Comfortably Numb: How Psychiatry Is Medicating a Nation

[marmar]

from AlterNet:




Comfortably Numb: How Psychiatry Is Medicating a Nation

By Onnesha Roychoudhuri, AlterNet. Posted April 17, 2008.

Author Charles Barber discusses Americans' unrealistic notions about happiness. We've medicalized a lot of life issues that aren't mental illnesses.




While we've now become accustomed to the barrage of prescription drug commercials on prime-time TV, it's jarring to learn that this advertising is legal only in the United States and New Zealand. The pharmaceutical industry doesn't just target Americans directly, but also spends roughly $25,000 per physician per year. With the aid of information from data mining companies, a pharmaceutical representative knows exactly how many prescriptions for what medication a doctor has written, allowing the industry to individually target them.

How Americans came to this fraught relationship with the pharmaceutical industry and its drugs -- particularly antidepressants -- is the subject of Charles Barber's new book, Comfortably Numb. A veteran of mental health programs in homeless shelters and a lecturer in psychiatry at the Yale University School of Medicine, Barber trains his eye to the confluence of science and culture that have led to the widespread prescribing of medications once reserved for the most serious cases.

While the field of neuroscience continues to churn out new data about the way our brains work, Barber is quick to remind us how much more is yet to be understood. Barber recently spoke with AlterNet about how less sexy treatments like social interventions and therapies can be just as effective in changing the brain.

Onnesha Roychoudhuri: What led you to write the book?

Charles Barber: When I started in the mental health field in the late '80s there wasn't really a name for what I did. If I talked to professional, educated people, they didn't understand psychiatric diagnoses or medications. Then, 10 years later, people were very up on diagnoses, they were sympathetic to what I was doing, and there was now a name for the field: mental health. Many of them were taking the same medications that my clients were. There was a series of events over the late '80s and early '90s that set all that up. The main thing being Prozac and its cousins Paxil and Zoloft, which became totally mainstream; the TV advertising of drugs in the mid-'90s, well-known figures going public with their clinical depression, and a lot of subsequent pop culture stuff: The Sopranos and A Beautiful Mind, for example. All of this brought psychiatry, particularly medications, into the fore.

OR: Can you talk about your involvement in the mental health field and what it has enabled you to observe?

CB: I fell into the field for a lot of different reasons. I worked in psychiatric homeless shelter programs for about 10 years in New York -- Bellevue being the most well-known. So I was working with the really seriously mentally ill, many of whom had been in and out of prisons and state psychiatric facilities and homeless shelters. What I found was that psychiatry, at least for certain diagnoses, has confused the really serious forms of the illness with the far lesser forms. The best example is depression. Many of the folks that I worked with suffered from severe depression. I make the distinction in the book between big "D" depression and small "d" depression. In its severe forms, it's an absolutely brutal, horrific and malevolent illness where people are at dire risk of hurting themselves.

It's jarring to go to a cocktail party and hear people talking about being bummed out or hear that they're going through a divorce, and their family doctor put them on an antidepressant. There has been a confusion and conflation of this diagnosis that confuses serious disorders with far lesser conditions or, in many cases, life problems. We've medicalized a lot of life issues that are not mental illnesses.

OR: Just to be clear, this book is not about medication as a "bad" thing.

CB: Absolutely not. I think I make clear in the book that for serious disorders, I've seen the medications work really, really well. However, there are often side effects that the field has overlooked and is becoming more aware of these days. And these medications still don't work a good percentage of the time for people with serious disorders. My critique is that the further you get away from serious or moderate disorders, where you're treating nondisorders or marginal disorders with medication, the risk/reward calculus of the medications becomes more iffy -- particularly antidepressants.

When the SSRI (selective serotonin reuptake inhibitor) antidepressants like Prozac and Zoloft and Paxil first came out, they were considered pretty much side-effect-free, largely because the previous generation of antidepressants had a lot of side effects. But in the past few years, people have become more aware that they have more side effects. These effects are seen most when people are getting on and off the drugs. .......(more)

The complete piece is at: http://www.alternet.org/healthwellness/82455/

[Kitty Herder]

1. I've suffered from depression most of my life and I gotta tell ya,

SSRIs suck!!!

They started me on them when I was in high school. They didn't actually lessen the depression. If they changed anything at all, they just made me more numb to both the good and the bad in life. When one didn't work, they'd try another one. I've been on Zoloft, Paxil, Celexa, Effexor, Prozac and Wellbutrin(that one's an absolute nightmare!!).

When I finally decided that any positive benefit I was receiving from these drugs was outweighed by the negatives, I'd been on Effexor for five years. Even though I weaned myself off of it very slowly, I suffered weird withdrawal symptoms. Now I'm SSRI free for the first time in my adult life and I'm glad of it. The world seems somehow clearer, as if before I was looking at life through a frosted window pane.

Depression seems to be a genetic trait from my mother's side of the family. I also think it's a product of learning poor self-esteem from our parents who have poor self-esteem, since a low opinion of ourselves seems to be a big factor in the depression most of the family suffers from. But none of us have ever derived any great benefit from anti-depressants, except one cousin who claims Prozac cured the post-partum depression she developed after her last child was born. But it took four years and her youngest going to pre-school. My suspicion is that her four stair-step kids finally growing up enough to give her some free time had more to do with it than anything.

You know what has helped me with my depression? Cognitive therapy, exercise out of doors, yoga, meditation, and a full-spectrum, 10,000 lux light-box in the winter. It ain't as easy as popping a pill, but it works a lot better and doesn't make me numb. I've slipped a bit in doing those things in recent months and the depression monster is rearing its ugly head again, but at least I know what to do to combat it.


edited to add: I'm talking about serious depression here. I and many of my family members have been hospitalized at various times. But anti-depressants didn't help much. There have been studies that have shown that these SSRIs are no more effective than placebo and the drug companies were selective in choosing the studies that did show a slight benefit to present to the FDA.

[proud2BlibKansan]

2. Sounds familiar

I finally weaned myself off of anti-depressants about 5 years ago and it was the smartest thing I have ever done. I got lots more benefits from counseling than from pharmaceuticals.

[notesdev]

4. My experience

I once scored 37 out of 50 on a depression test, having answered 'no' only the questions relating to self-mutilation or suicide.

They tried to put me on Effexor - I took half the recommended dose one time. I would never touch the stuff again, it was like swallowing rat poison and two pots of coffee all at once.

It turned out that the reasons I was depressed were all grounded in realities - I was in a sucky situation, and had good reason to be depressed about it. My cure came from changing my situation, remediating the things that brought me down. The psychiatric/pharmaceutical complex was most annoyed at my overwhelming success in solving the problem.

While there are some factors I had no control over, correcting the ones I could correct did the job, and I learned to be at peace with the rest.

[The Backlash Cometh]

9. That's it in a nutshell.

Just one thing different in my case. I wish I could easily release from things that I have no control over, but, as it turns out, that is the crux of my situation. For some ungodly reason, I keep getting victimized by just about every crack in the system. Whether it's medical malpractice or crooked city attorneys I seem to continue to be in the path of their recklessness.

Now, if the black cloud insists on following you, then one must face the cloud and paint every detail, so you can know every dark furrow, and at least you can warn others when you see it coming. That, at least, is some control over it.

[tama]

10. Individual depression

is normal and healthy response to the severe collective mental disorder that humanity is suffering from. You know, alienation from nature, worship of greed etc.

Regular walks in a forest help cure and alleviate depression much better than pills, thus sayeth also scientific studies, d'uh! Only problem is that a walk in a forest is very difficult to commercialize... ;)

[Kitty Herder]

12. I agree with you on both counts.

I came to the conclusion that it was normal for us to suffer from mental illnesses when we live in a sick culture after reading Derrick Jensen's books. He's extreme and I don't agree with him on everything, but he certainly makes a good case for the collective insanity of civilization


As for walks in the forest, forests are hard to come by in the Utah desert, but I think walks in fields and in the desert are just about as good.

[tama]

14. Derrick Jensen

According to wikipedia he's an anarcho-primitivist. Me likes.

And isn't desert a forest of sand and stones? ;-)
Desert shapes up men very differently from forests, as does arctic etc. Variety is good and beautifull.

[Kitty Herder]

15. I highly recommend reading Derrick Jensen's stuff if you're into anarcho-primitivist ideas.

I'll warn you, though, he does advocate eco-terrorism on a large scale, which I disagree with. If you decide to read his books, I would advise you to NOT start with Endgame. It's pretty extreme. I'd start with A Language Older Than Words.

A Language Older Than Words was mind-opening and paradigm-changing for me. I read it at a time when my life was in turmoil and it helped me clarify some of my own values and beliefs.

And yes, I love the desert. It lacks many of the beneficial negative ions you get in a forest, but I think it's just as good for the soul.

[tama]

16. Anarcho-primitivism

My interest with anarcho-primitivism has more to do with "primitive" tribes, ecovillages and shamanism than eco-terrorism, though I have - on my weaker moments - fantasized about "terrorizing" some forest raping bureaucrats by putting a curse on them... ;)

And thanks for the book tips.

[Kitty Herder]

19. You sound just like me.

The eco-terrorism is where I part company with Derrick. But he opened my eyes to the insanity of our life-destroying, planet-destroying culture.

I share your interests in ecovillages, shamanism, etc. and I fantasize about putting curses on those who are actively destroying ecosystems.

[tama]

23. And we are both insane!

I was recently diagnozed with "paranoid psychoses" as a consequense of a PTSS and given box of pills to eat. Not too bad, and counceling too with OK types.

But in "reality" what happened is that shamanic realities mixed up with everyday realities a wee bit too strongly for my poor old little fragile head to cope, at least without a need for a long good rest from the "mania" period.

[Kitty Herder]

25. Yep!

I think it probably helps to actively pursue shamanic states through drumming, trancework, etc.

I've never had the two realities get mixed up, but I think it's part of my nature to delve into that reality and I'm a much happier person when I do it on a regular basis. I don't use drugs to do so, although I'm not opposed to that and I am vehemently opposed to legislation that disallows the use of entheogenic drugs for that purpose.

I'm lucky; I've learned to enter a trance-like state at will. I don't care what anyone says, I learn valuable things in a shamanic trance. I get more insight from that than I got from sixteen years of school.

It took a long time for me to find that part of myself. I was raised Mormon and was utterly miserable. It never fit me and it didn't allow for what I consider "real", deep, spiritual exploration. I think that might be part of the problem with my family, too. They're stuck in that religion, and since most of them are a lot like me, I figure it doesn't fit them well, either, and contributes to their depression.

[tama]

28. Three and more realities

It's (being insane) not about pursuing shamanic states, but about trying to avoid them or at least learning to confine them to appropriate situations. Like drumming where help and support is nearby - fellow drummers and the spirits of drums etc. I don't have the disease really bad way - thank god! - but enough of insight and experience to understand that those who habitually trance unvolitionally whenever and wherever don't have what you could call easy lives! Especially when the society is more interested in medicating them into zombies instead of helping to become wholesome and fulfilling their potential, so they could be a great blessing to their communities and all of mankind. Holy men.

And I don't have any respect for wannabeism. That's just plain stupid. But on the other hand, it's a catching disease... maybe for a good reason.

[sandnsea]

20. Different diagnoses require different meds

Bipolar will respond horribly to general depression meds, and vice versa. You can't apply your illness to others. It's as stupid as being treated with an antibiotic when you have a virus, and then saying antibiotics suck.

[Kitty Herder]

26. Who ever said anything about bipolar disorder?

I have no familiarity with that illness or the treatments for it. I can't speak to their effectiveness.

I speak only of my own experience, which is with unipolar depression, the illness SSRIs purport to treat. They do not work for me, or for others in my family, but do create unwelcome side-effects.

And it's not just me or my family, which I find comforting. They've been found in to be no more effective than a placebo. Which is not to deny the power of placebos; they can work wonders. Our minds are incredible things.

http://www.healthcentral.com/depression/c/18/21229/sugar-pills/

At least, it's not just us. They say they can help the most severely depressed people, but not all of that subset responds, either.

[bpeale]

22. and i have exactly the opposite effect for Zoloft

i was seriously depressed almost to the point of not being able to get out of bed in the morning. my dr. prescribed the lowest dose of zoloft, 25mg, at first ... all i can say is WOW! the effect was amazing, like night & day. and that was immediately too. my dr. upped the dose to 50mg, then to 100mg. i remained on it for 6 months & was then taken off it. i didn't experience any side affects coming off, nor have i had to go back on it because serotonin levels dropped. my levels so far have remained constant for 3 yrs. the relief i got from zoloft was amazing. perhaps that particular drug was not the right one for you ... and too, you were a teenager, so those drugs affect teens differently. SSRIs are amazing & a life saver for a lot of people. you probably need an antidepressant that doesn't mess with SSRIs. maybe your depression was a result of something entirely different. it's all trial & error to find the right one. and your studies you quote don't take into account that not everyone is affected by them the same way & they tend to only quote those who agree with their hypothesis. zoloft was a wonder drug for me.

[notesdev]

3. overprescription

is rampant and a major contributor to the rising cost of health care.

I first became concerned with this when they started handing out Ritalin en masse to children, even very young ones, as if normal childhood behavior could be construed a 'disease' that needed to be medicated out of existence.

[Kitty Herder]

5. I agree. Of course, kids have a hard time paying attention in school.

That's the nature of kids and of school. Medicating them for it seems really screwed up to me.

[The Backlash Cometh]

6. Mea Culpa, I didn't read the main post, but it triggered this idea:

Sometimes there are real obstacles that create feelings of depression, but instead of tackling those obstacles, we're being encouraged to take medication so we can ignore them. Problems don't go away when you ignore them, and it's a terrible society we're creating that teaches people to ignore their gut feelings when making decisions. Turn off the button for empathy and you turn off the button for sympathy.

[notesdev]

7. see above

I related my story which is pretty much exactly as you described above under "my experience".


I have also seen people who took the medication-only approach. I saw one individual over the course of a year do absolutely nothing to address key issues which were literally driving him insane, but he had his drugs and was 'happy' - 'happy' enough that he could still get to work most of the time. He was a smart guy too, but when it came to the key issues in his life he wasn't so smart.

[tama]

11. Dunno for sure

but I guess that most persons that go on rampant school killings have been or are on some psychiatric "medication". Treating just the symptoms, not the cause.

That was the case in the Jokela masskilling in Finland (the killer had raged against pills he was fed on youtube) and after there was some discussion about the pill-policy. A chief doctor defended the system by saying that it has succeeded, despite huge cuts in counselling and hospital beds in psychiatric departments, to keep the crowds still able to work their menial non-meaningfull jobs to serve the rich. Talk about totalitarian "part of the machine" soviet style psychiatry!!!

In an insane world there only very few sane people. More the reason to keep them sedated, prisoned etc... ;-)

[ConcernedCanuk]

8. "Problems don't go away when you ignore them" - well said

.
.
.

And in response to the OP - I thought I had clinical depression last year after losing my father of 95 years, an illegal eviction, and an uncertain future.

I went to the hospital clinic, told them I thought I was clinically depressed, and they handed out a prescription (anti-depressant) WITHOUT SO MUCH AS 5 MINUTES CONSULTATION.

Further visits the doctors encouraged me to stay on the anti-depressants, again, with visits of less than 5 minutes.

I'm off them now, weaned myself off of them according to info I searched the internet for.

NONE of these physicians were shrinks, and none spent more than a few minutes with me while I tried to explain that my problem was not being able to sleep.

EVERYONE has stress of some sort, and lack of sleep makes it harder to handle these things on a daily basis.

I now take a hormone supplement occasionally, Melatonin; which helps with the sleep cycle.

And I got back into reading books and magazines, and shut the 'puter off more often.

Doctors are just too eager to get one to "take a pill" and get back to them in a week or so.

Makes one wonder why they call a doctor's career a "practice".

I think you get it.

[hunter]

13. I welcome anyone to live with my unmedicated self.

No really! When I'm in my full unmedicated glory I don't suffer nearly so bad as the people around me. I'm a big black cloud full of lightening and hailstones. Scientologists nervously look away and cross the street when they see me coming.

Yep, the stuff is overpriced and overprescribed, but that's entirely a consequence of our stupid for-profit health care system. It doesn't mean that these drugs are inappropriate for everyone.

The hell of it is that the people most in need of help, people who might benefit from psych drugs, are among the least likely to seek care, and threads full of meaningless anecdotes like this one don't improve that grim situation.

[spoony]

18. Yep

I hate these "I was taking pills for awhile but it turned out I was sad 'cuz my goldfish died and I cured it by walking in the park so you should too" bullshit-fests.

[sandnsea]

21. I transported patients to the state hospital

I remember one with catatonic schizophrenia. I guess we should have just driven her around the park for a few months. :crazy:

I get annoyed with these people too. It doesn't take a lot of intelligence to know what works for you isn't necessarily going to help the next person. What's worse is the number of people who may just have a misdiagnosis and could be helped if they'd try a new doctor, or a real doctor in the first place.

[tama]

24. Agree

"What's worse is the number of people who may just have a misdiagnosis and could be helped if they'd try a new doctor, or a real doctor in the first place."

Or a shaman or any spiritual healer by any name. I don't see any need for either-or when it comes to healing and helping, spiritual aid and chemical aid are not mutually exclusive but often both are needed, preferably in cooperation. And needles to be said, there are charlatans and fuck-ups in every trade.

[htuttle]

17. I've been having a lot of luck with St. John's Wort extract...

"...Ask your Doctor about St. John's Wort Extract..."

Works well, and I've experienced no side effects. However, do NOT take it with any other anti-depressants.

[treestar]

27. Depends on who you ask

SSRIs work wonderfully for me.

I was myself for the first time at the age of 39. I finally learned what it was like to feel normal.

It's not that you're happy all the time. It's that you can handle the challenges of life.