News:

Can anyone ever be sufficiently committed to Sparkle Motion?

Main Menu

A mental illness epidemic? Think again

Started by Cain, June 14, 2011, 03:36:28 AM

Previous topic - Next topic

Cain

As you would expect from the New York Review of Books, this is an excellent article:

QuoteA large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent 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. The categories were "anxiety disorders," including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); "mood disorders," including major depression and bipolar disorders; "impulse-control disorders," including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and "substance use disorders," including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment—up from a fifth in a similar survey ten years earlier.

Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from "talk therapy" to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by 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. The increased use of drugs to treat psychosis is even more dramatic. The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US.

What is going on here? Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? 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?

There is a lot more at the link, including a thorough debunking of the "chemical imbalance" "theory" of mental illness:

QuoteWhen it was found that psychoactive drugs affect neurotransmitter levels in the brain, as evidenced mainly by the levels of their breakdown products in the spinal fluid, the theory arose that the cause of mental illness is an abnormality in the brain's concentration of these chemicals that is specifically countered by the appropriate drug. For example, because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine. Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, "By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain." Or similarly, one could argue that fevers are caused by too little aspirin.

But the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed. All three authors document the failure of scientists to find good evidence in its favor. Neurotransmitter function seems to be normal in people with mental illness before treatment. In Whitaker's words:

    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.

Carlat refers to the chemical imbalance theory as a "myth" (which he calls "convenient" because it destigmatizes mental illness), and Kirsch, whose book focuses on depression, sums up this way: "It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong."

QuoteWith long-term use of psychoactive drugs, the result is, in the words of Steve Hyman, a former director of the NIMH and until recently provost of Harvard University, "substantial and long-lasting alterations in neural function." As quoted by Whitaker, the brain, Hyman wrote, begins to function in a manner "qualitatively as well as quantitatively different from the normal state." After several weeks on psychoactive drugs, the brain's compensatory efforts begin to fail, and side effects emerge that reflect the mechanism of action of the drugs. For example, the SSRIs may cause episodes of mania, because of the excess of serotonin. Antipsychotics cause side effects that resemble Parkinson's disease, because of the depletion of dopamine (which is also depleted in Parkinson's disease). As side effects emerge, they are often treated by other drugs, and many patients end up on a cocktail of psychoactive drugs prescribed for a cocktail of diagnoses. The episodes of mania caused by antidepressants may lead to a new diagnosis of "bipolar disorder" and treatment with a "mood stabilizer," such as Depokote (an anticonvulsant) plus one of the newer antipsychotic drugs. And so on.

Some patients take as many as six psychoactive drugs daily. One well- respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain, and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, "The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."

Getting off the drugs is exceedingly difficult, according to Whitaker, because when they are withdrawn the compensatory mechanisms are left unopposed. When Celexa is withdrawn, serotonin levels fall precipitously because the presynaptic neurons are not releasing normal amounts and the postsynaptic neurons no longer have enough receptors for it. Similarly, when an antipsychotic is withdrawn, dopamine levels may skyrocket. The symptoms produced by withdrawing psychoactive drugs are often confused with relapses of the original disorder, which can lead psychiatrists to resume drug treatment, perhaps at higher doses.

I'd like to think, a la Scientology, that there is some kind of sinister, social-control style agenda behind all of this, but in all likelihood it is due to biased initial approaches to mental illness, plus money.  Nevertheless, I think it suggests a critical attitude towards psychiatry is not the preserve of cranks but, rather, quite a sensible position to hold.

I'm looking forward to part two of the article.

Telarus

Wow, that was a very well written piece. Thanks for sharing that Cain.
Telarus, KSC,
.__.  Keeper of the Contradictory Cephalopod, Zenarchist Swordsman,
(0o)  Tender to the Edible Zen Garden, Ratcheting Metallic Sex Doll of The End Times,
/||\   Episkopos of the Amorphous Dreams Cabal

Join the Doll Underground! Experience the Phantasmagorical Safari!

Chairman Risus


Mesozoic Mister Nigel

Really interesting stuff; thank you, Cain!
"I'm guessing it was January 2007, a meeting in Bethesda, we got a bag of bees and just started smashing them on the desk," Charles Wick said. "It was very complicated."


Pope Pixie Pickle

Psychiatry is very flawed, and as a current end user of mental health services its of a personal concern to me.

Thanks Cain.

LMNO

...having a brother who is a Scientologist, I find this very interesting, as well as putting me in the odd situation of possibly having to admit that he came to correct conclusions while still presenting erroneous evidence.

Triple Zero

I mostly agree with [what Cain quoted from] the article, except this bit, which strikes me as a littlebit too quickly reasoned:

Quote"By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain." Or similarly, one could argue that fevers are caused by too little aspirin.

Or maybe, I'm understanding it wrong. But if you have an illness Q that is not directly caused by a deficiency of X, but which can be treated with drug Z that stimulates, produces or "inhibits reuptake of" X, then I would still pose that Z is a reasonable treatment for Q, right?

Because pain-relief medications are a reasonable treatment for chronic pain, right?

Certainly it would be wrong to claim that Z somehow "fixes" or "cures" Q, but barring an actual drug that does so, Z would be the next best thing.

That said, I'll repeat I don't want to argue against the general position taken in the article as the rest of the stuff said seems pretty spot-on, but I just wanted to highlight that bit that strikes me as somewhat shady reasoning.

Reading again, I see that the point they're making is that depressive disorders apparently were retroactively chalked up to be caused by serotonin deficiencies because that's what the drugs appeared to be "fixing". On the one hand I wonder if it's really as black-and-white as that, though on the other hand I can totally see sloppy medical research coming to such a backwards conclusion.

Also, I especially like this bit:
QuoteAnd 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?
Ex-Soviet Bloc Sexual Attack Swede of Tomorrow™
e-prime disclaimer: let it seem fairly unclear I understand the apparent subjectivity of the above statements. maybe.

INFORMATION SO POWERFUL, YOU ACTUALLY NEED LESS.

Mangrove

Excellent stuff, Cain.

I can't remember the name of the book I picked up about this very subject, but it was written by a Psychiatrist who had the realization that he had gone from being a 'talk therapist' into a conveyor belt script writer. In one part of the book he found himself prescribing certain drugs to his patients because he thought the sales rep from the drug company was 'cute' and they had some nice lunches together!

So, he snaps out of it and is now concerned about the same kinds of things this article gets into - that psychiatrists rarely, if ever, do the job they actually trained for. Instead, the therapy is doled out to psychologists, counselors etc.

On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one?


I think, yes. And not just mental disorders but for other things. Blood Pressure, Bone Density, Blood Sugar, Cholesterol  - the levels of these have all been redefined (lower) so that it increases the catchment for diagnosis. Plus we have bullshit terms like 'pre-diabetic' (it's the disease before the disease) and 'osteopenia' (the non-disease you get before osteoperosis).

We need more articles and research like this. [My particular bugbear is that Doctors have been getting women to gorge themselves on calcium which has caused no drop in the incidence of bone fractures or fatalities from bone fractures. IT DOES NOT WORK. Arghh!!]

I had a client a few months ago who was seen by both a psychiatrist and a psychologist. She had been diagnosed with multiple 'issues' and for the life of me, I couldn't see anything abnormal about her. The bottom line was that the poor girl was stressed. She worked tough job, had to live at home because she was broke and she was planning a career change that her family & peer group didn't support. You're not sick, you're frustrated.



What makes it so? Making it so is what makes it so.

LMNO


The Good Reverend Roger

Quote from: LMNO, PhD on June 14, 2011, 04:45:18 PM
It's those damn Spiders.

And, as I have said, WE are the spiders.

We've made life so fucking complex and stressful that the only way to stay reasonably sane is to stun yourself stupid with chemicals.

Looking around, you may have noticed that everyone seems a little...Off?  Except for me, I am clever and empowered with the libido of a tyrannosaurus. 

The reason everyone is a little off is because they are either stunned as per above, or drowning in information that they don't need at a rate they cannot process.

So of course they're all crazy.  I mean, it's not like the species was wired properly in the first place.
" It's just that Depeche Mode were a bunch of optimistic loveburgers."
- TGRR, shaming himself forever, 7/8/2017

"Billy, when I say that ethics is our number one priority and safety is also our number one priority, you should take that to mean exactly what I said. Also quality. That's our number one priority as well. Don't look at me that way, you're in the corporate world now and this is how it works."
- TGRR, raising the bar at work.

Mesozoic Mister Nigel

"I'm guessing it was January 2007, a meeting in Bethesda, we got a bag of bees and just started smashing them on the desk," Charles Wick said. "It was very complicated."


The Good Reverend Roger

" It's just that Depeche Mode were a bunch of optimistic loveburgers."
- TGRR, shaming himself forever, 7/8/2017

"Billy, when I say that ethics is our number one priority and safety is also our number one priority, you should take that to mean exactly what I said. Also quality. That's our number one priority as well. Don't look at me that way, you're in the corporate world now and this is how it works."
- TGRR, raising the bar at work.

LMNO

I now need to shoop a pic of me looking in a mirror, and a spider looking back out.

The Good Reverend Roger

Quote from: LMNO, PhD on June 14, 2011, 06:30:55 PM
I now need to shoop a pic of me looking in a mirror, and a spider looking back out.

Heh.  If we didn't demand this shit, we wouldn't have these problems.
" It's just that Depeche Mode were a bunch of optimistic loveburgers."
- TGRR, shaming himself forever, 7/8/2017

"Billy, when I say that ethics is our number one priority and safety is also our number one priority, you should take that to mean exactly what I said. Also quality. That's our number one priority as well. Don't look at me that way, you're in the corporate world now and this is how it works."
- TGRR, raising the bar at work.

Jenne

Quote from: The Good Reverend Roger on June 14, 2011, 05:47:16 PM
Quote from: LMNO, PhD on June 14, 2011, 04:45:18 PM
It's those damn Spiders.

And, as I have said, WE are the spiders.

We've made life so fucking complex and stressful that the only way to stay reasonably sane is to stun yourself stupid with chemicals.

Looking around, you may have noticed that everyone seems a little...Off?  Except for me, I am clever and empowered with the libido of a tyrannosaurus. 

The reason everyone is a little off is because they are either stunned as per above, or drowning in information that they don't need at a rate they cannot process.

So of course they're all crazy.  I mean, it's not like the species was wired properly in the first place.

:mittens:  You are spot on there. 

I just like, personally, an approach to being skeptical about EVERYFUCKINGTHING.  I guess I am lucky in that the doctor I'm married to is naturally inclined towards this personality-wise AND human experience-wise (shit, grow up in a civil war after first Russians then Afghan Communists take over and yeah, you might be a little cynical about everything).  So there's no over-Rxing in this house unless of course you MEAN to over-Rx. 

Medicine for TOO LONG has been so quick to prescribe everything they can with a broadbrush because they just wana FIX it almost before they KNOW wtf it is.  And the science is ever-changing.  So last decade's FIX is what's being "fixed" NOW.  Repercussions don't come down the pike for years and years.  But jumping the gun and using trial drugs is what gets the happy on.  So why the fuck not, right?

I think Rog is so right on when he says we've painted ourselves into a virtual fucking corner.  That's why articles like this are so awesome--they show you exactly how easy it is to paint that corner.  And it's neat and tidy with no drips so it's so believable as THE answer to EVERYTHING.

Why should there be MORE than one answer?  The easiest and quickest solution should always work best, right?