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?

Following is the second in an ongoing series based on talking points Robert Whitaker has raised in his recent book, Anatomy of an Epidemic ...

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 ...


Max said...

VERY impressive! I am looking forward to checking these all out – what a great way to get the word out about all the helpful information you have to share!
Mental Health Specialists

Tony said...

You know what resonates with me is how we as a society have come to rely on science a little too much. That's not to say that medical science has nothing to offer and we throw the baby out with the bath-water, but at the same time, we really have to get in touch with ourselves to know when to sound the alarm bell to bring science to bear and when to let things take their course and move through us as they should.

Look, we do it all the time with other medical practices. How many of us successfully stop taking a medication once we feel we are better, despite a doctors assertion that we need to take said drugs for X amount of days/weeks? Probably all of us. So is it any wonder that once we're out of crisis with a psychiatric illness and we want to get better... that we inherently want to get off the drugs and continue our healing? There is a completely logical path that we as patients try to go down, but get blocked at times by a system that tells us that our desires are part of our illness, a need for that "high" as if we're meth junkies looking for the next fix. Let's compound that with the rate of addiction among those diagnosed with a mental illness and one can clearly see the correlation that our caregivers make. What makes mental illness different from any other kind of chronic illness? I say nothing. How many people have you seen make lifestyle changes and turn medical problems completely around? I know I've seen plenty. Why should mental illness be any different?

Where Roberts book looks at the meds as cause, I view them as the piece of the puzzle that keeps us back, stuck like the many people you've seen at DBSA gatherings and the people I saw so many years ago in DMDA gatherings. (DMDA was DBSA's older name reflecting Depression, Manic Depressive Association).

John McManamy said...

Hey, Tony. If I had a nickel for every asshole psychiatrist who thinks we go off meds because we're addicted to the highs. Yes, it's perfectly natural to want to move on with recovery by going off meds. Psychiatry should be helping us out here. Yes, some of us may be like a diabetic with insulin. But others are more comparable to throwing away the crutches. And we all need find our own optimum routines. It's a message that bears constant repeating.