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This blog is home of some of the most interesting topics we have covered along the last years. One of the main focuses has been on the prescription drugs abuse epidemic but we have also discussed medical marijuana, at risk behaviours, drug trafficking and smart drugs.
Is Psychiatry a Scam?
Do psychiatric drugs really work? Is Psychiatry a perfect science? Well, according to some professionals of this discipline, the answer is no. Marcia Angell, a senior lecturer in social medicine at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, explains it clearly on a recent article appeared in the New York Review of Books. In the article she reviews three books recently published on this subject and written, in order by a psychologist, a psychiatrist and a journalist.
The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch (2009);
Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis , Daniel Carlat (2010);
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America , by Robert Whitaker (2011).
What emerges is how the discipline of psychiatry has changed in the last 50 years gradually shifting the focus from the mind to the brain till to embracing the idea that mental disease need psychoactive drugs and so becoming the darling of the pharmaceutical industry.
Western countries seem in the midst of an epidemic of mental illnesses. According to a large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, 46 % of them met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. A result that leads to think that under these standards, almost half of the population must be considered mentally sick.
And the epidemic of mental illness is not aimed to stop in North America. As Edward Shorter, Historian of Psychiatry, has pointed out, American medicine is a sort of international guideline for medical research, "what happens in the US then the rest of the world follows". Is then very likely that the american mental health model it will be rapidly exported to China and other countries where the middle class is growing and the mental health industry is still in a developing stage.
The astonishing percentage brings Angell to wonder. "Is the prevalence of mental illness - she asks - really that high and still climbing? 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?".
What is sure is that in the last 5 decades psychiatry has changed a lot. In the beginning it was the Freudian model, and psychiatrists were much more interested in patients' stories than symptoms. Then, gradually, talk therapy was replaced by a biological model: mental illness equals brain disease and because brain is made of chemical connections, to fix it what you need is chemicals. Drugs.
It all started with the idea of "chemical imbalance". A theory that, as Angell explains, "became broadly accepted, by the media, the public and 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".
Problem is that according to many scientists, chemical imbalance theory is a scam.
"Prior to treatment - writes the journalist Robert Whitaker in Anatomy of an epidemic - 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". Daniel Carlat, the Boston psychiatrist author of Unhinged: The trouble with Psychiatry, refers to the chemical imbalance theory as a convenient "myth" because it destigmatizes mental illness.
It looked very appealing to pharmaceutical manufacturers though. The industry started to work closely with some of the most authoritative faculty psychiatrists of prestigious academic medical centers. Within years, the ties between industry and academy became so strong that now, of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost ninety-five had financial ties to drug companies.
The DSM, the Diagnostic and Statistic Manual of Mental Disorders, is the Psychiatry's bible, it contains a classification and a codification of all mental illnesses. In the last 50 years, the number of diseases kept growing.
In 1952, the DSM included 128 mental diseases, then in the 1994 fourth edition, the number was 357.
The new edition, the DSM-V which is due in 2013, will probably contain many new disorders, such as "binge eating" and "restless leg disorder." It will also expand existing categories by tacking on words like "spectrum" to the end of a known disorder, Angell reports. "It looks as though it will be harder and harder to be normal," she writes. Beside the Major Anxiety Disorder, we also find the General Anxiety Disorder. And what about recurring bad dreams? That may be a Nightmare Disorder.
For every disease there is a code and a matching psychoactive drug that need to be prescribed. Problem is that, according to these authors, chances are that these drugs don't even work. First of all, explains Angell, when they have been manufactured, they were not meant to treat mental illness but they were derived from drugs meant to treat infections and were found, by accident, to be effective in altering mental states. Irving Kirsch, author of The emperor's New Drugs, claims that psychiatric drugs work just a little better than a placebo. He has came to this conclusion after having reviewed all placebo-controlled clinical trials, whether positive or negative, submitted to the FDA for the initial approval of the six most widely used antidepressant drugs approved between 1987 and 1999: Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor.
"There were forty-two trials of the six drugs - writes Kirsch - most of them were negative. Overall, placebos were 82 percent as effective as the drugs, as measured by the Hamilton Depression Scale (HAM-D), a widely used score of symptoms of depression. The average difference between drug and placebo was only 1.8 points on the HAM-D, a difference that, while statistically significant, was clinically meaningless. The results were much the same for all six drugs: they were all equally unimpressive. Yet because the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants".
As for Psychiatry being a perfect science, Doctor Carlat, explains that "unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness, no lab data or MRI findings, and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that".
The scam of psychiatry. Historian of medicine and professor of Psychiatry at the University of Toronto Edward Shorter talks on how psychiatry switched its focus from mind to brain and how DSM is more a political rather than a scientific document. Chances are, he says, diseases like depression and schizophrenia don't even exist.
The Epidemic of Mental Illness: Why? New York Review of Book
(23 June 2011) part I
(14 July 2011) part II
|Edward Shorter transcript.doc||65.5 KB|