Posted by pseudoname on February 11, 2006, at 12:00:21
In reply to The dramatic rise of mental illness, posted by detroitpistons on February 10, 2006, at 13:39:25
What a great thread. Thanks for starting it, DP.
I am also deeply ambivalent and skeptical about psych meds, even as I keep taking them. But without denying any of the comments in this thread, I still want to point to some problems in Whitaker's essay.
As others have said, our current infrastructure, motivations, and techniques for diagnosing mental illness are enormously different than they were even 50 years ago, let alone 100. The rates are just not comparable. From my own family's anecdotes, I know of a dozen cases in my extended family 1900-1950 that were not formally diagnosed or "in the system" but would surely be diagnosed and in the system now.
Whitaker cites Healy saying the response rate for in-patients was better 100 years ago, even though they were worse off at admission. But if one group is worse off, their higher improvement rate could be explained simply as regression to the mean. If there are different inclusion criteria, then the two groups are simply not comparable. And since the 1900-era inpatient non-horrific treatments are all still available and given at least to a lucky few (rest, seclusion, beautiful surroundings, etc), current persuasive data for that approach should be available. Whitaker doesn't cite any. I've tried the rest/seclusion thing: it's better than high-stress living, but it was no cure for me. Very sadly.
Whitaker focuses on SSRI-induced mania. But that real problem doesn't explain why there are more people diagnosed with depression (and thus taking the SSRIs) to begin with. Whitaker also doesn't back up his assertion that people who have bad responses to SSRIs are "well along on the road to permanent disability", but it's a sobering possibility.
Even if the actual incidence of mental illness is rising (not just the diagnoses), the fact that it roughly correlates with increased prescriptions proves nothing in itself. When sales of sunglasses increase, the rate of drownings also increases, but sunglasses don't cause drownings. Both are caused by a third factor, people going to beaches and pools in warm, sunny weather.
As others have posted, there are many possible "third factors" that may be making people today more likely to have mental illness. I always think of the study showing that exposure to lots of TV images before age 3 changes brain development and leads to attention problems at the very least.
Another factor Whitaker leaves out is current research showing that untreated depression leads to actual, long-term physiological changes in the brain and other increased illness and mortality. (Like Peter Kramer summarized in "Against Depression".) Maybe without psych meds, our overall statistics today would be even WORSE. That idea has as much of a basis as Whitaker's conclusion.
That said, I agree that psych meds are oversold by pdocs and the media, and the many problems with them are not considered enough by docs or authorities. Maybe articles like Whitaker's, for all the problems I see in them, help by getting more people talking about it. My fear is that they lead to defensive, dismissive reactions from the system's "experts".
Like I said, this is a great discussion. I hope I've contributed to it and not detracted from it. Sorry I went on so long.
poster:pseudoname
thread:608339
URL: http://www.dr-bob.org/babble/20060205/msgs/608631.html