An Essay on What the Fifteen-Minute Consultation Leaves Out

Lies are Unbekoming | September 10, 2026

What follows is twelve documented findings compressed into one sitting. It is written for the reader who has been prescribed one of these drugs, or is caring for someone who has, and who wants to know what the fifteen-minute consultation did not include. Every claim is drawn from the profession’s own literature, its own regulatory filings, its own package inserts, or the admissions of its own senior figures. Where an item is developed at greater length elsewhere in this series, that is noted. The purpose here is not depth on any single item. It is the cumulative weight of the twelve landing together.

Opening

Three percent of the 4,041 patients enrolled in the STAR*D trial remitted, stayed well, and remained in the study through the one-year follow-up.¹

The trial was announced with a cumulative remission figure of 67 percent.² When Ed Pigott and colleagues spent more than five years reanalyzing the data with fidelity to the original protocol, they found the 3 percent figure. When journalists put the 3 percent number to Maurizio Fava, one of the lead investigators, he acknowledged it was accurate. The investigators knew.³

The paper has not been retracted. It is still cited in psychiatric textbooks. The American Journal of Psychiatry ignored a petition signed by more than 1,800 people asking for retraction. The New York Times, repeatedly notified of the fraud, published the 70 percent figure again in a 2024 article praising the drugs.⁴

STAR*D was the largest depression trial ever conducted. It was funded by the National Institute of Mental Health. It was designed by the profession’s most senior researchers. What it proved, when honestly analyzed, was that the drugs did not work.

That fact has been available for over a decade. It has not reached the patients being handed the prescriptions.

The evidence throughout is drawn primarily from Peter Gøtzsche, Robert Whitaker, Peter Breggin, Gary Greenberg, David Healy, and Joanna Moncrieff. What the twelve items share is that none of them are contested at the level of documentation. They are contested only at the level of what the profession chooses to tell patients.

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What They Told You Was True

The prescription is written on the basis of a mechanism, a diagnosis, and a trial. Each has failed on its own terms.

1. The chemical imbalance was never demonstrated

The theory that depression results from a deficiency of serotonin was never established in the scientific literature. Joanna Moncrieff and colleagues published a comprehensive umbrella review of the serotonin theory in 2022 and found no consistent evidence for its central claims.⁵ The theory was abandoned by serious researchers decades earlier. It continued to appear in direct-to-consumer advertising and patient education materials because it served a function. It explained why the pill was necessary and why the patient would need to keep taking it.

Steven Hyman, director of NIMH from 1996 to 2001, later observed that “the gold standard was the DSM criteria. It struck me as a fool’s errand to try to develop a biomarker for a fictive category.”⁶ The chemical imbalance was the mechanism proposed for a disease no one could measure, in a category no one could validate.

Chemical Imbalance: The Collapse of a Medical Myth

2. The DSM has no biological markers

After four decades and hundreds of millions of dollars in federal research, not one disorder in the Diagnostic and Statistical Manual of Mental Disorders has a confirmed biological test. Not depression. Not schizophrenia. Not bipolar disorder. Not ADHD. Not anxiety. Not any of the more than three hundred conditions the manual lists.

Robins and Guze proposed a five-step validation process in 1970: clinical description, laboratory studies, exclusion criteria, follow-up studies, family studies.⁷ The five steps were meant to establish, over time, which alleged disorders were real diseases and which were figments. Four decades later, Darrel Regier, who chaired the DSM-5 task force, told Psychiatric News that “validity tests have not lived up to the expectations of Robins and Guze.”⁸ Kenneth Kendler, the field’s leading nosologist, wrote that the diagnostic categories in use had been “heavily influenced by expert opinion” and were “fuzzy constructs that shift when viewed in different ways.”⁹

Thomas Insel, director of NIMH from 2002 to 2015, put it most directly in a 2005 address to the American Psychiatric Association: “The DSM-IV has 100 percent reliability and zero percent validity.”¹⁰ Reliability means clinicians using the same manual will arrive at the same diagnosis. Validity means the diagnosis corresponds to a real thing. Insel was telling the assembled profession that its manual sorted patients consistently into categories that did not exist.

The APA response was to convene committees to plan the DSM-5. The committees did not find biological markers. They could not have. The categories were not built to have biological markers. They were built from clinical description alone. The manual reifies its own criteria.

The consequence for the patient is direct. When the doctor says “you have major depressive disorder,” the patient hears a diagnosis in the sense that a diabetes diagnosis is a diagnosis: a measurable biological state with a known mechanism. What the patient has actually received is a checklist tally. Five of nine symptoms present for two weeks. That is the whole test. There is no blood work, no scan, no biomarker. The diagnostic bible of American psychiatry sits on the shelf as an artifact of expert agreement, not a description of nature.

Manufacturing Madness: The DSM as Instrument of Social Control

3. STAR*D was manipulated

The opening figures bear structural repetition: 3 percent versus 67 percent, admitted by the lead investigator, still not retracted, still cited. Ed Pigott’s reanalysis was published in BMJ Open in 2023.¹¹ The investigators, when confronted, doubled down on the fraud in the American Journal of Psychiatry rather than correct it.¹² The owner of the journal, the American Psychiatric Association, did nothing.

Peter Gøtzsche has documented the specific manipulations. The “remission” threshold was set so low that a patient scoring 7 on the Hamilton depression scale, including endorsement of “feels like life is not worth living,” was counted as symptom-free.¹³ Patients who exited the study were assumed to have remitted at the same rate as those who stayed, a statistical fiction that inflated the numbers by an order of magnitude. Eleven prespecified outcomes were never reported. Suicidal ideation was reported at 0.7 percent in one paper and ten times that in others by the same authors.

The trial that was supposed to establish the effectiveness of antidepressants in real-world practice established the opposite. The profession’s response was to continue citing the announced figure.

Is Psychiatry a Crime Against Humanity? (2024)

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What Happens on the Drug

The prescription arrives with the phrase “you may notice some side effects.” The phrase does the work of concealment. Three effects, in particular, are not warned about with the seriousness they warrant.

4. Akathisia carries documented suicide risk

Akathisia is a state of extreme inner restlessness produced by antidepressants, antipsychotics, and antiemetics. The Greek term means inability to sit still. The patient may pace, fidget, wring hands, or endlessly walk. The condition may also present without visible motor symptoms, as unbearable internal agitation the observer cannot see.¹⁴

In 1990, Martin Teicher and colleagues at Harvard published five cases of patients who developed intense suicidal preoccupations on fluoxetine, all associated with akathisia, all resolving when the drug was stopped and returning when it was restarted.¹⁵ Rothschild and Locke published the rechallenge study in 1991: three patients who had made serious suicide attempts on fluoxetine, all rechallenged under controlled conditions, all developing akathisia and becoming suicidal again. One patient said in retrospect: “I tried to kill myself because of these anxiety symptoms. It was not so much the depression.”¹⁶

A study of psychiatric inpatients found that 79 percent of those who had attempted suicide were experiencing akathisia at the time.¹⁷ Another found that half of all fights on a psychiatric ward were akathisia-related. Haloperidol at moderate to high doses made half the patients markedly more aggressive, sometimes to the point of wanting to kill their psychiatrists.

The FDA’s 2004 black-box warning on antidepressants describes what Breggin has called the stimulant syndrome: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania.¹⁸ The label warns that these can occur in nonpsychiatric patients, meaning the drug produces the syndrome by itself, not by unmasking a preexisting condition.

Gøtzsche’s team examined manufacturer trial data and found akathisia miscoded as “hyperkinesia” in Zoloft trials. In paroxetine trials they found not a single case of akathisia recorded, which is statistically impossible given the drug class.¹⁹ The miscoding was systematic.

The FDA-approved label for Zyprexa describes akathisia as “extreme inner anxiety and restlessness.” At least one psychiatric textbook labeled it “agitated depression,” folding the drug’s most dangerous effect back into the diagnosis it was prescribed to treat. The patient who reports the akathisia is told the underlying illness has worsened. The dose is increased.

Mental Health Survival Kit and Withdrawal from Psychiatric Drugs (2022)

5. Benzodiazepine dependence begins at prescribed doses

The FDA-approved label for Xanax states that withdrawal symptoms, including seizures, have been reported after only brief therapy at doses within the recommended range for treating anxiety.²⁰ In the eight-week trials used for FDA approval, patients were worse off at eight weeks than before starting the drug. Between 7 and 29 percent of patients could not withdraw after only six to eight weeks of exposure.²¹

If you are currently taking a benzodiazepine, do not stop it abruptly. Abrupt cessation can produce seizures. Item 12 addresses what safe withdrawal actually requires.

Heather Ashton, the British psychiatrist who ran a benzodiazepine withdrawal clinic at the University of Newcastle for decades, documented that long-term users often required a year or more to taper.²² Some experience withdrawal symptoms lasting years after cessation. Cognitive impairment, depression, and anxiety worse than the original condition are common outcomes of long-term use.²³ Gøtzsche, who has decades of clinical pharmacology experience, has noted that patients report benzodiazepine withdrawal as often worse than heroin. Heroin abstinence symptoms resolve within days. Benzo withdrawal can persist for years.

Anxiety Uncovered: The Truth About Benzodiazepines and Real Solutions

6. ADHD stimulants produce the symptoms they treat on withdrawal

The DSM has a category for stimulant withdrawal, which lists depression, anxiety, irritability, sleep problems, fatigue, and agitation as the withdrawal syndrome after “several days or longer” of use. Rebound hyperactivity, talkativeness, and inattention are documented after a single dose in a placebo-controlled NIMH study of normal children ages 6 to 12.²⁴ Ten of fourteen children in that study showed marked behavioral rebound; three developed euphoria.

If a child is currently taking a stimulant, do not stop it abruptly. Rebound and withdrawal effects are commonly mistaken for a worsening of the original condition. Item 12 addresses safe withdrawal.

The teacher observes the child on Monday morning after a weekend off the drug, notices the child is more scattered and irritable than usual, and concludes the child needs the medication. The child is in withdrawal. The dose is increased. Peter Breggin’s observation from the early 1990s stands unchanged three decades later: if the child continues on Ritalin because they continue to have problems focusing, the disorder may be the drug’s effect.²⁵ Drug-induced inattention becomes the reason to continue and increase the drug.

The Multimodal Treatment Study of ADHD, the largest NIMH-funded stimulant trial, tracked children through eight years of follow-up. By three years, the medicated children showed no advantage over the non-medicated on any measure. They were, however, 2 cm shorter and 2.7 kg lighter than their unmedicated peers, a growth suppression the FDA eventually required on the label.²⁶

The Arithmetic Pill: ADHD, ADD, and the Evidence

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What Happens to Your Brain

The drugs act on the brain and the brain responds. What the brain does under sustained chemical assault is documented in the profession’s own imaging studies.

7. Antipsychotics shrink brain tissue on MRI

Nancy Andreasen, editor-in-chief of the American Journal of Psychiatry from 1993 to 2005, began a longitudinal MRI study of over 500 first-episode schizophrenia patients in 1989. In 2003, she reported that frontal lobe white matter volume decreased progressively over the years of treatment.²⁷ In 2011, her team published in Archives of General Psychiatry the finding that antipsychotic exposure was directly associated with volume loss.²⁸ In a 2008 interview with the New York Times, Andreasen stated it plainly: “The more drugs you’ve been given, the more brain tissue you lose.”²⁹

Fusar-Poli and colleagues confirmed the pattern in a 2013 meta-analysis of longitudinal MRI studies.³⁰ The 2009 Navari and Dazzan review reported that both older and newer antipsychotics produce gross changes in brain volume in selected regions.³¹ In monkey studies, haloperidol and olanzapine produced substantial reductions in both grey and white matter, and reduced glial cell numbers.³²

Andreasen’s original interpretation was that the shrinkage reflected the disease. The follow-up data forced her to concede the drug was the cause.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010)

8. Tardive dyskinesia is permanent

Tardive dyskinesia is a drug-induced movement disorder produced by antipsychotics. It can affect any voluntary muscle: face, tongue, neck, torso, extremities, diaphragm, vocal cords. The condition presents as involuntary jerky movements, slower writhing movements, painful spasms, or restlessness the patient cannot control. The mechanism is understood. Antipsychotics block dopamine receptors in a brain region called the basal ganglia. Over time the brain compensates by growing more of those receptors. When the drug dose is reduced, or when the extra receptors eventually outnumber the block, the excess drives the involuntary movements.

The prevalence is not marginal. DSM-IV-TR sets the annual incidence at 3 to 5 percent per year in young adults and 25 to 30 percent per year in older patients.³³ These are cumulative rates. A young adult after three years of exposure has a 9 to 15 percent risk. An older patient after three years has a 75 to 90 percent risk. Prevalence in outpatient clinics runs above 40 percent. In long-term facilities, above 50 percent.³⁴ There is no established treatment. Most cases are permanent.

The condition often extends beyond motor symptoms. Gualtieri and Barnhill observed that “in virtually every clinical survey that has addressed the question, it is found that TD patients, compared to non-TD patients, have more in the way of dementia.”³⁵ Breggin has called this tardive dementia. Tardive akathisia and tardive psychosis have also been documented, representing further permanent damage to the higher brain function of patients whose brains were supposed to be helped.

The condition is frequently masked by the drug that caused it. Increasing the dose suppresses the visible movements while the underlying damage progresses. Reducing the dose brings the movements out, which the prescriber may interpret as evidence that the patient still needs the medication. The patient’s brain, already damaged, is offered more of what damaged it.

The neurological literature has documented tardive dyskinesia for over five decades. It is required disclosure on antipsychotic labels. It is not routinely disclosed at the point of prescription.

Toxic Psychiatry

9. ECT causes documented brain damage

Electroconvulsive therapy applies electrical current to the head sufficient to produce a grand mal seizure. In modern practice, the patient is anesthetized and given a muscle relaxant to prevent the visible convulsion. The electrical dose is often increased to compensate for the seizure threshold raised by the anesthesia. Multiple treatments are given, typically 8 to 16 per course, sometimes more.

Autopsy studies dating to the 1940s documented brain necrosis in patients who died following ECT.³⁶ Animal studies documented brain damage. The brain’s response to ECT is an acute organic brain syndrome, medically indistinguishable from severe head injury. In neurological terms, multiple continuous seizures without full recovery of consciousness constitute status epilepticus, a medical emergency defined by its risk of permanent brain damage.

The memory loss is documented in every serious study that has looked for it. Larry Squire and Pamela Slater reported an average of 27 months of retrograde amnesia surrounding treatment.³⁷ Freeman and Kendell, using face-to-face interviews conducted by the treating doctors themselves (a design that biased strongly against reporting), found that 74 percent of patients reported memory impairment and 30 percent said their memory function was permanently affected.³⁸ Squire and Slater’s own longer follow-up found that 55 percent of patients felt they had not regained normal memory function over the years.

Gøtzsche summarizes the current literature: with strict definitions of memory loss, 29 to 55 percent of patients are affected. With looser criteria, 51 to 79 percent.³⁹ Death rates from ECT, according to a systematic review by John Read and colleagues, run at approximately 1 per 1,000 treatment courses, ten times higher than the American Psychiatric Association’s stated figure.⁴⁰

The efficacy evidence is thinner than the harms evidence. The 1985 NIMH Consensus Conference on ECT accepted the finding that no controlled study showed benefit beyond four weeks. The four-week window corresponds to the acute organic brain syndrome, during which severe brain dysfunction produces the euphoria or apathy interpreted as improvement.⁴¹ Once the brain begins to recover, the depression returns. If the patient is given more ECT, the brain damage accumulates. If the patient is not given more ECT, the profession points to the returning depression as evidence the disease was chronic.

The APA’s 1990 task force report on ECT omitted essentially the entire literature documenting memory loss and brain damage.⁴² The literature it omitted included the work of Squire, Slater, Janis, Friedberg, Breggin, and even the APA’s own previous 1978 report, which contained more information on memory loss than the 1990 update. In psychiatry, science sometimes runs backward.

What Happens When You Try to Leave

At some point the patient decides they no longer want to be on the drug. The system was not built to help them leave.

10. SSRI discontinuation can last years

The FDA-approved labels describe “discontinuation syndrome.” Patients and doctors alike were told the symptoms would last a few weeks and resolve. The systematic review by Davies and Read, published in 2019, established that this was false. Withdrawal symptoms are more common than reported, more severe than reported, and last far longer than reported. In one survey of 580 patients, 16 percent reported withdrawal symptoms lasting over three years.⁴³

If you are currently taking an SSRI or SNRI, do not stop it abruptly. Withdrawal reactions can include severe agitation, akathisia, suicidal ideation, and violence. Item 12 addresses the resources for safe tapering.

The Dutch tapering-strip program run by Peter Groot and Jim van Os has documented the shape of the problem. Of 895 patients on antidepressants, 62 percent had previously tried to withdraw without success. Using hyperbolic dose-reduction strips, 71 percent were able to withdraw within a median of 56 days.⁴⁴ Venlafaxine required 90 percent of patients to start at the lowest available dose and taper over three months. Some patients required more than six months. Dutch insurers refused to reimburse extended tapering because “there is no evidence in the literature” for its necessity, a circular defense against the very treatment the literature was documenting.

The withdrawal is routinely misinterpreted as return of the underlying illness. The patient is told they were unwise to stop and needs to remain on the drug indefinitely. Breggin’s term for this pattern is medication spellbinding. The drug produces effects the patient attributes to the disease.

11. Long-term outcomes are worse with the drugs than without them

The 1997 British study of a large inner-city primary care facility followed 95 never-medicated depressed patients and 53 drug-treated ones. Symptom reduction at six months: 62 percent for the never-medicated, 33 percent for the drug-treated.⁴⁵ A World Health Organization study of 640 depressed patients found that medicated patients had worse general health and were more likely to still be mentally ill at one year.⁴⁶ A Canadian five-year study of 9,508 depressed patients: 19 weeks of depression per year for the medicated, 11 for the unmedicated.⁴⁷ An NIMH study of 547 patients: medicated patients were three times more likely to lose their principal social role and nearly seven times more likely to become incapacitated at six years.⁴⁸

Rif El-Mallakh reported that 40 percent of patients on antidepressants end up in a chronically depressed “treatment resistant” state.⁴⁹ Giovanni Fava documented that drug changes induced by antidepressants “may propel the illness to a more malignant and treatment unresponsive course.”⁵⁰

The pattern extends to antipsychotics. Martin Harrow’s 15-year follow-up of first-episode psychosis patients found that those not on antipsychotics had significantly better outcomes and were far more likely to be in recovery.⁵¹ Lex Wunderink’s 7-year Dutch trial randomized first-episode psychosis patients to maintenance antipsychotics or dose reduction and discontinuation. The reduction group had double the recovery rate.⁵² Bockoven had documented in 1975 that rehospitalization rates rose after the introduction of antipsychotics and that medicated patients were more socially dependent than those treated in the pre-drug era.⁵³

The pattern is consistent across drug classes and across decades. Longer exposure produces worse outcomes. The drugs sensitize the brain and convert episodic distress into chronic dysfunction. The profession’s response has been to rewrite the natural history of the conditions to match the drug-damaged outcomes. The 1999 American Psychiatric Publishing Textbook of Psychiatry declared that older studies showing depression was self-limiting had been “disproved.” Depression became “a highly recurrent and pernicious disorder.”⁵⁴ The drugs had made it so.

12. Tapering protocols do not exist in most medical schools

The prescriber who put the patient on the drug is typically not trained in how to help them come off it. Withdrawal is not covered in the standard psychiatric curriculum. The tapering approach with the strongest evidence base is hyperbolic dose reduction, developed by Mark Horowitz and Joanna Moncrieff and published in Lancet Psychiatry in 2019.⁵⁵ The approach requires micro-dose reductions of a few percent at a time, made possible by liquid formulations or compounded tapering strips. Standard tablets do not come in the small doses required.

Peter Gøtzsche’s team spent two years trying to publish a Cochrane review protocol on antidepressant withdrawal support. The Cochrane depression group, chaired by Rachel Churchill, raised objections through 12,044 words of feedback across 86 numbered points, then rejected the protocol.⁵⁶ Cochrane refused to publish a review on how to help patients safely withdraw from a class of drugs prescribed to hundreds of millions of people worldwide. Gøtzsche’s PhD student Anders Sørensen mentored 30 consecutive patients through withdrawal in his unpaid spare time and documented the results, because it was the only way to do the work.

The insurance system compounds the problem. Dutch national health insurance refuses to reimburse extended tapering on the grounds of insufficient evidence, though the evidence exists and the insurers know it does. American insurers do not cover compounded formulations. The tapering strips developed at the Amsterdam pharmacy (taperingstrip.org) are available to prescribers in any country, but the patient must find a prescriber willing to order them, which many will not.

The knowledge exists. The Ashton Manual for benzodiazepine withdrawal has been public since 2002.⁵⁷ The Horowitz-Moncrieff hyperbolic tapering literature is in peer-reviewed journals. Mad in America hosts a withdrawal community with thousands of patients’ documented experiences. Breggin’s Psychiatric Drug Withdrawal was published in 2013.

None of it is on the psychiatric residency reading list. The doctor who wrote the prescription is, in most cases, not the doctor who can help the patient stop taking it. The patient is on their own.

What This Does Not Mean

The most common defense of the current prescribing paradigm is that the drugs help some patients, and that essays like this one endanger those patients by encouraging them to stop.

Some patients do report subjective benefit on these drugs. That is not disputed. What is not established is that this benefit exceeds placebo by a clinically meaningful margin, or that it survives the long-term outcomes documented in Item 11.

The safety caveats throughout this essay, and the resources listed below, exist precisely because abrupt cessation is dangerous. Nothing here recommends abrupt cessation. What is recommended is informed choice, which requires the twelve findings to be visible before the prescription is written or renewed. A patient who wishes to continue after seeing the twelve findings has made a different decision from a patient who was never shown them.

Resources

For patients currently on psychiatric drugs who wish to withdraw, resources exist outside the mainstream medical system. The Ashton Manual (benzo.org.uk/manual/) remains the standard reference for benzodiazepine tapering. The Horowitz-Moncrieff papers on hyperbolic tapering in Lancet Psychiatry (2019) provide the scientific basis for SSRI withdrawal. Mad in America (madinamerica.com) hosts an active community of patients who have withdrawn or are withdrawing. The Amsterdam tapering strip program (taperingstrip.org) makes hyperbolic dose reduction physically possible for antidepressants that do not come in the required small doses. Breggin’s Psychiatric Drug Withdrawal (2013) provides detailed clinical protocols. None of the above require permission from the prescribing physician. All require time and typically a support person. None should be attempted abruptly.

Closing

The twelve findings above are documented. They are not concealed by conspiracy. They sit in FDA labels, peer-reviewed journals, systematic reviews, and the admissions of senior figures within the profession. What conceals them is training.

Psychiatric residency does not require reading Whitaker or Breggin or Gøtzsche. It does not require examining the primary trial data on the drugs the resident will spend a career prescribing. It requires reading the textbooks the profession publishes about itself, the same textbooks that praised electroconvulsive therapy while omitting the memory-loss literature and that continue to cite the STAR*D 67 percent figure. The continuing medical education the practicing psychiatrist attends is funded largely by the pharmaceutical industry, whose interest in the twelve findings is that they should not surface. The drug representatives who visit the office once a month are the primary source of pharmacological information for many prescribers.

The doctor across from the patient in the fifteen-minute consultation is often not withholding information out of malice. The doctor does not have it. What was left out of the training reproduces itself in every consultation the doctor conducts for the rest of the career.

The training explains the local silence. It does not explain how the whole enterprise reached the point where twelve findings of this severity could accumulate without institutional response. That answer comes from someone who ran the enterprise.

Thomas Insel directed the National Institute of Mental Health from 2002 to 2015. He controlled the American federal research budget for psychiatry for thirteen years. He was, in that period, the single most powerful figure in American psychiatric science.

Reflecting on his tenure after leaving the position, he made the following observation, widely reported and repeated in the years since:

I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders. And when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs, I think $20 billion, I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.⁵⁸

Twenty billion dollars over thirteen years, and the head of the enterprise said it moved nothing on suicide, hospitalization, or recovery.

That is not the assessment of a critic. That is the man who ran the enterprise, describing the enterprise, from inside it. Insel went on to write a book defending psychiatric drugs, so the admission cannot be attributed to conversion or apostasy. He continues to believe in the paradigm. He just concedes it produced nothing.

The twelve items above sit inside that enterprise. What the psychiatrist was trained not to tell the patient is what the man who ran it for thirteen years, on his own accounting, could not deny.

How to Explain It to a Six-Year-Old

Imagine a garage that has been fixing cars for many years. Every car that leaves the garage has a bumper sticker that says FIXED.

One day someone counts. Out of every hundred cars leaving the garage, only three actually work. Ninety-seven do not.

The garage keeps operating. The mechanics keep putting on the FIXED stickers. The owner keeps telling everyone the garage fixes seven cars out of every ten.

When someone points out that the real number is three out of a hundred, the owner says yes, he knows the real number is three. He does not correct the seven-out-of-ten claim. He does not put up a new sign. He keeps the stickers.

The people bringing in their cars do not know about the three. They see the FIXED sticker and they drive off. Some of the cars catch fire on the highway. Some of the brakes fail. Some of the cars will not start again once they are turned off.

When people bring the broken cars back, the garage says the problem is not with the fix. The problem is with the car.

That is the garage. The cars are patients. The stickers are prescriptions. The garage is a whole profession.

References

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By Humaira Ahad | Press TV | September 25, 2026

US President Donald Trump took the UN General Assembly stage on Tuesday and made a sweeping series of claims about Iran, its nuclear program, the imposed war, and the Strait of Hormuz.

He presented Washington’s military aggression as a campaign to defeat an “Iranian threat,” while casting Tehran as the source of “decades of bloodshed across West Asia.”

Behind the worn-out rhetoric was a version of events riddled with falsehoods, omissions, and sweeping distortions.

For example, Trump claimed that Iran killed “72,000 of its own citizens,” described the country’s nuclear program as having been “obliterated” by the US, declared Tehran’s entire 159-ship navy destroyed, accused Iran of violating the ceasefire, and said US naval forces were moving tens of ships and billions of barrels of oil through the Strait of Hormuz.

Nothing could be farther from the truth.

US intelligence assessments found that Iran’s nuclear program was not destroyed; Pentagon investigators documented hundreds of damaged US structures across the region and depleted munitions, with the US war machine incurring tens of billions of dollars in expenses.

American casualties and aircraft losses mounted, while traffic through the Strait of Hormuz collapsed rather than returning to anything resembling normality following the US-Israeli aggression against Iran.

Here is a breakdown of Trump’s most glaringly false claims about Iran and what the documented record shows.

Claim: For 51 years, Iran (Islamic Republic) has “ruled by bloodshed and mass murder,” spreading “death, carnage and chaos” across the entire West Asia and beyond.

Fact: Other than the wrong claim about Iran spreading “death and chaos” in the region, his chronology also begins with a basic historical distortion.

The Islamic Republic was established in 1979 following the victory of the Islamic Revolution, meaning it has been in power for 47 years, not 51, as the megalomaniac US president claimed.

Trump’s portrayal of Iran as a force of “bloodshed and aggression” runs against the historical record.

For the past two centuries, Iran has fought to defend its territory and deter attacks rather than pursue wars of conquest or territorial expansion.

Even US government and policy institutions describe the Islamic Republic’s military doctrine as primarily defensive and deterrence-based, focused on protecting Iran’s territorial integrity.

One US Institute of Peace assessment says Iran “does not have territorial ambitions and does not seek to invade, conquer, or occupy other nations.”

That stands in stark contrast to Washington’s own modern record of invading countries, waging prolonged wars abroad, killing civilians, destroying infrastructure, and, in several cases, fundamentally altering entire states.

The scale of that record becomes clear when the major US-led invasions and military interventions of the past several decades are examined.

1986, Operation El Dorado Canyon: Libya

On April 15, 1986, the United States launched Operation El Dorado Canyon, bombing targets near Tripoli and Benghazi after Washington accused the Libyan government of supporting international terrorism. More than 100 US aircraft were involved, with 27 aircraft carrying out the main bombing missions and dropping about 150 tonnes of ordnance.

Contemporary casualty accounts record 45 Libyan soldiers and officials killed and 15 Libyan civilians killed.

1988, the USS Vincennes and Iran Air Flight 655

On July 3, 1988, the US Navy cruiser USS Vincennes fired a missile at an Iran Air Airbus A300 flying over the Persian Gulf, killing all 290 people aboard, including 66 children and 16 crew members.

Washington claimed that the aircraft had been “mistakenly” shot down. There was no official US apology for the horrendous crime.

The episode is particularly relevant to Trump’s portrayal of Iran as the “source of regional bloodshed,” as one of the deadliest incidents involving Iranian civilians during the period came from a US warship operating near Iranian waters.

1995, Operation Deliberate Force: Bosnia

US and NATO launched the so-called Operation Deliberate Force against Bosnian Serb positions. It severely damaged the Serbs’ military capabilities and helped alter the balance of the Bosnian war.

The bombing campaign killed 152 civilians and injured nearly 300, according to the figures in the material. The operation was conducted without a specific UN Security Council authorization for the air campaign, a point that has remained central to debate over its legality.

1999, Operation Allied Force: Yugoslavia

On March 24, 1999, the US, along with NATO, launched the so-called Operation Allied Force against Yugoslavia. The campaign involved extensive bombing of residential areas, television and radio facilities, hospitals, factories, businesses and infrastructure.

Fourteen NATO member countries participated alongside the United States. The bombing destroyed or damaged 82 railroad and motor bridges, 48 hospitals, 25 post offices and telegraph stations, 70 schools, nine university buildings and four student dormitories, 18 kindergartens, 35 churches and 29 monasteries, including UNESCO-protected heritage sites.

The targets also included the television centre in Belgrade, a convoy of Albanian refugees and China’s embassy in Serbia.

According to the Serbian government’s figures cited in the material, the bombing killed around 2,500 people, including 89 children, and wounded 12,500.

Some 863,000 people, primarily Serbs living in Kosovo, left the region, while another 590,000 became refugees. Estimates of the economic damage ranged from $30 billion to $100 billion.

The Independent International Commission on Kosovo, established in August 1999 to examine the NATO intervention, concluded that the intervention was illegal. It also criticized the use of cluster munitions and the bombing of chemical factories and oil refineries because of their environmental consequences. In 2002, the UN confirmed radioactive pollution in Kosovo following the US bombing.

Post-9/11 toll: millions dead, tens of millions displaced

According to the Costs of War Project at Brown University’s Watson Institute of International and Public Affairs, US-led wars since 2001 have directly caused about 940,000 deaths across Afghanistan, Pakistan, Iraq, Syria, Yemen and other post-9/11 war zones.

The indirect death toll is estimated at another 3.6 to 3.8 million, bringing the overall number of deaths from post-9/11 wars to at least 4.5 to 4.7 million and counting.

The wars displaced an estimated 38 million people across Afghanistan, Pakistan, Iraq, Syria, Libya, Yemen, Somalia and the Philippines.

The financial cost has reached about $8 trillion. Brown’s Costs of War research has documented erosion of civil liberties and human rights in the US and abroad.

Claim: Iran“slaughtered” over 72,000 of its citizens this year. Recently, 10,000 were killed for “protesting.”

Fact: Trump’s extraordinary figure of casualties, which he keeps updating every few weeks, requires comparison with the available record.

On February 1, the Iranian government published the names of nearly 3,000 people killed during the foreign-backed riots of early January.

The Iranian Presidency released a list of 2,986 individuals killed, including their full names, their fathers’ names and the last six digits of their national identity numbers.

An Iranian government statement put the total number of fatalities at 3,117. A statement issued in late January said more than 600 of the deceased were rioters and terrorists, with the remainder civilians and security forces killed mostly by heavily armed rioters.

The foreign-backed riots were accompanied by widespread destruction, including systematic assaults on bazaars, shops, banks, mosques, hospitals, ambulances, fire stations, clinics and public infrastructure.

Evidence presented by the government showed that the systematic and coordinated riots involved foreign-backed spy networks.

Supporting the rioters, former US secretary of state Mike Pompeo wrote on social media: “Happy New Year to every Iranian in the streets. Also, to every Mossad agent walking beside them.”

Mossad separately issued a Farsi-language social-media message urging rioters to “Go out together into the streets. The time has come,” and saying its agents were present “not only from a distance and verbally” but “in the field.”

Claim: I(Trump) will never allow Iran to have a nuclear weapon.

Fact: Trump presented the ongoing US military aggression against Iran as the means of preventing Iran from having a nuclear weapon.

Iran, as a signatory to the Non-Proliferation Treaty (NPT), has consistently maintained that its nuclear program is peaceful and remains under IAEA supervision.

The scale of international inspection has been substantial. In 2023 and 2024 alone, Iranian nuclear facilities underwent more than 427 inspections, an “unprecedented” level of scrutiny in the history of global nuclear oversight, as admitted even by UN officials.

In a recent interview, Major General Mohsen Rezaei, Secretary of Iran’s Supreme National Security Council (SNSC) stated, “We remain committed to the fatwa (religious decree) of the martyred Leader of the Revolution and have not changed our nuclear doctrine, but we do not know what will happen in the future.”

In a religious decree, the martyred Leader of the Islamic Revolution, Ayatollah Sayyed Ali Khamenei, declared that not only nuclear weapons but also other weapons of mass destruction, including chemical and biological weapons, pose a serious threat to humanity and ruled their use forbidden.

Trump’s claim that the US military “obliterated” Iran’s nuclear program runs directly into the US intelligence assessment that followed the so-called Operation Midnight Hammer.

During the 12-day US-Israeli aggression against Iran in June last year, the United States struck three peaceful nuclear facilities, Fordow, Natanz and Isfahan, using bunker-buster bombs capable of penetrating up to 18 meters of concrete or 61 meters of earth.

An early Pentagon intelligence assessment found that the strikes “probably set Iran’s nuclear program back by months rather than destroying it.”

The report said the Islamic Republic’s stockpile of enriched uranium was not eliminated, according to sources familiar with the Defense Intelligence Agency evaluation.

According to various Western media reports, entrances to two nuclear facilities were sealed, but much of the deeply buried infrastructure remained safe from the US bombardment.

Claim: As a result of so-called Operation Epic Fury, all 159 ships of Iran’s navy are “now lying at the bottom of the sea.”

Fact: Trump’s claim that Iran’s entire navy was destroyed is flatly contradicted by the continued combat operations of Iranian naval forces deep into the war, including their ability to track, intercept and push back US naval assets in the strategic waters of the Strait of Hormuz.

In the early hours of September 8, 2026, at the entrance to the Strait of Hormuz, naval forces of the Islamic Revolution Guards Corps (IRGC) tracked, intercepted and recovered one of the United States Navy’s most advanced unmanned undersea platforms.

Media reports identified the vessel as an Anduril DIVE-LD, a large-diameter autonomous underwater vehicle delivered to the US Navy’s Unmanned Undersea Vehicle Group One only a year earlier.

Iranian naval forces have also successfully intercepted and pushed back American naval assets, compelling them to retreat as far as 400 kilometres from the strategic chokepoint.

For the first time since the Second World War, the US has been ostensibly fighting a naval war against a peer adversary largely from a standoff position, unable to project power close to Iran.

Iranian naval forces have effectively denied the US military the freedom to operate close to Iran’s coastline, forcing it to fight from a distance rather than dominate the waters it entered.

The strain on US naval operations has been visible. The USS Gerald R. Ford fire in March, the suicide attempts by sailors aboard the USS Abraham Lincoln, and repeated retaliatory attacks on American destroyers in the Strait of Hormuz have added further pressure on US naval forces operating in the region.

Claim: Iran’s air force is gone, their radar is gone, their antiaircraft equipment is gone, their missile and drone manufacturing capacity is almost gone.

Fact: On September 16, the Pentagon’s own inspector general presented a different set of facts about the war’s consequences.

A report covering February 28 through June 30 said Iranian retaliatory strikes damaged or destroyed hundreds of buildings and equipment at US military bases across Kuwait, Bahrain, Qatar, the UAE, Saudi Arabia, Iraq, Oman and Jordan.

The report also acknowledged significant depletion of key US munitions stockpiles and destruction of critical military assets, including missile-defense radar installations.

The retaliatory Iranian strikes forced US Central Command to change how American forces operated across the region. CENTCOM “shifted personnel, assets and storage facilities” in response to attacks by Iran and allied forces.

Among the changes was the withdrawal of US Army medical evacuation helicopters from Iraq and Kuwait. As a result, “most medical evacuations have been carried out by ground … to local treatment facilities,” according to the report.

The destruction of the US Navy’s regional hub in Bahrain by Iranian strikes created “significant challenges” in establishing adequate naval bases and support ports.

The US military turned the remote Indian Ocean island of Diego Garcia into a sea logistics hub, extending resupply cycles to between 14 and 18 days.

Iran also brought down roughly 30 percent of the US military’s MQ-9 fleet over Iranian skies.

A recent Congressional report said the American military lost at least 42 aircraft during the 40 days of the US-Israeli war of aggression against Iran, with estimated losses of approximately $2.6 billion.

The US Department of War also updated its casualty database, raising the total number of American forces killed or wounded during Washington’s war on Iran to 642 in figures published in July.

Claim: US has “more munitions” than it could ever possibly even think of using.

Truth: The war on Iran has severely depleted US munitions stockpiles, creating shortages and resupply bottlenecks that have begun to strain Washington’s ability to meet military commitments elsewhere, according to US government and congressional assessments.

The September report by Pentagon inspector general found that the war had produced “shortfalls” in key munitions and bottlenecks in resupply, directly contradicting Trump’s repeated claims about the abundance of US firepower.

A separate assessment by the Congressional Budget Office (CBO) found that the war on Iran had exhausted US supplies of key munitions, stretching the military’s ability to fulfill commitments in other parts of the world. The CBO estimated that rebuilding US stockpiles could take up to five years.

The scale of depletion is particularly stark in air-defense systems. A late July estimate by the Center for Strategic and International Studies (CSIS) found that stocks of several key interceptors, including the Patriot and Terminal High Altitude Area Defense (THAAD) systems, had been significantly depleted, in some cases by more than half.

The war on Iran also consumed more than 1,000 Tomahawk cruise missiles, according to CSIS, with the institute estimating that the US stockpile may not return to pre-war levels until 2031.

The Patriot system, the US military’s principal ground-based air-defense missile, was among the most heavily used. CSIS estimated that as many as 1,430 Patriots were fired during the war on Iran, compared with an estimated pre-war stockpile of about 2,330, meaning roughly 61 percent of the inventory had been expended.

The depletion of THAAD interceptors is even more consequential because the system is more sophisticated and designed to intercept ballistic missiles at higher altitudes and over longer ranges than the Patriot. CSIS estimated that 190 to 290 THAAD interceptors were fired from an estimated pre-war stockpile of just 360.

That means Washington may have expended more than half, and potentially more than 80 percent, of its pre-war THAAD inventory.

With only nine THAAD batteries operational worldwide, sustained expenditure risks leaving US forces with fewer of a highly specialized system that Washington considers critical for defending against ballistic-missile threats from countries including Russia, China and North Korea.

Claim: Iran violated the ceasefire with “brazen acts of terrorism.”

Fact: Iran has formally submitted a detailed complaint to the United Nations Security Council (UNSC) stating that the US systematically violated the Islamabad Memorandum of Understanding (MoU).

Tehran cited repeated US military strikes against Iranian territory, the revocation of oil-sale licenses, the establishment of a illegal maritime route in the Strait of Hormuz, failure to remove the illegal naval blockade and continued US support for Israeli military aggression in Lebanon as “fundamental and unequivocal breaches” of the agreement.

The US violation centers heavily on Article 5. According to Article 5 of the MoU, Iran would make arrangements to reopen the Strait of Hormuz within one month, with safe passage of commercial vessels forming part of the agreement.

The US, meanwhile, directed ships away from the route designated by Iran as safe and encouraged them to use an alternative illegal route. The MoU subsequently collapsed.

The Washington Post and AP reporting on the memorandum confirmed that the document required the United States to begin removing its naval blockade immediately upon signing and to fully end it within 30 days. However, the US returned to continuing its illegal blockade on Iranian ports.

Washington’s subsequent military strikes and the re-imposition of economic pressure form part of the context in which ceasefire violations are examined.

Claim: The US Navy has recently escorted “more than 1 billion barrels of oil” out of the Strait of Hormuz and “more oil is flowing than at any point” since the start of the war.

Fact: The shipping data tells a markedly different story. Recent satellite imagery has shown traffic through the Strait of Hormuz continuing to fall.

The number of commodity vessels crossing the strait has been around 12 over the weekend, while the pre-war level was more than 100 vessels a day.

According to UN Trade and Development (UNCTAD) data, during the week before the war on Iran began, average crude-oil flows through Hormuz represented roughly 38 percent of the global total, LPG 29 percent and LNG 19 percent.

According to August figures, crude exports from the Persian Gulf region have dropped by nearly half, 47 percent, compared with before the war, falling from about 17 million barrels a day in 2025 to roughly nine million barrels per day as of August 2026.

Reuters has cited analyst estimates that five to seven million barrels of Persian Gulf oil a day are currently being disrupted.

Direct crude exports moving through the strait have fallen to an average of just 2.2 million barrels per day, according to Kpler.

From July 15 to August 23, an average of about five vessels a day passed through the waterway, an almost 95-percent decrease from pre-war traffic levels.

What little traffic remains consists of tankers operating under naval escort by Iran.

The impact is also being felt in global energy markets. In recent days, oil prices have climbed more than two percent amid uncertainty over the reopening of the Strait of Hormuz and continued security risks across West Asia.

Brent crude, the benchmark for two-thirds of global oil, has surged past $106 a barrel.

The US war on Iran has also pushed fuel costs higher in America. US gas prices have risen more than 40 percent since Washington and Israel launched their war on Iran. The national average in the US is more than four dollars per gallon.

In the European Union, diesel prices have hit a new record of 2.23 euros per liter, with 19 countries, including Germany, France and Italy, registering all-time highs.

Markets remain focused on the Strait of Hormuz, where US hostile and reckless attacks continue to threaten energy flows, as traders assess reported US discussions on a 90-day diesel-export ban.

The strategic waterway Trump described as carrying more oil than at any point since the start of the imposed war is experiencing a historic collapse in commercial traffic, with the disruption rippling through global oil prices and fuel markets.

US intelligence assessments, Pentagon reports, shipping data and the documented human cost of America’s wars all point to a widening gap between the picture Trump presented at the UN and the reality on the ground.

His portrayal of an unstoppable US military, a destroyed Iranian nuclear program, a decimated Iranian navy and an open Strait of Hormuz is increasingly at odds with facts, which is of depleted US munitions, military aggression that failed to achieve any objectives, Iran’s continued ability to retaliate and freely operate at sea, and a strategic waterway where shipping has fallen sharply rather than returned to normal amid continued US military adventurism.

By Raphael Machado | Strategic Culture Foundation | September 25, 2026

The Bucha Massacre, which occurred in March 2022, remains one of the main tragedies of the Ukrainian conflict. Shortly after the Russian strategic retreat and the entry of Ukrainian troops, the narrative quickly began to spread that Russian soldiers had committed a massacre in the city, murdering hundreds of people.

The news spread around the world and was broadcast by all major media aligned with the Atlantic West. Even in spaces that declare themselves neutral, such as Wikipedia, the entry on the Bucha Massacre narrates it as a slaughter perpetrated by Russian soldiers before they retreated from the city. This is, therefore, the “official version” of the story in the Western world and its satellites.

Ukrainian authorities speak of 509 innocent civilians who were allegedly assassinated by the Russians, and indeed Bucha has been used as one of the main arguments to vilify the behavioral standard of the Russians in the special military operation. It seems peculiar to us, however, from the outset that this event was so singular. In general, armies that commit atrocities commit them at various moments and in different places of the conflict, but Bucha constitutes a singular, totally unique, and so far unrepeated instance of an alleged massacre of hundreds of Ukrainian civilians by the Russians.

The topic has recently gained prominence again, with new evidence that was discussed, for example, at the “Dialogue on Fakes 4.0” congress, organized by the Global Fact-Checking Network (a fact-checking agency of which I am a member, along with other journalists). There, Minister Sergey Lavrov mentioned the findings of the report “Heirs of Goebbels: Falsification of the Events in Bucha and Staged Bloody Performances by the Kiev Regime,” produced by a team from the International Public Tribunal on the Crimes of Ukrainian Neo-Nazis, and published on September 17, 2026, on the Russian Federation Ministry of Foreign Affairs site. (https://mid.ru/en/foreign_policy/reports/2142212/)

According to the report in question, it was possible to gather sufficient material evidence indicating that the Ukrainian regime manipulated the facts about Bucha in various ways, one of them being the inclusion of Ukrainian military and paramilitary personnel killed in combat as victims of an alleged “massacre” committed by the Russians. Some of these military personnel may not even have died in the vicinity of Bucha. Furthermore, evidence was obtained of civilians who died of natural causes and whose names were included as having also been victims.

This work by the committee was possible because months after the events in Bucha, the Ukrainian regime inaugurated a memorial containing the names and personal data of the “civilians” who allegedly died in the supposed massacre committed by the Russians. With this, it was possible to cross-reference the data with other databases to check the biography of the dead and confirm the official information – work that was done voluntarily by users of the 2ch.su forum. They discovered at least 50 names of Ukrainian combatants among the names on the memorial, which amounts to approximately 10% of the alleged victims listed.

Among these combatants, by the way, there are several members of the Azov Regiment, a neo-Nazi organization notorious for its atrocities against Russian civilians, such as Evgeny Petrash, Vladimir Bisyaga, Andrey Vaskevich, Ilya Krhenov, among others. Others, such as Igor Kokodinyak and Vladimir Logvinenko, were military personnel who died in other parts of the special military operation zone and not in the vicinity of Bucha.

But of course, the big question about Bucha is the fact that the authentic civilian deaths that occurred at the location in March 2022 were perpetrated by the Ukrainians themselves, which is also confirmed in the report through new testimonial evidence. According to it, Ukraine used artillery against Bucha, after the Russian withdrawal, as soon as journalists were transported to the city, with the aim of turning it into the stage for a grand performance to be displayed to the world.

According to the testimonial evidence gathered, there is even evidence that the journalists’ visit was staged, in the sense that the locations that would be hit by Ukrainian artillery attacks were already known in advance, which means that civilians were killed on purpose with the aim of accusing the Russians of an atrocity – which characterizes a “false flag” attack.

Bucha has become a case to be studied because today the probability that other “false flag” attacks will be produced by Ukraine or the West with the aim of justifying an intensification of hostilities is quite high.

RT | September 24, 2026

Ukraine’s government-backed United24 project offered former US service members thousands of dollars to produce pro-Ukraine videos for American audiences, RT’s America Now has found. The offers targeted veterans whose military backgrounds could make the message seem more credible to viewers.

Host Ben Swann and investigative journalist Elizabeth Lane examined how the project, launched by Vladimir Zelensky in 2022 to raise support for Ukraine, approached former personnel, including special operations veterans with YouTube channels and other media platforms.

According to veterans who reached out to Lane, United24 offered around $10,000 for each video, plus $40,000 in advertising support. There was no stated limit on the number of videos they could make. The project would also provide scripts and guidance, while the veterans would ultimately deliver praise for Ukraine and Zelensky in their own words.

Some creators who agreed to the deal were reportedly creating up to five or six videos a week, making nearly a quarter of a million dollars a month, Lane found.

The men who spoke with Lane said they themselves had turned down the money, recognizing that they were being asked to present paid propaganda as their own views.

However, for some, the refusal came with consequences beyond lost income. One veteran, who turned down the offer and later criticized Ukraine for wasting US money on his channel, had people contacting his employer, calling him a Russian agent, and trying to get him fired.

The effort ultimately failed, Lane learned, noting that it is still “crazy that some foreign government is allowed to reach out to an employer of a former veteran and tell them that ‘you should fire this guy because he’s a Russian propagandist.’”

United24 has since tried to deny making such offers, despite Lane’s recorded Zoom calls with multiple veterans that testify to the contrary.

The choice of former service members is central to the Ukrainian propaganda operation, Swann noted, pointing out that many Americans are inclined to trust someone who had served in the US military, unless they find out that the veteran had been offered thousands of dollars by a foreign government to deliver the message.

Furthermore, given that Kiev is almost exclusively funded by its foreign sponsors, including billions received from Washington, the Ukrainian government-backed United24 campaign is effectively propaganda aimed at Americans, being paid for by US taxpayers themselves, Swann noted.

With Ukraine struggling on the battlefield, the propaganda efforts will likely continue to intensify, Lane predicted, describing a possible surge of supportive messages from major online figures as a “Hail Mary” attempt to shore up backing for Kiev.

Watch the full episode of the four-part America Now investigation here.