Are we all going mad, or are the experts crazy? / Are psychiatric drugs an assault on the human condition?
Fri, 19 Aug 2005
Below, two companion pieces: An Op Ed in the Los Angeles Times, by Stuart Kirk, a professor of social welfare at UCLA, addresses psychiatry’s conundum: the absence of a scientific foundation for either psychiatry’s diagnostic classifications or its prescribed interventions. Kirk notes that in the absence of scientific evidence to back up psychiatry’s practices, organized psychiatry has pathologized an ever increased number of human behaviors.
“Since 1979, for example, some of the new disorders and categories that have been added include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, social phobia, borderline personality disorder, gender identity disorder, tobacco dependence disorder, eating disorders, conduct disorder, oppositional defiant disorder, identity disorder, acute stress disorder, sleep disorders, nightmare disorder, rumination disorder, inhibited sexual desire disorders, premature ejaculation disorder, male erectile disorder and female sexual arousal disorder. If you don’t see yourself on that list, don’t fret, more are in the works for the next edition of the DSM.
Because so little is known about the causes of most mental disorders, just about any behavior can look like a symptom. Here is a selection from hundreds of behaviors listed in the DSM, behaviors that signify one disorder or another: restlessness, irritability, sleeping too much or too little, eating too much or too little, difficulty concentrating, fear of social situations, feeling morose, indecisiveness, impulsivity, self-dramatization, being inappropriately sexually seductive or provocative, requiring excessive admiration, having a sense of entitlement, lacking empathy, fear of being criticized in public, feeling personally inept, fear of rejection or disapproval, difficulty expressing disagreement, being excessively devoted to work and productivity, and being preoccupied with details, rules and lists. For children, signs of disorder occur when they are deceitful, break rules, can’t sit still or wait in lines, have trouble with math, don’t pay attention to details, don’t listen, don’t like to do homework or lose their school assignments or pencils, or speak out of turn.”
The medicalization of human behavior and psychiatry’s reliance on psychotropic drugs–no matter how inappropriate–is the product of an “unholy alliance” as the late Dr. Loren Mosher called it, between the pharmaceutical industry and their paid collaborators, the American Psychiatric Association and the National Alliance for the Mentally Ill. Though skeptics, Kirk included, “are suspicious of the motivations of the APA and the drug companies that may view the expanding sweep of mental disorders like a lumber company lusting after a redwood forest. But unlike the environment, with its leagues of watchdogs, the medicalization of human foibles has few challengers.”
The second item is an interview with Robert Whitaker, author of Mad in America, a documented history of the treatment of schizophrenia, the most severe and disabling mental disorder. This book pulled the rug out from under psychiatry’s foundation built on false claims about the safety and value of its treatment armamentarium. Whitaker acknowledges that when he began to research the subject, “I absolutely believed the common wisdom that these antipsychotic drugs actually had improved things and that they had totally revolutionized how we treated schizophrenia. People used to be locked away forever, and now maybe things weren’t great, but they were a lot better. It was a story of progress.”
But his research into psychiatry’s radical “cures” such as insulin coma, lobotomy, electroshock, and mega doses of neuroleptic drugs-all of which were touted in their day by The New York Times–revealed that these “cures,” in fact, worsened patients’ health and quality of life–because they caused irreversible brain damage. Whitaker, an investigative reporter, did not limit his examination to the historical record. He put psychiatry’s claims about its current treatments to the test, and soon discovered from concealed scientific evidence which he obtained from the FDA, that psychiatry’s claims about “breakthroughs’ have no scientific basis. Furthermore, psychiatrists continue to deceive the public and patients with false claims about the function, the safety, and benefit of the new, antidepressants (SSRIs) and the so-called ‘atypical’ antipsychotics.
Psychiatry’s claims, that these drugs “balance brain chemistry” in psychotic patients are sheer invention and speculation. Whitaker examined the evidence from both–clinical trials, outcome studies and the rate of mental disability in the US. The story of progress is a marketing myth: Whitaker’s investigative search for the facts revealed that the scientific evidence refutes most of psychiatry’s claims. The evidence shows that patients’ recovery rates have declined, the drugs have caused more harm than good by causing chronic disability in patients exposed to the drugs for long periods of time. Far from an improvement over the old neuroleptics–when prescribed at low doses–the ‘atypical’ antipsychotics pose greater hazardous to patients. Citing Dr. Steven Hyman’s published findings, Whitaker notes the new drugs create perturbations in neurotransmitter functions which result in metabolic dysfunction and organ damage, which explain the high mortality rates.
Contact: Vera Hassner Sharav
The Los Angeles Times
Are we all going mad, or are the experts crazy?
Op-Ed By Stuart A. Kirk
August 14, 2005
STUART A. KIRK is a professor of social welfare at UCLA. He is the coauthor of “The Selling of DSM” and “Making Us Crazy.” His most recent book is “Mental Disorders in the Social Environment: Critical
PSYCHIATRIC researchers recently estimated that half of the American population has had or will have a mental disorder at some time in their life. A generation ago, by contrast, only a small percentage of the American population was considered mentally ill. Are we all going mad?
Freud started this. He made us suspicious that any behavior was potentially rife with psychopathology. As a neurologist, he used the medical language of pathology to suggest that the demands of civilization on our fragile human nature were such as to make all of us somewhat neurotic.
The current psychiatric bible published by the American Psychiatric Assn., “The Diagnostic and Statistical Manual of Mental Disorders,” or the DSM, continues this tradition of making us all crazy.
Because there are no biological tests, markers or known causes for most mental illnesses, who is counted as ill depends almost entirely on frequently changing checklists of behaviors that the DSM considers as symptoms of mental disorder. In the recent research, lay interviewers asked a sample of people to respond to lengthy questionnaires based on the DSM lists. Computer programs then counted the responses to determine if those interviewed had ever had the required number of behaviors for any mental disorder at some time in their life.
We keep getting higher estimates of mental disorders in part because the APA keeps adding new disorders and more behaviors to the manual.
Since 1979, for example, some of the new disorders and categories that have been added include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, social phobia, borderline personality disorder, gender identity disorder, tobacco dependence disorder, eating disorders, conduct disorder, oppositional defiant disorder, identity disorder, acute stress disorder, sleep disorders, nightmare disorder, rumination disorder, inhibited sexual desire disorders, premature ejaculation disorder, male erectile disorder and female sexual arousal disorder. If you don’t see yourself on that list, don’t fret, more are in the works for the next edition of the DSM.
Because so little is known about the causes of most mental disorders, just about any behavior can look like a symptom. Here is a selection from hundreds of behaviors listed in the DSM, behaviors that signify one disorder or another: restlessness, irritability, sleeping too much or too little, eating too much or too little, difficulty concentrating, fear of social situations, feeling morose, indecisiveness, impulsivity, self-dramatization, being inappropriately sexually seductive or provocative, requiring excessive admiration, having a sense of entitlement, lacking empathy, fear of being criticized in public, feeling personally inept, fear of rejection or disapproval, difficulty expressing disagreement, being excessively devoted to work and productivity, and being preoccupied with details, rules and lists.
For children, signs of disorder occur when they are deceitful, break rules, can’t sit still or wait in lines, have trouble with math, don’t pay attention to details, don’t listen, don’t like to do homework or lose their school assignments or pencils, or speak out of turn.
Granted, one momentary feeling or behavior will not qualify you as having a DSM mental disorder; it requires clusters of them, usually for several weeks, accompanied by some level of discomfort. Nevertheless, as Freud suggested, the signs of potential pathology are everywhere.
The vast broadening of the definition of mental disorders has its skeptics, myself included, who are suspicious of the motivations of the APA and the drug companies that may view the expanding sweep of mental disorders like a lumber company lusting after a redwood forest. But unlike the environment, with its leagues of watchdogs, the medicalization of human foibles has few challengers. That’s too bad: The misdiagnosis of mental illness often leaves a lasting trail in medical records open to schools, employers, insurance companies and courts.
Does it advance psychiatry to view an increasing expanse of human troubles as the expression of psychopathology rather than as part of the texture and diversity of life? Psychiatry once focused on the prevention and treatment of serious behavioral problems, of which there are plenty. But based on the metastasizing DSM, the psychiatric association appears to be caught up in a contemporary narcissistic quest for individual perfection.
The grand American experiment once was an attempt to structure our social and political institutions to create a more civil and just society. Perhaps, frustrated that we still contend with gross inequality, stinging poverty and rampant political and corporate corruption, we now embrace the perfectibility of individuals, not social institutions.
The public is being asked to swallow the view that all manner of human troubles – from anxiety, interpersonal squabbles to misbehavior of many kinds – be viewed not as inevitable parts of the human comedy, but as psychopathology to be treated, usually with drugs, as expugnable illnesses. The implicit ideal – the healthy, normal and truly happy camper – will, properly medicated, harbor no serious worries or animosities, no sadness over losses or failures, no disappointments with children or spouses, no doubts about themselves or conflicts with others, and certainly no strange ideas or behaviors. Their moods will be perfectly controlled in all circumstances, and bad hair days will be things of the past.
Is it inevitable that the rest of us, the recalcitrant, flawed resisters to the movement for individual perfection, will show up in future counts of the mentally disordered? Count me in.
Psychiatric Drugs: An Assault on the Human Condition
Interview by Terry Messman
Street Spirit: Your new line of research indicates that there has been an enormous rise in the incidence of mental illness in the United States, despite the seeming advances in a new generation of psychiatric drugs. Why do you refer to this increase as an epidemic?
Robert Whitaker: Even people like the psychiatrist E. Fuller Torrey wrote a book recently in which he said it looks like we’re having an epidemic of mental illness. When the National Institute of Mental Health publishes its figures on the incidence of mental illness, you see these rising numbers of mentally ill people. Some recent reports even say that 20 percent of Americans now are mentally ill.
So what I wanted to do was two-fold. I wanted to look into exactly how dramatic is this increase in mental illness, and particularly severe mental illness. Part of this rise in the number of people said to be mentally ill is just definitional. We draw a big wide boundary today and we throw all sorts of people into that category of mentally ill. So children who are not sitting neatly enough in their school rooms are said to have attention deficit hyperactivity disorder (ADHD), and we created a new disorder called social anxiety disorder.
SS: So what used to be called simply shyness or anxiety in relating to people is now labeled a mental disorder and you supposedly need an antidepressant like Paxil for social anxiety disorder. RW: Exactly. And you need a stimulant like Ritalin for ADHD.
SS: This increases psychiatry’s clients, but doesn’t it also increase the number of people that giant pharmaceutical companies can sell their psychiatric drugs to?
RW: Absolutely. So part of what we’re seeing is nothing more than the creation of a larger market for drugs. If you think about it, as long as we draw as big a circle as possible, and expand the boundaries of mental illness, psychiatry can have more clients and sell more drugs. So there’s a built-in economic incentive to define mental illness in as broad terms as possible, and to find ordinary, distressing emotions or behaviors that some people may not like and label them as mental illness.
SS: Your research also shows that there is a real increase in people who have a severe mental disorder. Now, this seems counterintuitive, but is it true that you believe much of this increase is caused by the overuse of some of the new generations of psychiatric drugs?
RW: Yes, exactly. I looked at the number of the so-called severely disabled mentally ill — people who aren’t working or who are somehow dysfunctional because of mental illness. So I wanted to chart through history the percentage of the population who are considered the disabled mentally ill.
Now, by 1903, we see that roughly 1 out of every 500 people in the United States is hospitalized for mental illness. By 1955, at the start of the modern era of psychiatric drugs, roughly one out of every 300 people was disabled by mental illness. Now, let’s go to 1987, the end of the first generation of antipsychotic drugs; and from 1987 forward we get the modern psychiatric drugs. From 1955 to 1987, during this first era of psychiatric drugs — the antipsychotic drugs Thorazine and Haldol and the tricyclic antidepressants (such as Elavil and Anafranil) — we saw the number of disabled mentally ill increase four-fold, to the point where roughly one out of every 75 persons are deemed disabled mentally ill.
Now, there was a shift in how we cared for the disabled mentally ill between 1955 and 1987. In 1955, we were hospitalizing them. Then, by 1987, we had gone through social change, and we were now placing people in shelters, nursing homes, and some sort of community care, and gave them either SSI or SSDI payments for mental disability. In 1987, we started getting these supposedly better, second-generation psychiatric drugs like Prozac and the other selective serotonin re-uptake inhibitor (SSRI) antidepressants. Shortly after that, we get the new, atypical antipsychotic drugs like Zyprexa (olanzapine), Clozaril and Risperdal.
What’s happened since 1987? Well, the disability rate has continued to increase until it’s now one in every 50 Americans. Think about that: One in every 50 Americans disabled by mental illness today. And it’s still increasing. The number of mentally disabled people in the United States has been increasing at the rate of 150,000 people per year since 1987. That’s an increase every day over the last 17 years of 410 people per day newly disabled by mental illness.
SS: So that leads to the obvious question. If psychiatry has introduced these so-called wonder drugs like Prozac and Zoloft and Zyprexa, why is the incidence of mental illness going up dramatically?
RW: That’s exactly it. This is a scientific question. We have a form of care where we’re using these drugs in an ever more expansive manner, and supposedly we have better drugs and they’re the cornerstone of our care, so we should see decreasing disability rates. That’s what your expectation would be.
Instead, from 1987 until the present, we saw an increase in the number of mentally disabled people from 3.3 million people to 5.7 million people in the United States. In that time, our spending on psychiatric drugs increased to an amazing degree. Combined spending on antipsychotic drugs and antidepressants jumped from around $500 million in 1986 to nearly $20 billion in 2004. So we raise the question: Is the use of these drugs somehow actually fueling this increase in the number of the disabled mentally ill?
When you look at the research literature, you find a clear pattern of outcomes with all these drugs — you see it with the antipsychotics, the antidepressants, the anti-anxiety drugs and the stimulants like Ritalin used to treat ADHD. All these drugs may curb a target symptom slightly more effectively than a placebo does for a short period of time, say six weeks. An antidepressant may ameliorate the symptoms of depression better than a placebo over the short term.
What you find with every class of these psychiatric drugs is a worsening of the target symptom of depression or psychosis or anxiety over the long term, compared to placebo-treated patients. So even on the target symptoms, there’s greater chronicity and greater severity of symptoms. And you see a fairly significant percentage of patients where new and more severe psychiatric symptoms are triggered by the drug itself.
SS: New psychiatric symptoms created by the very drugs people are told will help them recover?
RW: Absolutely. The most obvious case is with the antidepressants. A certain percentage of people placed on the SSRIs because they have some form of depression will suffer either a manic or psychotic attack — drug-induced. This is well recognized. So now, instead of just dealing with depression, they’re dealing with mania or psychotic symptoms. And once they have a drug-induced manic episode, what happens? They go to an emergency room, and at that point they’re newly diagnosed. They’re now said to be bipolar and they’re given an antipsychotic to go along with the antidepressant; and, at that point, they’re moving down the path to chronic disability.
SS: Modern psychiatry claims that these psychiatric drugs correct pathological brain chemistry. Is there any evidence to back up their claim that abnormal brain chemistry is the culprit in schizophrenia and depression?
RW: This is the key thing everyone needs to understand. It really is the answer that unlocks this mystery of why the drugs would have this long-term problematic effect. Start with schizophrenia. They hypothesize that these drugs work by correcting an imbalance of the neurotransmitter dopamine in the brain.
The theory was that people with schizophrenia had overactive dopamine systems; and these drugs, by blocking dopamine in the brain, fixed that chemical imbalance. Therefore, you get the metaphor that they’re like insulin is for diabetes; they’re fixing an abnormality. With the antidepressants, the theory was that people with depression had too low levels of serotonin; the drugs upped the levels of serotonin in the brain and therefore they’re balancing the brain chemistry.
First of all, those theories never arose from investigations into what was actually happening to people. Rather, they would find out that antipsychotics blocked dopamine and so they theorized that people had overactive dopamine systems. Same with the antidepressants. They found that antidepressants upped the levels of serotonin; therefore, they theorized that people with depression must have low levels of serotonin.
But here is the thing that one wishes all of America would know and wishes psychiatry would come clean on: They’ve never been able to find that people with schizophrenia have overactive dopamine systems. They’ve never been able to find that people with depression have underactive serotonin systems. They’ve never found consistently that any of these disorders are associated with any chemical imbalance in the brain. The story that people with mental disorders have known chemical imbalances — that’s a lie. We don’t know that at all. It’s just something that they say to help sell the drugs and help sell the biological model of mental disorders.
But the kicker is this. We do know, in fact, that these drugs perturb how these chemical messengers work in the brain. The real paradigm is: People diagnosed with mental disorders have no known problem with their neurotransmitter systems; and these drugs perturb the normal function of neurotransmitters.
SS: So rather than fixing a chemical imbalance, these widely prescribed drugs distort the brain chemistry and make it pathological.
RW: Absolutely. Stephen Hyman, a well-known neuroscientist and the former director of the National Institute of Mental Health, wrote a paper in 1996 that looked at how psychiatric drugs affect the brain. He wrote that all these drugs create perturbations in neurotransmitter functions. And he notes that the brain, in response to this drug from the outside, alters its normal functions and goes through a series of compensatory adaptations.
In other words, it tries to adapt to the fact that an antipsychotic drug is blocking normal dopamine functions. Or in the case of antidepressants, it tries to compensate for the fact that you’re blocking a normal reuptake of serotonin. The way it does this is to adapt in the opposite way. So, if you’re blocking dopamine in the brain, the brain tries to put out more dopamine and it actually increases the number of dopamine receptors. So a person placed on antipsychotic drugs will end up with an abnormally high number of dopamine receptors in the brain. ..cut.. See complete article in Street Spirit: http://www.thestreetspirit.org/August2005/interview.htm
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