Monday, October 18, 2010
If Meds Work As Well As Our Psychiatrists Tell Us, Then Why Do We Have MORE Mental Illness Today Rather Than Less?
Anyone who has attended a mood disorders support group with any regularity cannot help but notice that a good many there are seemingly “stuck” in their recovery. These are people who are stable and not in crisis, but not well. Or, even if they manage to pass for well, are nevertheless facing major challenges in their relationships and careers.
Another phenomenon involves those who turn up for the first time expressing their profound gratitude for finding the group. These are people who have very recently taken medical leave from work, but are now on an upward trajectory. They religiously attend subsequent groups, make excellent contributions to the discussions, then one day they announce they will be going back to work. You never see them again.
Two streams of people - the stuck and the unstuck. Unfortunately, I have observed way too many of the former. So has author and journalist Robert Whitaker, who sat in on at least one session of a DBSA group meeting at McLean Hospital, just outside Boston. The wrap-up to the gathering, he observed in his book, Anatomy of an Epidemic, could have passed for that of a PTA meeting or a church social. Yet, as far as he could tell, despite the advanced education of most of the attendees and the fact that they were all on meds, only one in their number was currently employed. Most of the others were on disability.
The fate of those with schizophrenia, we know, is far more problematic. If they are not cycling in an out of hospitals and the criminal justice system, we tend to find them in day rooms, staring blankly at TV sets, or living at home with their aging parents. But we also know there are those who do get well, who experience a remission in their illness, who are able to go off their meds, then vanish from the psychiatric radar to lead full and productive lives in the real world.
What is going on? Given the advances in psychiatric care over the the past 50 years, we should be expecting huge drops in the number of mentally ill regarded as disabled. Instead, the numbers have skyrocketed - four times the disability rates for people with psychosis since the introduction of Thorazine in the fifties, according to figures cited by Whitaker.
Shouldn’t it be the other way around? If our meds really worked, shouldn’t the numbers be down, way down? David Healy MD of Cardiff University asked this question some time ago, and in a 2003 article on my website I reported:
“Indeed, he concluded, if SSRIs worked for depression or anxiety the way antibiotics do for GPI (syphilis), we wouldn’t have the illness around anymore.”
Dr Healy has conducted numerous studies pointing out the potential for antidepressants to cause harm in patients, though he himself does prescribe them, presumably with considerable caution.
These days, even psychiatrists not named David Healy are acknowledging that our meds are hardly magic bullets and that there is a major risk of them doing more harm than good. There has been a lot of commentary on this (including on this blog), but Whitaker has gone a lot farther with his provocative and very well documented thesis that our meds may in fact be the CAUSE of a worldwide epidemic in mental illness.
The conversation has just grown a lot more interesting.
Much more to come ...