Is there an epidemic of mental illness?
That is the question posed by Marcia Angell in her two-part series in the New York Review of Books. Reviewing three new books on the prevalence of medication and the failures of psychiatry, Angell, a senior lecturer at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, writes with persuasiveness about how we are over-medicated and over-diagnosed as a society.
I agree with her, particularly on her point, raised in the second part of her series, that children are victims of the pharmaceutical-industrial complex. Even 10 years ago, children almost never received diagnoses of schizophrenia or bipolar disease. Now, such diagnoses occur with alarming frequency.
Has our fast-paced technological lifestyle contributed to all of the angst? Yes. But should droves of children be ingesting psychotropic medication? No.
Children's brains are not fully developed. Moreover, children are not psychologically ready to take anti-depressants, anti-psychotics and the like. I would not have been happy about taking such medication when I was a preteen or a teen. It would have harmed me psychologically more than any possible benefit that I could have received.
As Angell writes, "One would be hard pressed to find... a boy in fifth grade who is not sometimes inattentive, or a girl in middle school who is not anxious. (Imagine what taking a drug that causes obesity would do to such a girl.)"
As an adult, however, I, and many others I know, have benefited greatly from taking psychotropic medication, and the benefits have gone way beyond the placebo effect.
In 1999, when I was becoming unhinged and stopped taking my medication for perhaps a week, I went on a harrowing trek across L.A. County for six hours, convinced that I would be assassinated and blamed for a series of murders sweeping the nation. Through a bit of luck and some fortitude, I ended up at the UCLA Neuropsychiatric Institute.
As I have written before, the nurse and the orderlies ordered me to take my medication. After arguing with them for a while, I complied. That may have saved my life, for I was deeply psychotic and suicidal, and I may not have recovered without getting back on my meds. Over the following 72 hours, I stabilized, at which time my psychiatrist released me to my father, who later turned me over to my angelic girlfriend, Barbara, who is now my wife.
She gave me love and support, critical to my recovery, as I returned to work.
Still, I needed to get back on my medication, so it is very disheartening to read articles like Angell's (similar in point of view to one written a year ago in the New Yorker by Louis Menand), which make statements such as, "If psychoactive drugs are not all they're cracked up to be -- and the evidence is that they're not..."
I am puzzled by this statement given that there is indeed evidence that psychotropic medication works. A few months ago, I wrote a piece about the benefits of anti-depressants despite the possibility that they may cause a thickening of the carotid artery. In that piece, I cited Andrew Solomon's National Book Award-winning, The Noonday Demon: An Atlas of Depression.
Solomon quoted John Greden, then-director of the Mental Health Research Institute at the University of Michigan, as saying, "No one has yet taken Prozac for 80 years. But I certainly know the effects of nonmedication, or of going on and off medication, or of trying to reduce appropriate doses to inappropriate levels -- and those effects are brain damage."
That is not to say that medication alone is a panacea.
Solomon referred to a study by Martin Keller of Brown University's Psychology Department which indicated that "more than 80 percent" of those participating "experienced significant improvement" when they took anti-depressant medication and engaged in cognitive-behavioral analysis. When the participants did not combine their medication with therapy, less than 50 percent improved significantly.
Solomon concluded, "The case for combination is pretty well incontrovertible."
I agree. That is why I remain in therapy and continue to take Zoloft as well as Abilify.
I am not saying that pharmaceutical companies and psychiatrists on their payroll are innocent little lambs. They are not.
Angell is right that doctors should be barred from prescribing psychotropic medication "off-label," meaning for any purpose other than that specified by the FDA. And I agree with Angell that the proliferation of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders is out of control and seems to be based less on science than on commerce.
I just wish that she would have given more hope to those of us suffering from mental disorders. Hope is critical, as I have long contended and as a recent New York Times front-page profile on Dr. Marsha Linehan pointed out. Instead, Angell pays credence to a study by Nancy Andreasen, who argued that the use of anti-psychotic drugs "is associated with the shrinkage of the brain."
Who knows what to make of such a study? It is certainly a frightening prospect, but it is one I refuse to believe.
I would rather cite The Noonday Demon again. In his tome, a definitive work on depression, Andrew Solomon quoted Robert Post of the NIMH, whose words still ring true: "People worry about side effects from staying on medication for a lifetime, but the side effects of doing that appear to be insubstantial, very insubstantial compared to the lethality of undertreated depression."