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Has the tide really turned against psychoactive medications?

July 26, 2011
by Jack Carney, DSW
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Don't get your hopes too high. Ethan Watters book, Crazy Like Us: The Globalization of the American Psyche, leaves no doubt that the big pharmacuetical companies and their principal advocates, American psychiatry and its DSM-IV, have spread around the world. Just last week, a PBS report featured one of its chief correspondents, Ray Suarez, interviewing an Indonesian psychiatrist about his efforts to persuade a patient diagnosed with schizophrenia to take a neuroleptic medication.

It was as if the WHO studies questioning the effectiveness of the disease model for treating schizophrenia never took place. In any event, Suarez didn't know about them and accepted the Indonesian psychiatrist's approach without question. The modern, i.e., American, notion of mental illness and treatment appears to trump all.

This is Watters' chief concern: that the social-cultural aspects of psychotic episodes, the key to understanding them as human experiences, are being washed out by an imperialism of greed and arrogance.

Closer to home and reason for some hope are the dueling series of articles and letters to the editor recently published in the New York Review of Books and The New York Times challenging then defending the use of psychoactive medications. The first salvo was fired by Marcia Angell, former editor-in-chief of the New England Journal of Medicine, in two articles in the New York Review on June 23 and July 14 where she favorably and enthusiastically endorsed three books written within the past year that questioned the scientific basis of the disease model and its companion medication treatment regimen. The first was Irving Kirsch's The Emperor's New Drugs: Exploding the Antidepressant Myth; followed by Robert Whitaker's Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America; concluding with Daniel Carlat's Unhinged: The Trouble With Psychiatry: A Doctor's Revelations About a Profession in Crisis.

Angell not only provides a thorough overview of these books -- I've only read Whitaker's polemic, but the other two, thanks to Angell, are now on my list -- but uses them as a platform to join in and bash the disease model. She's in sync with the three authors and believes, as they do, that psychoactive drugs, given the absence of scientific validity, are a fraud perpetrated on the American public. In the interest of journalistic balance, The Times offered the front page of its July 10thSunday Review section to Peter Kramer, author of Listening to Prozac, published almost twenty years ago, in 1993, who offered a pretty standard rationale for anti-depressants, particularly SSRIs.

Significantly, The Times has demonstrated great interest in the medication issue and, more generally, in behavioral health treatment, publishing a lengthy front page article in its Sunday, March 6th edition, describing the several explanations offered by a psychiatrist in private practice for restricting his practice to prescribing psychoactive medications. With "parity" and health care reform legislation promising greater accessibility, and with the controversy surrounding the deadly side effects of neuroleptics, The Times has apparently concluded that they've hit on an issue of increasing public concern.

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Jack Carney

Jack Carney

Jack Carney, DSW, is a practicing social worker with 42 years of experience in the field. He is...