[di meliora]

Head Case is the title of an article in The New Yorker by Louis Menand. He asks, "Can psychiatry be a science?" Menand states the unsurprising:

There is suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry’s direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off). The Food and Drug Administration has been accused of setting the bar too low for the approval of brand-name drugs. Critics claim that health-care organizations are corrupted by industry largesse, and that conflict-of-interest rules are lax or nonexistent. Within the profession, the manual that prescribes the criteria for official diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, known as the D.S.M., has been under criticism for decades. And doctors prescribe antidepressants for patients who are not suffering from depression. People take antidepressants for eating disorders, panic attacks, premature ejaculation, and alcoholism. http://www.newyorker.com/arts/critic...#ixzz2EnB9yBZq

Mr. Menard draws much of his discussion from two authors, Gary Greenberg* and Irving Kirsch, to:

... suggest that dissensus prevails even among the dissidents. Both authors are hostile to the current psychotherapeutic regime, but for reasons that are incompatible ...

Greenberg:

Greenberg basically regards the pathologizing of melancholy and despair, and the invention of pills designed to relieve people of those feelings, as a vast capitalist conspiracy to paste a big smiley face over a world that we have good reason to feel sick about. The aim of the conspiracy is to convince us that it’s all in our heads, or, specifically, in our brains—that our unhappiness is a chemical problem, not an existential one. Greenberg is critical of psychopharmacology, but he is even more critical of cognitive-behavioral therapy, or C.B.T., a form of talk therapy that helps patients build coping strategies, and does not rely on medication. He calls C.B.T. “a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment.”

In fact, Greenberg seems to believe that contemporary psychiatry in most of its forms except existential-humanistic talk therapy, which is an actual school of psychotherapy, and which appears to be what he practices, is mainly about getting people to accept current arrangements. And it’s not even that drug companies and the psychiatric establishment have some kind of moral or political stake in these arrangements—that they’re in the game in order to protect the status quo. They just see, in the world’s unhappiness, a chance to make money. They invented a disease so that they could sell the cure.

Kirsch:

Kirsch’s conclusion is that antidepressants are just fancy placebos. Obviously, this is not what the individual tests showed. If they had, then none of the drugs tested would have received approval. Drug trials normally test medications against placebos—sugar pills—which are given to a control group. What a successful test typically shows is a small but statistically significant superiority (that is, greater than could be due to chance) of the drug to the placebo. So how can Kirsch claim that the drugs have zero medicinal value?

His answer is that the statistical edge, when it turns up, is a placebo effect. Drug trials are double-blind: neither the patients (paid volunteers) nor the doctors (also paid) are told which group is getting the drug and which is getting the placebo. But antidepressants have side effects, and sugar pills don’t. Commonly, side effects of antidepressants are tolerable things like nausea, restlessness, dry mouth, and so on. (Uncommonly, there is, for example, hepatitis; but patients who develop hepatitis don’t complete the trial.) This means that a patient who experiences minor side effects can conclude that he is taking the drug, and start to feel better, and a patient who doesn’t experience side effects can conclude that she’s taking the placebo, and feel worse. On Kirsch’s calculation, the placebo effect—you believe that you are taking a pill that will make you feel better; therefore, you feel better—wipes out the statistical difference.

Menand covers a lot of ground in addressing the current state of psychiatry. The article is lengthy and informative. Mr. Menand concludes:

Mental disorders sit at the intersection of three distinct fields. They are biological conditions, since they correspond to changes in the body. They are also psychological conditions, since they are experienced cognitively and emotionally—they are part of our conscious life. And they have moral significance, since they involve us in matters such as personal agency and responsibility, social norms and values, and character, and these all vary as cultures vary.

Many people today are infatuated with the biological determinants of things. They find compelling the idea that moods, tastes, preferences, and behaviors can be explained by genes, or by natural selection, or by brain amines (even though these explanations are almost always circular: if we do x, it must be because we have been selected to do x). People like to be able to say, I’m just an organism, and my depression is just a chemical thing, so, of the three ways of considering my condition, I choose the biological. People do say this. The question to ask them is, Who is the “I” that is making this choice? Is that your biology talking, too?

The decision to handle mental conditions biologically is as moral a decision as any other. It is a time-honored one, too. Human beings have always tried to cure psychological disorders through the body. In the Hippocratic tradition, melancholics were advised to drink white wine, in order to counteract the black bile. (This remains an option.) Some people feel an instinctive aversion to treating psychological states with pills, but no one would think it inappropriate to advise a depressed or anxious person to try exercise or meditation.

The recommendation from people who have written about their own depression is, overwhelmingly, Take the meds! It’s the position of Andrew Solomon, in “The Noonday Demon” (2001), a wise and humane book. It’s the position of many of the contributors to “Unholy Ghost” (2001) and “Poets on Prozac” (2008), anthologies of essays by writers about depression. The ones who took medication say that they write much better than they did when they were depressed. William Styron, in his widely read memoir “Darkness Visible” (1990), says that his experience in talk therapy was a damaging waste of time, and that he wishes he had gone straight to the hospital when his depression became severe.

What if your sadness was grief, though? And what if there were a pill that relieved you of the physical pain of bereavement—sleeplessness, weeping, loss of appetite—without diluting your love for or memory of the dead? Assuming that bereavement “naturally” remits after six months, would you take a pill today that will allow you to feel the way you will be feeling six months from now anyway? Probably most people would say no.

Is this because of what the psychiatrist Gerald Klerman once called “pharmacological Calvinism”? Klerman was describing the view, which he thought many Americans hold, that shortcuts to happiness are sinful, that happiness is not worth anything unless you have worked for it. (Klerman misunderstood Calvinist theology, but never mind.) We are proud of our children when they learn to manage their fears and perform in public, and we feel that we would not be so proud of them if they took a pill instead, even though the desired outcome is the same. We think that sucking it up, mastering our fears, is a sign of character. But do we think that people who are naturally fearless lack character? We usually think the opposite. Yet those people are just born lucky. Why should the rest of us have to pay a price in dread, shame, and stomach aches to achieve a state of being that they enjoy for nothing?

Or do we resist the grief pill because we believe that bereavement is doing some work for us? Maybe we think that since we appear to have been naturally selected as creatures that mourn, we shouldn’t short-circuit the process. Or is it that we don’t want to be the kind of person who does not experience profound sorrow when someone we love dies? Questions like these are the reason we have literature and philosophy. No science will ever answer them. ♦

When I sought professional help for the first time, I was desperate. I relied on the professionals and believed what they told me. I would get better. While I believe I am alive today because of the professionals and medications, I also believe I was sold a bill of goods.

Only after accepting full responsibility for my well-being did I begin to function at a higher level. By then, I had stopped working and over time more and more isolated.

Now, after reading articles like this one, I wonder if it is true -- I just needed to get over it.

*A podcast of an interview with Gary Greenberg is here: http://www.garygreenbergonline.com/pages/interviews.php

[pachyderm]

We are proud of our children when they learn to manage their fears and perform in public, and we feel that we would not be so proud of them if they took a pill instead, even though the desired outcome is the same.

Is it the same? Is the learning that takes place, if one learns, to be discounted? Is the long-term outcome the same?

[Open Eyes]

"Now, after reading articles like this one, I wonder if it is true -- I just needed to get over it." quote Di Meloira

How would you have known that really though? And if I recall you were also diagnosed with PTSD, and they have found that with that disorder there are changes in the brain that can be identified and can present extra challenges in how the patient can control anxiety and anger and other challenges that plague them. What you experienced most likely is that you reached a point where you just simply could not control this condition and as you discribe, became "desperate", that is also what happened with me as well. And in all honesty, di meloira the increasing desire to isolate is something that all patients that struggle with PTSD gravitate to doing.

And unless we find a therapist that really understands this condition and how to understand our anger and frustration, we are not going to truely get the help we need, infact the wrong therapist can do even more harm to us and cause us to suffer even more.

The one thing I do know about PTSD is that it can cause the patient to experience a great deal of "self loathing" and "self disappointment" and unless the patient learns to understand this and keeps making efforts to work away from it, it can get serious.

I had the pleasure of having a Neuropsychiatrist come out to my farm as a client. She talked about how they are now studying brain injuries and how these injuries affect emotions. She did say that we do know that with PTSD we can see that changes/injury has occured in the brain where the hypocampus shows cell damage and shrinkage and the amigdyla also shows changes as well. So this idea of maybe I just needed to get over it somehow, is not so simple. She also talked about memory problems with PTSD as well. I do experience that myself, but comes to me in more of how I can lose track of time, or may be deep in thought and be going to do something and suddenly forget what it was. However I can remember things about "interactions" that affect me where others may simply forget.

I do agree that psychiatrists/therpists diagnose too quickly and in that can promote confusion or misunderstanding of the patient.

What I do my best to try to remember is that while I see the mistakes that happened to me, I try my best to take note of them but stay in the now and continue to focus on learning and making gains. I also remind myself to be grateful for what is known about how I struggle and that I can learn about it and get therapy for it as well. I honestly don't know how others in the past dealt with this challenge before it was recognized and efforts were made to understand it and learn how to treat it.

Open Eyes

thanks for sharing the artickle

it's interesting