Nov 1, 2010

Unhinged: The Trouble With Psychiatry - A Doctor's Revelations about a Profession in Crisis


I read a fascinating book about psychiatry written by a practicing psychiatrist who, as the book flap says, exposes deeply disturbing problems plaguing his profession.  He writes about how psychiatry is mostly about prescribing drugs these days, with all the troubling consequences that entails, and has largely forsaken talk therapy.  This is because they will earn far less doing therapy than by prescribing drugs.  He says if he did therapy, he could see one patient an hour and he would earn about $70/hour.  He typically saw three patients an hour, for years, and he made $180 an hour (factor in expenses and he made closer to $130 an hour).

He writes about how they treat symptoms after determining that the patient exhibits an arbitrary number of signs that match a supposed disorder.  They spend fifteen minutes on a patient and don't bother finding out about the patient's life.  He shows how DSM diagnoses are not particulary scientific, and tells us that the number of possible diagnoses has increased from 182 to 263.  Unbelievably, a committee votes on deleting what is considered old-fashioned disorders and voting in newfangled disorders.

What he says backs up many things I have believed about the profession but I am no authority; he is! So when I read that a practicing psychiatrist says there is no proof to the chemical imbalance theory of depression, I say wow! I have read numerous articles over the years in frum and not Jewish media that speak about a chemical imbalance with the same confidence we reserve for the sun rising in the morning!

He says the scientific literature contains thousands of papers proposing neurobiological theories to explain PTSD, depression, bipolar disorder, schizophrenia and other psychiatric disorders but these theories remain unproven! He says, "the shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all."

Even as I was amazed by the honesty of the author in showing the major flaws of his profession, I was shocked that he still goes through the motions.  How pathetic to drug someone when their problem is clearly loneliness or unhappiness with their job.  As a colleague of his put it, "Most of the people I see have misery and unhappiness rather than major depression.  They are miserable because of problems in relationships or difficulties coping with their life's circumstances."  She doesn't drug them.  She makes half of what a full-time psychiatrist in private practice makes because she does talk therapy instead.

There is a chapter on how drug companies market their drugs to psychiatrists.  Oh boy ... it's so crooked that the author, who started out innocently working as a paid drug endorser for one of these drug companies, stopped working for them despite the great pay ($30,000 - and this is aside from his private practice) and perks because he realized he was selling his soul and was no longer willing to do so.

It's a readable book for the layman and I highly recommend it.  Time that more people realized that "the emperor has no clothes."  Our health, mental and otherwise, is at stake!

16 comments:

  1. The history of mental illness is mentioned in the Tanach and throughout history there has been various attempts to treat mental illness and most of these attempts were cruel. In modern times before medication was available, the mentally ill were given shock treatments and brain surgery. Some mental illnesses showed up in childhood and others waited until adolescence and some did not appear until adulthood or old age.
    Many mental illnesses will not respond to talk therapy; even those that appear should. There are even catatonic states that can appear with mental illness and these are serious and no amount of talk will help. The old novel Jane Eyre has a mentally ill woman in it and apparently "madness" was considered incurable.
    I don't know what the real answer is but I am sure that many mentally ill people tried everything and would be a danger to themselves and others if they were not snowed with drugs. Some mental illnesses are more serious and possibly fatal than cancer.

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  2. 1) Mentioned in Tanach - are you referring to King Shaul? Do you think he was mentally ill? A psychiatric case? That is not what I have learned. I learned that he was a very great man whose ruach ha'kodesh departed from him, who was tested by Hashem, who followed the advice of evil advisors.

    2) The psychiatrist author of the book doesn't think that most mental illnesses are illnesses. There are actually very few cases of crazy behavior characterized by delusions etc.

    3) Little has been reported about the ill effects of medication on a person's mental state. Sounds ludicrous but one of the side effects of antidepressants is increased risk of suicide.

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  3. Regarding Shaul ha Melech, mental illness can be situational. Widows with no known mental illness have grieved themselves to death. Today every new mother is warned about post-natal depression that can occur even in women who were otherwise considered mentally stable.
    Probably the delusional mentally ill are the smaller percentage tip of the iceberg in terms of numbers, but those are the ones who are dangerous when unmedicated. Some types of disorders such as sociopaths, are people who seem to have no concept of right and wrong but medication probably would not help that.
    Depression is a catchall phrase that can be situational or chronic to the point the the person ceases to take care of him or herself. A person who is depressed over a difficult life event might be better off with talk therapy, if the insurance would cover it and this is the reason why most people end up with medicine instead of talk therapy.
    There are anxious moments in a person's life, such as when facing surgery, where a bit of medication can take the edge off of the anxiety and allow the person to enter anesthesia in a calm state.

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  4. 1) Regarding Shaul - if you have a source in a commentary that he was ill, let me know.

    2) As for widows who grieve and die in their grief, that is not an illness. It is grief. They are not sick.

    3) Too bad if that's true, that every new mother is warned about depression. I don't think it's helpful to inform vulnerable women that they can succumb to depression. The power of suggestion is great. Not surprisingly, the numbers of depressed post-partum women are increasing.

    4) How many people are on the loose who are dangerous because they are not medicated? How many murders are committed because of these people? Maybe it's just me and I'm not hearing all these stories, or maybe they are simply not happening much.

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  5. I would not know how to find a source in commentary on Shaul but in one of the tehillim, Dovid ha Melech speaks of feigning mental illness. I don't know that we can positively diagnose someone who lived in an earlier time period.
    If grief is fatal, is it not an illness? If the grief is of such magnitude that the person neither eats or sleeps, should they not take medication?
    The average mother that gets what used to be known as "baby-blues" will recover without treatment. I know of someone in the frum community who could not take care of the baby for a full year due to post-natal depression. It was a real illness.
    Nearly every week we see in the news where someone killed members of their family and then killed themselves. I think that murders are frequently carried out by people who are mentally unstable and sometimes people are injured but not killed. There was a story last week of a woman addicted to facebook who shook her baby to death for crying and interrupting a game she was playing on facebook. If she is proven to be mentally unstable, she will avoid a lengthy sentence. Sometimes no one was aware that the person was sick until they injure or kill someone. I think that most murderers have some emotional instability or why would they kill in the first place?

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  6. http://www.nejm.org/doi/full/10.1056/NEJMp068229
    Here is an article about links between mental illness and violence. Other articles say that mental illness in and of itself do not increase the risk of violence but mental illness coupled with substance abuse doubles that person's risk of becoming violent.

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  7. Read the above article. It talks of mental health professionals injured or killed by patients.

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  8. It's a tough one. While there is no blood test to determine that someone has a mental illness I don't think one can say there is "no proof" of a chemical imbalance.
    The proof is that by prescribing chemicals to a suffering person a change in behavior is seen.
    the tough call is deciding what and if the person actually has.
    Depression is most likely over diagnosed. It's easier to say a person has depression and give drugs then to investigate thoroughly to see what's really going on, or to change one's diet and lifestyle.
    But there are conditions out there that are devastating to the patients and people in their lives. One can't just ignore them and say there is no proof. Sometimes it's poshut dangerous, other times it's heart breaking. If the medicine works for some and gives them a normal life when otherwise they wouldn't have one then how can we say not to.

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  9. "Too bad if that's true, that every new mother is warned about depression. I don't think it's helpful to inform vulnerable women that they can succumb to depression. The power of suggestion is great. Not surprisingly, the numbers of depressed post-partum women are increasing."
    I know someone whose mother commited suicide due to severe ppd.
    "How many people are on the loose who are dangerous because they are not medicated? How many murders are committed because of these people? Maybe it's just me and I'm not hearing all these stories, or maybe they are simply not happening much. "
    I don't know why you don't hear about it because I have heard more then I care to, and I am someone who avoids following the news.

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  10. "While there is no blood test to determine that someone has a mental illness I don't think one can say there is "no proof" of a chemical imbalance.
    The proof is that by prescribing chemicals to a suffering person a change in behavior is seen.
    "

    p. 7 of the book says:
    "The fact that many antidepressants increase levels of serotonin has led to a serotonin-deficiency theory of depression, even though direct evidence of such a deficiency is lacking. 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. In fact, pain is caused by a multitude of mechanisms, depending on what organ is involved. Chest pain from a heart attack is not caused by an opiate deficiency, for example, but by a lack of blood flow to certain cardiac tissues which damages heart cells. This is a true physiological explanation of a disease, one that has guided the development of cardiac medications that act by increasing blood flow to the heart muscle. By contrast, the shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any ilness at all."

    in short: aspirin may cure a headache, but it doesn’t mean that headaches are caused by an aspirin deficiency.

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  11. "I know someone whose mother commited suicide due to severe ppd."

    She needed help and didn't get it.

    The point I was raising was how much harm is done by drilling into new mothers how otherwise normal feelings might be signs of serious mental illness.

    A related example - professionals were certain that counselors should rush in after disasters to treat traumatized people. The problem: there was little evidence that it helped. In fact, study after study published during the 1990's showed that early interventions were either ineffective or actually caused harm!
    Early interventions sometimes appeared to be priming victims to experience certain symptoms! That is precisely what I think the danger is with new mothers.

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  12. I heard something terrible the other day about anti-depressants. A child in a state children's asylum for unwanted children was overweight due to anti-depressants that he had been given. He was depressed over having not been adopted so the best way for the facility to deal with him was to give him medication. The poor child now has a weight problem in addition to being an unwanted child.

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  13. So the author is saying then that antidepressants are like a Tylenol. They treat the symptom but not the cause?
    Or is he denying the condition all together.
    I'm open to his opinion but I just wonder. If he is indeed denying that there is a physical reason for the condition, then how is it that a medicine can work?

    The reason I brought up the person whose mother committed suicide is because it happened very soon after she gave birth, while she was in hospital still. Whether medicating her is acting as a Band-Aid or not the fact of the matter is had she been given the medication right away then the immediate danger she was in would have been avoided until another solution was found.

    so what I feel/think is that when it comes to relatively mild depression or ppd before rushing into medication action should be taken to make sure the sufferer is getting the right sleep, nutrition and support that they should have to bring them back to a healthy state.
    However when a person is a danger either to themselves or others, or their actions are tearing families apart then I think that regardless of it being a Band-Aid or not, something has to be done for their immediate security.

    What does the author indeed suggest to do in such situations? Is he giving an alternative?

    Rosie that story is sad. But in any area of medicine, whether alternative or conventional there is unfortunately such a thing as using treatments irresponsibly.

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  14. They treat the symptom but not the cause?

    Yes.

    If he is indeed denying that there is a physical reason for the condition, then how is it that a medicine can work?

    This is an interesting article from Newsweek magazine:
    http://www.newsweek.com/2010/01/28/the-depressing-news-about-antidepressants.html

    Some highlights:
    Patients on a placebo improved about 75 percent as much as those on drugs. Put another way, three quarters of the benefit from antidepressants seems to be a placebo effect.

    had she been given the medication right away then the immediate danger she was in would have been avoided

    Yet it can take weeks for anti-depressants to take effect and often adjustments need to be made in which medication to use and the dosage.

    The author, despite blowing the whistle on his own profession, has not stopped seeing patients and prescribing medication. He will recommend a therapist to them, if he thinks it will be helpful.

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  15. Over Shabbos I was reading a book that reminded me of this posting.
    I neither agree nor disagree with what you have written here. I don't have the qualifications to do so. I don't I have any medical expertise nor do I have (thank G-d) much experience with mental illness. So to put it simply, I don't have a strong opinion either way other then in severe cases where there is no alternative a person needs meds.

    Anyway to get to my point, the book I was reading was about a woman that had a condition that caused bleeding on her brain. Until her surgery and for a good while after till she was weaned off she was prescribed steroids to stop the bleeding which could potentially be fatal. The steroids affected her mood causing her to be apathetic and have clinical depression. Her whole personality changed until she was weaned off the medication. Does this not show that chemical changes do have an affect on the brain and a person's personality?
    So if it can be artificially induced, then maybe there is truth to the theory that chemical imbalances in the brain cause mental illness. No?

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  16. Sure medication (and brain tumors) can affect personality. However, the theory of chemical imbalance as a cause for depression has not been proven even though it is spoken of by many people as a fact (just like the theory of Evolution has not been proven but is spoken of by many as a fact).

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