Good Gawd, are they STILL peddling that tired old fable that psych meds are “just like insulin for diabetes?”
In a word: Yes. The National Alliance on Mental Illness San Diego has produced a brochure titled, An Illness Like Any Other: Mental Illnesses are Brain Disorders which contains the following words of wisdom:
“ As a diabetic takes insulin, most people with serious mental illness need medication to help control symptoms.”
There’s just one problem with that simile – it doesn’t make any sense.
There was a time within living memory when a diagnosis of diabetes was a death sentence. Today, with insulin therapy, diabetics can enjoy decades of productive existence. What similar success do the purveyors of psych meds have to point to?
In his meticulously researched book, author Robert Whitaker shreds the idea that science understands the cause of or the cure for mental “illness.” In the United States, we currently spend more than $40 billion a year on psychotropic medication. If these drugs were truly curing mental illness, then we should expect that the proportion of people disabled by mental illness should have gone down, or at the very least stabilized. In fact, since these meds were introduced, the proportion of people disabled by mental illness has skyrocketed.
That makes no sense at all if you think these drugs are curing mental illness. But it makes perfect sense if you think they are CAUSING mental illness.
Note we’re not talking about the proportion of people LABELED mentally ill (although that, too, has skyrocketed). We’re talking about the proportion who are DISABLED by mental illness.
There is an epidemic both of overdiagnosis and an epidemic of iatrogenesis. The overdiagnosis is how they get people in the door – by classifying as “mental illness” conditions which used to be considered part of the normal range of human experience. Then the real fun begins – the cascade of more drugs, stronger drugs, higher doses. Someone who started out suffering from what sounded like nothing more than standard-issue teenage- or twenty-something angst ends up permanently disabled, or dead.
Oh by the way, since the publication of Whitaker’s book, new information on the matter has come to light. In his blog on psychologytoday.com, Whitaker notes that between 1990 and 2003, the number of adults being treated for mood disorders nearly doubled, from 11.16 million to 21.77 million. During that same period of time, the number of people receiving SSI or SSDI for mental illness doubled as well, from 1.47 million to 3.25 million.
I believe that is what the medical profession refers to as a “dose-dependant relationship.”
More than a dozen years ago, in his book Blaming the Brain: The Truth About Drugs and Mental Health, Eliot S. Valenstein, Professor of Psychology and Neurology at the University of Michigan, handily dispatched the “like-insulin-for diabetes” argument:
“When insulin is prescribed for a diabetic, it is only after a reliable test has measured the extent of a patient’s glucose metabolism problem, from which, in most instances, an insulin deficiency can be inferred. The dose of insulin that is prescribed can be based on a reasonably good estimate of the magnitude of the deficiency. Moreover, we also have a good understanding of how insulin regulates glucose metabolism and how a deficiency of that hormone can produce diabetic symptoms. In sharp contrast, a psychiatrist performs no laboratory test to determine if a mental patient has any chemical deficiency or excess. Instead, the implication that the drug prescribed is correcting an abnormal biochemical condition is, at best, an inference made in part from weak and unreliable group trends reported in the experimental literature, but based mainly on the simple belief that the drug will help.”
David Healy, a psychiatrist at the Cardiff University School of Medicine put it more succinctly:
"When it comes to dead bodies in current psychotropic trials, there are a greater number of them in the active treatment groups than in the placebo groups. This is quite different from what happens in penicillin trials or trials of drugs that really work."
Photo via Wikimedia Commons
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As always, thanks for reading and commenting.
Rated for concrete vs the abstract.
Would your next blog post perhaps be about how western medicine is useless, and there are NO drugs that are not placebos? Or is it just psych meds that you object to?
As with anything, there's likely to be abuse and mis-use and all the rest of it, but I don't see throwing out a needy baby with the bathwater...
I know about this because I have dealt with my own chronic, sometimes severe depression for most of my adult life, sometimes with medication, sometimes not. One problem with figuring out what medication and dosage will work for a particular person is that the magic brain probes that you suggest should be used don't exist to my knowledge.
There are other psychological illnesses, as well, and they can be treated much more effectively now with medications that are better than what was available in the past.
I don't know what space the idea that dosages must continually increase came from, but it's an incredibly overbroad and often incorrect statement.
I'm not going to do backflips to try to sort out what level of empricism might satisfy you, Patrick, but the attitudes your comments appear to represent are consistent with the prejudices and stigmas that discourage many people from seeking the treatment that most likely would help them live a fuller life.
My ex-husband became severely mentally ill in his early 30's. Psychosis, schizo-affective, schizophrenic, depressed (who wouldn't be, with voices telling you to kill yourself?), etc. Meds saved his life. It took time to find the right med to help him stabilize. He always said that big pharma saved his life.
The brain is a complex thing. No matter what any of us say, you will stick with your silly ideas because for some reason you're invested in that. I work to show people that mental illness, whether it's "only" depression (only! hah!) or something more severe, can get better with treatments, whether it's meds or therapy or a combination. I've seen too many people suffer with untreated mental illness, and I've seen so many who have benefitted from meds.
Attitudes like this are the sort of thing that prevent people from getting help. Meds don't work for everyone, that's true. But when it's your life on the line, you need to try all the options.
Fingerlakeswanderer: I am glad you have not been killed or seriously harmed by psych meds. You must be aware not everyone who ingests these substances is so lucky. On pages 141-146 of his book, Whitaker gives the story of aspiring musician Hal Pflugman, who, like you, suffered from anxiety attacks and, like you, began taking Klonopin. The drug took away his finger dexterity and made him feel like a zombie. At the age of 31 he gave up, moved back in with his parents, and went on SSI. He tried several times to kick Klonopin but failed. Worse, the anxiety attacks have returned with a vengeance, and Klonopin no longer controls them.
I never said all of Western medicine is useless. I certainly believe much of it is. I am not yet ready to say most of it. You are cordially invited to scan my other posts.
Jonathan: Not the argumentum ad scientologum. C’mon, old boy, you can do better than that.
Myriad: thanks for stopping by. Always a pleasure to hear from you.
Tony: I suppose what I should have said was, “more drugs and/or stronger drugs and/or higher doses.” Thank you for calling attention to my error. Whitaker fleshes out his book with numerous examples of how this cascade works. This post was inspired by another post by a fellow who said he is taking a drug for anxiety that causes sleeplessness and a drug for sleeplessness that causes anxiety. I predict this will not end well for him.
Pauline: I am sorry about your aunt. It is not a foregone conclusion that psych meds would have helped her. A 2000 paper published in Psychiatry Research found that 70% of bipolar patients were prescribed antipsychotics and 80% were prescribed antidepressants. Both classes of drugs have been linked to increased risk of suicide.
Snowden: thanks for stopping by. Always a pleasure to hear from you.
Monique: I am glad you were not killed or seriously harmed by psych meds. Hundreds of thousands are not so lucky. Why not pick up Whitaker’s book and decide for yourself?
Thanks to everyone for reading and commenting.
In fairness, I should note that they do not entirely eschew the use of psychoactive drugs. Clients may be given an occasonal benzo for unbearable anxiety or an occasional sleeping pill. But that is about as far away as it is possible to get from the current indiscriminate drugging of one out of eight (one out of eight!) American citizens.
But why take my word for any of this? Why not take a look at the book yourself? This is all discussed in pages 334-344.
Wow, I thought this was going to be a throwaway post. Thanks to everyone for reading and commenting. Good night.
denese
Well, I’ve written 111 posts here on Open Salon, and 106 of them have nothing to do with Whitaker’s book.
I became interested in these matters about five years ago when I read Overtreated by Shannon Brownlee and Worried Sick by Nortin M. Hadler, M.D. I am a biology teacher and so many of my students want to become physicians or nurses or other medical professionals and of course I want to see them do well, but looking into these matters has been like finding out the emperor has no clothes. I think most people would be astounded if they had any idea how much harm and how little good is done by the medical profession.
The problem is not confined to the psychiatric profession. But psych meds are a particularly egregious example.
At times readers have taken me to task because I do not have a medical degree, a charge to which I plead guilty. My background is in zoology, and it is perfectly obvious that living things evolved to function, and to function very well. They didn’t evolve to malfunction. (That is, they evolved to function for a time. Then they evolved to die and get the Hell out of the way of the next generation – but that’s a topic for another essay, another day.) Our Paleolithic ancestors trekked hundreds of miles in search of game, ran down wooly mammoths, and battled giant cave bears – not to mention each other. They didn’t lie down and say, “I am too depressed to go on,” and if any of their contemporaries did, they got weeded out of the gene pool. After the Neolithic Revolution, our ancestors were, for the most part, peasant farmers, doing back-breaking labor to survive, until to generations ago in my case, and I think I am fairly typical in that regard. We were meant to thrive. The notion that one out of eight of us is walking around with a “chemical imbalance” of the brain (said chemical imbalance has never been demonstrated, by the way) is as preposterous to me as the notion that there is a winged horse in my backyard. I don’t need to look out the window to see that cannot possibly be true.
The most familiar example of the “chemical imbalance” theory is the idea that depression is caused by low levels of serotonin. That fable has been so thoroughly, completely debunked, I predict that two hundred years from now, they will be studying it in universities as an example of pseudodscience. But millions of people still believe it.
Of course, how a medicine works is not nearly as important as that it works. The drug companies’ own data – the data they didn’t want you to see – say that antidepressants are not significantly better than a placebo for major depression (see The Emperor’s New Drugs by Irving Kirsch). If anyone has a problem with that, don’t take it up with me. Take it up with the drug companies – they are the ones who paid for the studies.
I find that people who pride themselves on being skeptical and scientifically-minded will believe the most amazing claptrap if it is couched in the language of science. There is a name for this mentality – it’s called scientism.
To me, our obsession with psych meds mirrors our obsession with cancer screening, cholesterol levels, oral hypoglycemics, etc. We are turning into a society of fussy, fearful hypochondriacs who are obsessed with tiny risks and tinier (or even nonexistent) reductions in risk. That is especially galling when you realize that most people cannot be bothered to do the simple things which have been proven to promote health and longevity – exercising, eating sensibly, maintaining a normal body weight, and refraining from smoking and excessive drinking.
People think the cocktail of pills they are swallowing every day, or their mothers are swallowing every day, is helping them to live longer. I submit they do not know this, and in most cases the docs prescribing these pills don’t know either.
We do know that between 1980 and 2003, per-capita spending on drugs in the United States rose by seventeen times. Not seventeen per cent more – seventeen times as much. At the same time, life expectancy at 80 barely budged – and I’d wager most of the increase, maybe all of it, is due to the fact that fewer people are smoking. Something is very wrong here.
I don’t believe the drug companies are in the business of promoting health. I have come to the conclusion that they are in the business of promoting illness. You know, this post was inspired by another post by a fellow who told us that he was taking a drug for anxiety that produces sleeplessness and a drug for sleeplessness that produces anxiety. I predict this will not end well for him. He asked, rhetorically I assume, “Would being afraid to leave the house be considered a disability?” I’d like to know who was enabling that behavior, and what that person was getting out of it. I think he would leave the house if he were hungry enough, psych meds or no.
At the University of Cape Coast in Ghana, I used to know a little crippled demi-orphaned beggar girl who would wander around campus and cajole the lecturers out of food and money. Polio had twisted her right hand into a useless claw, she walked with a limp, and she talked like she had a mouthful of mush. (She also suffered from sickle-cell anemia). I wonder what she would have thought of this educated full-grown white man (who knows karate, for crying out loud) saying he was afraid to leave his house?
This is not what I call health. I believe this is about making people easy to control. People who believe they are fragile vessels who need endless medical interventions throughout their lives, while at the same time are in constant fear of losing their jobs (and hence their employer-based health insurance) are not likely to be making waves.
The drug companies have lied to us about so many things I cannot see why anyone would believe anything they say. These companies are run by psychopaths who don’t care how many people they hurt or kill. They don’t care. See Our Daily Meds by Melody Peterson and Blood Feud by Kathleen Sharp for some examples.
The problem goes deeper than psych meds or even the medical profession in general. What’s wrong with our Medical-Industrial Complex is what wrong with all of our major institutions – our Prison-Industrial Complex, our Banking-Industrial Complex, our University-Industrial Complex: they are all run by pychopaths surrounded by sycophants. I could have written about any of those (I have written a few posts about our Prison-Industrial Complex) but I have chosen to concentrate on medical hubris and overmedicalization because it is an area my background has somewhat equipped me to understand (although I contend anyone with a high school education and a dictionary can comprehend the medical literature, if he is willing to make the effort) and because it is an area where a lot of big questions come into focus: what kind of society do we want to live in, and what does it mean to be a human being.
I could go on, but this comment is already almost twice the length of the original post. I hope you see this goes a lot deeper than one author and one book. But yeah, obviously I think this is an important book or I wouldn’t have written five posts about it. We are spending forty billion dollars a year on psych meds and at the same time the proportion of people disabled by mental illness has skyrocketed – the exact opposite of what we would expect if these drugs were curing mental illness.
I knew when I put this stuff on the internet that some people would think I am a monster for saying these things, and I am okay with that. I invite everyone to take a look at Whitaker’s book and decide for themselves.
All the best, Pat
This is the rub with regards to the evolution and natural selection argument, as in we evolved to thrive and survive. No one is 'weeded out' in today's society, the weak (genetically and otherwise) survive and reproduce. That has species repercussions.
While I won't argue with all you're saying (it sounds reasonable enough to a lay person) nothing you've mentioned addresses environment (both physical and mental/emotional/social) which all have necessary impact on species well being. To suggest that if we simply live a 'healthy lifestyle' all of our medical problems will magically vanish (or at least shrink to a more manageable number) is to ignore both the genetics of our evolution and the environment/s we live in.
Now am I understanding correctly that you're saying there's no way medically to test/measure such a thing as a chemical imbalance (of any kind in the brain) so that such a thing can be determined to be the problem needing treatment? And if this is so, then doesn't this also mean there's no way to medically determine that such a thing isn't the problem? Or are you saying that many in the medical profession don't routinely do these tests before prescribing the medications? In which case it's not the medication at fault but the practitioners. Either way presents problems with the argument that psychotropic treatment is the bad guy in this issue.
http://open.salon.com/blog/xylocopa/
2011/03/27/exploding_the_antidepressant_myth
Scientists are now thinking they got the mechanism -- as to how these drugs work -- wrong. They think now that they change brain plasticity rather than changing the re-uptake of serotonin. And as my Brother in Law, a neuropsychiatrist at USC said to me, they're finding a link between what severe anxiety does to the brain and dementia. He is one of many who believe that taking SSRIs, for certain populations, will ward off dementia later. You write about primitive societies not suffering from these disorders and you are probably right, these are First World diseases brought about by the incredible pressures of modern society. They aren't for everyone. Sometimes the side effects are worse than the disease, but what an improvement in QOL they bring compared to Tricyclic Antidepressants which make most people into zombies. And what a blessing SSRIs are for folks who would never have been able to respond to talk therapy but for the meds.
I think that's all I have to say.
Denese