these groups, 19 of the 23 schizophrenia patients (83%) with uniformly poor outcome at the 15-year follow-ups were on antipsychotic medications.’”(Harriow, et al Do Patients with Schizophrenia Ever Show Periods of Recovery? A 15-Year Multi-Follow-up Study, Schizophrenia Bulletin vol. 31 no. 3 pp. 723-734, 2005. as reported by Sharav, www.ahrp.org, 5/23/07)

A 2006 Oregon State University review of 2,287 studies involving ADHD drugs found no long-term safety or effectiveness of those drugs in children.

• There is very significant influence of the pharmaceutical industry on diagnosis and medication prescribing

“All DSM task force members on mood and psychotic disorders tied to drug industry” (Critical Think Rx, Module 8, slide 37, http://criticalthinkrx.org/pdf/m8/Module-8-Complete-Slide-Presentation.pdf)

“From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.” (Carey, et al, Psychiatrists, Children and Drug Industry’s Role, New York Times, 5/10/07)

“In 2007, a series of investigative reports revealed that an influential advocate for diagnosing bipolar disorder in kids, the Harvard psychiatrist Joseph Biederman, failed to disclose money he’d received from Johnson & Johnson, makers of the bipolar drug Risperdal, or risperidone.” (Greenberg, Inside the Battle to Define Mental Illness, Wired Magazine, 12/27/10)

“As reported to Senator Grassley, pharmaceutical companies contributed an average of 56% of national NAMI’s budget annually for the period 2005 to 2009” LETTER FROM NAMI EXECUTIVE DIRECTOR MICHAEL J. FITZPATRICK, April 28, 2009 http://www.mindfreedom.org/kb/psych-drug-corp/nami

If experts have this many disagreements, how can teachers be expected to properly teach this issue? Given all of these controversies, combined with the problems that I mentioned at the beginning at the beginning of this testimony due to cost, erosion of local control, and dilution of academics, mandating this kind of controversial curriculum is clearly not in the best interest of Minnesota students.  Instead we urge the legislature to allow schools to concentrate on their primary job of education and make sure the public is aware of the dangerous side effects of psychiatric medications and their lack of effectiveness.  Many studies show that two parent families that are the best form of mental illness and poverty prevention mechanism there is.  Welfare and divorce reform would help our children far more than another mandated curriculum.  In addition, there needs to be a formal inquiry into the role of psychiatric drugs in every incidence of mass violence.  Thank you.