Mental Health Parity: A Debate
INTRODUCTIONThe article that appears below by the late U.S. Senator Paul Wellstone (D- Minn.) advocating a nationwide, federal law requiring health insurance providers pay for psychiatric treatment under the same rules as they pay for treatment of physical disease (often called a mental health parity law) appeared in The Hill, a newspaper published in Washington, D.C., on June 19, 2002. The Hill publishes articles about the actions of the U.S. Congress and is published primarily for members of Congress and others working on Capitol Hill. A few weeks later, the webmaster of this website, Douglas A. Smith, submitted a reply to Senator Wellstone's article to The Hill and asked the editors of newspaper to publish it for the purpose of making the arguments on both sides of this issue available to the newspaper's readers. What appears below is an expanded and revised version of what was submitted to The Hill. An abridged version of about the same length as Senator Wellstone's article was also submitted. In telephone calls in November 2002 Hill editors Ed Eisele and David Silverberg could recall no articles having been published in the newspaper opposing mental health parity. Furthermore, a month after the publication of Senator Wellstone's article, on July 17, 2002, in a special section on healthcare, The Hill published another article advocating a federal mental health parity law, this one by U.S. Rep. Marge Roukema (R-N.J.), Ending discrimination against mental illness. The one-sided presentation of mental health issues and the unwillingness of most of America's news media to let the arguments against psychiatry be heard has resulted in most people not knowing how harmful biological psychiatry is, not knowing that so-called psychotherapy is no better than conversation with untrained but sympathetic people, and not being aware of the violations of human rights in the form of involuntary psychiatric "treatment" taking place in America and other so-called democracies. However, The Hill managing editor David Silverberg did give us permission to reproduce Senator Wellstone's article on this website so that readers of this website can read both sides here; he also said articles by membes of Congress appearing in The Hill are in the public domain and therefore can be legally reproduced by anyone.
This page was in the process of construction prior to Senator Wellstone's death in an airplane crash on Friday, October 25, 2002. The debate about compulsory mental health parity in health insurance will go on, albeit without Senator Wellstone.
Senator Wellstone's arguments for a federal mental health parity law and Douglas Smith's arguments against one are presented here for your consideration.
_______________________________________________ It's time to act on mental health parity issue
by U.S. Senator Paul Wellstone (D-Minn.)(Appearing in The Hill, June 19, 2002, page 42, available on line at: http://www.hillnews.com/061902/ss_wellstone.aspx)
Recently, President Bush boldly announced his support for "full mental health parity" - health-care coverage for millions of Americans suffering from mental illness on par with coverage of other medical illnesses. In so doing, he dramatically raised the profile of one of the most urgent policy questions facing Congress, and reaffirmed the critical importance of our bipartisan goal: that mental illness be treated like any other disease in health care coverage. Enacting full parity offers Americans a major breakthrough to end the widespread discrimination in our healthcare system that has affected the families of millions of Americans with a mental illness.
I believe the president was standing up for what he knows is right, even in the face of the current opposition from some of his allies. Sen. Pete Domenici (R-N.M.) and I, who have spent years working on this issue, are thrilled to have the president now on our side. It was experiences in our own families that first motivated our bipartisan partnership to end the healthcare coverage discrimination against the mentally ill, and we stand ready to move this legislation again without delay.
Predictably, the president's announcement has moved parity opponents into action. They have launched a massive insurance industry-driven disinformation campaign against it. But instead of directly criticizing the president or the idea of parity, they have demeaned certain diagnoses of mental illness. Ironically, they have been most critical of those illnesses that are either explicitly excluded in our parity proposal, or almost certainly would not meet the "medical necessity" standard that is specifically required. These desperate attacks are meant to distract from what is really at stake in this debate: treatment for the millions of Americans suffering from mental illness.
Full mental health parity means that health plans which offer mental health benefits cannot set limits on coverage (such as through co-pays, deductibles or limits on inpatient or outpatient treatment) that are different than those placed on other medical and surgical benefits. Of course, it is not the business of Congress to establish the specific medical and scientific standards for the definition of mental illness, just as it does not do so for physical illness.
Instead, we must rely on the scientific and medical standard on mental illness - the Diagnostic and Statistical Manual (DSM) - to define what should be covered. This manual is the recognized authority, accepted and routinely used by the insurance industry and healthcare providers alike. By using the industry standard as our guide, we prevent further discrimination against the mentally ill, while providing the insurance companies with reasonable parameters for plan administration. The Federal Employees Health Benefits Package (FEHBP), Medicare and Medicaid, and 15 states with parity laws already successfully use the DSM as the basis for coverage for mental illness.
Efforts to further limit the bill's scope of coverage must be avoided. While opponents of mental health parity have argued that doing so would eliminate coverage for what they consider frivolous ailments, it could actually result in the exclusion of a number of painful and even life-threatening illnesses, many affecting children, such as autism, anxiety disorders, eating disorders, and post-traumatic stress disorder (PTSD). Scientific understanding of PTSD is greater than that of many other medical illnesses.
Still, due to the widespread discrimination against mental illness, a New York firefighter suffering today from an injured back and PTSD after rescue efforts at ground zero would get two-tiered care under the city's most widely used health plan: unlimited care to appropriately treat his back, but care limited to 20 outpatient visits per year, regardless of the pain or disability he experiences, for his PTSD.
We have an unprecedented opportunity to reach across party lines to address one of the most serous, for some even life-threatening, public health crises in our country. Forty-three million American men, women and children suffer from a diagnosable mental disorder each year.
We need federal action now to end the discrimination in coverage of mental illness and ensure that mental health parity is the law of the land. A bipartisan majority of both the House and Senate, a broad coalition of 200 organizations, and millions of Americans support taking action on real mental health parity legislation like ours. The president's courageous move to support mental health parity sent a clear message: the time to act is now.
_______________________________________________ This is what's wrong with mental health parity
by Douglas A. Smith, Antipsychiatry Coalition activist
and webmaster of www.antipsychiatry.orgA mental health parity law forcing health insurance companies to pay for mental health care would be wrong for several reasons.
First, the concept of mental illness itself is flawed and misleading. As psychiatrist E. Fuller Torrey wrote in his book The Death of Psychiatry in 1974: "The very term ['mental disease'] is nonsensical, a semantic mistake. The two words cannot go together except metaphorically; you can no more have a mental 'disease' than you can have a purple idea or a wise space."1 Mental illnesses do not exist in the same sense that physical illnesses do. Physical illnesses have known physical causes. Mental illnesses do not. In his book Toxic Psychiatry, published in 1991, psychiatrist Peter Breggin, M.D., said "there is no evidence that any of the common psychological or psychiatric disorders have a genetic or biological component."2 In their book Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs in 1999, Drs. Peter Breggin, M.D., and David Cohen, Ph.D., said: "...there's no substantial evidence that any psychiatric diagnoses have a physical basis."3 In his book Blaming the Brain: The Truth About Drugs and Mental Health, published in 1998, Elliot S. Valenstein, Ph.D., Professor Emeritus of Psychology and Neuroscience at the University of Michigan, said: "Contrary to what is often claimed, no biochemical, anatomical, or functional signs have been found that reliably distinguish the brains of mental patients."4 In his book The Complete Guide to Psychiatric Drugs, published in 2000, Edward Drummond, M.D., Associate Medical Director at the Seacoast Mental Health Center in Portsmouth, N.H., said: "First, no biological etiology has been proven for any psychiatric disorder (except Alzheimer's disease, which has a genetic component) in spite of decades of research. ... So don't accept the myth that we can make an 'accurate diagnosis.'"5 Alzheimer's is not generally considered a mental illness.
No psychiatric problem falls within a reasonable definition of the word disease. In her book about fibromyalgia, Miryam Williamson said "A disease is a condition that has a known cause and can be identified by one or another set of laboratory tests."6 By this definition, no mental illness can be called a "disease." As Harvard-trained psychiatrist Loren R. Mosher, M.D., said in 1998, "there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder."7 In his book Prozac Backlash, published in 2000, Joseph Glenmullen, M.D., clinical instructor in psychiatry at Harvard Medical School, said "In medicine, strict criteria exist for calling a condition a disease. In addition to a predictable cluster of symptoms, the cause of the symptoms or some understanding of their physiology must be established. ... Psychiatry is unique among medical specialties in that... We do not yet have proof either of the cause or the physiology for any psychiatric diagnosis. ... In recent decades, we have had no shortage of alleged biochemical imbalances for psychiatric conditions. Diligent though these attempts have been, not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven false. ... No claim of a gene for a psychiatric condition has stood the test of time, in spite of popular misinformation."8 Or as Edward Drummond, M.D., said in his book The Complete Guide to Psychiatric Drugs, published in 2000: "Psychiatric disorders are vastly different from physical disorders, however, because our understanding of how the normal brain works is incomplete. ... The treatment you receive depends on the orientation of your psychiatrist, not on a solid foundation of knowledge about the etiology and pathogenesis of the disorder itself."9 A similar observation was made by Columbia University psychiatry professor Jerrold S. Maxmen, M.D., in his book The New Psychiatry in 1985, an observation that remains true today: "It is generally unrecognized that psychiatrists are the only medical specialists who treat disorders that, by definition, have no definitively known causes or cures. ... A diagnosis should indicate the cause of a mental disorder, but as discussed later, since the etiologies of most mental disorders are unknown, current diagnostic systems can't reflect them."10 In 1999 neurologist Fred A. Baughman, M.D., said: "The country's been led to believe that all painful emotions are a mental illness and the leadership of the APA [American Psychiatric Association] knows very well that they are representing it as a disease when there is no scientific data to confirm any mental illness."11
Forty-one years ago in his classic book, The Myth of Mental Illness, psychiatry professor Thomas S. Szasz, M.D., said "It is customary to define psychiatry as a medical specialty concerned with the study, diagnosis, and treatment of mental illnesses. This is a worthless and misleading definition. Mental illness is a myth. Psychiatrists are not concerned with mental illnesses and their treatments. In actual practice they deal with personal, social, and ethical problems in living."12
Should there be a federal law (or state laws) requiring health insurance companies to pay for "therapy" for mere problems in living? In his interview on CBS television's 60 Minutes on April 21, 2002, psychiatrist E. Fuller Torrey, M.D., said no. He argued that so-called therapy for mere problems in living is not health care. He said "problems of living" are matters such as "why is your third wife divorcing you, or why were you passed over for office chief, or why won't your teenage daughter talk to you." He said "I'm not saying that these are not problems. They are problems. But I'm saying that I don't think that medical resources or medical insurance should be used to cover why your teenage daughter won't talk to you." State or federal laws requiring parity for mental health treatment would require medical insurance to pay for counselling or "psychotherapy" or other therapy such as (supposedly) antidepressant drugs for such problems.
In his June 19, 2002 article in The Hill advocating enactment of a federal mental health parity law, Senator Paul Wellstone said "it is not the business of Congress to establish the specific definition of mental illness... Instead, we must rely on the scientific and medical standard on mental illness - the Diagnostic and Statistical Manual (DSM) [published and revised every few years by the American Psychiatric Association] - to define what should be covered" by health insurance. In 1998, psychiatrist Loren Mosher, M.D., said the "DSM IV [fourth edition] is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document."13 In 1996 psychiatrist David Kaiser, M.D., called the DSM "perhaps one of the greatest sophistries psychiatry has pulled off in its illustrious history of sophistries ... For those who do serious work with patients, this manual is useless."14 A problem with requiring health insurance coverage for all diagnoses in the DSM was pointed out by Sydney Walker III, M.D., who is both a neurologist and a psychiatrist, in his book A Dose of Sanity, in 1996: The "DSM's ever-increasing list of conditions makes it easy for therapists to spot pathology where none exists."15 In another book, The Hyperactivity Hoax, in 1998, Dr. Walker said: "The other major flaw of the DSM, related to the first, is that it labels virtually everything as some type of disorder. Thus a child who sees a DSM-oriented doctor is almost assured of a psychiatric label and a prescription, even if the child is perfectly fine. ... individual DSM labels include so many vague criteria that almost anyone can qualify. ... This willy-nilly labeling of virtually everyone as mentally ill is a serious danger to healthy children, because virtually all children have enough symptoms to get a DSM label and a drug."16 Anyone who thinks every so-called mental illness in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) should be covered by health insurance should take a look at the book. In it you will find such matters as inability to express oneself well in writing (disorder of written expression, diagnosis number 315.2) or lack of sexual desire (hypoactive sexual desire disorder) are - amazingly enough - considered to be mental disorders. If "therapy" for everything listed as a disorder in the DSM must, by law, be paid for by health insurance, there is almost no limit to what types of problems must be covered by health insurance, including those that are well within the range of normal human thinking and behavior or which are the normal emotional consequences of disappointments or frustrations of life - not true health problems.
The simple truth about psychiatry said twenty years ago by Harvard Law School professor Alan M. Dershowitz remains true today. He said psychiatry "is not a scientific discipline."17
Current mental health treatment is not merely unscientific. It is harmful, partly because of its erroneous biological orientation and resulting reliance on psychiatric drugs and electric shock treatment, both of which are still being administered to unwilling as well as voluntary patients. In the words of psychiatrist Peter Breggin, M.D., in 2000: "Nothing has harmed the quality of individual life in modern society more than the misbegotten belief that human suffering is driven by biological and genetic causes and can be rectified by taking drugs or undergoing electroshock therapy. ... If I wanted to ruin someone's life, I would convince the person that biological psychiatry is right - that relationships mean nothing, that choice is impossible, and that the mechanics of a broken brain reign over our emotions and conduct. If I wanted to impair an individual's capacity to create empathetic, loving relationships, I would prescribe psychiatric drugs, all of which blunt our highest psychological and spiritual functions."18 He also said "All psychiatric drugs produce severe biochemical imbalances and related abnormalities by interfering with the normal brain function."19 In a book published in 2001 he said: "If a drug has an effect on the brain, it is harming the brain. Science has not found or synthesized any psychoactive substances that improve normal brain function. Instead, all of them impair brain function."20
Many commonly prescribed psychiatric drugs cause permanent brain damage. These include neuroleptics, often called major tranquilizers or antipsychotics, and antidepressants, both the tricyclic and selective serotonin reuptake inhibitor or SSRI types. In his book Prozac Backlash in 2000, psychiatrist Joseph Glenmullen, M.D., says these drugs "are toxic to the brain" and because of their "neurotoxicity" may be "damaging or destroying critical parts of the brain." He says "The unfortunate irony is that drugs heavily promoted as correcting unproven biochemical imbalances may, in fact, be causing imbalances and brain damage"21 He says "In recent years, the danger of long-term side effects has emerged in association with Prozac-type drugs, making it imperative to minimize one's exposure to them. Neurological disorders including disfiguring facial and whole body tics, indicating potential brain damage, are an increasing concern with patients on the drugs. ... With related drugs targeting serotonin, there is evidence that they may effect a 'chemical lobotomy' by destroying the nerve endings that they target in the brain."22 A U.S. Court of Appeals judge reviewed the evidence and then reached this conclusion: "Unlike the temporary and predictable effects of bodily restraints, the permanent side effects of antipsychotic drugs induce conditions that cannot be corrected simply by cessation of the regimen. The permanency of these effects is analogous to that resulting from such radical surgical procedures as a pre-frontal lobotomy."23 In his book Molecules of the Mind: The Brave New Science of Molecular Psychology, University of Maryland journalism professor Jon Franklin observed: "This era coincided with an increasing awareness that the neuroleptics not only did not cure schizophrenia - they actually caused damage to the brain. Suddenly, the psychiatrists who used them, already like their patients on the fringes of society, were suspected of Nazism and worse."24 In his book Psychiatric Drugs: Hazards to the Brain, psychiatrist Peter Breggin, M.D., alleges that by using drugs that cause brain damage, "Psychiatry has unleashed an epidemic of neurological disease on the world" one which "reaches 1 million to 2 million persons a year."25 Neuroleptic drugs also cause thousands of deaths each year from neuroleptic malignant syndrome. Neurological injury and death inflicted by these drugs has not stopped the FDA from approving them nor psychiatrists from prescribing them, however. Psychiatrists have even supported the recent enactment of "outpatient commitment" laws in the U.S., the main purpose of which is to force people to take these harmful psychiatric drugs while living outside psychiatric institutions. Psychiatrists also play a central role in persuading U.S. courts to authorize forced administration of these harmful psychiatric drugs to hospitalized patients.
The proposals for mandatory coverage of mental health treatment would force health insurers to pay for prescription of these harmful psychiatric drugs and for electric shock treatment, now often called electroconvulsive therapy or ECT. ECT is now used mostly for depression. According to Maurice Victor, M.D., Professor of Medicine and Neurology, Dartmouth Medical School, and Allan H. Ropper, M.D., Professor and Chairman of Neurology, Tufts University School of Medicine, in their textbook Adams and Victor's Principles of Neurology, published in 2001: "The mechanism by which ECT produces it effects is not known."26 But in truth, the way ECT produces its effects is known: It damages the patient's brain sufficiently to prevent him from remembering or appreciating whatever was upsetting him. It has been scientifically shown that ECT causes both temporary and permanent brain damage. Of course, these findings are vehemently denied by psychiatrists who administer ECT. Brain damage from ECT includes cerebral hemorrhages (abnormal bleeding), edema (excessive accumulation of fluid), cortical atrophy (shrinkage of the cerebral cortex, or outer layers of the brain), dilated perivascular spaces in the brain, fibrosis (thickening and scarring), gliosis (growth of abnormal tissue), and rarefied and partially destroyed brain tissue. The scientific evidence proving this is summarized in a book, Electroshock: It's Brain Disabling Effects, by psychiatrist Peter Breggin, M.D.27 This brain damage causes loss of memory and intelligence, some of which is temporary and some of which is permanent. The late Sidney Sament, M.D., a neurologist, described ECT this way: "Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means. No doubt some psychiatric symptoms are eliminated ... but this is at the expense of brain damage."28 We should not have laws mandating health insurance coverage for this cruel and harmful therapy.
That these "therapies" are offered to gullible, ignorant, and trusting patients is bad enough, but mental health parity legislation would go a step further and force insurers to pay for involuntary mental health treatment. In the past, involuntary mental health treatment has often been imposed unnecessarily and without justification, and this problem continues today. This is a violation of human rights, and it will probably become more widespread if insurance coverage for involuntary mental health treatment is mandated by law. A U.S. Congressional investigation in 1992 found "that thousands of adolescents, children, and adults have been hospitalized for psychiatric treatment they didn't need; that hospitals hire bounty hunters to kidnap patients with mental health insurance; that patients are kept against their will until their insurance benefits run out; that psychiatrists are being pressured by the hospitals to increase profit; that hospitals 'infiltrate' schools by paying kickbacks to school counselors who deliver students; that bonuses are paid to hospital employees, including psychiatrists, for keeping the hospital beds filled; and that military dependents are being targeted for their generous mental health benefits."29 According to an article in the August 3, 1992 Investor's Business Daily: "Last Thursday...eight major insurance companies sued NME [National Medical Enterprises] for alleged fraud involving hundreds of millions of dollars in psychiatric hospital claims. Their complaint, filed in federal court in Washington, accused the company of a 'massive' scheme to admit and treat thousands of patients regardless of their need for care. ...some institutions were paying 'bounty fees' for patient referrals or misdiagnosing patients to get maximum reimbursement."30 Time magazine later reported NME settled the case for a record $300 million.31 An article in the September 15, 1992 New York Newsday about a similar suit filed in Dallas, Texas said: "Two of the country's largest insurance companies filed suit yesterday against a national chain of private psychiatric and substance abuse hospitals, charging it with illegally admitting patients who did not need treatment and then not releasing them until their insurance benefits ran out."32 According to Edward Drummond, M.D., in his book The Complete Guide to Psychiatric Drugs, published in 2000: "Some psychiatric hospitals made a practice of admitting adolescents in distress, using the diagnosis of bipolar disorder inappropriately in order to increase their billing to insurance companies. This practice was so widespread that the federal government finally intervened, charging the hospitals with fraud and assessing fines of millions of dollars."33
In other words, what is called mental health care is an attempt to deal with matters that are not true health problems with harmful treatments that are often imposed by force against innocent people. Under the Tenth Amendment, Congress has no constitutional authority to enact legislation requiring health insurers throughout the nation to provide equal coverage for mental health care. Even it did, however, it would be illogical, unwise, and wrong for Congress to do so. Congress should not promote psychiatry's unscientific, harmful, and unethical treatment with a mental health parity law.
REFERENCES
1. E. Fuller Torrey, The Death of Psychiatry (Penguin Books, 1974), p. 36
2. Peter R. Breggin, M.D., Toxic Psychiatry (St. Martin's Press, 1991), p. 291
3. Peter R. Breggin, M.D. & David Cohen, Ph.D., Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs (Perseus Books - Reading, Massachusetts - 1999), page 93
4. Elliot S. Valenstein, Ph.D., Blaming the Brain: The Truth About Drugs and Mental Health (The Free Press, New York, 1998), p. 125
5. Edward Drummond, M.D., The Complete Guide to Psychiatric Drugs (John Wiley & Sons, Inc., New York, 2000), page 15-16.
6. Miryam Williamson, Fibromyalgia: A Comprehensive Approach, in an excerpt from the book appearing at http://pinksunrise.com/mta/williamson2.htm, accessed 6/6/02
7. From a letter dated December 4, 1998 by Loren R. Mosher, M.D., a psychiatrist, resigning from the American Psychiatric Association, available on the internet at http://www.oikos.org/mosher.htm.
8. Joseph Glenmullen, M.D., Prozac Backlash (Simon & Schuster, New York, 2000), pages 192-193, page 196
9. Edward Drummond, M.D., The Complete Guide to Psychiatric Drugs, (John Wiley & Sons, Inc., New York, 2000), pages 8-9
10. Jerrold S. Maxmen, M.D., The New Psychiatry (Mentor, 1985) pages 19 & 36 - italics in original
11. Fred A. Baughman, M.D., quoted in Insight magazine, June 28, 1999, p. 13
12. Thomas S. Szasz, M.D., The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Dell Publishing Co., New York, 1961), p. 296.
13. From a letter dated December 4, 1998 by Loren R. Mosher, M.D., a psychiatrist, resigning from the American Psychiatric Association, available on the internet at http://www.oikos.org/mosher.htm.
14. David Kaiser, M.D., "Commentary: Against Biologic Psychiatry," Psychiatric Times, December 1996, available on the Internet at http://www.mhsource.com/pt/p961242.html, accessed July 7, 2002.
15. Sydney Walker III, M.D., A Dose of Sanity (John Wiley & Sons, New York, 1996), p. 128
16. Sydney Walker III, M.D., The Hyperactivity Hoax (Springer 1998), pages 23-24 - italics in original
17. Alan Dershowitz quoted in "Clash of Testimony in Hinckley Trial Has Psychiatrists Worried Over Image", The New York Times, May 24, 1982, p. 11
18. Peter R. Breggin, M.D., in the foreword to Reality Therapy in Action by William Glasser, M.D. (Harper Collins, 2000), p. xi
19. Peter R. Breggin, M.D., Reclaiming Our Children (Perseus Books, Cambridge, Mass., 2000), page 140
20. Peter R. Breggin, M.D., The Antidepressant Fact Book - What Your Doctor Won't Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox (Perseus Publishing - Cambridge, Massachusetts, 2000) p. 168
21. Joseph Glenmullen, M.D., Prozac Backlash (Simon & Schuster, New York, 2000) pages 49 & 94
22. Joseph Glenmullen, M.D., Prozac Backlash (Simon & Schuster, New York, 2000), p. 8
23. Rennie v. Klein, 720 F.2d 266, 276 (3d Cir., 1983, quoted in Douglas S. Stransky, University of Miami Law Review, "Civil Commitment and the Right to Refuse Treatment..." Vol. 50:413, 434, note 135
24. Jon Franklin, Molecules of the Mind: The Brave New Science of Molecular Psychology (Dell Pub. Co., 1987) p. 103
25. Peter Breggin, M.D., Psychiatric Drugs: Hazards to the Brain (Springer Pub. Co., New York, 1983), pages 109 & 108
26. Maurice Victor, M.D., and Allan H. Ropper, M.D., Adams and Victor's Principles of Neurology - Seventh Edition (McGraw-Hill Medical Publishing Division, New York, 2001), page 1620
27. Peter R. Breggin, M.D., Electroshock: It's Brain Disabling Effects (Springer 1979)
28. Sidney Sament, M.D., Clinical Psychiatry News, March 1983, p. 4
29. quoted in: Lynn Payer, Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick (John Wiley & Sons, Inc., 1992, pp. 234-235
30. Christine Shenot, "Bleeder at National Medical Insurers Cry Of 'Fraud' Reopened A Big Wound", Investor's Business Daily, Monday, August 3, 1992, p. 1, quoted in "Unjustified Psychiatric Commitment in the U.S.A." by Lawrence Stevens, J.D., www.antipsychiatry.org/unjustif.htm, accessed 7/1/02
31. Time magazine, April 25, 1994, p. 24
32. Michael Unger, "Hospitals Called Cheats - Insurers say health-care chain pulled off nationwide scam", New York Newsday, Thursday, September 15, 1992, Business section, page 33, quoted in "Unjustified Psychiatric Commitment in the U.S.A." by Lawrence Stevens, J.D., www.antipsychiatry.org/unjustif.htm, accessed 7/1/02
33. Edward Drummond, M.D., The Complete Guide to Psychiatric Drugs (John Wiley & Sons, Inc., New York, 2000), pages 13-14See also A Retort to President Bush on Mental Health