INVEIGHING AS I GO -- NUMBER FOUR

 INVEIGHING AS I GO – NUMBER FOUR

VOODOO PSYCHIATRY – THE AMERICAN DISEASE

James R. Fisher, Jr., Ph.D.

© June 28, 2011

REFERENCE:

Should you examine my books, articles and missives, you would see I have been suspect of psychiatry.  It is prominent in A LOOK BACK TO SEE AHEAD (2007).  We have come to treat our neuroses like favorite relatives. 

My writing emanates from experience and observation.  I was a spirited boy, often in trouble for the inclination.  An episode IN THE SHADOW OF THE COURTHOUSE (2003) illustrates how the good Sisters of St. Francis at St. Patrick Catholic School handled it without drugs, or psychiatric intervention, but with understanding care. 

Later, as an adult and professional in the complex organization, it was suggested that I see a psychiatrist after presenting a paper at a conference on what a sham employee involvement was (Participative Management: An Adversary Point of View, 1984).  A few years later, I wrote a prophetic book that hasn’t lost its relevance (WORK WITHOUT MANAGERS 1990).  One reviewer saw it as “angry,” while another thought I should seek psychiatric help.  We are uncomfortable with naysayers.

A trained observer, I have watched voodoo management sink organizations into quicksand with the temerity to point this out.  Now I see voodoo psychiatry copying management's playbook.  Look anywhere as you see the Ritalin Generation of children confined to the lethargic prison of pharmaceuticals.  I have seen my own relatives bounce off the walls triggered by a confection of drugs prescribed by psychiatrists partnering with pharmaceutical companies.  The "Prozac Promise" of the good life has instead produced a generation of walking zombies.    

I should mention that I am an industrial psychologist, not an MD, or a psychiatrist.  I have read widely on mental illness and share views similar to those of anti-psychiatrist Thomas S. Szasz.  Szasz sees mental illness largely as a myth, but he is outside the mainstream of psychiatry, and not taken seriously.  That is changing. 

What follows are highlights of a two-part essay published by Dr. Marcia Angell that appeared in THE NEW YORK REVIEW (June 23 and July 14, 2011).  Dr. Angell is Senior Lecturer in Social Medicine, Harvard Medical School, and former Editor in Chief of The New England Journal of Medicine

When I quote her from this piece, her words will appear in italics.

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IATROGENIC “COOKBOOK” MEDICINE, OR WHEN THE TREATMENT IS WORSE THAN THE DISEASE

Dr. Marcia Angell ends this two-part article with this:

Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere). 

It is too late.  Psychiatry has done enormous harm.  The practice of psychiatry is iatrogenic, the cure is worse than the disease. 

The insanity of the times is that anyone who steps outside of what is considered the norm are labeled, if not with a disease with some idiosyncratic designation. 

Thanks to the literary ingenuity of psychiatry, we have a whole new vocabulary for mental illness.  Like self-fulfilling prophecy, it has taken on the dimensions of an epidemic. 

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) increased nearly two and a half times between 1987 and 2007.  For children, the rise is even more startling – a thirty-five-fold increase in the same two decades.  Mental illness is now the leading cause of disability in children.

Years ago, a random sample of New Yorkers was taken and the majority were found to suffer from schizophrenia, yet they managed to keep the city going.  More recently, the National Institute of Mental Health (NIMH) conducted a statistical relevant random survey of adults between 2001 and 2003 and found 46 percent met criteria for being mentally ill. 

A chapter in THE TABOO AGAINST BEING YOUR OWN BEST FRIEND (1996) is titled “The United States of Anxiety.”  Psychobabble, at the time, was leavened with Beavis and Butt-Head cartoons and jokes.  Freeze frame that time and you might think you were in a time warp.

Common speech has become so laced with psychiatric terms that people sound like therapists: “Oh, he has an anxiety disorder for sure,” or "I understand he’s suffering from PTSD from taking so many finals at once,” or “Well, you know her son is ADHD, and I wouldn’t be surprised if the daughter is, too,” “Have you noticed how she drifted into depression after the miscarriage?  She is clearly bipolar if you ask me,” or “I don’t like to work with him.  He has a mood disorder for sure,” or “I know she can’t help herself.  She shops until she drops, clearly suffers an impulse-control disorder,” or "I hate to say it but her boy seems autistic.” 

Seemingly, everyone is happy to discuss the regiment of drugs they are taking.  Medications are conversation pieces if not for themselves surely for their mates and children.

It has happened with the emotional shift from Freud’s talking therapy to the new science of the brain holding the answers to mental health.  Psychiatry and pharmaceutical companies have discovered a bonanza with people's mind-body chemistry while operating mainly in the dark. 

It is fascinating to contemplate the brain with its billions of nerve cells arrayed in complex networks and communicating apparatuses holding the boilerplate to human behavior.  It takes us off the hook, and puts voodoo psychiatry and acquisitive pharmacology in charge.  Unfortunately, this does not compute with reality:

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.

Angel asks:

If psychoactive drugs are useless, or worse than useless, why are they so widely prescribed by psychiatrists and regarded by the public and the profession as something akin to wonder drugs? 

She takes that up in the second part of her essay.

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AMERICAN PSYCHIATRY FROM “BRAINLESSNESS” TO “MINDLESSNESS”

This was the conclusion of Dr. Leon Eisenberg of Harvard Medical School after studying the effects of stimulants on attention deficit disorder in children. 

When Freudian psychology faded with the view that mental illness had its roots in unconscious conflicts, usually originating in children, a vital touchstone to human experience was lost.  Angell writes:

Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients.  Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. 

Eisenberg became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.

Psychiatry, once free of the talking cure mystique, gravitated to cookbook medicine.  Angell writes:

To do that, each diagnosis was defined by a list of symptoms with numerical thresholds.  For example, having at least five of nine particular symptoms got you a full-fledged diagnosis of a major depressive episode within the broad category of “mood disorders.”  But there was another goal – to justify the use of psychoactive drugs.

This medical cookbook is known as the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM).  It is dedicated to “reliability,” but as Angell says:

If nearly all physicians agree that freckles were a sign of cancer, the diagnosis would be “reliable,” but not valid.

George Vaillant, a professor of psychiatry at Harvard Medical School wrote that the DSM-III represented “a bold series of choices based on guess, taste, prejudice, and hope.”

The pharmaceutical industry is like all other American industries, more interested in what is legal as opposed to ethical, and what will sell and how best to find that market.  Angell writes:

 As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession.

Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly.  They showered gifts and free samples on practicing psychiatrists, hired them as consultants, and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials.

Pharmaceutical companies don’t stop there.  Eli Lilly gave $551,000 to the National Alliance on Mental Illness, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD patient advocacy group), and $69,250 to the American Foundation for Suicide Prevention.  These totals are only for three months.

Eli Lilly is not alone in this deceptive marketing strategy.  Yes, it heightens awareness of psychiatric disorders, but is even a more effective and less intrusive way to promote the use of psychoactive drugs.

The problem with cookbook medicine, besides being dangerous, is that it is self-perpetuating.  Dr. Daniel Carlat writes:

Patients often view psychiatrists as wizards of nerurotransmitters who can choose just the right medication for whatever chemical imbalance is at play.  This exaggerated conception of our capabilities has been encouraged by drug companies, by psychiatrists ourselves, and by our patients’ understandable hopes for cures.

The cookbook medicine of matching symptoms to drugs, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels."  He then goes on to say: "A typical patient might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa) and Viagra for impotence (another side effect of Celexa)."

He (Carlat) doesn’t believe there is much basis for choosing among them.  “To a remarkable degree, our choice of medications is subjective, even random.  Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep.”  And he sums up: "Such is modern psychopharmacology."

Most incredible still, when a patient does respond well to medication, Dr. Irving Kirsch suggests what they are really responding to could be an activated placebo effect.

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THE PLIGHT OF THOSE MOST VULNERABLE

THE CHILDREN

I suppose you could say the reason I’ve been up all night creating this missive from Dr. Angell’s essay is that the most vulnerable to this cookbook medicine are children and the poor. 

Angell writes:

What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. 

These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects. 

The apparent prevalence of “juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of “autism” increased from one in five hundred children to one in ninety over the same decade.  Ten percent of ten-year-old boys now take daily stimulants for ADHD – “attention deficit/hyperactivity disorder” – 500,000 children take antipsychotic drugs.

There seem to be fashions in childhood psychiatric diagnoses, with one disorder giving way to the next.  At first, ADHD manifested by hyperactivity, inattentiveness, and impulsivity usually in school-age children, was the fastest growing diagnosis.  But in the 1990s, two highly influential psychiatrists at the Massachusetts General Hospital proposed that many children with ADHD really had bipolar disorder that could sometimes be diagnosed as early as infancy.

They proposed that the manic episodes characteristic of bipolar disorder in adults might be manifested in children as irritability. That gave rise to the flood of diagnoses of juvenile bipolar disorder.  Thus these psychiatrists created a new monster.

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THE POOR

Whether such children are labeled as having a mental disorder and treated with prescription drugs depends a lot on who they are and the pressures their parents face.  As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive.  It is more generous than welfare, and it virtually assures that the family will also qualify for Medicaid.

Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines. 

In December 2006, a four-year-old child named Rebecca Riley died in a small town near Boston from a combination of Clonidine and Depakote, which she had been prescribed along with Seroquel, to treat ADHD and “bipolar disorder" – diagnoses she received when she was two years old. 

Clonidine was approved by the FDA for treating high blood pressure. 

Depakote was approved for treating epilepsy and acute mania in bipolar disorder.

Seroquel was approved for treating schizophrenia and acute mania. 

None of the three was approved to treat ADHD or for long-term use in bipolar disorder, and none was approved for children Rebecca’s age.  Rebecca’s two older siblings had been given the same diagnoses and were each taking three psychoactive drugs . . . The family’s total income from SSI was about $30,000 per year. 

Dr. Angell concludes this most sobering piece with this: At the very least, we need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness, or emotional distress.  Amen! 

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