Economy · July 14, 2022

Book Review: The Limitations of Drug-Based Psychiatry

Lambert here: I missed being drugged in elementary school, for better or for worse. A big generational difference!

By Joshua C. Kendall, Boston-based journalist and author. His articles on psychiatry, neuroscience and health policy have appeared in numerous publications, including BusinessWeek, The Boston Globe, The New York Times, The Los Angeles Times, The Daily Beast, Scientific American, and Wired. Originally posted on Undark.

About 40 years ago, Daniel Bergner’s younger brother Bob, then 21 years old and who had dropped out of college, had a psychotic breakdown. He became disappointed; he was convinced that he could be the messiah and that he could cure his grandfather’s Alzheimer’s disease. Exhausted from insomnia, Bob was also neglecting his personal hygiene. Out of desperation, the brothers’ parents arranged for Bob to be admitted to a locked psychiatric unit, where he was soon loaded with a heavy dose of Haldol, an antipsychotic drug.

Shortly after Bob was hospitalized, his father handed Daniel a popular book by the late Ronald Fieve – first published in 1975 – on mood disorders. According to this eminent psychopharmacologist, psychiatry was undergoing “a third revolution,” which was leading to highly effective new drug treatments for major mental disorders, including schizophrenia, bipolar disorder and major depression. This book, notes Daniel Bergner in “The Mind and the Moon: My Brother’s Story, The Science of Our Brains, and the Research of Our Psyche,” gave his parents hope that his brother’s condition could be cured. “It was as if they had swallowed the sentences of the book and elevated its paragraphs to articles of faith,” he writes. “They converted immediately.”

As Bergner, a New York Times Magazine contributing writer points out, in his poignant narrative, the main claim in that past bestseller – that mental illnesses are diseases for which chemical cures exist – has come to gain a lot of popularity. But Bergner himself has for some time harbored reservations about this biological reductionism.

As he recounts in this deep dive into the history of psychiatric treatments over the past century – which features interviews with leading neuroscientists and psychiatrists, as well as profiles of people like Bob who have waged long battles with psychiatric problems – the biological revolution in psychiatry has come close to maintaining. its grand promises.

Medicines can actually reduce emotional suffering. Bergner cites research that suggests that about half of people who take selective serotonin reuptake inhibitors, or SSRIs – a popular antidepressant category that includes the highly successful Prozac – experience symptom relief “if the comparison to placebos comes from. ignored “. But while the number of Americans taking psychiatric drugs has steadily increased over the past 20 years (more than 40 million adults and up to 40 percent of college students, according to recent estimates), drug treatment, he points out, often doesn’t work at all. it is sometimes harmful due to harmful side effects. For example, SSRIs can cause both sexual dysfunction and withdrawal symptoms, both of which, Bergner notes, their manufacturers have minimized. And antipsychotics can cause weight gain and increase the risk of diabetes; According to pharmaceutical company Eli Lilly internal records, 16% of patients taking its hit drug Zyprexa gained more than 66 pounds.

The triumph of biological psychiatry, Bergner suggests, has everything to do with the close links between Big Pharma and academic psychiatry and has little to do with compelling scientific evidence. As he notes, an opinion piece in the New England Journal of Medicine stated in 2019 that “psychiatric diagnoses and medications proliferate under the banner of scientific medicine, although there is no biological understanding of either the causes or treatments of psychiatric disorders.”

Take the chemical imbalance theory – as deeply rooted in the contemporary cultural firmament as Freud’s tripartite theory of mind was a couple of generations ago – which positively claims that a deficiency in serotonin can cause depression. Psychiatrist Steven Hyman, a former director of the National Institute of Mental Health who now heads a center for psychiatric research at the Broad Institute of MIT and Harvard, suggests this idea is just marketing talk. As he explains to Bergner, “How people can think that mediocre drugs – important, but mediocre – how SSRIs can give us any understanding is beyond me. The logic is to say, I have pain so I must have an aspirin deficiency.” .

Similarly, Eric Nestler, a professor of psychiatry, neuroscience, and pharmacological sciences at the Icahn School of Medicine at Mount Sinai, tells Bergner that it would be easy to argue that psychopharmacology has gotten into a bind, noting that “there is.” It has been a truly new mechanism for the treatment of any psychiatric disorder in over half a century ”.

During his first hospital stay in 1983, Bob was diagnosed with bipolar disorder and told he would have to take lithium for the rest of his life. After three or four years, he could no longer bear the side effects: a tremor in his hands and the feeling as if a blanket had been placed over his brain. After another stint in a psychiatric hospital, he was transported to a homeless shelter. But after Bob stopped taking his meds and distanced himself from both of his parents, he was able to rebuild his life. He got married to “the love of his life” and now works as a pastor. “I’m just lucky,” Bob tells his brother, “that I’m crazy enough to have refused to be crazy.”

Bergner also tells the story of Caroline, who, as a young man, began to hear a slew of different voices. One of her warned her that several family members were in danger. Another, who identified as Miss Kathy, repeatedly chastised her and told her that her clothes stank. At age 9, she Caroline was taking a daily cocktail of antipsychotics to treat her troubling symptoms. But the drugs didn’t help her much, and she became obese.

As a teenager, Caroline added some recreational drugs like heroin and ecstasy to the mix, which she would later pay for with sex or by selling her prescription pills on the street. After dropping out of college, she remained in residential facilities such as a therapeutic farm and group home. She changed her life when she stopped taking drugs and became a roller derby star. Caroline found a job with a non-profit organization that planned to work as an au pair consultant with the Hearing Voices Network (HVN), an international movement that offers support by helping people accept their voices rather than trying to suppress them. Though her own rumors have not gone away, Caroline has since become a national leader in the HVN.

Bergner tries to discuss what might be happening in Caroline’s brain with Donald Goff, a schizophrenia expert and professor of psychiatry at New York University. Goff’s immediate reaction is to ask Bergner if she had been “tried on clozapine,” an antipsychotic reserved for severe cases due to its particularly dangerous side effects. Goff’s response upsets Bergner. “He skipped the question of what life might be like now, for Caroline, without drugs,” he writes. “We spoke with the presumption, the principle, that drugs were the correct and best way to go”.

Although Bergner’s critique of the disease model of mental illness may seem overly harsh, it accords with the growing academic view that psychiatry’s current assortment of somatic treatments – namely its many drugs for major mental illnesses – does not served the patients very well. This disappointing story is also underlined in “Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness,” a recently published history of the field by sociologist Andrew Scull. Like Bergner, Scull points out how severely distressed people need those who care for them – both their doctors and their loved ones – to do a better job of hearing exactly what’s going on in their hearts and minds. . They are not just sick brains.

As Bergner argues, just as there are various pathways for mental illness, there are also various pathways for recovery; and although drugs can be a useful tool, they are not a sine qua non condition. Psychiatry, he writes, needs to evolve because currently “the reflective reaction of the profession to discomfort and divergent realities, to the agonies of life and its precipices, is to provide whatever drug is available and to urge its long-term or permanent use, no matter how bad the drugs are, no matter how often they are useless and no matter how potentially harmful. “

Sadly, as Bergner shows in his well-crafted fiction, the longstanding belief that there is a pill (or drug cocktail) for every psychiatric illness is little more than a widely shared illusion, which can sometimes make life even more. harder for those who turn to psychiatry to alleviate their mental anguish.