Peter Breggin Goes Off the Deep End

Peter Breggin

Peter Breggan is a psychiatrist who is often highly critical of the use of any and all psychiatric medication, which makes him the favorite psychiatrist of the rabid anti-psychiatry movement along with Tom Ssazz. 

For some of these zealots, it is very understandable why they hate psychiatrists so much.  As anyone who reads my blog knows, incompetent psychiatrists or those docs who have been brainwashed by big Pharma often do a lot of damage to patients through misdiagnosing them, using inappropriate medications, and/or not monitoring their patients for side effects.

I cannot blame such victims for having a highly emotionally charged negative attitude towards my entire profession. 

Still, that does not make everything they think correct.  In fact, it often kind of impairs their ability to be objective about psychoactive substances.

Personally, I always felt that Breggin has used half truths to justify some of his opinions.  But now I think he has gone completely off the deep end. 

After reading what follows, I have this to say to anyone who still thinks he has a shred of credibility: You should look into joining the Flat Earth Society. You’d fit right in.

A news article by Phil Willon of the Los Angeles Times appeared on June 12, 2012, with a follow up story the very next day and again on June 21.  I quote parts of the three stories:

“A San Bernardino County prosecutor Tuesday urged a jury not to be swayed by testimony that the antidepressant Zoloft put a former Westminster police detective in a fog that made him not responsible for kidnapping and raping a waitress in 2010. Deputy Dist. Atty. Debbie Ploghaus called the so-called Zoloft defense, backed by a psychiatrist's testimony, "a bunch of baloney" and a desperate attempt by Anthony Nicholas Orban to sidestep overwhelming evidence against him.

Orban was identified by the victim, was implicated by his best friend, was captured on security video footage at the scene of the attack and left his police service weapon, with his name on it, in the victim's car. Ploghaus told the jury that while bar-hopping in Ontario before the kidnapping, Orban groped a woman's chest, grabbed a man's crotch and repeatedly texted a former girlfriend hoping for an afternoon tryst. "He was a highly trained officer who wanted to have sex. He had sex on the mind. Don't forget that," Ploghaus told jurors in her closing argument.

The Westminster detective is accused of abducting the waitress, then 25, as she walked to her car after a Saturday shift at the Ontario Mills mall. His police service weapon drawn, Orban forced the victim to drive to a self-storage lot in Fontana, according to authorities. The victim told the jury that Orban sexually brutalized her in the parked car, hidden behind tinted windows, as people walked a few feet away.

At one point, Orban snapped pictures with his cellphone, telling her to "smile for the camera." He chambered a round in his semiautomatic pistol, shoving the barrel deep into her mouth as tears rolled down her cheeks, she said. "He said if I cried, he would kill me," the victim told jurors. "Then he pulled the gun out and said, 'I think we'll continue this in the desert.'"

Orban had shared eight margaritas and two pitchers of beer with a friend, and was seeking sexual encounters before he kidnapped the victim at gunpoint and made her drive to a Fontana storage facility, where he raped her, Ploghaus told jurors.

Orban's attorney, James Blatt of Los Angeles, said the assault ran counter to a life spent protecting community and country as a police detective and a Marine veteran of the Iraq war. The only plausible explanation for the defendant's behavior, Blatt argued, was the potent effects of Zoloft, which sent Orban spiraling into an "unconscious" delirium.

"At the time he was not aware, not aware of the torturous things he had done,'' Blatt told the jury…The victim sat in the front row of the Rancho Cucamonga courtroom, clutching a friend's hand, as the prosecutor recounted her testimony that Orban rubbed his weapon against her face during the attack.

Now here’s the relevant part:

The defense relied on Dr. Peter Breggin, a New York psychiatrist and critic of psychotropic drugs who has testified in other cases across North America. Breggin said he believed Orban suffered a psychotic break from reality shortly before the kidnapping and was in an unconscious state of delirium, void of control or memory, during the attack. "I don't even think he knows he's tormenting her," Breggin testified. "He would not under any circumstances behave like this if he was not driven over the edge by the drugs." Orban had temporarily quit taking Zoloft, prescribed by his psychiatrist, then resumed it at full dosage five days before the attack, which Breggin said sent him into a state of manic psychosis.

Breggin testified that Orban had stopped taking the prescribed antidepressant, then resumed it at full dose, provoking a psychotic break during which he was "delirious" and not fully aware of his actions.

The prosecutor criticized Breggin as "intentionally misleading" and told jurors that the scientific community rejects his medical theories. Ploghaus' medical expert, Dr. Douglas Jacobs, an associate clinical professor at Harvard, testified that Zoloft has been prescribed to millions of people and proved to be safe. There has been no evidence that Zoloft causes delirium or unconsciousness, he said.

While antidepressants can definitely cause someone who actually has bipolar disorder to become manic (more on that near the end of the post), and even though Breggin used the word "manic" in his testimony, symptoms of mania were not what Breggin and the defendant testified to.  


They said he was in an unconscious state of delirium.  That is not and has never been alleged to be a symptom of mania at all.  And the degree of the planning and execution of the series of events involved in the rapes is entirely inconsistent with delirium, which is defined as a disturbance of consciousness - reduced clarity of awareness of the environment with reduced ability to focus, sustain or shift attention - and is usually caused by metabolic abnormalities due to a medical condition or to an overdose of certain drugs, Zoloft not being one of those drugs.  


The actions of the defendant seemed  pretty focused to me! In fact, it sounded as if he were mentally quite sharp even though he had mixed the Zoloft with a lot of alcohol. (Being drunk is not at all the same as being delirious).


And then there was this from the defendant:

Within days, he said, he was overwhelmed, hearing voices at night, contemplating suicide and fantasizing about killing his wife and dog.

Sounds more like depression to me, not mania.  Perhaps a “mixed state,” but those are fairly rare.

And the kicker: the prosecutor questioned the defendant about parallels between his testimony and similar accounts in a magazine and book by a well-known critic of psychotropic drugs.  Orban acknowledged reading both works, but denied they had influenced his testimony.  Oh, and the critic who authored the book?  Breggin!


And now to the issue of antidepressant-induced mania. Apparently no one else testified that the detective had any history of having the disorder.  If he were bipolar and Zoloft was going to make him switch into mania, it would have most likely already happened when he was first taking the drug – not when he resumed it after a short break.  Resuming a “full dose” may lead to other side effects, but not that one.  As far as I know, the ability of antidepressants to kick someone into a manic state is not dose-related.

Besides, very few patients in a manic state become violent rapists. 

And patients in a manic state still can still tell right from wrong unless they are out-of-their-mind psychotic.  There was apparently no evidence he was delusional.  (If there is, then I might have to take back some of what I am saying about this case, and, if it turns out that the detective had a grandiose delusion that raping the woman would somehow save the world from an alien invasion, owe Dr. Breggin an apology).


As to the rape being "counter to a life spent protecting community and country?"  As we all know, soldiers in Iraq and police are never guilty of violent behavior.  Before he died, you could have asked Rodney King.  And I suppose we know for a fact that this was not just the first time he got caught.

What this is, barring further revelations about the defendant’s history of mental illness, is a variation of “The devil made me do it.”  Or perhaps a version of assassin Dan White’s defense in the case of his murder of two San Francisco politicians, “He did it because he was depressed, as evidenced by the fact that he was pigging out on a lot of Twinkies.”

Dan White assassinated  San Francisco Mayor George Moscone and  Supervisor (and gay hero) Harvey Milk on November 27, 1978, and was sentenced to only seven years

Apparently, the jurors also thought it was a stupid defense:

A jury of eight women and four men deliberated less than a day before dismissing that defense and finding Orban guilty of kidnapping, two counts of rape, two counts of forced oral copulation, two counts of sexual penetration with a foreign object and one count of making a criminal threat.

Orban is now facing a sanity hearing to determine whether he knew the difference between right and wrong at the time of the attack. He almost certainly faces a life prison sentence if the jury determines he was sane. If declared insane, he would be sent to a state mental institution for treatment, and later could be released. The same jurors have been impaneled for the sanity proceeding.

"What it comes down to is whether, at the time of this incident, he understood the difference between right and wrong," Orban's attorney, James Blatt of Los Angeles, said outside the courtroom. "I believe [the jury] will keep an open mind in reference to the sanity phase."


Addendum (6/27/12): The jury rejected the insanity defense, although some prosecutors apparently did blame the alcohol (rather than the Zolfot) for his "mental fog."  That's nonsense, too, considering the intricacies of his actions during the attack.  Looks like he had a lot of tolerance to the booze.

Medical Racism in America a Giant Mind Boggling Game Without End

An explosive book that came out last year, Black and Blue:  the Origins and Consequences of Medical Racism, should have reverberated throughout the medical community and caused we physicians to closely examine our own prejudices and how they have affected the behavior of, and our relationships with, our black patients. 

So of course there has hardly been a whimper in the medical community. I did see a rather bland, "balanced" (almost namby-pamby) review by two African-American psychiatrists in the American Journal of Psychiatry, the official journal of the American Psychiatric Association. I don’t think much will come of it.

The author of the book, University of Texas professor John Hoberman, explains many of the reasons why the medical profession does not look at itself much in this regard, most of which I will not discuss in detail here. One of the biggest reasons can be summed up in one phrase: the mutual estrangement of puzzled Whites and resentful Blacks.

John Hoberman

Just to be extremely clear, there is no doubt that the problem of racist beliefs in medicine started with white racists and not their black victims. Many of the ideas about physical and mental differences between Blacks and Whites came from the colonialist opinions of Europians that Africans were more primitive than white people – less further along than Whites on the evolutionarily scale and therefore sub-human. Thus, their bodies and minds were supposedly simpler and therefore less or more prone to certain diseases. 

As seen originally by colonialists,  the black body, being more simple, was hardier than the white one. Black skin, for example, was thought to be tougher. This conveniently provided slaveholders a justification for working their slaves in the cotton fields for long hours in the hot sun. At the same time, being supposedly simpler mentally, slaves could be thought of as less likely to get depressed, so the myth was born of the happy black slave, grinning from ear to ear with his strong white teeth while eating watermelon, content being taken care of by his benign white masters.

While physicians in general no longer express these ideas, derivatives of them became part of medical folklore and were passed down as an oral tradition from medical student to medical student. For example, observations by white doctors of what a non-naïve individual would see as the understandable reluctance of Blacks to be put under anesthesia (and therefore under the complete control of a potentially racist doctor), was instead put together with the notion of black hardiness, and voila!  Black patients are far less likely even today of being given adequate anesthesia during surgery.

Hoberman describes in detail how racist ideas from the past have morphed into medical folklore about Blacks concerning the treatment of diseases of nearly every organ system.

Disparities in the health care of white and black patients such as the one just mentioned have been endlessly documented, so their existence should not be in the least controversial. White doctors unfamiliar with the racist history of American medicine, however, are likely to misinterpret the mistrust of their black patients as an innate tendency to be non compliant - or just plain lazy - which in turn makes the white doctor reluctant to put a whole lot of energy into convincing black patients to follow their advice.

Black patients have good reasons for their mistrust of the medical profession, including of psychiatrists.  White physicians tend to think that 1962 was a long time ago.  That was the year the American Medical Association stopped deferring to Southern state medical associations (doctors have to join the state and national associations at the same time), and allowed all African American physicians to become members.

Then again, I guess 1972, while more recent, seems like the distant past to such physicians.  That was when the Tuskeegee Syphilis Experiment came to public light -  a clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of the untreated disease in rural African American men who thought they were receiving free health care from the U.S. government. The men were never told they had syphilis, nor were they ever treated for it.

When I moved to Memphis, I was impressed that seemingly every African American I spoke with was aware of this history – even those who were not particularly educated.  For white doctors, not so much. Unfortunately, human beings have very long memories. The Serbs and Albanians, for example, still have strong feelings about a battle that was fought in the year 1389! 

It doesn’t help when white doctors like conservative commentator Sally Satel blame treatment disparities entirely on the resistant attitudes of black people without any reference to this history.  She also writes that racial profiling is important in medicine and justifies this idea (http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html?pagewanted=all&src=pm) with the example of the implications for choosing medications based on the real difference in the racial distribution of different versions of enzymes that metabolize certain drugs (different alleles on the genes responsible for producing the metabolizing enzymes). 

In picking on one of the extremely few areas where there actually are racial differences, she ignores the far greater quantity of ideas within medical folklore purporting differences that do not in fact exist.  Like the supposed proneness of the black brain to produce hallucinations in psychiatric disorders, for example (originally attributed by doctors to its “primitive” state).

The mistrust of racism in medicine has unfortunately led a significant proportion of Blacks to believe in some seemingly far-fetched conspiracy theories. Many Blacks believe HIV and birth control programs were invented and designed by the white establishment in order to commit genocide against minority groups. 

These conspiracy theories even reached all the way to Africa, leading to the disasterous AIDS policies of South African president Thabo Mbeki. To most Whites, these theories sound completely irrational and paranoid. Of course, historically, Planned Parenthood was indeed founded by an Anglo-American eugenicist, one of whose goals was to limit the number of children of east European immigrants to the United States, whom she considered genetically inferior beings.

There is also a rather crazymaking problem for Whites who attempt to take an interest in the whole problem of the consequences of racism on black folks. This problem was exemplified by the vicious attacks on Senator Patrick Moynihan for his 1965 report, “The Negro Family: The Case for National Action.” The report discussed the “pathology” that racism had created for many Blacks and their families.

According to the Hoberman’s book, the black intelligentsia protested the report with sentiments something akin to, “How dare some white social scientists tell black people who and what they are?”  They thought that the report pathologized and stigmatized black urban culture, and that it seemed to be an oblique endorsement of old racist biology that regarded black people as inherently diseased and beyond salvation.

This has led to a situation where even today it is considered a breach of academic etiquette for any white social scientist to theorize about Black culture. I personally was crazy enough to do some of that in my first book, since a problem seen frequently in the Black urban poor community provided the clearest example of a point about the development of family system dynamics I was trying to make. Fortunately - I guess - that section of my book was completely ignored by reviewers. Whew!

So one of the reasons that white doctors are reluctant to look at their own attitudes and the history and consequences of medical racism is a fear of open discussions about that very subject. They do not want to be considered racists. So what are they supposed to say?  That racism did not create a host of problems for African Americans, so they do not seem to pathologize them and over-generalize about them? If it did not, then what is the big deal? If they ignore the problems, they could then be accused of covertly wanting racist practices to continue. Damned if you do, damned if you don’t.

Maybe if we just do not bring up the subject, no one will notice. Except maybe for that troublemaker Hoberman.

So here we have the explanation  for the “mutual estrangement of puzzled Whites and resentful Blacks” phenomenon. To oversimplify a bit, Blacks will not tell doctors that they are mistrustful of white doctors (and of Black doctors as well, for reasons discussed in the Hoberman’s book) for fear of being labeled as paranoid, and white doctors are afraid of getting labeled as racist no matter how they discuss the problem!

This is a perfect example of the family system game without end on a larger, societal scale, which makes solving this problem so devilishly difficult. No one trusts anyone else who claims they want things to be different, so anything anyone does or says can be - and invariably is - reframed as just the same old thing – just another manifestation of the Black belief in the incorrigible racism of all Whites, or of the White belief in the presence of innate Black pathology and inferiority. No wonder we get stuck!

This game without end can lead to paradoxical and at times bizarre situations. Hoberman bemoans the fact that black kids are much less likely to get stimulants for “ADHD” than white kids, which he attributes partially to white doctors’ subconscious belief in the stereotype of the “happy Negro” described above. Black mothers, on the other hand, do not want their kids to take these drugs because they believe that the drugs would be used to pacify young black males and rob them of their spontaneity, thereby making social control of Black people easier.

I doubt that the motives of most White doctors are that pernicious, but the mothers are actually right about the effects of the drugs. In this case, the idea that stimulants are being used to control behavior is correct, and the black kids are better off not getting the drugs. The problem is not, as Hoberman implies, that black children are not getting a needed medication, but that too many white kids are getting medication they do not need instead of getting family therapy! Of course, black families are not getting as much of that as white families either.

The author’s solution to the problem of medical racism, although he probably does not know about the concept of the game without end nor necessarily totally appreciate the intricacies of interpersonal miscommunication, is for medical schools to teach the history of medical racism and about the presence of incorrect folkloric beliefs that many physicians still hold. This way, the doctors would hopefully not misinterpret the lack of cooperation they receive from their black patients, and take time to explain more about what they are recommending, and reassure the patients that they understand any reluctance the patient may have to follow their doctorly advice. 

Hoberman admits, however, that there are not very many people available who are qualified to even begin to teach such a course.

As to his book itself, it is sometimes annoyingly repetitive, and at time a little confusing. When he discusses discrepancies in the care of black and white patients, it is sometimes unclear if his examples are due in his opinion to medical mythology, a misunderstanding of actual differences, black mistrust of white doctors, or all of the above. Nonetheless, since there aren’t many books that take this whole subject on, I recommend it.

Themes of This Blog Seen In Newspaper Advice Columns The Game without End Gender Role Division

In Amy Dickinson’s advice columns of 5/29, 6/14 and 6/18/17, and in Carolyn Hax’s column of 6/23/17, the Agony aunts published letters which serve as a good, simple and straightforward illustrations of something that family therapists have called the game without end, described in several previous posts.

Whenever one member of a couple or a family makes a good case for changing the rules by which people in the family operate, other members of the family (or the other member of the couple) get suspicious. The person making the request has always followed the old rules. I mean, they say they want things to be different, but do they really?

So the person making the request gets “tested” to see how sincere their request really is. The others make the requested changes, but do so in an obnoxious or annoying manner. My favorite illustration of this is a situation widely created by rapidly evolving changes in gender role functioning, which the letters that are the subject of the current post clearly illustrate.

Both members of a couple work, but somehow everyone - including the females - has always expected the female to do all or most of the housework due to the rules followed by earlier generations of men and women.  The woman often has treated the kitchen, for example, as her own personal fiefdom in which she is the undisputed boss of how things are supposed to be done.

If she suddenly asks her husband or boyfriend to help clean up and do his share of the cooking, he wonders if she reallywants that - because of her prior attitude and the accompanying behavior, which had been readily and repeatedly observable up to this point.

So, when it’s his turn to clean the kitchen, he does a half-baked job and puts the dishes and pots and pans in all new places, so that his partner cannot find them when it’s her turn to do, say the cooking. Or he does any of numerous other passive-aggressive things that annoy the heck out of her. So she criticizes him unmercifully for his poor performance.

In a sense, she starts criticizing him for doing the very thing she had asked him to do in the first place.

His conclusion: "See, she really didn’t want me to help out after all." I can never understand why he discounts his own behavior in drawing this conclusion, but that is highly typical.

An effective way to handle a game without end so that the rules really can change is described here.

So for those readers to are skeptical, here are some abbreviated letters from the advice columnists:

5/29/17. Dear Amy: I am really tired of my husband asking: “How can I help you?” “What can I do for you?” or “What do you need?”Here’s why this upsets me: If I am cooking dinner for the both of us and he asks, “What can I do for you?” I think, well, you are eating this dinner too, so why not just ask, “What can I do?” Why is he offering to do something “for me”? I get so frustrated that my response is: “…nothing.” When I suggest that he just pitch in, he tells me that I do these household things so much better than he does. 

He seems to want me to need him. I don’t need him. I just want him to initiate the household work on his own. He watches TV while I run around picking up the house or making dinner, and his only response is, “Am I in your way?”...When he finally does something like putting a load in the washer, he needs to announce it like it’s the second coming. What can I do? - — Frustrated!

A response from a man to the above letter: 6/14/17. Dear Amy: I am a man who has been in the same position as “Frustrated’s” husband, who would ask, “What can I do for you?” instead of just taking responsibility for his half of the household chores. I used to be like this. I just didn’t know how to be helpful and I didn’t want to get in the way. Honestly, my wife basically trained me how to take on more responsibility and now we work together. — Reformed (This guy is still letting her be the boss!)

Dear Reformed: I have received a huge response to this letter, and many men echo your statement — they needed some guidance and when they got it, they stepped up.

6/18/17. Above letter, continued. Dear Amy: I understand a lot of men are responding to the letter from “Frustrated!” about her husband’s lack of initiative regarding household chores. In my case, I jump in and do my best, but my efforts are criticized and belittled. It is hardly inspiring me to do more. — Also Frustrated

6/23/17.  Dear Carolyn: I love my partner. He recently moved in... I’m so tired of people who won’t clean up after themselves and leave it until I do it. I made it very clear to my partner before he moved in that it was important to me...But I’m already tired of asking and I’ve been reading about “the mental load.” Like last night: I was stressed and headed to my second job and he asked what he could do to make me feel better (sweet!) so I said, get wrapping paper and a card and wrap your sister’s wedding present. And when I got home later, he had! But. The box was left out instead of recycled, the couple of dishes I used to feed us before I went to work weren’t done, the living room was a mess . . . he just doesn’t see it…— I’m Already Tired