During my sophomore year at Middlebury College, I took notoriously tricky course called Introduction to Modern Logic. An early requirement for philosophy majors (one of the many declarative detours I flirted with before landing on the equally useless History degree), it focused on good reasoning and the technical breakdown of arguments.

A basic example:

If Bellaroo is napping on her dog bed, then Bellaroo is not taking a walk.

Bellaroo is napping on her dog bed.

Therefore, Bellaroo is not taking a walk.

The statement is true in all circumstances, regardless of time, interpretation, or the laws of physics. If Bellaroo is napping on her bed, she is irrefutably not taking a walk.

The point of this course is to help students identify patterns of good reasoning and patterns of bad reasoning, so they have a better idea of what to follow and what to avoid. The tricky part occurs when a statement seems true at first glance, but breaks down when logic is applied. These are called logical fallacies, and they are everywhere.

A few examples:

The Appeal to Ignorance, where we assert a claim because no one can prove otherwise.

People have been praying to God for years. No one can prove He doesn’t exist. Therefore, He exists.

The Bandwagon, where we assume something to be true or good just because many others believe it to be true or good.

Everyone at the gym is wearing Lululemon. I need to buy their yoga pants.

The Red Herring, were we use irrelevant information to distract from an argument.

There are starving children in Africa. Eat your broccoli.

Psychiatry, more than any other branch of medicine, is saturated with logical fallacies. Hell, we can apply all three of the above examples to cultural rationale within the world of psychiatry and mental health:

The most pervasive logical fallacy in psychiatry and mental health diagnoses, though, is circular reasoning, which is an argument that uses the same statement as both the premise and the conclusion.

The reason why circular reasoning is so pervasive in psychiatry compared to other specialties is because psychiatry doesn’t have any form of objective boundaries. The rest of medicine, generally, agrees on parameters that define a pathological disease. Diabetes in the United States is only diagnosed as diabetes when two fasting A1C blood sugar tests read 6.5% or higher. Doctors—and even different countries—debate 6.5% as the cutoff, but all agree that at a certain point, high blood sugar levels indicate disease.

But psychiatric criteria cannot explain behaviors or experiences through any means beyond subjective opinion. Furthermore, as we’ve been exploring throughout the last few issues, these subjective opinions are rooted in norms and meaning. They can’t be measured independently, and they are not necessarily true across time and culture.

And yet, the flywheel of circular reasoning continues to spin, flinging the world of mental and emotional health further away from the solution. As British child psychiatrist Sammy Tammi said in his open letter on the diagnostic model of psychiatry to the Society of Humanistic Psychology, “The result of this basic [logic] error is that medical scientific knowledge in the area of mental health is at a standstill. No chemical imbalances, consistent neurological differences, genetic abnormalities or markers found. None. Billions of dollars of wasted money on wasted biological research that leads nowhere…higher levels of reported stress and anxiety, higher numbers of people disabled due to a mental health condition and rates of significant improvement from those attending mainstream services hovering at around a quarter to a third of those they see. These are not the outcomes you would expect to see from an effective model of clinical care.”

Before you go…

After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes in August 2022.

Order it now.

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Happiness Is A Skill was created as an outlet for me to reach the kind of people who email me every day. Ever since my Washington Post Article, “I spent half my life on antidepressants. Today, I’m off the medication and feel all right” became the #1 read piece on WaPo National the day it was published, my inbox likes to fill up with people who are struggling to get off their antidepressants or benzodiazepines. I respond to every person who contacts me, and often that correspondence leads to a longer conversation.

About 12 weeks ago, after one of these conversations melted two hours away from my day, it occurred to me that I was spending a lot of time saying similar things to lots of different people. Why not take all that information and distill it down into a digest that could reach lots of people at once? And so Happiness Is A Skill was born. There are two overarching themes of these emails. First, people are desperate to find relief from the pain of withdrawal, all while trying to process the anger they have for prescribed drugs and doctors that were supposed to help them. Second, they are looking for someone, anyone, who understands. Psychiatric drug withdrawal is an excruciatingly long and lonely process that you simply cannot relate to unless you have experienced it. It’s rare to encounter another person going through withdrawal in the wild because people in severe withdrawal probably aren’t leaving their house. (And those who are experiencing mild or moderate withdrawal are likely so irritable that they aren’t exactly projecting warm fuzzies.)

Until recently, antidepressant withdrawal was swept under the rug by psychiatrists and doctors, largely due to a lack of substantial research surrounding long-term use and tapering. (Antidepressants and benzos are designed, studied, and tested for short term use, i.e., weeks. There is not a single study on the effects of long-term antidepressant use, and yet 1 in 4 people on antidepressants have been taking them for more than 10 years.)

But in 2019, a group of American and British psychiatrists came together and urged national withdrawal guidelines to be updated after they “discovered” what many patients already knew: it is a hell of a lot easier to start taking antidepressants than it is to get off of them. In a systematic review of existing research, the authors determined that “nearly half of those experiencing withdrawal (46%) report it as severe, and that reports of symptoms lasting several months are common in many recent studies.”

The authors go on to say that their evidence directly contradicts the position of the UK’s National Institute for Health and Care Excellence (NICE) guidelines, which state that “[withdrawal] symptoms are usually mild and self-limiting over about 1 week.” In short, this research shows that half of all antidepressant users will likely experience withdrawal of a substantially longer duration and severity than current guidelines recognize. Shockingly (to this American, anyway), the NICE guidelines were updated to reflect these findings, giving suffering withdrawal patients a smidgeon of validation. All this to say that the tides are changing. My article and others like it are finding space in mainstream media and a new cohort of psychiatrists and researchers are starting to take our claims seriously. But arguably the biggest contribution to bringing this issue to light is the new documentary, Medicating Normal. I had the pleasure of watching a screening a few days ago, and it both broke my heart and fed the fire within me.

“Combining cinema verité and investigative journalism, Medicating Normal follows the journeys of a newly married couple, a female combat veteran, a waitress and a teenager whose doctors prescribed psychiatric drugs for stress, mild depression, sleeplessness, focus and trauma. Our subjects struggle with serious physical and mental side effects as well as neurological damage which resulted from taking the drugs as prescribed and also from attempting to withdraw. Says one psychiatrist, ’There’s not a chemical on the planet, to my knowledge, that can require years to taper — not Oxycontin, not crack cocaine, not heroin, and not alcohol. But psychiatric medications, any tapered patient will tell you, can take sometimes years if possible, at all.’ … [Medicating Normal] is the untold story of what happens when profit-driven medicine intersects with human beings in distress.”

Statistically, a good chunk of Happiness Is A Skill readers are taking some form of antidepressant or anti-anxiety/benzodiazepines like Xanex or Ativan. For those people, none of this is meant to scare you or bully you into getting off the drugs. You do you. However, if you ever do want to get off these drugs, I implore you to do your research and work with your doctor to create a slow, deliberate tapering plan. Doctors are not required to give patients informed consent when it comes to psychiatric drugs, nor are they well versed in safe withdrawal. It’s not their fault. The medical system simply doesn’t teach them how to take people off these medications. It is possible to wean off psychiatric drugs safely and with few side effects, but the techniques for doing so are being developed at a grassroots level by people who have experienced it, like me. For more information on safe withdrawal, check out SurvivingAntidepressants.org, Mad In America, and the Inner Compass Initiative. You can also email me directly. Lastly, Medicating Normal is being screened virtually at several film festivals and hosted events. I would recommend it to anyone who is taking antidepressants or benzos, but I believe it should be required watching for all practicing psychiatrists and doctors. You can find tickets and upcoming screenings here.

Coming September 6, 2022

May Cause Side Effects

Brooke’s memoir is now available for preorder wherever books are sold.

This is a heart-rending and tender memoir that will start conversations we urgently need to have. It’s moving and important.

Johann Hari, author of New York Times bestseller Chasing the Scream and international bestseller 
Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions

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When I first began speaking openly about long term antidepressant use and antidepressant withdrawal, it didn’t take long for me to be faced with a wall of academic journals and research papers. At first, my instinct was to read the abstract, get the gist of what I was trying to understand and move on. But much like sourcing all your information exclusively from Fox News, that approach left me a dangerous kind of dumb. I had just enough information to confirm my bias but zero original thoughts surrounding the source, scope of work, journal reputation, limitations of the study, and industry response.

When it dawned on me that just reading the abstract was no better than just reading sensational news headlines and deeming yourself informed, I began to read the studies in full. At least, I tried. For those of us who haven’t spent their entire adult lives in research and academia, these papers are a nightmare.

While I understand that there are longstanding reasons why academic papers are written the way they’re written, it bothers me that only people with a PhD are taught to comprehend this sort of work. How can the individual be expected do their own research and make their own decisions for their own wellness if they can’t understand the research that policy and marketing is built upon?

Which brings me to the first installment of How to Read a Scientific Paper. I’m tired of taking other people’s word on research as gospel, so I’m going to learn how to do it myself and chronicle the journey here. Hopefully, I can beef up the entertainment factor, because damn these articles are dry.

I’m going to begin with a recent article spearheaded by psychiatrist Saeed Farooq and published in the Journal of Affective Disorders, entitled, “Pharmacological interventions for prevention of depression in high risk conditions: Systematic review and meta-analysis.”

I first found out about the study thanks to a Keele University tweet that said, “The study, led by Professor Saeed Farooq, found that using antidepressants as a pre-emptive measure could help to prevent depression in patients considered to be at high risk of developing the condition, for example following stroke or heart attack.” The tweet linked not to the article, but an in-house blog post that feels a bit too much like propaganda. The fact that we’re even considering doping people up on antidepressants before they become depressed deeply concerns me, so I want to learn more about it before I go full oh no you di’n’t! on the topic.

In reality, this was not a research study or clinical trial, but a systematic review and meta-analysis. And for us to learn to read journal articles, we must understand the difference.

A research article is a study designed and performed by the paper’s author or authors. It will explain the methodology of the study—or rather, the methods and systems used to conduct the study—and clarify what the results mean. All of the steps are listed in detail in order to allow other researchers to conduct similar experiments.

One of the best ways to tell if you’re reading a research article is to look for phrases like “we found” or “I measured” or “we tested.” This indicated that the authors who are writing the article are the ones who also conducted the research.

Next, look at the formatting of the article. Research papers include sections that are listed in a particular order: abstract, introduction, methods, results, discussion, and references.

Review papers do not include original research conducted by the authors(s). Instead the author(s) give their thoughts on existing research papers for the purpose of identifying patterns or forming potential new conclusions based on a variety of research studies. For example, a researcher may look at a study performed in 1980 and compare it to a similar study from 2010 in order to provide an overview of the topic as a whole.

Reviews are particularly useful for people looking to get background information on a topic before diving into detailed or technical research papers. However, there is no formal process to dictate which articles must be included in a review, which gives authors the freedom to overlook existing research that may not fit their agenda. Thus, it can be difficult to determine if the author’s conclusions are biased.

Systematic reviews were developed to eliminate that bias by requiring multiple authors to track down all available studies on a particular topic and execute high-level analysis of existing research in order to answer a clearly defined, clinical question. Systematic reviews can take months or years to complete, whereas standard reviews may only take a few weeks.

Systematic reviews contain a lot of data and to the untrained eye, can look a lot like original research. Systematic reviews are held in the same echelon as original research and are often presented to the public as if the research was new (like in the Keele University tweet.) This strikes me as potentially misleading, not because the research isn’t valid or useful, but because of the language used to promote the research.

For example, Farooq’s article concludes that based on his analysis, “Prevention of depression may be possible in patients who have high-risk conditions but the strategy requires complete risk and benefits analysis before it can be considered for clinical practice. However, not a single clinical study has been conducted to support or disprove that statement and the tweet says nothing about that and instead presents the research as if it were a new, exciting discovery.

Meta-analysis is a research process used to manage and interpret all the data for a systematic review. In layman’s terms, meta-analysis is how researchers make sense of the data in hundreds or thousands of individual papers. After extracting the data, analysts use a variety of methods to account for differences like sample size, variations in study approach that may affect the overall outcome of the systematic review, and overall findings.

Frankly, I don’t understand a lick of how meta-analysis works. But, I’ve learned that I don’t have to understand it as long as I understand what role it plays in research: meta-analysis pools the data sets from different studies into a single statistical set of data in order to analyze it and come to a single conclusion.

*  *  *

For or those of you who like visuals, check out this article by Concordia University that visually breaks down the structure of various journal articles so you can recognize what you’re reading.

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