Following up yesterday's post regarding students popping Adderal, Ritalin and other stimulants to boost academic performance (Steroids for Students), a reader pointed me to this article in Sunday's NYT, "Mind over Meds," regarding the over-pathologizing and over-medicating rampant in psychiatry today.
Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period was a reference to psychiatry’s early infatuation with psychoanalysis; the mindless period, to our current love affair with pills. J.J., I saw, had inadvertently highlighted a glaring deficiency in much of modern psychiatry. Ultimately, his question would change the way I thought about my field, and how I practiced.In other words, a sugar pill is just as likely to "cure" depression as whatever drug dujour Big Pharma is pushing at the moment. And good old fashioned talk therapy, torpedoed by Big Insurance, is more effective than pills.
A result is that psychiatry has been transformed from a profession in which we talk to people and help them understand their problems into one in which we diagnose disorders and medicate them. Insurance companies typically encourage short medication visits by paying nearly as much for a 20-minute medication visit as for 50 minutes of therapy. And patients themselves vote with their feet by frequently choosing to see psychopharmacologists rather than therapists. Weekly therapy takes time and is arduous work. If a daily pill can cure depression and anxiety just as reliably, why not choose this option?
But over the past few years, research studies have shown that therapy is just as effective as medications for many conditions, and that medications themselves often work through the power of placebo. In one study...antidepressants are, indeed, effective, because on average patients taking the pills showed a 40 percent drop in depression scores. But placebo was also a powerful antidepressant, causing a 30 percent drop in depression scores. This meant that about three-quarters of the apparent response to antidepressants pills is actually due to the placebo effect.
This thesis is also backed up in a book review I read last week, "Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America" by Robert Whitaker (summary here):
The percentage of Americans disabled by mental illness has increased fivefold since 1955, when Thorazine – remembered today as psychiatry’s first “wonder” drug – was introduced into the market. The number of disabled mentally ill has also increased dramatically since 1987, the year Prozac was introduced.Basically, his thesis fits the the thesis of Conflict theory and mental illness: Big Pharma, aided by a willing psychiatric profession, has created a tsunami of mental illness throughout the country. “Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?” This is precisely the questions Labeling theory in sociology, via the Medicalization of Deviance, has been asking for 20 years.
Conditions that disrupt brain chemistry may cause delusions, hallucinations, disordered thinking, and mood swings – the symptoms of insanity. Infectious agents, tumors, metabolic and toxic disorders and various diseases could all affect the brain in this manner. Psychiatric medications also disrupt brain chemistry. Psychotropic drugs increase the likelihood that a person will become chronically ill, and they cause a significant percentage of patients to become ill in new and more severe ways.
Whitaker's website "Mad in America" offers more, including push back from the psychiatric-industrial complex (the axis of evil between Psychiatry, Big Pharma, and Big Insurance), trying to label Whitaker and others who dare challenge it along the lines of "AIDS deniers."
In the final part of the review, Dr. Rosen—who has not given any description of who I am—likens me to Thabo Mbeki, the former president of South Africa who, a decade ago, “refused to accept that AIDS was caused by the HIV virus.” This denial led to the “premature death of 365,000 South Africans,” Rosen writes, and he then warns that with my ill-informed book, I may be doing similar harm. “Those who would seize the opportunity to cast psychiatry as a discipline into the rubbish heap without consideration for the benefits it has brought to so many would do well to remember how Mbeki’s inability to distinguish between theory and fact exacted such an enormous toll in human life and suffering.”Wow. The Dr. Rosen he is referring to defends psychiatry in a review in the Boston Globe. I've seen straw man arguments before, but this one looks like the Scarecrow from the Wizard of Oz (and sounds like him too..."If I only had a brain").
Whitaker's book is something to be taken seriously and certainly deserves a better, more in-depth airing. No one suggests that psychiatry itself is completely at fault (or hasn't contributed good things over the past 50 years). But when you read these two articles together, the picture becomes clear: psychiatry has changed, many now feel for the worse.
We need a "war on drugs" alright: to stop the epidemic of psychotropic drugs plaguing virtually every corner of our society today.