Tuesday, June 26, 2012

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.


  1. "Psychiatric expert testimony: mendacity masquerading as medicine."
    Thomas Szasz

    That's S-Z-A-S-Z

  2. This is hard for me to share, but in the interest of science...that guy might not have been totally there. And that's just from my personal experiences.

    This is my shortened version of what I am like on meds: Put me on a stimulant every day and it will work for a while, but you will eventually give me lots of panic and irritabiliy. Put me on an SSRI and you will make me feel like I want to slash your tires. Put me on an atypical antipsychotic and I WILL in fact slash your tires.

    When I was young, I was put on every psychiatric medication under the sun. Ritalin, Paxil, Zoloft, Celexa, Zyprexa, Prozac...and abilify. Those were hard years. The meds made me worse and I didn't want to take them, but my family bullied me and so did my school. I tried telling people, but they didn't believe me. In fact, if I tried telling school staff that I wanted to kill myself, that was AUTOMATICALLY because I needed a med change and not for the reason that i thought (the drug was screwing with my brain). I was treated like a behavior problem and was told by the school psychologist that I was selfish for wanting to die.

    Anyhow, when I was 17, I was put on Abilify. To this day, I have no clue what happened. It was like I felt nothing. All of the things that used to excite me no longer got my blood going. I was totally unmotivated and I couldn't concentrate. Then the worst thing happened. I stopped being able to read. I was the type of person who would get lost in books for hours. But I couldn't do it anymore. I begged and pleaded with my father to take me out of school. I couldn't do it anymore, and I felt like I wanted to die. Not because I was miserable, but because I couldn't even feel misery anymore. He was a screamer though and he wouldn't have it.

    So...I broke the law. I went to some teenagers at my high school and told one of them I wanted to die and no one cared. I was falling apart and I wanted her to tell the school I threatened to kill her. She did and her friends backed her up. The school called the cops. I don't know why, but I told them I wanted to kill myself. Weirdly, they were really nice to me, and they said they wanted to get me help. I wasn't expecting that from cops. Also, maybe I imagined this, but I didn't get the impression that they believed I threatened to kill the girl at my school... I ended up in a mental hospital.

    Then I was put on Wellbutrin, and somehow, beyond my wildest expectations, it actually reversed some of the Abilify damage. I still felt like I wanted to die, but before I was released, I was reading again to some extent...and enjoying it. I remember that. I read a little while I was there and did a book report for my couple hours of class I had a day.

    And then I went on Lithium, and Ativan, and Zoloft again, and la de da de da.

    My point is...I am sure you could call me a B word who should have been put in prison but lucked out with some really nice cops who had zero interest in putting me in jail...and told a staff person to tell the psychiatrist that. But I do think that these drugs can really screw you up and get you to do things you wouldn't normally do.

    To this day, I have trouble reading. And that was eight years ago. I got it back, but I never again was able to read like I used to. The Abilify did something to my brain.

    If these drugs can make me act that devious, then I could see someone flipping out and getting violent. I was pretty focused about getting kicked out of school...but I wouldn't say I was all there.

  3. Some people have reactions to drugs that other's will never experience, so it's not out of the realm of possibility to me that the policeman was in the former category. Just a few days ago I learned that one of my son's teachers, who is retired, was given an antidepressant on top of whatever he is taking for his chronic insomnia. He sat down with a knife and sliced his arm from wrist to elbow. He has absolutely no idea why he did this as he was not depressed or suicidal. So, while Dr. Allen may not like Dr. Breggin, all this says to me is that the medication defense is beginning to look like playing the race card and whoever raises it is going to be viewed with suspicion. Isn't everyone entitled to the best defense possible? Dr. Breggin's reputation may have had the opposite effect on the jury that the defense intended.

  4. Not that this is what happened to Nicholas Orban, but going off an antidepressant without adequate tapering can result in neurological hypersensitization.

    If the person resumes a full dose of the antidepressant (or any neuroactive substance), unpredictable and dramatic reactions can occur due to a "kindling effect." The person may say they feel out of control or their nervous system is collapsing.

    From what I've seen among perfectly ordinary people, usually the hyper-reactivity makes the person feel very ill. Agitation, akathisia, and sleeplessness are common. Waves of rage, thoughts of violence or self-harm are less common but have been reported.

    Quite understandably, people may be angry or frightened by the drug's turning on them.

    (These adverse reactions are often misdiagnosed as emergence of bipolar disorder.)

    However, when this is mixed with large amounts of alcohol, who knows what nihilism might take over?

    1. Hi Altostrata -

      I agree with everything you say.

      Fortunately, the majority of people will quickly stop taking a drug that makes them feel that bad. It's hard enough to get people to take meds regularly even without untoward side effects, as the extensive literature on non-compliance with medical prescriptions indicates.

      The planning and execution involved in this particular rape indicate that the perpetrator was clear-headed despite the booze, that this was well thought out beforehand, and that the perpetrator may very well have had prior experience with this sort of thing. That just isn't the way drug reactions play out.