10 January 2009


I got into this argument several times before I realized there was probably no point to it, if only because a preponderance of people on the opposing side are self-acknowledged lunatics.

Okay, "lunatic" is at once an archaic and over-broad term, and even "crazy" is a little too judgment-laden and nonspecific, so let's just say that most of those who disagree with my contention that psychiatric drugs are massively overprescribed and can do more harm than good are, at the very least, suffering from some sort of mental illness.

Not (didn't I just used this Seinfeldism the other day?) that there's anything wrong with that. Perhaps what is wrong is that so many completely understandable and normal human conditions have in recent years been rediagnosed as diseases, and that apart from mental patients, the other main interest group championing the cause of psychopharmacology has been those who develop, manufacture, market and prescribe the plethora of pills being pushed on the American public.

Having seen friends reduced to tears and/or rage by the slightest suggestion that the medications they were convinced had saved their sanity or even their lives were at best superfluous, I also learned to hold my tongue on the far more sensible grounds that I just didn't know enough. I have no medical or scientific background, after all, nor have I ever taken psychiatric drugs, though it's been suggested several times by both doctors and laymen that I ought to.

My antipathy toward such substances, then, was largely a visceral reaction, one which seems especially odd considering how readily I subjected my mental chemistry to massive chemical modification of the illegal sort during the 1960s and 70s. However, by the time psychiatric drugs came fully into vogue, I had kicked nearly all my drug habits of old, reasoning in turn that I should not rush into substituting them with new drug habits, regardless of how legal and socially accepted they might be.

But now comes some powerful evidence that my views may not have been entirely knee-jerk or untutored ones: Marcia Angell, Harvard lecturer and former editor of the New England Journal of Medicine, provides this devastating critique of how new drugs are tested and approved and diseases discovered - the less charitable might say invented - that make those drugs profitable.

She focuses primarily on psychiatric drugs, though her conclusions are equally valid when it comes to overmedication of somatic disease, and identifies two main problem areas. The first is that the majority of researchers, including staff members of most of our major universities, are making as much or more from drug company stipends as they are from their university salaries, and that this has given the drug companies a controlling interest in most drug testing and approvals.

Secondly, she points out that mental illness is poorly defined and understood, to the point where many "diseases" or conditions lack objective criteria by which researchers can evaluate a treatment's effectiveness or lack thereof. This in turn leads to the phenomenon that I, mystified at how, for example, millions of American children could suddenly have acquired ADHD, a condition that didn't exist when I was a child and still barely exists in many other countries, dubbed "disease du jour." Ms. Angell points out how ADHD, which provided justification for dosing an entire generation with powerful amphetamines, is now giving way to "bipolar disorder, "another condition which didn't even exist a few years ago, but now requires that millions of Americans be treated with powerful mood alterants whose full effects are poorly if at all understood.

She cites Christopher Lane's book Shyness: How Normal Behavior Became A Sickness as a case study of how a previously nonexistent mental disorder was brought into being along with powerful (and powerfully expensive) drugs alleged to cure it, pointing out:

Since there are no objective tests for mental illness and the boundaries between normal and abnormal are often uncertain, psychiatry is a particularly fertile field for creating new diagnoses or broadening old ones.=
and quoting a product director for Paxil:
Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder.
"Social anxiety disorder," if you hadn't guessed, is the new name for shyness, a "disease" that's historically been more likely to be "treated" - and probably no less effectively - with copious self-administration of alcohol.

I don't mean to trivialize the genuine pain endured by those who suffer from depression or shyness or related conditions, particularly since I've been afflicted with them myself. But I feel rather strongly that what is called for in the vast majority of such cases - my own included - is changes in lifestyle, nutrition, exercise and attitude, all of which is unlikely to occur if medication is employed as a first rather than last resort. Once when I was at one of my own lower points, I was mightily annoyed by an AVA contributor who intoned, "Depression is not an illness. It means your life is fucked. Change it."

How dare she, I thought, and very well might have throttled her on the spot if she'd been there in person and/or wasn't bigger and stronger than me. But she was right. Since those days, I've stopped using alcohol and drugs, undergone a course in cognitive behavioral therapy, changed locations and careers, and guess what: though not always brimming over with joy and good cheer, I'm hardly ever depressed. This after battling with the alleged "illness" for most of my life.

But there's one other issue that Ms. Angell doesn't touch on sufficiently in her otherwise excellent article: the disastrous effect that over-reliance on an ever-expanding and ever more expensive pharmacopeia is one of the principal reasons that the American health care system has become so obscenely expensive - and ever more obscenely, why it excludes tens of millions of citizens from obtaining the basic, routine care that they need.

Bush's Medicare prescription drug program, one of the factors most likely to wreck Medicare altogether, was in reality a shocking giveaway to the drug industry, in which the government has agreed to pay for whatever drugs that industry can come up with, at whatever price the industry demands, with virtually no independent oversight into whether those drugs are fairly priced, or for that matter, of any value at all. This is but one of the madnesses of King George that will have to be undone, and quickly, if we're to have any hope of salvaging our health care system or, for that matter, our economy.


andrea said...

My mother was prescribed antidepressants to give up smoking because "she wouldn't be able to make it without them". She did. He also said if I didn't get treatment I'd be depressed all my life, which only encouraged me to get to know myself better.

Anonymous said...

I dunno. I have massively mixed feelings about this one. I used to rail against such medications, thinking they were unnecessary and could be replaced by just "working shit out"... and I was turned off by my belief that they changed who a person was, and that by taking them, one would be sacrificing some or all of their unique personality for the sake of an easy fix for problems.

Then my mother started taking prozac, and it changed the way I thought about such things. Growing up, my mother was angry, stressed out and, as a result, pretty abusive. Once she started taking medication, I could see her able to better control those things, and what was left shining through was my mom. The way I see it, Prozac allowed my mother to BE who she is, instead of her personality being overshadowed by the results of her depression and rage. The combination of going to therapy and taking these medications pretty much saved my mother's soul, and saved the happiness of my family.


Lefty said...

how about this, then: if everything is going great, and you still feel like crap, maybe then you're depressed?

Anonymous said...

Lefty, what about if everything is NOT going great, but your emotions are still disproportionate to your situation?

I generally think it's positive that things like depression, anxiety or social anxiety are now medically treatable. I DO think it's a slippery slope, and I DO think there are a lot of dangers involved if these things are used improperly, but generally speaking, I think it's a positive thing. Depression and anxiety can ruin lives as much as any physical disease