The Epidemic of Mental Illness

Marcia Angell has a great essay on the "epidemic" of mental illness in America. It persuasively argues that there is no real science behind the drugs that attempt to treat psychological conditions by fixing "chemical imbalances" in the brain. Meanwhile, the number of children now diagnosed and treated with psychotropic drugs has increased 35-fold in two decades. What can explain this astonishing development?

It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it.... Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with 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. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain. The number of people treated for depression tripled in the following ten years, and about 10 percent of Americans over age six now take antidepressants. 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.

What is going on here? Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn’t we expect the prevalence of mental illness to be declining, not rising?

More here. The article is in two parts, with the second part here.

Comments

[Namit]

More links for those who liked the above article and want to explore further.

1. Head Case: Can psychiatry be a science?

You arrive for work and someone informs you that you have until five o’clock to clean out your office. You have been laid off. At first, your family is brave and supportive, and although you’re in shock, you convince yourself that you were ready for something new. Then you start waking up at 3 a.m., apparently in order to stare at the ceiling. You can’t stop picturing the face of the employee who was deputized to give you the bad news. He does not look like George Clooney. You have fantasies of terrible things happening to him, to your boss, to George Clooney. You find—a novel recognition—not only that you have no sex drive but that you don’t care. You react irritably when friends advise you to let go and move on. After a week, you have a hard time getting out of bed in the morning. After two weeks, you have a hard time getting out of the house. You go see a doctor. The doctor hears your story and prescribes an antidepressant. Do you take it?

2. The Americanization of Mental Illness

... we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.

3. A Critique of the DSM (Diagnostic and Statistical Manual of Mental Disorders, read more)

The DSM is more a political document than a scientific one. Decisions regarding inclusion or exclusion of disorders are made by majority vote rather than by indisputable scientific data.

4. Psychiatrists On Psychiatry, youtube video (look for other related videos on the sidebar).

5. Psychological Research Conducted in 'WEIRD' Nations May Not Apply to Global Populations

A new University of British Columbia study says that an overreliance on research subjects from the U.S. and other Western nations can produce false claims about human psychology and behavior because their psychological tendencies are highly unusual compared to the global population.

6. Opening Pandora’s Box: The 19 Worst Suggestions For DSM5

Dr Frances was the chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

7. Revising the book on mental illness

After years of research, professional infighting and maneuvering from various interest groups, the nation's psychiatrists Tuesday unveiled proposed changes to the manual used to diagnose and treat mental disorders around the world.

8. Revision to the bible of psychiatry, DSM, could introduce new mental disorders

Children who throw too many tantrums could be diagnosed with "temper dysregulation with dysphoria." Teenagers who are particularly eccentric might be candidates for treatment for "psychosis risk syndrome." Men who are just way too interested in sex face being labeled as suffering from "hypersexual disorder."

9. Crazy Like US

Crazy Like Us is a vivid, humane, and thought-provoking examination of "the globalization of the American psyche" - the process by which, slowly but surely, the world has adopted America's way of thinking about mental illness.

10. Street Spirit Interviews the Author of Mad in America, Robert Whitaker

This interview focuses on Robert Whitaker's book Mad in America, and brings to light the untold history of cruel and torturous psychiatric techniques, and shows how those past techniques evolved into today's psychiatric arsenal. This is an earlier interview that predates Street Spirit's new interview with Whitaker on his latest research, entitled "Psychiatric Drugs: An Assault on the Human Condition." We are printing both interviews in this August 2005 issue of Street Spirit because, taken together, they provide a comprehensive overview of psychiatry's torturous practices of the past and its hazardous over-reliance on toxic and dangerous drugs in the present.

[Namit]

More articles and sites via my friend Louise Gordon, who follows these topics much more closely than I do.

1. Use of Antipsychotics in Children Is Criticized

Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

2. New antipsychotic drugs carry risks for children

To study the growing use of atypical anti-psychotic medications among children, as well as the symptoms associated with their use, USA TODAY analyzed data from several public and private sources.

3. Mad in America

4. Testimony to Texas House Select Committee, Hearing on Psychotropic Drugs in Foster Care.

5. Are Drugs Being Misused On Foster Kids?

6. Info on abuse by psychiatry in foster care

You'll find a variety of items here related to how young people are especially vulnerable when in the care of the state, because of abuse by the mental health care system, especially massive psychiatric drugging.

7. The Law Project for Psychiatric Rights (PsychRights)

Currently, due to the massive growth in psychiatric drugging of children and youth and the current targeting of them for even more psychiatric drugging, PsychRights has made attacking this problem a priority. Children are virtually always forced to take these drugs because it is the adults in their lives who are making the decision. This is an unfolding national tragedy of immense proportions. As part of its mission, PsychRights is further dedicated to exposing the truth about these drugs and the courts being misled into ordering people to be drugged and subjected to other brain and body damaging interventions against their will.

8. Antipsychotic Drugs, their Adverse Effects, and Tort Reform

There are many problems within our legal system that could benefit from reform. But within the area in which I have great experience as a psychiatric expert, so-called tort reform has already gone too far. It is already too difficult for injured patients or their surviving families to bring malpractice suits against physicians and health facilities, and product liability suits against drug companies, even when their cases have great merit. I believe in private health care and I believe in the free market, but liberty requires checks and balances. The right to sue medical practitioners and pharmaceutical companies provides a necessary control in our free market system, as well as a means for individuals to seek compensation and justice.

9. The encyclopedia of insanity: A psychiatric handbook lists a madness for everyone

If every aspect of human life (excepting, of course, the practice of psychiatry) can be read as pathology, then everything human beings thought they knew, believed, or had deduced about their world is consigned to the dustbin of history or a line on an insurance form.

10. Shyness: How Normal Behavior Became a Sickness

Nowadays, if we're to believe preeminent psychiatrists and fabulously profitable drug companies, almost 19% of the population is so fearful of others' judgments, it shuns activities that would risk incurring them. Gone are the days when we could value exuberance and shyness, as well as a vast repertoire of similar moods. Today many psychiatrists and doctors assert that those who aren't sufficiently outgoing may be mentally ill.

[Louise Gordon]

Thank you, Namit.

Here are two more important links:

http://www.psychologytoday.com/blog/mad-in-america

http://www.zurinstitute.com/dsmcritique.html

[Louise Gordon]

Sorry. I see you already posted Ofer Zur's critique of the DSM.

Noteworthy is Robert Whitaker's "Fact Checking the New Yorker," on his Psychology Today blog.

[Namit]

If you read Marcia Angell's two-part essay, you may find this NYRB debate on it interesting: ‘The Illusions of Psychiatry’: An Exchange

[Glenn]

Supposeldy, the need for mental health treatment can now be diagnosed from a kiosk. Who knows what criteria it uses to accomplish this amazing feat? Source: http://www.brookhavenhospital.com/mental-health-and-technology-new-solutions-mark-innovations-in-behavioral-healthcare/