Posts Tagged ‘Psychiatric drugs’

Antidepressants not a cure for lost connections

April 23, 2018

Journalist Johann Hari said in his new book that people who are depressed are not victims of bad brain chemistry.  They are depressed because they are disconnected from things that make life worth living.

They are disconnected from meaningful work, meaningful values and meaningful relationships with other people, from status and respect, the natural world and a secure or hopeful future.

In LOST CONNECTIONS: Uncovering the Real Causes of Depression—And the Unexpected Solutions (2018), Hari walks the reader through the scientific research that shows how people suffer when they are disconnected from the things they need, and how they can heal when they recover those connections.

Depression and anxiety are big problems.  Hari said psychiatric drugs are being taken by one in five American adults, one in three French adults and an even higher proportion in the UK.

The death rate in the United States is actually increasing, driven by “deaths of despair”—suicide, drug overdoses and alcohol-caused liver disease.   The World Health Organization reported in 2010 that depression is the world’s second leading cause of disability.

Hari said therapists can help, and gave examples.  He said there are ways people can help themselves, and gave examples.  Medication has its place, although often ineffective.  Hari deeply regrets the 13 years of his own life that he spent taking antidepressants.

But feelings of depression and anxiety are not the problem, according to Hari.   Pain, whether mental or physical, is a message that lets you know something is seriously wrong.   The rising rate of depression is a message telling us that something is wrong with our society.

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In organizations, you might think that the managers and decision makers would be under the most stress, while those with less responsibility would be the least stressed.  A study of the British civil service, among others, showed that the opposite is true.  The lower your rank, the higher the stress.

What causes stress is lack of control, Hari reported.   Employees are stressed when they have to produce results without being able to use their best judgment as to how to produce these results.

They are stressed when they don’t know the meaning or purpose of their work.  They are stressed when nobody notices whether they are doing a good job or not.  They are stressed when they’re on call even after the work day ends.   They are stressed when they don’t know whether they are going to have a job next week or next year.  Lost Connections gives examples of workers dealing with all these things.

Stressful working conditions are on the increase.  We the people were told that technological advances would result in all the routine work being done by machines, and more fulfilling, higher-level tasks being done by humans.  I believe such a path is possible, but it has not been the path chosen.

Instead we got Frederick W. Taylor’s scientific management, factory automation and computer numerically-controlled machines.  The purpose of these innovations was not to make workers more skilled.  It was to make them more replaceable.

High tech executives continue to push to eliminate the human factor from work, even when there is no need or demand for it, such as self-driving cars, and even when the public hates it, such as elimination of human interaction from customer service.

Workers do not suffer from a chemical imbalance, Hari wrote; they suffer from a power imbalance.

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The military’s real drug abuse problem

October 7, 2013

army_pills-aOvermedication of psychiatric drugs in the U.S. armed forces are claiming lives far from the battlefield.  Painkillers and antidepressants may help keep stressed and exhausted troops in combat, or give relief from bad feelings later on, but sometimes they pay a heavy price.

Kelly Vlahos in a disturbing article in the American Conservative reported how quick many military psychiatrists are to prescribe drugs whose labels carry warnings of possible suicidal thoughts and possible psychosis, and also of increased heartbeat rate and heart failure.   Such drugs may be a cause of the alarming increase in the suicide rate among veterans and members of the armed forces.

“It’s a very significant problem,” Tom Tarantino, a former Army Captain who served as a platoon leader in Iraq in 2006, and is now spokesman and policy associate for IAVA [Iraq and Afghanistan Veterans of America].

“It’s one of those things that really starts with medicine on the battlefield, and in deployment you are just trying to treat symptoms so people can keep going,” he tells TAC, describing how pills were handed out in Ziploc bags in the field. “The availability is so much easier than when you are at home. When you get home, they say ‘we’re not giving you a bag full of Oxycontin, no.”

Psychiatric drugs have their place.  They help relieve symptoms of mental illness, although the means by which they work is poorly understood.  Medical scientists are learning how dangerous it it is to prescribe large doses, to prescribe for “off-label” uses and to prescribe “cocktails” of drugs whose possible interactions are unknown.

Click on The Military’s Prescription Drug Addiction for the full article.   This is part of a larger societal problem of indiscriminate use of psychiatric drugs, which is well-described in Anatomy of an Epidemic by science journalist Robert Whitaker

An abused minority: the mentally ill

February 6, 2012

I recently read Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness by science journalist Robert Whitaker, which described the abuse of psychiatric drugs by the psychiatric profession and the pharmaceutical industry in the last decades of the 20th century.

That book was so well-documented, so well-written and so shocking that I went back to read Whitaker’s 2003 book,  Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill.   In this book, Whitaker showed that the abuse of the mentally ill has a long history.

He told how the insane in the 18th and 19th centuries were routinely “spun” until they grew so weak and dizzy they couldn’t move, how they were subjected to removal of teeth, ovaries and intestines, and how they were submerged in water or chilled to the point of hypothermia.  Some were exhibited in madhouses as subhuman freaks.  None of these supposed treatments were of any benefit to the patient.  They merely made mentally ill people more passive and less troublesome.

The exception was “moral treatment” originated by Quakers in York, England.  This consisted of good food, regular exercise, an orderly routine and kind treatment.  Most of the mentally ill who received moral treatment recovered, and the Quakers treated those who did not as brothers and sisters who were worthy of kindness and help.  Philadelphia Quakers adopted the same system with good success.

Ironically this was undermined by the humanitarian reformer Dorothea Dix.  She campaigned for state governments to set up mental institutions along Quaker lines.  They did, but the underfunded state mental institutions over time became warehouses in which the mentally ill, the mentally retarded, the senile elderly, alcoholics and syphilitics were thrown in together without much treatment for any of them.

Moral treatment was not considered scientific; eugenics was, and it shaped psychiatry during the 20th century, Whitaker said.  I had know generally what eugenics was and why it was bad, but I had not known how widespread and enduring it was.  The mentally ill were classified among those who were unfit to reproduce.  From there, as Whitaker said, it is a short step to defining them, as the Nazis tried to do, as unfit to live.

Since being mentally ill defined you as being at the nadir of human existence, then anything that could be done to remove the mental illness was, by definition, justified.  Mental patients were subjected to lobotomies, insulin shock and electroshock, whose “cure” consisted in making them passive and obedient.

The next wave of reform of mental institutions came from Quaker and Mennonite conscientious objectors who did alternative service during World War Two in mental institutions.  Appalled at the conditions they found, they sought something better.  This led initially to improvement of conditions in mental institutions, but in the long run to the widespread use of psychiatric drugs as a substitute for institutional care.

Starting in the 1950s, patients were subjected to new drugs which, like shock therapies and lobotomies, worked by damaging the brain.  As the harmful side effects of each generation of drugs came to be known, the pharmaceutical industry kept coming out with new drugs which, in many cases, deepened the patients’ suffering, created addictions and impaired hope of recovery.

I wouldn’t say, and I don’t think that Whitaker would say, that psychiatric drugs should never be used.  Like most Americans, I know people who need medications in order to be able to function.  What I would say, and I think Whitaker would say, is that mental illnesses such as schizophrenia are poorly understood, and psychiatrists should exercise humility in presuming to prescribe.  Psychiatric drugs are less like insulin for diabetics than they are like mastectomies, hysterectomies, radical prostate surgery or brain surgery, a drastic intervention to be made only when there is no alternative.

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America’s real drug epidemic (3)

December 16, 2011

Medical journalist Robert Whitaker wrote an explosive book, ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, in which he argued that much mental illness is caused or made worse by the use of psychiatric drugs.  Here are some videos showing him making his case.

Fast forward through the first minute and a half of the above video to get to the gist of Whitaker’s presentation.

Fast forward through the first five or so minutes to get to the gist of Whitaker’s presentation.

I recommend reading the book or, if you don’t have time for that, my previous two posts, but the videos give the gist of his argument for those who learn better by listening than by reading.

Click on Anatomy of an Epidemic for Robert Whitaker’s home page and links to the scientific studies he cites in his book.

Click on Antipsychotic drugs and chronic illness for Robert Whitaker’s list of studies for his earlier book, Mad in America.

Click on Mad in America for Robert Whitaker’s web log for Psychology Today.

Click on Robert Whitaker’s Anatomy of an Epidemic: the Carlat Take and The Carlat Take Part 2 for an thoughtful critique of Whitaker’s book by a psychiatrist named Daniel Carlat.  Both his mini-essays and their comment threads are well worth reading.

Click on Do Psych Drugs Do More Harm Than Good? for an account of a confrontation between Whitaker and Andrew Nierenberg, a psychiatrist who directs Massachusetts General Hospital’s bipolar research program.

Click on The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry  for a two-part series by Marcia Angell in the New York Review of Books.

My two earlier posts on this subject were a review of Whitaker’s book and a presentation of charts illustrating his argument.

America’s real drug epidemic (2)

December 16, 2011

Robert Whitaker, author of ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, was a believer in the benefits of psychiatric drugs until he came across a study by the World Health Organization that showed that schizophrenia outcomes were much better for patients in poor countries such as India and Nigeria than in rich countries such as the United States.  What was the reason, he wondered, why mental illness was so much worse in the United States when treatment was so much more advanced.

He said that another study that made him a skeptic was a 1994 study by Harvard Medical School which showed that outcomes for schizophrenia patients had worsened in the previous 20 years, and were no better than they were a century before.  Surely, he thought, with all the wondrous psychiatric drugs available, the trend out to be in the opposite direction.

The number of people receiving Social Security Disability Income or Supplemental Security Income because of mental disabilities has increased eight-fold in the past 20 years.  We don’t know how much is due to an actual increase in disability, and how much to the widening definition of disability.

Marcia Angell, in the New York Review of Books, said that for many low-income families, applying for SSI payments on the grounds of mental disability is a way to survive.  It is more generous than welfare and guarantees eligibility for Medicaid.  But to qualify requires the applicants, including children, to take psychiatric drugs.

She told about four-year-old Rebecca Riley, who died of a combination of Clomidine and Depakote, which has been prescribed when she was two years old [!!] along with Seroquel to treat ADHD (attention deficit hyperactivity disorder) and bipolar disorder.  Her two older siblings were also taking psychiatric drugs.  The parents had obtained SSI benefits for themselves and the siblings, and were applying for SSI benefits for Rebecca when she died.  The family’s total SSI income, Angell reported, was $30,000 a year.

Double click to enlarge

Correlation is not causation, but if psychiatric drugs aren’t a cause of the epidemic of mental illness among children and youth, they clearly aren’t the solution.

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America’s real drug epidemic

December 16, 2011

In ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Robert Whitaker, an award-winning science journalist, argues that the increasing use of psychiatric drugs has not only failed to stem a huge increase in mental illness in the United States, but that the drugs themselves may be a factor—maybe the main factor—in that increase.

This is an astonishing claim, but he backs it up with scientific evidence and illustrates it with heart-breaking accounts of people who’ve struggled with debilitating addiction to psychiatric drugs.  I am surprised that Whitaker’s book has not gotten more attention than it has.  It ought to have the impact of Rachel Carson’s Silent Spring or Ralph Nader’s Unsafe at Any Speed.

If psychiatric drugs were as effective as antibiotics or insulin, you would expect mental illness to be declining.  But the reverse is true.  Conditions that once were rare and temporary are now common and long-lasting.  In the past 30 years, the number of disabled mentally ill in the United States has tripled.

Psychiatric drugs are sold based on the claim that they correct chemical imbalances in the brain.  But according to Whitaker, there is no evidence that mental illness is linked to chemical imbalances, nor do psychiatric drugs correct chemical imbalances.  Rather the drugs alter brain function, sometimes permanently.

Some people undoubtedly are helped by psychiatric drugs, Whitaker wrote.  He believes drugs have their place.  But he cited studies show that in the long run, patients on psychiatric drugs don’t fare any better than patients on placebos or unmedicated patients, and sometimes do a lot worse.

Long-term recovery rates are higher for unmedicated schizophrenia patients than for medicated patients.  Taking an anti-depressant increases the risk that the person will become disabled by the disorder.  Bipolar disorder was once rare and short-lived; now it is common and long-lasting.  Long-term studies of children with ADHD (attention deficit / hyperactivity disorder) do not show any benefit from ADHD drugs.  Drugs are dangerous, and their use should be a last resort, not a first resort, Whltaker said.

Robert Whitaker

Whitaker traced the origins of the drug epidemic to the American Psychiatric Association’s struggle  in the 1950s and 1960s to define psychiatry as a profession.  Psychiatry was under attack on the one hand by critics who claimed that Freudian psychotherapy was too expensive and had no scientific basis, and by various New Age therapies that offered alternatives to psychiatry.  What gave psychiatrists an edge was that they, unlike psychologists and other therapists could, could prescribe drugs.

About the same time there was a move to close mental institutions, both because they were costly and because often patients were badly treated.  It was thought that mental patients could live in society, provided their aberrant behavior was controlled by drugs.

In the 19th century, when drugs and medicines of all kinds were freely available, the American Medical Association gave itself the watchdog task of evaluating these drugs on a scientific basis.  When the Food and Drug Cosmetics Act of 1938 gave physicians an exclusive right to prescribe certain drugs, the medical profession became a purveyor rather than an evaluator of drugs.   The same thing happened to the psychiatric profession.

The pharmaceutical industry saw its opportunity, and formed an alliance with the APA.  Drug companies sponsored symposia at APA conventions, and paid top scientists (known as to the companies as KOLs, or key opinion leaders) to serve as consultants, on advisory boards and as speakers.  The value of psychiatric drugs became an orthodoxy that was dangerous to challenge.

Loren Mosher, head of schizophrenia studies at the National Institute of Mental Health, ran a 12-year project in which patients – 82 in all – were helped to work through their problems without benefit of drugs.  He compared his patients with a matched group of patients taking drugs, and found his patients did better.  But the APA did not accept the validity of his results, Mosher lost his position, and there never was a follow-up study to verify or refute his findings.

Whitaker gives many case studies, many of which are like classic cautionary tales of the danger of getting hooked on drugs.   A number of his stories are about high school and college students who felt severely depressed or had other psychological problems, and were given an antidepressant, which was followed by a bipolar episode, after which they were given an anti-anxiety medication.  Soon they had begun careers as a drug addict and mental patient, from which a heroic few were able to wean themselves.

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