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The last decade of my medical career was perhaps the most intellectually and clinically rewarding years that I spent as a physician – although they were also the least remunerative.  Having abandoned my attempts, after years of trying, to conform to the new corporatized form of American medicine where patients became “things” in the shareholder-based, for-profit “industry”.
The Big Business of Medicine was being increasingly administered by financial (not medical) experts who had all graduated from prestigious MBA schools (Masters of Business Administration programs - where the term “business ethics” is considered an oxymoron). The new hospital and clinic administrators seemed to many of us old-timers to be unaware that there was at one time something called “medical ethics”. Medicine as the honorable profession it once was, was soon changed for the worst – probably forever - and the biggest losers were the patients.
The new business-savvy administrators that came on the scene back then manage health industries by the textbook, just like the other MBA graduates who were being eagerly hired by the (never ethical) entertainment, financial, advertising, gambling, war-profiteering, weapons, drug or prostitution industries. The idea, of course, was to make as much money as possible for their investors and fellow managers, patient ethics be damned.

The Curse of Big Business, Big Pharma, Big Medicine

During America’s build-up to convert the vocation of medicine into a highly profitable and impersonal Big Business, most of these clever managers successfully sold most of us physicians on the idea of converting compassionate, independent, hometown clinics and small hospitals into regional or national HMOs - that mythical so-called “preventive medicine” notion that was supposed to hold down the costs of health care. The physicians would, at the same time, relinquish the financial control of things to non-medical administrators who would “take care of business” far away from the clinic, where patient’s real needs were being gradually ignored.
One of the first steps of this new model was to begin referring to patients as “consumers” and re-labeling physicians as “providers”, clever labels that seemed innocent enough until we realized too late that the term “consumer” was diminishing the humanity of our patients. Soon we “providers” were callously limiting our patients to only one complaint per visit and writing quick band-aid prescriptions because it was faster and more “efficient” than doing the time-consuming work of trying to cure the problem. Soon management was refusing to allow us to see patients who had no health insurance; we were sending the late-payer consumers to collection agencies; and we were referring to our increasingly anonymous (but still suffering) patients as “the gall bladder in Room 210”.

Eventually the Big Business of Medicine, while proclaiming to achieve lower costs (and higher profit margins), was spending a lot of new money by adding irrelevant and very expensive non-medical “middlemen” (like corporate middle managers, big advertising budgets, expensive high tech machinery, fancy building expansions, and lots of insurance policies, consultants, accountants and malpractice lawyers). We were told that every new expense was just part of the cost of doing business. And while all these changes were being made the high costs of the Big Business of Medicine and Pharmaceuticals were condemning many of our “now-less-than-human” consumers into personal bankruptcies and foreclosures – while simultaneously adding to the risk of national insolvency.

The Big Business of Medicine is Killing the Golden Goose

Who among us is unaware of the massively escalating costs of health care, insurance, co-pays, deductibles, and the increasingly unaffordable, addictive and non-curative, “life-long” use of prescription drugs. Who hasn’t been angry about the hospitals charging $5 for an aspirin pill, the over-priced medical supplies, the increasingly unaffordable office calls and surgical procedures and the heartless collection agencies that make life miserable for those unfortunates who choose to feed their children instead of paying off the medical bills when there isn’t enough money for everything.
    
Part of my heightened awareness over the decades about what was going on in the transformation of American medicine during my 40 years in medicine (after “burning out” from 20+ years of rural family practice at a small clinic in one of the poorest counties in Minnesota), was the fact that I worked at a mental institution, providing non-psychiatric care for the in-patients who had been diagnosed as chronically “mentally ill”, drug-impaired, “criminally insane” or who had been involuntarily incarcerated for one reason or another.

Every one of the patients that I had contact with had, usually in their childhood or adolescent experiences, been victimized by serious (and usually prolonged) physical, sexual, emotional or spiritual abuse and/or neglect and each of them had taken various combinations of potent, disabling, brain-altering, neurotoxic psychiatric drugs for years or even decades before they had been admitted. Some of them had also had been subjected to courses of equally brain-disabling electroshock “treatments” that had not made them any better.

PTSD and Psych Drugs: Common Denominators in Mental Ill Health

Most importantly, every one of the patients I encountered easily qualified for a diagnosis of totally preventable PTSD (posttraumatic stress disorder - for which, by the way, there is no FDA-approved psychiatric drug). Interestingly, none of my patients had ever been diagnosed with PTSD.

In my face-to-face encounters with these doomed patients, I found myself recognizing the humanity in each of them, even though the drugs obscured much of it. I also realized that each of them at one point in their lives, prior to their victimization by various forms of violence or neglect, had had normal intelligence, creativity and real prospects for normal lives if only they had been had nonviolent child-rearing, nurturing educational opportunities, brain-healthy, non-toxic nutrition, and had been lucky enough to avoid toxic or addicting drugs, either legal or illicit.

During my years at that institution, I did a lot of research about PTSD which, I soon came to realize, was an epidemic root cause of mental illness labeling for centuries in our world’s neglectful, violent, militarized, racist, sexist, malnourished, sleep-deprived, punitive and poverty-laden society. None of the patients that I saw at that institution actually had a mental illness of “unknown etiology”, and therefore each of them had been victims of preventable early life problems that could have been cured by good compassionate psychotherapy, adjunctive brain nutrient therapy and gradual drug withdrawal without the need for permanent/life-long drugging.

So, when the time came for me to decide what type of medicine that I wanted to practice at the end of my career (and that was also outside of the control of the Big Business model), I decided to put the above learned lessons and theories to the test and set up an independent practice that I called holistic mental health care. That practice soon evolved into one where most of my patients were coming to see me desperately aware that they might never had actually been mentally ill and that they were also being sickened and even mentally disabled by the synthetic prescription drugs to which they were also addicted.

So, in contemplating all of the above, I was heartened to recently come across an important peer-reviewed journal article published in 2011 that was authored by a psychiatrist whose many books have informed me over the past two decades. The article was published in the International Journal of Risk & Safety in Medicine [23 (2011) pp. 193–200].  

The author I am referring to is Dr Peter Breggin, whom I regard as one of many of my mentor (mostly because of his books and journal articles and some personal communications we have had. (The link to Dr Breggin’s website, which is packed with practical information for both professionals and laypersons, is www.breggin.com). Breggin is Director of the Center for the Study of Empathic Therapy and has a private practice in Ithaca, New York. His newest book is titled Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.

Dr Breggin is the author of many important books that have been basically black-balled by the American Psychiatric Association and Big Pharma, mainly because the whistle-blowing  information in the books that would adversely impact the financial health of the psychiatric and pharmaceutical industries that have come to rely on the widespread use dangerous and addictive psychoactive drugs. I hope that honest and interested “consumers” and “providers” of standard American drug “therapeutics” will check out some of the these books by Dr Breggin: “Brain-Disabling Treatments in Psychiatry”, “Toxic Psychiatry”, “Talking Back to Prozac”, “Talking Back to Ritalin”, “Medication Madness”, and “Your Drug May be Your Problem: How and Why to Stop Taking Psychiatric Medications”, among others.

Below are excerpts from Breggin’s article in which he proposes a useful new set of psychiatric diagnoses. The article is titled

“Psychiatric drug-induced Chronic Brain Impairment (CBI): Implications for long-term treatment with psychiatric medication”

Abstract

“Understanding the hazards associated with long-term exposure to psychiatric drugs is very important but rarely emphasized in the scientific literature and clinical practice. Drawing on the scientific literature and clinical experience, the author describes the syndrome of Chronic Brain Impairment (CBI) which can be caused by any trauma to the brain including Traumatic Brain Injury (TBI), electroconvulsive therapy (ECT), and long-term exposure to psychiatric medications.

The syndrome of Chronic Brain Impairment (CBI)

“The clinical effect of chronic exposure to psychoactive substances, including psychiatric drugs, produces effects very similar to those of closed-head injury due to traumatic brain injury (TBI) or the Post-concussive Syndrome. Generalized or global harm to the brain from any cause produces very similar mental effects. The brain and its associated mental processes respond in a very similar fashion to injuries from causes as diverse as electroshock treatment, closed head injury from repeated sports-induced concussions or TBI in wartime, chronic abuse of alcohol and street drugs, long-term exposure to psychiatric polydrug treatment, and long-term exposure to particular classes of psychiatric drugs including stimulants, benzodiazepines, lithium and antipsychotic drugs.

“Based on these observations I have proposed the syndrome and diagnosis of Chronic Brain Impairment (CBI). The specific cause of the CBI is added as a prefix, as in Alprazolam CBI, Antipsychotic Drug CBI, or Poly Psychiatric Drug CBI. Other examples are ECT CBI, Polydrug Abuse CBI, and Concussive CBI.

Symptoms and characteristics of CBI

“CBI leads individual patients to seek psychiatric help for themselves, but often they do not attribute their worsening condition to drug effects. Instead, they attribute it to ‘mental illness’.

“The CBI syndrome can be divided into four symptom complexes which commonly present together:

• Cognitive dysfunctions which manifest in the early stages as short-term memory dysfunction and impaired new learning, inattention and difficulty concentrating.

• Apathy or loss of energy and vitality, often manifesting as indifference (“not caring”) and fatigue, loss of higher mental processes, sensitivity to others, and spontaneity.

• Emotional worsening (affective dysregulation) including loss of empathy, increased impatience, irritability, and anger, as well as frequent mood changes with depression and anxiety.

• Anosognosia – lack of self-awareness of these symptoms of brain dysfunction. Whether it involves TBI, Alzheimer’s disease, drug-induced tardive dyskinesia, or psychiatric drug CBI – patients commonly fail to identify their mental symptoms of brain dysfunction.

Conclusion

“By learning to recognize Psychiatric Drug-Induced Chronic Brain Impairment (CBI), clinicians can enhance their ability to identify patients who need to be withdrawn from long-term psychiatric drug treatment. CBI symptoms are the main reason why patients and their families seek professional help in withdrawing from psychiatric medications.

“Most patients begin to recover from CBI early in the withdrawal process. Many patients, especially children and teenagers, will experience complete recovery. Others may recover over a period of years. Even when recovery is incomplete, or psychiatric relapses occur off the medication, (or withdrawal symptoms become intolerable – ed. note) most patients remain grateful for their improved CBI, and wish to remain on reduced medication or none at all.”

Disclaimer: Dr Kohls warns against the abrupt discontinuation of any psychiatric drug because of the common, often serious withdrawal symptoms that can occur with the chronic use of any dependency-inducing psychoactive drug, whether illicit or legal.  Close consultation with an aware, informed physician who is familiar with dealing with drug withdrawal syndromes and the drug-intoxicated and nutritionally-depleted brain is critically important.