Background: why I give a shit

For a long time, I have been concerned about the increasing use of antidepressants and other drugs for various mental "disorders". I have noticed that many of my friends and family members and the friends of my daughters are on antidepressants or lithium or "antipsychotics". Worse, they are under the impression that they cannot be without them, that these drugs are doing miraculous things, that they correct imbalances in their brain chemistry.

I also have considerable experience with depression. I first saw a psychiatrist for it in my early 20s, when I moved to California. She was helpful in getting me to talk about it, in discovering the value of my dreams.

I moved on from her to a therapist in the LA County mental health system, and through her to a group. I think it was this group that was the most helpful for me. After I had been attending for about a year I realized that I was no longer having suicidal thoughts and that I had learned skills to cope. About this same time, my step-mother gave me A Guide to Rational Living, by Ellis (with Robert Harper). I scoffed at the idea that one could change one's emotions by changing one's thoughts. But I am now a big believer in this technique. I further recommend it to others - in part because the technique is so specific that it is hard for you or a therapist to screw up. In other words, if you reasonably like the therapist you are going to get the program.And for that matter, if you don't want to see a therapist there's a book that will do the job.

I entered therapy a couple of other times in my adult life, much later, to cope with events and to iron out continuing self-view problems. Right now I see a therapist as much for someone to hear me as for anything else. I think it's a luxury to have someone listen to you, be there just to pay attention to you. No need to reciprocate because this is your time.

I don't have a medical degree but I have good instincts. Some things just don't add up for me and I wonder about them. When I started hearing about how an increasing number of Americans is being diagnosed as "depressed" or having "anxiety disorder" or "obsessive-compulsive disorder" or the current darling, "bipolar disorder", or some other mental problem, I was not willing to attribute this to "better diagnostic methods" or to some over-arching changes in our society that make people ill.

Not that I don't think our culture can't make anyone ill. In some very real and physical ways it surely does. But I'll get into that later.

When I read Mad in America, by Robert Whitaker, I found that my suspicions were justified. Whitaker is a medical journalist. His book starts with a reference to a World Health Organization study that discovered that persons with "schizophrenia" do better in non-industrialized societies than they do in the "first-world" countries. The only factor that seems to be common to these countries is that they do not have easy access to psychiatric medications. I have seen references to this study several times since, and found the study itself.

The book tells the history of treatment of the mentally ill in America and suggests that we are no better off now than we were when we practiced blood-letting. Perhaps worse. I have read many reviews of this book, all positive, and nowhere have I seen anything that faults Whitaker on his research.

After reading Whitaker's book I had to know more. I found a few other books on the subject that provided additional evidence against psychiatric medications. Among them:

• Prozac Backlash by Joseph Glenmullen, M.D.
• The Anti-depressant Fact Book by Peter R. Breggin, M.D.
• Toxic Psychiatry by Peter R. Breggin, M.D.
• Orthomolecular Treatment for Schizophrenia by A. Hoffer, M.D., Ph.D.
• Nutrition and Mental Illness by Carl C. Pfeiffer, Ph.D., M.D.
• Let Them Eat Prozac by David Healy, MD FRCPsych
• Blaming the Brain by Elliott Valenstein, Ph.D.

There are mailing lists primarily for "survivors" of forced mental illness treatment. One, ActMad, is particularly active and has many writers of intelligence and skill. What I have read from their stories and references reinforces what the above writers say.

Medical doctors who take strong stands against the use of psychiatric medications are subject to attacks and ostracization because they do not recommend "conventional treatment" or because they suggest that doctors and drug companies are not doing their jobs.

I have seen web pages that label Peter Breggin a "quack" because of his unconventional views and his willingness to express them.

Because Breggin's approach appears sometimes reckless, his advocacy of "talk therapy" drowning out any other discussion, I read more moderate advocates of other therapies as well. I think the more moderate, like Glenmullen and Healy, are more difficult to attack because they do not offer blanket generalizations.

But this doesn't mean that these doctors are not attacked. Healy was invited to leave a new position in a University in Toronto because his views on Prozac and suicide. He was fired from a position with a drug company. He was subjected to persuasion by a leading psychiatrist in the U.S. to abandon his current course of investigation into the links between Selective Serotonin Reuptake Inhibitors (SSRIs) and suicide, for his own future.

The message in these and other publications:

• There is no evidence that schizophrenia or bipolar disorder or depression are physical illnesses, diseases. Diagnoses are made based on observation and questionaires, not hard scientific evidence. Studies that purport to show genetic linkages are based on such weak findings as the discovery that schizophrenia tends to run in families. So does fat.
• There is no proven "chemical imbalance" that is corrected by these drugs. In fact, there is stronger evidence that the drugs cause chemical imbalances, well beyond what was intended. These effects are better described in the above books and elsewhere, so I will not attempt that description here. Valenstein's book reviews the evidence exhaustively.
• There are many physical illnesses, including imbalances of nutrients in the system, that cause behavior that is often diagnosed as mental illness. Correct the nutrition and the problem goes away.
• Psychotropic medications and antidepressants can cause brain damage. In many cases the damage is irreversible. Usually brain damage is assured if the medications are taken for a long period of time, but sometimes it occurs shortly after the patient begins taking the drug. Most common damage is to motor functions, causing tics and other involuntary movements. Many psychatric patients end up on anti-seizure medication as well because of these effects.
• Most antidepressants are prescribed by medical practitioners who are not psychiatrists. They are usually not well-informed about the way the drugs work, tend to accept the explanations given by the pharmaceutical companies.
• Psychiatric schools now emphasize the use of drugs over other therapies. In some, doctors do not even learn psychotherapy.
• Antidepressants are not effective for major depression, and are linked to increased rates of suicide and violence in mildly depressed and healthy (undepressed) persons. (for the strongest argument yet see Healy, above).
• Although a huge number of persons now use antidepressants, the average number of suicides per year per population has not dropped. In other words, these drugs do not prevent suicide.

MY message:

Know what you are doing. Be informed. Do not take your doctor's word for it. Find out for yourself the effects of any medications you are taking, and find out for yourself if you may have a physical problem that causes depression, manic behavior, or other unusual emotional and mental symptoms. Do not trust, without question, information that comes from the drug companies OR your doctor. Look for other solutions.

I know that sometimes people manage to get into spirals of depression that appear to be resistant to logical intervention. They are "too far gone" to be able to listen. In cases like this, it may be helpful to use psychiatric medications for a short time. Long-term use is never justified, in my opinion. My main point, though, is not simply "don't take drugs". It is BE INFORMED. Don't do it if you don't really understand it. If you are aware of the risks of brain damage and other "side effects" (I put quotations around the term because many of these effects are inherent in the nature of the drug) and choose to take them anyway, then at least you know what you are doing, you have balanced the benefits and drawbacks.

Do NOT accept the "It's a disease. It's not my fault." line. Acceptance of this point of view makes you a victim. Even cancer patients, who have a disease that can be physically substantiated, don't lie down and accept everything their doctors tell them.

The "orthomolecular" approach: Two of the above books focus on nutrition and mental illness. I was not entirely convinced that the reasons given in these books for the way nutitional therapy works are based on incontrovertible evidence. I think, though, that the evidence is there that nutritional therapy can work in many cases. The message here is - can't hurt, might help, needs more study, seems promising.

Articles: The media is finally starting to question the "conventional wisdom". The FDA is starting to pay attention. Word on pharmaceutical company practices is starting to get out (not all of the following articles are specifically on mental illness or depression):

The Dark Side of Antidepressants
No proof of biological basis
FDA Likes Drug Use to Being Suicidal: Sept 14, 2004
F.D.A. Panel Urges Stronger Warning on Antidepressants
Drug companies still withholding data
Bitter Pills Depress our Happy Drug Euphoria: June 18, 2005
Medical Ethics Reform Urged: LA Times, January 25, 2006
Panel Advises Disclosure of Psychotic Effects, NY Times, March 23, 2006(ritalin)
Charities Tied to Doctors Get Drug Industry Gifts; NY Times, June 28, 2006
After Sanctions, Doctors Get Drug Company Pay; NY Times, June 3, 2007

Some other sources:

MindFreedom - an organization dedicated to eliminating the biopsychiatric emphasis

ActMad - a mailing list primarily for survivors of involuntary mental illness treatment, but open to all interested

ActMad forum - discussion area. New, not much happening yet.

Psychologists for Social Responsibility - it is what it says it is. Less about meds, more about politics, but worth knowing about.

Citizen's Commission on Human Rights - pages on schizophrenia treatment

Associated Psychological Health Services - pages on successful psychiatric treatment of serious mental illness without drugs. Many good references, articles, recommendations