The two primary (New York) intellectual organs, the New York Review of Books and The New York Times, have recently featured two powerful cultural icons saying exactly opposite things.
Marcia Angell, the first woman editor-in-chief of the New England Journal of Medicine and now at the Harvard Medical School, in an ongoing, two-part series in the New York Review of Books (part 1 of which is in the June 23 issue), argues against the firmly ensconced American view that mental illness can be (and it has been) resolved to brain functioning.
The New York Times, for its part, once again supports, with a profile of Nora Volkow, the visionary director of the National Institute on Drug Abuse (NIDA), the slightly more come-lately view of addiction as a brain disease.
Angell has fought her way to cultural icon status by combating the medical-pharmaceutical-industrial complex, first in her position as editor of the NEJM, and subsequently from her ethics perch at Harvard (where she also sometimes treads on toes).
Angell is naturally led to an anti-brain-disease position because it has been fostered and foisted by the pharmaceutical industry with which she has been warring. Quoting her in the New York Review of Books, the modern "psychiatric revolution" appeared due to "the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs." This revolution was spearheaded when the antidepressant "Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain."
Today, Angell points out, 10 percent of all Americans over the age of 6 are on antidepressants. This figure must grow, since younger Americans are being medicated at a much higher rate than current adults -- there was a 350 percent jump in youth mental illness diagnoses in the two decades after the introduction of Prozac, a figure that continues to climb.
But this does not begin to tap the extent to which Americans are diagnosable for mental illness. A large survey by the National Institute of Mental Health "found that an astonishing 46 percent met criteria established by the American Psychiatric Association for having had at least one mental illness" at some time in their lives. And antidepressants are far from the most prescribed psychiatric meds in the United States (although they once were). "The increased use of drugs to treat psychosis is even more dramatic. The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US."
This seemingly bottomless pit of mental illness in America -- one that is never, ever reversed, or even staunched, no matter how many pharmaceuticals are thrown onto the marketplace -- is actually the basis for the Angell series. It is titled, "The Epidemic of Mental Illness: Why?" One suspects that Angell's answer in the second of the two-part series will be "pharmaceutical companies."
Americans largely believe that their emotional problems are caused by brain imbalances that drugs redress. I spoke with a highly intelligent, critical-thinking, young drug-policy reformer about antidepressants, which she swears by. She formed this judgment because her mother was bedridden with depression, and Prozac "cured" her. (I haven't followed up with the woman, so I can't say how permanent this solution has proved to be. But fall-offs from optimal performance by these medications -- sometimes quite dramatic fall-offs -- are standard.)
Such personal proof is people's gold standard -- if they see it in their own lives, they believe it. But this is actually no proof at all. People around the world swear by any number of cures that Americans would sneer at, and many "proven" therapies once broadly accepted in the United States have been thoroughly discredited. This is why the FDA demands that randomly assigned subjects with a given ailment be treated with a drug and the results compared to an untreated control group before they approve a medication for prescription to Americans.
The science and the psychology behind this are that, when people receive any psychiatric therapy, they invariably improve. There are three key reasons for this. In the first place (and this truth has been increasingly buried by the psychiatric revolution and the definition of emotional disorders as diseases), people tend to improve over time. When people enter therapy, they are often at a nadir, one from which they would rebound to a lesser or greater degree on their own no matter what is done for them.
The second reason for improvement is that people tend to respond to care, no matter what kind of attention, medication or therapy it represents. This bias, of course, is controlled for by administering a placebo treatment to the control group in a therapeutic trial. The comparison of the results between the treated and placebo groups allows for the calculation of the third contributor to improvement -- the value added from actual therapy.
Which is where the first of the books Angell reviews, British academic psychologist Irving Kirsch's "The Emperor's New Drugs: Exploding the Antidepressant Myth," comes in. Broad scientific clinical trials of antidepressants have never found that much value added from them. The amount uncovered in such trials, if taken seriously, would stun and disillusion providers and patients alike. I would say the range is a 5- to 25-percent measured advantage of antidepressants over placebos, with a mean of 15 percent.
But with every refinement of the placebo, the drug's advantage declines. The best example is trials involving psychoactive placebos. If the placebo pill is inert, control subjects experience no chemical reaction of any kind. If the placebo is an active one, then the patient can say, "Oh, it's kicking in." When such psychoactive placebos are employed, the added improvement from antidepressants tends toward 5 percent.
Kirsch used the Freedom of Information Act to obtain all the trials drug manufacturers conducted on the key antidepressants, which they are obligated to present to the FDA. Many show no -- or even negative -- results. But overall results aren't averaged by the FDA, who are only checking for several positive demonstrations of efficacy. For their parts, of course, the manufacturers publish only the positive results. Kirsch and his colleagues performed an even-handed analysis of all the submitted data. He then pinpointed studies with active placebos and other refinements, all of which reduced the detected benefits of antidepressants.
Angell notes:
Kirsch reported a number of other odd findings in clinical trials of antidepressants, including the fact that there is no dose-response curve -- that is, high doses worked no better than low ones -- which is extremely unlikely for truly effective drugs. "Putting all this together," writes Kirsch,"leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing 'regular' placebos to 'extra-strength' placebos."
Robert Whitaker, a well-informed and passionate journalist, has written "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America." Whitaker's point of departure is that, no matter how many more Americans with mental illness we identify and treat, the number continues to grow. After four decades when this has been true, the argument that we are simply divining people who were previously missed to receive extremely effective therapies is beginning to lose its sheen. This process seems to be self-fulfilling or, using medical terminology, iatrogenic.
This is not, strictly speaking, a scientifically based argument (as Whitaker is not scientifically trained). But Whitaker does refer to sound pharmacology when he notes that psychiatric drugs have long-term consequences that both cause the brain to rely on them (and to show withdrawal discomfort, often severe, when removed), and may actually depreciate brain functioning. The latter conclusion is based on some extremely spooky research. As described by Angell:
One well-respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain, and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, "The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."
Whitaker's conclusion is one that Americans would never even consider: we have basically a mental-illness-causing psychiatric system.
The last book reviewed, by Daniel Carlat, is "Unhinged: The Trouble With Psychiatry -- A Doctor's Revelations About a Profession in Crisis." Carlat is a practicing psychiatrist, and perhaps as a result is not so radical as the other two authors can afford to be. And yet, in his calm presentation of the realities of psychiatric practice, the influence of drug manufacturers, and the distressing long-term trends in mental illness and our inability to get a handle on it, his book may be the most alarming of all. Carlat has no axe to grind, and yet he describes American psychiatry in a way reminiscent of the American economy -- it has reached a point of declining results from which there is no return.
How does all of this reflect on the psychiatric "illness" model? None of these three authors believes the brain-chemistry-dysfunction version of reality. According to Angell, "the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed. All three authors document the failure of scientists to find good evidence in its favor. Neurotransmitter function seems to be normal in people with mental illness before treatment."
Patients cannot be identified by pre-existing levels of any neurochemical or combination of them. For these authors, researchers and Angell, the modern disease model of psychiatric illness is a myth. Whitaker wonders whether this myth is in fact harming us substantially:
The number of disabled mentally ill has risen dramatically since 1955, and during the past two decades, a period when the prescribing of psychiatric medications has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate. Thus we arrive at an obvious question, even though it is heretical in kind: Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?
As Angell notes:
Moreover, Whitaker contends, the natural history of mental illness has changed. Whereas conditions such as schizophrenia and depression were once mainly self-limited or episodic, with each episode usually lasting no more than six months and interspersed with long periods of normalcy, the conditions are now chronic and lifelong. Whitaker believes that this might be because drugs, even those that relieve symptoms in the short term, cause long-term mental harms that continue after the underlying illness would have naturally resolved.
Now that is an idea to contend with! Shades of Thomas Szasz.
There are remarkable parallels to the story that Angell unfolds in the Nora Volkow version of addiction -- except, of course, her conclusion is exactly the opposite one. Volkow and her colleagues in and out of the NIDA measure brain and neurochemical changes due to various events -- for example, use of cocaine. Her conclusion, now and forever, and "she must say it a dozen times a day: Addiction is all about the dopamine."
What does that mean? Although drugs -- and many other activities -- cause distinctive changes in brain patterns, how does this equal addiction? "Well," we might say, "the brain becomes dependent on the drug for the presence of dopamine (read 'pleasure'), and this causes users to become addictively reliant on this neurochemical."
Not quite. Problem one: different drugs impact this reward system very differently (the following quotations are from the New York Times article):
All addictive substances send dopamine levels surging in the small central zone of the brain called the nucleus accumbens, which is thought to be the main reward center. Amphetamines induce cells to release it directly; cocaine blocks its reuptake; alcohol and narcotics like morphine, heroin and many prescription pain relievers suppress nerve cells that inhibit its release.
Yet, these disparate processes are all posited to be similar in their ability to produce addiction.
Problem two: what about gambling and sex and video games. Are they addictive? Is this addiction due to the same chemical process? How does that work?
Problem three: dopamine stimulation or no, few people become addicted to the key addictive drugs even after repeated administrations: "Addicts and first-time users alike get the high that correlates with the dopamine wave. Only a minority of novices, however, will develop the compulsion to keep taking the drug at great personal cost, a behavior that defines addiction."
("First-time users" in this quotation from The New York Times is disingenuously misleading. Consider how most patients receive substantial supplies of narcotics in the hospital and may be given extended courses of pain-killers to take home, yet the vast majority don't become addicted.)
Okay, so if not all users become addicted, then perhaps addicts do not produce or uptake sufficient dopamine naturalistically or have some other measurable neurochemical deficiency:
Researchers now postulate that addiction requires two things. First is a genetic vulnerability, whose variables may include the quantity of dopamine receptors in the brain: Too few receptors and taking the drug is not particularly memorable, too many and it is actually unpleasant. Second, repeated assaults to the spectrum of circuits regulated by dopamine, involving motivation, expectation, memory and learning, among many others, appear to fundamentally alter the brain's workings.
Note first the last sentence, which is an extremely large escape clause based on the effects of a variety of experiences; moreover, these residual effects are hard to surmise in any one individual, forming what seem more like after-the-fact explanations than scientifically specified precursors.
In fact, no neurochemical or brain differences have ever been found between addicts and others prior to taking drugs. This is very similar to the (absence of) findings that Angell and the books she reviews note with mental illness. Only Volkow and like-minded people nonetheless maintain their optimism about this basis for the problem behaviors they study. Look at how Angell (quoting Whitaker) describes something that could as easily be said about addiction:
Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known "chemical imbalance." However, once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function... abnormally.
That there is something inherent in the person to be found there -- in mental illness and addiction -- is received wisdom, not empirical fact. The belief derives from the assumption that these phenomena are medical diseases, and all that remains is to find such inbred or pre-existing physical states -- which, they feel, they will indubitably do. But scientific history is replete with tales where such precommitted assumptions turned out to be totally false.
Of course, Whitaker and Angel are also indicating that the introduction of pharmaceuticals create their own consequences -- medical backlashes, we might call them. Read the following from Angell, keeping withdrawal in mind:
Getting off the drugs is exceedingly difficult, according to Whitaker, because when they are withdrawn the compensatory mechanisms are left unopposed [introduction of any neurostimulus produces a compensatory counterreaction, such that] when an antipsychotic is withdrawn, dopamine levels may skyrocket. The symptoms produced by withdrawing psychoactive drugs are often confused with relapses of the original disorder, which can lead psychiatrists to resume drug treatment, perhaps at higher doses.
This sounds a lot like... addiction. Rather than being a different medical category, reliance on psychoactive pharmaceuticals and addiction to the illicit drugs with which Vokow and the NIDA are concerned may be part of the same class of events -- other than the setting and circumstances under which they occur, and the different types of people who rely on these different substances.
This brings us back to the major growing concern for Volkow and the NIDA, as reflected in The New York Times' front-page sub-headline on Volkow: "The scientist who leads the National Institute on Drug Abuse is facing a powerful enemy: prescription drug abuse." But if these drugs operate exactly the same way as cocaine, heroin, amphetamines et al., why would we have expected any other result? This new development is actually a major dagger in the heart of the model which Volkow is using to fight addiction.
Finally, the title for The New York Times' Volkow profile is, "General in the Drug War." It's a funny designation for a scientist to call her a general in a war, especially since this particular war has been attacked by a growing number of public health voices as unwinnable and self-exacerbating. What this points to is that Volkow is not a free agent as a scientist and a researcher. Her employer insists that she say illicit drug use is irredeemably bad, while she previously had no mandate for commenting on -- and was blind-sided by -- the addictive potential and other downsides of pharmaceutical drugs.
Which is why the NIDA and government are now playing catch-up with prescription meds. It's not a good sign for the underlying scientific veracity of the addictive brain disease model.
Follow Stanton Peele on Twitter: www.twitter.com/speele5
David J. Linden: The Neuroscience of Pleasure
Addiction and the Brain - TIME
Approaching Addiction as a Chronic Brain Disease | Psychology Today
I witnessed many men and women cave under the crushing-weight of useless diagnoses, which offered no path to integrate years of experience and no paradigm to restore wholeness. But what was often worse, was to witness the public-hospital, psych-med guinea-pigs attempting to make sense of experience in a mental mix-master.
Psychiatric medications are not useless; they can obviously be valuable, when appropriately prescribed and adequately monitored, but they are not the panacea they are marketed to be. What I can report from my observations over a long period of time, is that I have never seen people become so unreachable, so irrational and, therefore, so dangerous, on any drug, as those I saw on psych-meds, as they were dispensed, where I worked.
Anyway, Stan, this was just a note to say, "Thank You,"
for all of the wonderful people we helped to help themselves.
Joey Tranchina, Founding Executive Director
AIDS Prevention ACTION Network, Redwood City, CA USA
Because I certainly do believe that mental illnesses exist, as the post also states (this time quoting Whitaker), "The number of disabled mentally ill has risen dramatically since 1955, and during the past two decades, a period when the prescribing of psychiatric medications has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate." Somehow, you have me in the position of saying mental illnesses don't exist when I cite evidence that they are becoming more severe and commonplace, which greatly concerns me and which I would like to get to the bottom of (like Marcia Angell). I'm wondering where I failed to communicate.
The number of people living in psychiatric hospitals has decreased by a factor 10+ since 1955, so I am not sure where the idea that the rates of mental illnesses are exploding. State psychiatric facilities that used to be the size of small towns are now a couple of buildings.
In 1955 most American worked in factories or on farms. Now people with college degrees can't find work. Our economy has become much less forgiving of people that are at a competitive disadvantage, which could explain the rise in disability.
Also, there is less stigma attached to mental illness, so people that used to be sheltered in shame by families are now more open about disabilities and seeking benefits. Those same people will read these articles and feel more ashamed of seeking treatment, or worse more paranoid of the helping professionals who seek to help them.
Likewise, your confidence that "Addictions require pleasure, satisfaction, a high or euphoria" may not be consistent with observations in the field. Are cigarettes euphoria-producing? Do you think they are addictive? Research finds withdrawal from cigarettes and heroin to be most severe among common recreational drugs (more so than alcohol and cocaine). Not only don't most people report euphoria from smoking, but heroin and other narcotics are, of course, analgesics that depressed CNS function. Few report these drugs as euphoric (compared with, say, amphetamines, or even ADHD pharmaceuticals like Concerta). That some people find depressant drugs like narcotics and barbiturates alluring makes us consider their view of their life and opportunities -- like the Vietnam GIs who were addicted in Asia and spontaneously remitted at home.
When have you seen an article by these drug pushing doctors recommending that before you take meds, make sure you observe your nutrition, your work or absence of a meaningful job, your worries, your relationships, fears, your lack of self-care. Hey, design a daily health care plan that includes all of the human realms--physical, mental, emotional, spiritual and social--exercise all of them. Meditate daily and use all of the integrative health practices before getting stuck and dependent upon pills. Also, don't allow these mental health practitioners put a label of life on you. An open, accepting, allowing and appreciative mind is very eager to restore our health and wellbeing and these labels tend to stick to our psyche and prevent healing, restoration and resilience.
Post Traumatic Stress, Anxiety and Depression(PTSD) is not a Disorder, Disease or Illness it is a serious INJURY that affects the whole being--physically, mentally, emotionally, spiritually, and socially. Thus, everything in the whole body-mind-spirit must be worked and exercised, hopefully without the meds being the primary and often the only treatment modality. These meds are often Spirit and Motivation killers.
http://www.amazon.com/Tools-Beat-Addiction-Stanton-Peele/dp/1400048737%3FSubscriptionId%3D0JJEH4PKQM4ZHS8QY102%26tag%3Dthehuffingtop-20%26linkCode%3Dxm2%26camp%3D2025%26creative%3D165953%26creativeASIN%3D1400048737
I have listened to Stanton Peele for over 30 years. During this period of time the addiction field has morphed into and through managed care, acupuncture, medication management including Vivitrol, Suboxone, Subutex, Revia, and others to fight cravings, case-management, recovery oriented systems of care, cognitive behavioral therapies, motivational interviewing, sobriety courts, sober living residences, women and children recovery services, family reintegration programs through the department of social services, etc., etc. Stanton's ideas seem very similar to what he has been discussing for the past 30 plus years.There are two books listed above that may get some renewed interest over this article. This argument will continue long after he and I have both been pushing up daisies for a number of years. Ultimately, no matter what you believe, people struggle with this issue on a daily basis. If we sit around analyzing it for years, people will be stuck in the analysis. I believe that, no matter what theory you believe in, people have to take responsibility for living different lives on a daily basis. Usually their family and society do not have the luxury of having impaired people sit around figuring out whether the cart came before the horse or after .
This interview with Abram Hoffer about what's wrong with the medical profession, how the health system is sick, and how we need to hold them accountable for the problems we are facing with prescription drugs.
Abram Flexner was a Rockefeller man.
Now hold your breath as you read my letter from this link: http://orange-papers.org/orange-letters212.html#rowland and you will understand why AA, the program that treats sick alcoholics does not work. Rockefeller's trust owns AA. (I had forgotten to add this in that letter: In Clarence Snyder's book http://silkworth.net/chs/chs04.html we find this stated: "3) Frank Amos, an advertising man and close friend of Mr. Rockefeller. [Years later, in Frank Amos's obituary, he would be lauded as "one of the five men who founded Alcoholics Anonymous." The obituary pointed out that Amos had been a long term trustee of what was to become the Alcoholic Foundation in 1938.]")
From the above you will be able to understand why alcoholics, addicts and mental patients are finding it so difficult to recover.
Hope this helps you to dig deeper into the facts.
So that explains why 46pct of the population votes republican when it's not in their best interests. We've always wondered why that was.
At this point we don't let family doctors do brain surgery, or any real surgery really. We don't let them treat cancer, heart disease, diabetes or really anything beyond a cold, the flu or a rash. For some reason we do let them treat very serious problems with drugs that have proven time and again to be dangerous when used incorrectly.
GPs, as you said, don't treat cancer, it is a specialized illness and so are mental disorders. I have seen more than a few people be made worse because of their GP. I'm sure the doctor felt they were making the best decision, but the fact is, without specialized training, they just don't know what the best decision is.
- Natasha Tracy
Also in the majority time period of evolution, humans are wild wild "animals", they have been forcely (if you will) "domesticated" since the beginning of industrial revolution. Some adapts well, but not all. It's something called pressure, which drive all animals who doesn't "fit" into potential "abnormal" behaviors.
Evolution is working everyday.
Any brain as long as it functions it's always a beautiful close-circuit control system.
I hope someone better come up with some ideas how go gauge "signal" strength the frontal lobe "fed" to the brain. It seems to me that individuals perform "better" when they are biologically less aggravated by their emotions in the post industrial revolution era.
I am no way in this field. These are just my wild wild educated guess, with some of my "philosophies" thrown in. But if you are in this field and you can come up with a gauge to quantify emotions, I bet it would quite interesting, and become "rich and famous."
Or, maybe there is already something available in your industry. Who knows.
I'm not sure how doctors get away with saying there's no neurobiological evidence of mental illness before treatment. I've written quite a bit on the subject and there certainly is. http://natashatracy.com/mental-illness/depression/neurobiology-depression-%E2%80%93-depression-brain
They're correct when they say it isn't just a "chemical imbalance" we have known that since the 80s. But we also know monamines (like serotonin) do have something to do with mental illness like depression. When we modulate the monomines, we affect depression. Plain and simple. It's absolutely true we don't understand the mechanism but to suggest there isn't one there is just wrong.
I fully appreciate a critical look at psychopharmacology as these meds are powerful and should be used with care, but sick people develop a dependence on them - not the same as addiction. All sick people develop dependence on their medication - that is why they take it in the first place: http://natashatracy.com/treatment-issues/withdrawal/psych-meds-addictive-antidepressants
For all their imperfections, antidepressants work for many people. Here's an eight-year study that attempts to isolate and track the effects of antidepressants long-term. Yes, antidepressants help: http://natashatracy.com/mental-illness/depression/depressed-people-antidepressants-long-term
There's also a blood test in development for schizophrenia. (It's far from perfect, but it's getting there.) http://natashatracy.com/mental-illness-issues/research/blood-test-schizophrenia-veripsych-schizophrenia
- Natasha Tracy
As for the addictive properties of these medications, I suggest you look up addiction to Paxil. It's clearly addiction and not what you call 'dependence'. Withdrawal from that drug is, for many people, something closely resembling heroin withdrawal.
I take exception to your statement that we know there's a connection between depression and monamines. From what I understand, we've made several inferences, some of which are questionable, to come to that conclusion.
This study you link to on your site does not make any claims nearly as strong as you do and in fact EXPLICITLY states : "It is not possible to make inferences about causality based on our study."
Exercise certainly has shown itself to be useful in some cases. I would certainly not deny that. Antidepressants, however, have their place as this 8-year study suggests: http://natashatracy.com/mental-illness/depression/depressed-people-antidepressants-long-term/
Withdrawal is not, in and of itself, indicative of addiction. You are correct, some antidepressants can have nasty withdrawal. No doubt about that.
Regarding monoamines, I refer to this quote from the Pathophysiology of Depression paper:
"Almost every compound that inhibits monoamine reuptake, leading to an increased concentration of monoamines in the synaptic cleft, has been proven to be a clinically effective antidepressant. Inhibiting the enzyme monoamine oxidase, which induces an increased availability of monoamines in presynaptic neurons, also has antidepressant effects." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950973/?tool=pubmed
- Natasha
The fact that altering neurotransmitter levels does not produce improvements in symptoms does not mean that mental illness is not housed in the brain. For instance, the "brain disease" could be an inappropriate pattern of activation, not the amount of neurotransmitter.
Moreover, assuming a "physical illness" does NOT mean that drugs are necessarily the best way to treat a disorder. For instance, obesity is a physical problem (now called an illness), that can be treated with behavioral interventions (diet, exercise). Also, the fact that medication does not cure a disorder does not mean that it is not a medical problem. Arthritis, diabetes, heart disease etc. are all medical illnesses in which the symptoms are managed, but the underlying cause is not corrected.
That being said, I am no fan of antidepressant medications. There is NO evidence that antidepressants are effective treatment for mild to moderate depression. ALL of the drug trials for Prozac and other modern antidepressants recruit severely depressed adults. Thus, to the extent that antidepressants have any effect, it is for severely depressed individuals, not the vast majority of users, who fall in the mild to moderately depressed range.
Although the words mental illness encompass a great many different types of disorders, I am writing of the one that I am more than familiar with, the one that is the # 1 mental disorder in America, Anxiety, although this disorder is the easiest to recover from this is not always the case. There are many reasons why this particular type flourishes when it shouldn’t; the main reason is our ignorance of the disorder itself, if that were not the case there would be far fewer people suffering from its symptoms. This fear based disorder would be short lived if all understood the reality and the mechanics of how and why this disorder affects us. I take exception to the definition that is given for it as a mental disease; I prefer calling it a habit, a habit that becomes obsessive. Unfortunately the accepted treatment is usually medication, and that only tends to makes it more important that it really is, educating the patient and making them understand why it occurs would be more beneficial like(CB Therapy) and lessen the unknown factor that causes it, fear! I have been an advocate for those suffering with anxiety disorder for over forty years and the biggest problem is denial or being afraid to face the reality of what causes the disorder, the answer to that is, the way we think and an obsession with ourselves!
George Christophe
It's too bad the benzodiazepine was stigmatized by PHRMA itself in the pharmaceutical companies' rush to push all "older" medications out of the way in order to make way for the new, more profitable anti-depressant era of the 90's and 00's.
Probably the most notorious push was for Paxil to treat GAD. What a money-maker for the company when bzds and therapy would have been sufficient. But we'll never know now because that window has shut.
You can't get a pdoc to prescribe that combination unless you jump through ALL the AD, Anti-Psychotic hoops first. Even then, most docs will look at the patient cross-eyed when the patient tells them that a bzd works the best in the first place.
Drug testing should be taken over by the NIMH and not via the FDA 's revolving door that consists of corporate cheerleaders for the very same companies that they are supposed to be regulating.
I find that after the initial onset of anxiety with or without panic, each repeated episode is created by re-visiting the fear experienced at its first appearance, our power of suggestion and the anticipatory anxiety it creates lays the groundwork for perpetuating the fearful disorder. The culprit is always ignorance, ignorance of the reality and facts about the mechanics of anxiety. There was a gentleman in his late thirties who became a victim of anxiety/panic disorder; he had experienced a single episode of panic at the age of twenty-five and nothing again until the onset of the disorder. After thousands of panic attacks and dozens of doctors with countless visits to emergency rooms his manic behavior had become intolerable. Late one night during one of his terrifying attacks he asked his wife to drive him to the emergency room, after waking their two children his wife drove him feeling sure this time he was at deaths door. Arriving at the hospital he started to open the car door, as he did his wife turned to him with tears in her eyes and anger in her voice and said, if you go in to the emergency room now, the boys and I will be gone in the morning! The man didn’t go in that night and never needed to again, and that was the end of his long term disorder! The story I recounted was my own!
George Christophe