Why Lawsuits about Psychiatric Malpractice Are Difficult to Win

Why Lawsuits about Psychiatric Malpractice Are Difficult to Win
by Peter C. Gøtzsche at Brownstone Institute

When people under psychiatric care commit suicide or homicide, or are killed or seriously harmed, because of medical malpractice, it is extremely rare that it has any consequences for the doctors. Psychiatry seems to be the only area in society where the law is being systematically violated all over the world. Even Ombudsman¹ and Supreme Court decisions² are being ignored. 

In 2003, using scientific arguments, lawyer Jim Gottstein convinced the Supreme Court in Alaska to decide that the government cannot drug patients against their will without first proving by clear and convincing evidence that it is in their best interests and that there is no less intrusive alternative available.2 Unfortunately, this victory for human rights has not created a precedent in Alaska, where the authorities continue to force people into being treated with antipsychotics. Just like everywhere else, including in Norway.

I have collaborated with Norwegian former Supreme Court Attorney Ketil Lund on these issues, and we explained in a law journal why forced medication cannot be justified.³ The efficacy of antipsychotics is poor, and the risk of serious harms is so great that forced medication seems to do far more harm than good.² Two years later, the Ombudsman concluded in a concrete case, with reference to the Psychiatry Act, that it violated the law to use forced treatment with an antipsychotic.⁴

I studied consecutive cases where patients had appealed forced treatment orders, which had never been done before. It was difficult to get access to the records, but it was worthwhile as it turned out that the legal protection of patients was a sham. 

We found that the law had been violated in every single case.⁵ The 30 patients were forced to take antipsychotics, even though less dangerous alternatives could have been used, e.g., benzodiazepines.6 The psychiatrists had no respect for the patients’ experiences and views. In all 21 cases where there was information about the effect of previous pills, the psychiatrists claimed a good effect, whereas none of the patients shared this view.

The harms of prior medication played no role in the psychiatrist’s decision-making, not even when they were serious. We suspected or found akathisia or tardive dyskinesia in seven patients, and five expressed fears of dying because of the forced treatment. 

The power imbalance was extreme. We doubted the psychiatrists’ diagnoses of delusions in nine cases, and there is an element of Catch-22 when a psychiatrist and a patient disagree. According to the psychiatrist, it shows the patient has a lack of insight into the disease, which is a symptom of mental illness.

The abuse involved psychiatrists using diagnoses or derogatory terms for things they didn’t like or didn’t understand; the patients felt misunderstood and overlooked; and the harm done was immense.

The patients or their diseases were blamed for virtually everything untoward that happened. The psychiatrists were not interested in traumas, neither previous ones nor those caused by themselves or their staff. Withdrawal reactions after stopping drugs were not taken seriously – we didn’t even see this term being used although many patients suffered from them.

When Jim Gottstein and I wanted to do a similar study of 30 consecutive petitions from Anchorage, we were met with so many obstacles that it took over four years of litigation before Jim was granted access to redacted records. US psychiatrist Gail Tasch and I found that the legal procedures were a sham where the patients were defenceless.⁷ 

In violation of previous Supreme Court rulings, the patients’ experiences, fears, and wishes were ignored in 26 cases, even when the patients were afraid that the pills might kill them or when they had experienced serious harms such as tardive dyskinesia. Several psychiatrists obtained court orders for administering drugs and dosages that were dangerous. The ethical and legal imperatives of offering a less intrusive treatment were ignored. And the psychiatrists claimed, contrary to the evidence,² that psychotherapy doesn’t work. They never provided psychotherapy or family therapy. 

It is a serious transgression of the law and of professional ethics when psychiatrists exaggerate the patients’ symptoms and trivialise drug harms to maintain coercion, but this often happens. Psychiatrists can be said to operate a kangaroo court, where they are both investigators and judges, and they lie routinely in court about the evidence, which I experienced myself when I was an expert witness in Anchorage and in Oslo.⁸  

A Lawsuit in Québec

A court case from Québec exemplifies why it is close to impossible to win psychiatric malpractice cases. Lawyer M. Prentki in Montreal had three expert witnesses:⁹ James Wright from British Columbia, a specialist in internal medicine and an expert in clinical pharmacology and psychiatric medications; psychiatrist Josef Witt-Doerring from Utah, an expert in psychiatric drug withdrawal, and me, a specialist in internal medicine and an expert in psychiatric medications.

We all concluded that the patient, Nathalie Lavallée, was a victim of malpractice and suffered from benzodiazepine withdrawal symptoms, with serious consequences for her, whereas the witnesses for the defence and the judge disagreed.⁹ Nathalie was a teacher, and I wrote in my report that “On some issues, it seems that Ms. Lavallée is more knowledgeable than her psychiatrists.”

The Defendant

The defendant was Nathalie’s family doctor, Yves Mathieu. In 2006, he wrote briefly in his notes, “Trouble adapting, harassment at work,” and prescribed an antidepressant, venlafaxine, and an antipsychotic, quetiapine. This is bad medicine. These conditions are not indications for such drugs. 

A week later, he added two benzodiazepines, alprazolam and flurazepam, for sleeping problems and anxiety. After two more weeks, he added a muscle relaxant, cyclobenzaprine, which works like benzodiazepines. It was horribly bad medicine to put her on five drugs. Her issues were of a psychosocial nature and should have been treated as such. In addition, one should generally not use more than one psychiatric drug from the same therapeutic class, because increasing the total dose increases the risk of dying and of other harms without increasing the therapeutic effect.¹⁰ 

Concomitant treatment with an antipsychotic and a benzodiazepine also increases the risk of death, e.g. by 65% for clonazepam, which is why the Danish Board of Health recommended against this combination in 2006.¹¹ I doubted that there ever was a good reason to prescribe psychiatric drugs to Nathalie, and psychiatrist Adrian Norbash seemed to agree with me when he provided a full examination of her (see below).

Health Canada Advisories on benzodiazepines provide a list of symptoms that can occur during benzodiazepine use and withdrawal that match very well with the issues Nathalie had, and they also advised against combining an antipsychotic with an antidepressant. 

I considered it highly likely that Nathalie’s subsequent struggles to work resulted from the drugs prescribed to her. Despite the formidable initial drugging, she succeeded to come back to work, which said something important about her determination to work. 

When she wanted to stop venlafaxine eight months after Mathieu prescribed it, he halved the dose for a week, halved it again for another week, and then stopped it. This tapering is way too fast and can cause dangerous withdrawal symptoms that increase the risk of suicide.^2,12 In court, Mathieu put the blame on Nathalie whom he said insisted on proceeding quickly but it was his professional duty not to do so.

During only three months in 2010, Nathalie received an antipsychotic, two antidepressants, and five benzodiazepine-like drugs. This cocktail is not evidence-based and substantially increased the likelihood that Nathalie would become totally unable to function and that her doctors would misdiagnose the symptoms as representing psychiatric disorders, although they were drug harms. 

I explained in detail why I found Mathieu guilty of serious malpractice. The Code of Ethics for physicians in Québec states that, if the interest of the patient requires it, the doctor must consult a colleague; must only provide care or issue a prescription when these are medically necessary; must refrain from prescribing psychotropic substances in the absence of pathology or sufficient medical reason; and must not decrease the physical, mental, or affective capacities of a patient except where such is required for preventive, diagnostic, or therapeutic reasons. 

There was no indication in Mathieu’s notes that he informed Nathalie about any of the many serious harms of the drugs he prescribed to her, or that he consulted a psychiatrist, which I believe he should have done, given his obviously limited knowledge about the drugs he prescribed.

There were no notes in Nathalie’s file that Mathieu had educated her about the harms of the drugs and the dangers that could occur if she stopped taking them abruptly. I acknowledged that notes made by family physicians are often brief but if he had informed her properly, which takes time, he would surely have made a note to this effect in her file. There were no plans about length of treatment, which was also bad medicine. It had been known for decades^13-15 that benzodiazepines are highly addictive and that the effect, e.g., on insomnia, only lasts a few weeks, and that they therefore should generally not be prescribed beyond a few weeks. 

Mathieu’s explanation in court that he did not plan to prescribe the benzodiazepines for a long time was contradicted by his actions. Four months after he prescribed them, Nathalie was still on them, and at her last visit with him seven years later, she told him that she was still having difficulty sleeping, but instead of telling her that a sleeping pill only works for a couple of weeks and that she should come off it, he renewed the prescription.⁹

I drew attention to the package inserts for alprazolam, venlafaxine, and quetiapine that warned against the harms Nathalie had experienced, and I noted that these serious harms had been known long before Mathieu prescribed the drugs to her in 2006. 

James Wright noted that benzodiazepines should only be prescribed for a few weeks and never for more than a year, and he concluded that Mathieu showed serious failings by letting Nathalie take benzodiazepines for many years, by not ensuring follow-up for her to gradually stop taking them; and by not informing her of the associated dangers.

Josef Witt-Doerring agreed that Mathieu did not act in conformity with good practice, emphasised that Nathalie was not suffering excessively when he met her in 2006, and that he should have tried therapy before considering benzodiazepines. He found Mathieu’s conduct dangerous by not informing Nathalie about the risk of developing a dependence on benzodiazepines and the importance of gradually stopping them.

Stunningly, Franck Paul-Hus, a family doctor in Québec and expert for the defence, found that Mathieu’s various prescriptions were appropriate and compliant with the standards of practice for a family doctor, and he emphasised that to treat distress symptoms of the nature Nathalie had, a doctor would need to prescribe a combination of drugs with antidepressant, antipsychotic, and anxiolytic effects, which would allow her to improve psychologically, resume her activities, and plan a return to work.

There is no scientific evidence for the drug cocktail Paul-Hus found necessary, and he cannot know if Nathalie would have improved faster without the drugs, which I find highly likely. 

Another expert for the defence, Frédéric Poitras, a pharmacist practicing pharmacy in Québec, stated that benzodiazepines and antidepressants can be prescribed together and that benzodiazepines can be used for long-term treatment of anxiety disorders. He stated that some patients respond well to chronic benzodiazepine treatment, which is blatantly false. 

Poitras said that the doctor is the diagnosis specialist and will therefore generally transmit some information about the treatment but will expect all pharmaceutical advice to be provided by the pharmacist. This is also seriously misleading. Doctors are obliged by law to inform their patients about harms, particularly serious harms, of the drugs they prescribe. 

Poitras explained that good standards of practice recommend that pharmacists provide patients with a document about the dispensed medication; that the provision of this advice sheet had been very widespread throughout Québec pharmacies since the 2000s; and that the advice sheets for benzodiazepines specified not to stop taking them abruptly without professional advice.

Nathalie said during her out-of-court examination that the pharmacists from whom she obtained these medications did not give her such warnings, verbally or in writing. Indeed, she did not remember having ever received an advice sheet when receiving these medications and asserted that no pharmacist spoke to her about the importance of not stopping taking them abruptly.

Shockingly, Poitras advocated breaking the law (see the ruling by the Supreme Court of Canada below) by keeping patients completely in the dark. He noted that, despite some documented rare adverse effects, doctors will not systematically address them during consultations with their patients, as these manifestations are marginal and can hardly be convincingly linked solely to the use of the medication.

Psychiatrist Fiore Lalla, also an expert for the defence, argued with reference to a policy paper in the Journal of Clinical Psychiatry that long-term use of benzodiazepines could often be indicated in depression, panic disorders, generalised anxiety disorders, and post-traumatic stress disorder. He saw no negligence in the doctors who treated Nathalie and said that she was in no way deprived of follow-up; quite the opposite. 

Nathalie was on benzodiazepines for seven years. In 2014, she tried to kill herself by strangling but survived because the belt from her bathrobe tore apart. I found it likely that her severe withdrawal symptoms contributed to her suicide attempt and I noted in my expert report from October 2019 that it is typical for drug-induced suicide attempts that the means are violent, e.g. hanging, shooting, or throwing oneself in front of a train, as the attempt is not a cry for help but a genuine attempt of losing one’s life. The judge noted in her verdict that maybe it was not withdrawal symptoms, but that she was distraught by the situation where her boyfriend refused to continue their relationship if she took medication to treat a mental illness.⁹ 

After her suicide attempt, Nathalie saw a psychiatrist at the hospital who talked to her for five minutes and said she had a depression. She wondered how that could be since she was the happiest girl 30 days earlier. The psychiatrist wanted to give her more pills, which is bad medicine because the randomised trials show that antidepressants increase the risk of suicide at all ages.¹⁶

Nathalie asked the psychiatrist if the suicide attempt could be due to the drugs but her concerns about withdrawal effects were dismissed. She said that “everyone was in denial,” and they put her on two different benzodiazepines, as she didn’t want to get an antidepressant again. 

Her doctor at the time, Sana Eljorani, noted that she had very likely developed an abstinence depression, which is not a true depression but a drug harm that increases the risk of suicide and violence.^2,12 Eljorani did not start an antidepressant because Nathalie was worried about withdrawal symptoms.

I noted in my report that it is easy to distinguish between a real depression and an abstinence depression. Psychiatrists have described that if you give the full dose again, the abstinence depression usually disappears within a few hours, while a true depression doesn’t. 

Nathalie was approved for long-term disability allowance due to her protracted withdrawal symptoms. She told Eljorani that psychiatrist Adrian Norbash did not know that benzodiazepines are just as difficult to get off as heroin. I noted in my report that numerous psychiatrists and pharmacists have observed that it is much more difficult to get people off benzodiazepines than heroin. 

A Full Examination by Psychiatrist Adrian Norbash 

Nathalie was examined by Norbash in 2016. He was not Nathalie’s psychiatrist but her professional insurance’s psychiatrist. They paid him to produce a report that would contribute to strip Nathalie of her benefits. They essentially did everything they could to get rid of her.

Norbash didn’t make the connection that her suicide attempt could be caused by withdrawal effects and used inverted commas when he described the “withdrawal symptoms,” which suggested he didn’t believe what Nathalie told him. Moreover, he rejected the benzodiazepine withdrawal syndrome without even looking at her pharmacy reports or her medical notes with Mathieu.

Norbash also used inverted commas when Nathalie told him she had experienced a “seizure” after stopping benzodiazepines, although this is a well-known drug harm. His incompetence was staggering. He didn’t believe that benzodiazepine withdrawal can cause depression and argued that a depression doesn’t cause speech difficulties or memory loss, ignoring that abstinence reactions can include such symptoms. 

Norbash wrote that Nathalie didn’t like psychiatrists due to perceived misdiagnoses in the past and suspicions about the relationship between physicians and pharma. They were not “perceived misdiagnoses,” and Norbash also misdiagnosed her when he failed to consider the brain-altering effects of the drugs and issued an avalanche of insulting diagnoses: Conversion Disorder, Somatization Disorder/ Somatic Symptom Disorder; Narcissistic Personality Disorder; Somatic Symptom Disorder; and Borderline Personality Disorder.

Norbash noted that Nathalie “endorsed a high frequency of symptoms and impairment that is highly atypical of individuals who have genuine psychiatric or cognitive disorders. This suggests a high likelihood of potential feigning.” 

I noted in my report that, given the well-known long-term harms of previous use of psychiatric drugs, it is concerning that Norbash concluded that Nathalie was likely feigning symptoms and didn’t consider that they could be drug harms. It is bad practice to come up with psychiatric diagnoses in a patient whose brain is under the influence of brain-altering drugs. If a patient becomes psychotic after having taken LSD, we will not say the patient has schizophrenia. 

I explained that likely all psychiatric drugs can lead to chronic brain impairment, which may persist for years after the patient came off them. I noted that the American Psychiatric Association acknowledged in 2000 that benzodiazepine-like drugs may cause persistent memory problems and introduced the terms “Persistent Amnestic Disorder” and “Persistent Dementia” in its diagnostic handbook, DSM-IV-TR.¹⁴ 

I also noted that alprazolam seems to be a particularly dangerous benzodiazepine, with serious withdrawal effects. In a large trial, after stopping the drug, the patients had more panic attacks than when they entered the trial whereas those who got placebo did immensely better (slide from Robert Whitaker):¹⁷

Long-lasting withdrawal reactions can be almost anything but often resemble the harms of the drugs experienced during continued drug use.¹⁴ In 2012, my research group published a systematic review of the withdrawal reactions after benzodiazepines and antidepressants and found that they are very similar.¹⁵ Virtually all of the symptoms Nathalie had complained about can be found in Table 3 of our paper, which I reproduced in my expert report. 

I emphasised that Nathalie had experienced many of the symptoms listed for alprazolam but that Norbash used them against her, as if they would somehow prove that she feigned symptoms, which I found unprofessional. 

I noted that the evidence that psychiatric drugs, including benzodiazepines, can cause persistent harms many years after the patients came off them, is best documented in user forums where thousands of previous patients share their experiences and provide support to each other. A sizeable minority, perhaps 10-15% develop a “post-withdrawal syndrome,” which may linger for months or even years.¹⁸

I enclosed a book chapter by one of my colleagues, Luc Montagu, who suffered from persistent harms for over 10 years after benzodiazepine withdrawal and a Times Magazine article about it.¹⁹ Like Nathalie, Luc struggled for years to return to the work he so much loved. 

Norbash concluded that there was no clear indication for pharmacotherapy given the nature of Nathalie’s disorders and suggested psychotherapy. He ended his examination report with a self-gratifying remark: “Unfortunately, Ms. Lavallee shows no inclination toward accepting the recommendations of medical professionals, and as such the prognosis for a return to premorbid level of employment, and the likelihood of success with the use of vocational services, are both poor.”

Nathalie said she didn’t have a good opinion of psychiatrists because she wasn’t informed of the long-term risks of benzodiazepines and was told that quetiapine was a kind of relaxer.

I noted in my report that Nathalie seemed to have an odd personality. She was obsessed with medical tests; didn’t believe them when they were normal but wanted them repeated; and believed she had parasites in the liver. However, I also found it understandable that she was desperately looking for an explanation for her symptoms because her doctors denied that they could be caused by the drugs. 

The Verdict

The judge, Sophie Picard, delivered a not guilty verdict in the Superior Court.⁹ She relied heavily on the standards of practice argument: What would a reasonably prudent and diligent doctor have done in the same situation? She argued that a disciplinary fault – contravention of the Code of Ethics for physicians – would not necessarily constitute a civil fault within the meaning of the civil liability regime because the breach of the rule would need to give rise to a causal civil fault for the alleged prejudice.

This makes it difficult to conclude that anyone is guilty of medical malpractice, and she raised the bar even further. The standards of practice are a consensus established through the testimony of experts who practice in the same field as the defendant doctor, and there can only be fault in the presence of a violation of the medical consensus at the relevant time. Picard even noted that failure to follow the recommendations found in drug monographs does not in itself constitute a fault or an error generating liability. 

Moreover, Picard’s view was that the obligation to inform a patient about the risks of a treatment is circumscribed to those that are normally foreseeable and does not extend to exceptional risks. She quoted Paul-Hus who had said that doctors must mention the common risks of the medications they prescribe, and that he “would never discuss withdrawal syndromes since a rebound is certainly possible but in such an event, the patient comes back to see him and the symptoms generally do not last long.” 

I consider all these arguments invalid. The withdrawal symptoms can last many years.^{2,12,14,18,20} Furthermore, Picard’s view is in clear violation of the instructions from the Supreme Court of Canada.²¹ Over two decades ago, the Court imposed the standard that the adequacy of consent explanations is to be judged by the “reasonable patient” standard, or what a reasonable patient in the particular patient’s position would have expected to hear before consenting. Uncommon risks of great potential seriousness should be disclosed, and even if a risk is “a mere possibility” but has serious consequences such as paralysis or death, it requires disclosure.

Picard stated that it is important to determine whether the fault related to the duty to inform caused the claimed damages and that Nathalie had not established on a preponderance of evidence that Mathieu committed a fault generating liability towards her.

Picard found it notable that Nathalie did not have any expert witness who was a family doctor or who had practiced in Québec in this field and who was familiar with the reality of family medicine practice in Québec. She noted that, being unaware that the field of anxious-depressive disorders is primarily the responsibility of family doctors in Québec, Nathalie’s expert witnesses had criticised Mathieu for not calling upon a psychiatrist in 2007 whereas Paul-Hus had emphasised that psychiatric consultations for such disorders were mostly done only when the patient was refractory to pharmacological treatment. 

Yet again, Picard’s argument was invalid. We were fully aware that such disorders are primarily handled by family doctors, but this has absolutely nothing to do with our criticism of Mathieu. It is also totally irrelevant that we have not practiced in Québec because legal and ethical norms for doctors are universal, as demonstrated by the instructions from the Supreme Court of Canada. 

Picard mentioned that Nathalie had been unable to find experts practicing in Québec and that she had presumed they didn’t want to offer testimony unfavourable to a colleague. Indeed. Picard noted that Nathalie had said that a scheduled witness, Eljorani, who had followed her between 2014 and 2020, refused to testify, as did a doctor who had been following her for two years who said in February 2023 that she no longer wished to write a report despite her promise, fearing potential repercussions from her professional order.

Picard concluded that this problem did not allow Nathalie to circumvent the legal principles and rules of evidence applicable to everyone. This is a non-sequitur. The fact that ethical and legal rules are universal makes it irrelevant to find a local person to function as an expert.  

Picard criticised us – Natalie’s experts – for lacking significant factual elements to give an informed opinion on Mathieu’s treatment, e.g. we took for granted that psychotherapy had not been proposed, “which was absolutely false,” and that her problem when she first met Mathieu was “completely trivial.”

Picard’s accusations were false. Whether psychotherapy was offered or not is immaterial for our criticism of the lack of informed consent and we did not regard Nathalie’s issues as trivial but as psychosocial in nature, not in need of psychiatric drugs. 

Picard considered that it was incumbent upon Nathalie to demonstrate that Mathieu committed a fault regarding his duty to provide her with relevant information on benzodiazepines – the risk of developing dependence and the importance of not stopping taking them abruptly. But it is impossible to prove the existence of something that doesn’t exist. Picard mentioned that Mathieu did not systematically note everything he said to his patient but that it did not seem that he specifically and explicitly advised Nathalie of the risks of dependence related to benzodiazepine use or the possible consequences of rapidly stopping these medications: “Indeed, he says he does not remember it and did not mention it in his notes.” This comes close to a proof. 

Nathalie did not have very precise memories of the consultations. She did not recall at all that he spoke to her about the risk of benzodiazepine dependence or to gradually stop taking these medications. 

Picard found it difficult to determine whether Nathalie would have refused to take benzodiazepines if she had known the risks of dependence and the importance of gradually stopping their intake. I do not agree. She said on many occasions that she was against taking prescription drugs. 

Picard argued that Mathieu’s fault could not be causal because Nathalie was advised at least once, in the spring of 2012, by a health professional in another state of the importance of a long-term plan to reduce and stop taking flurazepam. 

Picard acknowledged that all of us – Nathalie’s experts – believed that her constellation of symptoms fit perfectly with “protracted benzodiazepine withdrawal symptoms” and that, in all likelihood, her condition, notably her inability to work full-time, resulted from the taking of the medications prescribed by Mathieu and the abrupt cessation of them, and that we believed Nathalie should not take medication.

In contrast, Lalla had the opinion that Nathalie’s symptoms were manifestations of her established diagnoses; Poitras found it highly probable that the long-term symptoms stemmed from an untreated underlying psychiatric condition; and Paul-Hus said that benzodiazepine withdrawal was definitely not the cause and was not retained by any psychiatrist who questioned and examined Nathalie.

Poitras considered that our arguments stemmed from “an unnuanced a priori,” in that all the physical and psychological manifestations presented by Nathalie were exclusively linked to a prolonged benzodiazepine withdrawal. This was false. We never expressed certainty but said that her symptoms matched very well with the known withdrawal symptoms. Picard criticised us for not knowing about several of Nathalie’s pre-existing symptoms when we wrote our reports, but I knew a lot about them and still found it highly likely that her symptoms were withdrawal symptoms. 

Poitras provided other falsehoods. He claimed that, failing to find anything else, I had granted “great credibility to observational cases, to the clinical findings of a doctor who published a book on the subject, and to non-scientific press articles.” I noted in my expert report that since there is a very large literature on long-lasting harms after exposure to psychiatric drugs, I had preferred to quote books that summarise what we know^13,14 but would also quote scientific articles. 

Picard’s trump card was that the plaintiff must “prove that the prejudice (harm) is a direct, logical, and immediate consequence of the fault.” She added that, in medical liability matters, expert evidence is generally required to analyse the causal link between the fault and the alleged prejudice, but that experts had disagreed.

As far as I know, liability cases are not about absolute proofs, which are often impossible to obtain, but about likelihoods. 

Discussion 

The verdict is from 25 February 2025.⁹ Nathalie’s lawyer had worked very hard on her case and found it extremely disappointing and unfair that the judge, as he had feared, did not have the courage to condemn the defendant doctor in any way. She cleared him of all faults by siding with the defence’s expert reports, ignoring or minimising many of our overwhelming pieces of evidence, and grossly reducing the scope, relevance, and validity of our expert reports. 

Prentki found the content of the judgment to be a profound injustice not just for Nathalie, but for the countless other patients who are also victims of abusive prescriptions of psychiatric drugs but have been abandoned by the system. The judge unfairly criticised Nathalie while protecting and exonerating the defendant doctor from the deplorable, irresponsible, and dangerous mistakes he committed.

Nathalie told Prentki that she knew several other patients to whom Mathieu had also abusively prescribed benzodiazepines, and who had suffered seriously as a result. 

Initially, Prentki could not come in contact with Nathalie to tell her the bad news, and he learned later that she had suffered a rather serious stroke. Shortly after he had told her of the verdict, she took her own life, disappointed by the injustice she had suffered. She felt profoundly betrayed, first by the medical system and subsequently by the justice system.

I told Prentki that I could understand why Nathalie felt she had had enough of this world: “She became yet another person among millions killed by psychiatry, the only atrocity that we officially allow in our societies. I have argued why psychiatry should be disbanded in my latest book.” I called the book, “Is psychiatry a crime against humanity?,” and answered affirmatively.¹⁰ One of the reasons why I wrote the book is that, as an expert witness in several court cases, and after having read many articles on the subject, I had found a total lack of accountability and a dysfunctional judicial system when the issue is psychiatry. 

Judge Picard ruled in clear contradiction of the instructions from the Supreme Court of Canada. Moreover, she made the value judgment that it is more important what local experts say than what the scientific evidence and far more qualified foreign experts say. On top of this, Prentki told me that the medical lobby in Québec is very powerful. There is an extremely strong solidarity among colleagues.

He argued this point to the judge, citing works by leading figures in Québec law, university professors, and very renowned judges, who denounced the existence of this professional solidarity and the denial of justice it caused for victims of medical errors and malpractice. However, Picard dismissed this evidence, as she did with so many other pieces of evidence.

Picard emphasised that the standards of practice are very important for judging a case. This is how judges always reason. But what if the standards of practice go against the scientific evidence, ethical and legal norms, international guidelines that also apply in Canada, and are in violation of the instructions from the Supreme Court of Canada? 

Then the argument falls apart. To take an extreme example, it was the “standards of practice” in Auschwitz to kill people in gas chambers, but that cannot justify it. In a similar vein, the standards of practice in psychiatry are so horrible that they have caused the death of millions of psychiatric patients.²² They must be changed radically for the benefits of the patients and society, and Picard could have contributed to this by finding the defendant guilty. I think any reasonable observer would come to the conclusion that he was guilty.

When something goes wrong in psychiatry, e.g. when a patient commits suicide or homicide, very likely caused by akathisia, a horrible withdrawal effect that predisposes to such acts; or when patients develop substantial memory loss after ECT; or when studies are published showing that patients with schizophrenia have about a 15 years shorter lifespan than others; or when psychiatrists call patients treatment-resistant when they don’t respond to the poor drugs they have been offered; the psychiatrists never blame their drugs or themselves, and the authorities and the drug companies also put the blame on the patients and their diseases.^2,10,12,23

This was exactly what the experts for the defence also did. It very conveniently relieves everyone involved from any accountability or culpability. I have documented in my books and articles that the patients or their diseases are blamed for virtually everything untoward that happens in psychiatry.^{2,5,7,10,12,23}

David Stofkooper from Holland took his own life in 2020, at only 23.¹² He made the fatal mistake of consulting a psychiatrist for minor psychological issues who put him on sertraline, an antidepressant. He became suicidal and zombified, with no libido and no emotions; his whole personality disappeared. Another psychiatrist told him to quit sertraline cold turkey, in just two weeks, like Mathieu did for Nathalie. 

David got into horrible withdrawal, which went on for months. When he told his psychiatrist how he felt, she didn’t believe him and said it was not due to the drug, as it was out of his system. David wrote in his suicide note that, “You present them with a problem that is created by the treatment you got from them, and as a reaction, get blamed yourself.”

His life had stopped. He couldn’t get pleasure out of anything. He wanted his story to be told, as a warning to others and I corresponded with his mother. They had read my first psychiatry book,² but unfortunately too late. If he had read it before he was put on sertraline, he might have refused to take the drug that killed him. Informed consent was ignored, also in this case. 

We must systematically educate lawyers and judges so that they can rule fairly in lawsuits related to psychiatry, which are virtually always farcical. Judge Picard’s biases and lack of courage and proficiency in this verdict were one of the causal factors that led to Nathalie’s suicide.

References

1. Gøtzsche PC. Forced drugging with antipsychotics is against the law: decision in Norway. Mad in America 2019;May 4. 
2. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.
3. Gøtzsche PC, Lund K. Tvangsmedisinering må forbys. Kritisk Juss 2016;2:118-57. 
4. Tvangsmedisinering – særlig om kravet til ”stor sannsynlighet” for positiv effekt. Sivilombudet 2018; Dec 18.
5. Gøtzsche PC, Vinther S, Sørensen A. Forced medication in psychiatry: Patients’ rights and the law not respected by Appeals Board in Denmark. Clin Neuropsychiatry 2019;16:229-33 and Gøtzsche PC, Sørensen A. Systematic violations of patients’ rights and safety: Forced medication of a cohort of 30 patients. Ind J Med Ethics 2020; Oct-Dec;5(4) NS:312-8.
6. Dold M, Li C, Tardy M, et al. Benzodiazepines for schizophrenia. Cochrane Database Syst Rev 2012;11:CD006391.
7. Tasch G, Gøtzsche PC. Systematic violations of patients’ rights and safety: forced medication of a cohort of 30 patients in Alaska. Psychosis 2023;15:145-54.
8. Gøtzsche PC. Seriously misleading testimony by psychiatry professor in Oslo district court about the effect of antipsychotics. Mad in America 2024;Dec 4.
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16. Gøtzsche PC. Observational studies confirm trial results that antidepressants double suicides. Mad in America 2025;Feb 8.
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22. Gøtzsche PC. Prescription drugs are the leading cause of death. And psychiatric drugs are the third leading cause of death. Mad in America 2024;April 16.
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Why Lawsuits about Psychiatric Malpractice Are Difficult to Win
by Peter C. Gøtzsche at Brownstone Institute – Daily Economics, Policy, Public Health, Society