Sunday, June 6, 2010

Anatomy of an Epidemic

I've referred briefly to this book by Robert Whitaker before.

Amazingly to me, and I think to a lot of people, there is clear, solid evidence that all the psychiatric drugs do more harm than good in the long term. They not only fail to get a patient well enough to work, study, have relationships, etc., but they generally introduce new illnesses, both mental and physical. When experts are asked specific questions about this, there has been no real doubt about it for decades. There is a true epidemic of mental illness--a higher proportion of the population is mentally ill than ever--and to a large extent this epidemic is caused, not successfully treated, by the psychiatric drugs that are constantly prescribed.

Why then does psychiatry keep prescribing these drugs? There is usually a short-term benefit in treating the extreme symptoms--and even in treating simple problems like anxiety or mild depression. Even though studies show the vast majority of people would recover without drugs, and even better, would avoid future episodes if they stay off drugs, it would take time to see these results. Western psychiatrists, and patients (and/or their families), like seeing short-term benefits, and they simply get out of the habit of asking about the long term. This tendency is reinforced by the fact that withdrawal from the drugs is often painful and difficult, and leads to an outbreak of the original symptoms. The drug "works" (initially); stopping the drug "doesn't work"; therefore people stay on drugs, even though their overall condition gets steadily worse on the drugs, in a way that was not true of mental patients before the "super drug" era, and the life expectancy of patients is drastically lowered.

Psychiatrists have convinced us--and to some extent, they seem to convince themselves--that all of this simply has to be accepted. These patients are mentally ill, they should never expect to "return to normal," all of the massive problems that result from the drugs have to be accepted because, after all, the drugs are necessary for the patients' main or biggest problem, etc.

Coming from where I do, I compare this to climate science, where there have been successful efforts to deliver skewed research, control the message that emerges from "peer-reviewed" publications, and then keep telling the public that "all the real climate scientists" think in only one way, based on evidence. With psychiatry, the real evidence about drugs is not difficult to find--to the credit of the profession, the research has been done, evidence has been published in peer-reviewed publications. But psychiatrists in their daily practice largely ignore this evidence. This is another twist on "trust the experts who use peer-reviewed research." Can a whole community of people, probably bright, with impressive degrees from good schools, trusted by millions, be going wrong all at once, due to a kind of group think? Yes. Does peer review protect us from that? No.

Why? Without super-drugs, what would psychiatrists have? Some kind of talk. They like to say patients have to take drugs all their lives, just as diabetics have to take insulin. But, amazingly, no mental illness has ever been successfully described in biological/chemical terms, in the way diabetes has been described, and the psychiatric drugs do not fix a biological/chemical problem in the way that insulin fixes the symptoms of diabetes. In my own crude language: some mental illness seem to involve an excess of brain activity (schizophrenia being the most extreme), others a defect or loss of activity (depression without mania). The drugs can counteract one or the other for about two weeks, and this is probably linked somehow--probably no one really knows how--with the alleviation of symptoms. But then--and again, this has been very well established--the brain compensates by doing even more of what the drug is trying to stop it from doing. The reason drug withdrawal is so difficult is that the brain now has a new kind of activity, triggered by the drug, somewhat in opposition to the drug, and that activity will cause the patient problems if the drug is abruptly withdrawn. But that changed or warped brain activity, ultimately caused by the drug itself, will cause lifelong problems. It is almost always better for the patient not to start on the drug in the first place. "The treatment turns a period of crisis into a chronic mental illness" (quoting Amy Upham, p. 205).

Nothing like this is true for diabetes and insulin. Insulin doesn't cause new problems which eventually worsen the original problem and add new ones. Insulin supplies a specific deficiency, and does exactly what "natural" insulin does in healthy people. Diabetes doesn't have "episodes" which come and go, and would eventually become little or no problem, if left untreated, for most patients. Psychiatrists want to be real doctors, not witch doctors or mere wise counsellors. Real doctors in the twentieth century were able to deploy "magic bullets"--antibiotics, insulin, and others, which respond to specific biological and chemical problems with specific solutions. If psychiatry still has nothing like that, it may be back somewhere before Freud. More evidence for this is the way the descriptions of diseases keep changing, and the fact that there is no official basis for preferring one approach to the field to another. I gather pretty much all psychiatrists prescribe drugs now, if only because billing for that is something insurers and funding agencies can understand.

Whitaker doesn't simply propose moving to a world with no psychiatric drugs as quickly as possible. He tends to say there may be some patients who actually need certain drugs, at least for a short time. He says many patients now treated with drugs may be difficult to live with or treat without them. They may require some kind of talk therapy in a community to get better--and that may be more expensive, in the short term, than the drugs. There are such people as hyper-active children--some of them calm down, and some of them don't, but it is unlikely that powerful drugs are the best solution. He says many psychiatrists and their official organizations, even government organizations, have told reassuring stories about drugs as opposed to the truth. His recommendations are as follows:

We need to become informed about the long-term outcomes literature reviewed in this book, and then we need to ask the NIMH, NAMI, the APA, and all those who prescribe the medications to address the many questions raised by that literature. In other words, we need to have an honest scientific discussion. We need to talk about what is truly known about the biology of mental disorders, about what the drugs actually do, and about how the drugs increase the risk that people will become chronically ill. If we could have that discussion, then change would surely follow. Our society would embrace and promote alternative forms of non-drug care. Physicians would prescribe the medications in a much more limited, cautious manner. We would stop putting foster children on heavy-duty cocktails and pretending that it was medical care.

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