The New York Times Magazine recently published a themed issue revolving around brain health. It featured the cover headline, "All in Our Minds." Inside the issue was a piece on anti-depressants by Siddhartha Mukherjee, titled "Post-Prozac Nation." The headlines were misleading. This followed the Times' much more obscene headline, "Increasingly, Suicide 'by Economic Crisis' Is a Symptom of the Downturn in Europe."
While I recognize the need to attract readers with provocative headlines, those headlines distorted the more nuanced portraits in the articles. That is not news. Headlines often do distort articles, but where mental health is concerned, this can be dangerous. In the issue on brain health, the headlines gave readers the impression that mental illness is not real and that anti-depressants do not work; neither point is true and both contribute to the stigmatization of the mentally ill.
In the case of the headline on suicide, the Times should know better than to attribute suicide to economic matters such as unemployment. While the paper of record put the offensive phrase in quotes, it still should have been more careful with its language. As is, the headline could give unemployed citizens an excuse to take their lives, as they may think that there is a new phenomenon that will be accepted by society.
Suicide is not and cannot ever be condoned, not even obliquely with a headline such as the one in the Times.
As for the article on anti-depressants, it argued that selective serotonin reuptake inhibitors (SSRI's) like Prozac and Zoloft may end up being effective not because they increase the flow of serotonin, a neurotransmitter, but because they may be associated with the birth of new neurons or nerve cells in the subcallosal cingulate. Located near the hippocampus, the area of the brain associated with memory, the subcallosal cingulate serves "as a conduit between the parts of the brain that control conscious thinking and the parts that control emotion," according to Mukherjee. He adds, "Think of the subcallosal cingulate as a potential traffic intersection on the road between our cognitive and emotional selves."
He concludes by arguing that in the future there will likely be new breakthroughs in medication, in which pharmaceutical companies produce "chemicals that directly initiate nerve growth in the hippocampus or stimulate the subcallosal cingulate."
Mukherjee's article was thoughtful and grounded in research, but I must still point out that he is an academic with a specialty in oncology, not psychiatry. I mention this because most clinicians who deal with mental-health patients on a regular basis see the benefits of psychotropic medication, and not just in the most severe cases.
I have written at length about the benefits that I and many others have experienced from meds. I have seen this numerous times up close from talking to those with a mental-health diagnosis and from attending panels on recovery. I have also cited a study mentioned by Andrew Solomon in his book, The Noonday Demon, indicating that anti-depressant medication, combined with therapy, leads to significant improvement in mental health in "more than 80 percent" of patients.
As it has become so fashionable for academics, Marcia Angell and Louis Menand among them, to denigrate the use of psychotropic medication, I decided to interview two of my former instructors in the Peer to Peer class offered by the National Alliance on Mental Illness; I did this to illustrate the effectiveness of psychoactive drugs in helping to heal those with mental disorders.
Roughly 20 years ago when he was a college student, Sanjeet Sihota plunged into a suicidal despair over the possibility of a female classmate rejecting him. He stopped eating and sleeping, symptoms of severe depression, a pattern that would repeat every time he stopped taking his medication.
Like many people with a mental disorder, he has received different diagnoses, including schizoaffective disorder, body dysmorphic disorder (a fixation on perceived body defects), and obsessive-compulsive disorder. To this day, he is not sure if one is absolutely correct.
But he does know that Zoloft has worked remarkably, "almost overnight," he says, in helping him combat his obsessions and depression. Of course, Sihota, a spiritual man who speaks in a New Age vocabulary about "experiencing energy and vibrations shooting through him," has regained his mental health not only because of Zoloft and Lamictal, a mood stabilizer; he also engaged in behavior therapy and developed "an emotionally close relationship" with Dr. Jamie Kay, director of family services at the Life Adjustment Team, a psychiatric rehabilitation facility in Los Angeles.
Kay got him out into the community and convinced him that he had gifts as a listener. Now, Sihota, a licensed social worker, runs his own business, Peer Coach, and lives on his own in an apartment, unthinkable years ago when he was hospitalized three times.
Another NAMI instructor, Frank Baron is a U.S. Navy veteran who has been hospitalized seven times in psychiatric wards.
I have written on a number of occasions about the need for better mental health care for our veterans and take it as a victory for all of us that the Department of Veterans Affairs, which has been criticized by the U.S. 9th Circuit Court of Appeals for its "unchecked incompetence," announced recently that it will hire an additional 1,600 mental-health clinicians.
However, Baron has nothing but good things to say about the VA. It was at the VA that he was properly diagnosed with schizophrenia after receiving an earlier diagnosis of bipolar disorder, which he calls a "Cadillac" diagnosis, since so many celebrities have embraced it.
He counts himself as "very lucky" to have received the correct diagnosis at the VA hospital in West L.A. because the clinicians there got him on the proper regimen of medication. He takes clozapine, which he says "turned my life around." It has helped keep him out of a psychiatric ward for 17 years.
As effective as clozapine has been for him, it is a high-maintenance medication. To monitor all of his vital signs and organs, Baron must take a blood test once a month. He also sees a therapist once a week, which helps him to remain stable.
One of the few consumers on the L.A. County Mental Health Commission, an honor bestowed on him by L.A. County Supervisor Zev Yaroslavsky, Baron not only teaches the Peer to Peer class for NAMI, he also takes care of his 86-year-old mother and lives on his own in an apartment.
Both Sihota and Baron have gained some weight from their meds, but they are among the many highly functional psychiatric patients who lead productive lives, lives that have been enhanced by therapy, work, sense of purpose and medication.