Fascinating review of three books on psychiatry, conflicts of interest, over medication and ultimately the culture of U.S. money driven medicine in the N.Y. Review of Books by Marcia Angell. This is a two part series. Part 2 is here. Comments here.
Among other issues Angell looks at:
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?
She discusses that there is a misunderstanding of the basis of these diseases; that they are over diagnosed; that neurotransmitter theories are unproven and probably wrong; that the pharmaceutical industry is funding (Medicynical Note: corrupting) psychiatry and psychiatrists more than any other specialty; placebo treatment in depression is virtually as effective as antidepressants; these drugs have serious long term side effects; and so on.
At the very least, we need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress. Both psychotherapy and exercise have been shown to be as effective as drugs for depression, and their effects are longer-lasting, but unfortunately, there is no industry to push these alternatives and Americans have come to believe that pills must be more potent. More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.
In particular, we need to rethink the care of troubled children. Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions—such as one-on-one tutoring to help parents cope or after-school centers for the children—should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive. Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better. Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere).
Read the articles and comments.