“Psychiatric Medications Have Led to Dramatic Improvements in Mental Health Outcomes” (Big Lie No. 2)

In continuing my discussion of Robert Whitaker’s Anatomy of an Epidemic from my last post, I begin with the results of a study on the use of anti-psychotic medication for treating schizophrenia; it is one of many such studies discussed by Whitaker which report very similar outcomes.  This study was funded by the National Institute of Mental Health (NIMH) and conducted at NIMH’s clinical research facility in Bethesda, Maryland.  According to Whitaker:

“[T]hose treated without drugs were discharged sooner that the drug-treated patients, and only 35 percent of the non-medicated group relapsed within a year after discharge, compared to 45 percent of the medicated group.  The off-drug patients also suffered less from depression, blunted emotions, and retarded movements.”  The investigators reported that, over the long term, the medicated patients were “less able to cope with subsequent life stresses.”

Study after study shows that, in the short term, anti-psychotics do reduce unrealistic thinking, anxiety, suspiciousness and auditory hallucinations, but in the long-term, they make those continuing on medication much more prone to relapse and re-hospitalization than non-medicated patients or patients given a placebo.   “Schizophrenic patients discharged on medications were returning to psychiatric emergency rooms in such droves that hospital staff dubbed it the ‘revolving door syndrome.’  Even when patients reliably took their medications, relapse was common, and researchers observed that ‘relapse is greater in severity during drug administration than when no drugs were given.'”

In other words, schizophrenic patients who received no medication had much better long-term results than those treated with anti-psychotic drugs.  This jibes with both (1) a historical comparison between long-term outcomes for schizophrenic patients prior and subsequent to the introduction of anti-psychotics; and (2) a comparison between long-term outcomes for schizophrenics treated with anti-psychotics in the developed world versus those in poor countries treated without them (much better).  Study after study bears this out.

In short-term usage, psychiatric medications for psychotic disorders have value in stabilizing patients and reducing the severity of their symptoms, but long-term usage makes those people more prone to relapse and “may prolong the social dependency of many discharged patients.”   And here is the tricky part:  If patients are withdrawn from their medications, they do poorly, then do better once they have been put back on those drugs.  For this reason, it appears to be proof that the drugs “work”; but do they only “work” in the sense that they ameliorate a problem created by placing the patient on those very drugs in the first place?  In study after study, it is patients given no medication whatsoever who have the best outcomes.

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“You Have a Chemical Imbalance in Your Brain” (Big Lie No. 1)

 

My colleague Jeff Kaye PhD recommended that I read Robert Whitaker’s The Making of an Epidemic (pictured above) for insight into the scientific evidence concerning the effects of psychiatric medication. I read the entire book in one day and feel it is the most important work I’ve read in years. This and the following two posts will summarize Whitaker’s most important findings but I recommend that you read this book if you’re at all interested in or concerned about these drugs and what they actually do.  Although some sections of the book discuss neurological processes and there’s a fair amount of statistical data to support his arguments, you don’t need to be a psychologist or a physician to understand the material. For me, the experience was like reading a well-written legal thriller: I found it riveting.   As a clinician, I’ve always doubted the effectiveness claims associated with Prozac and the other so-called “anti-depressants”, viewing them as propaganda that drives profits for Big Pharma, as I’ve discussed elsewhere.  The full truth is far more disturbing.

Whitaker began as a newspaper reporter, then co-founded his own publishing company that reported on the business aspects of clinical testing for new drugs; his readers worked at pharmaceutical companies, medical schools and private medical practices, so he did not come to his subject area with an ax to grind.  He began his research for Anatomy when he discovered that as a whole, schizophrenic patients in poor countries, only 16 percent of whom were regularly given antipsychotic medication, had much better long-term outcomes than patients in developed countries who received such drugs. He set out to understand this puzzle, not to launch a crusade.  Before writing his book, he “believed that psychiatric researchers were discovering the biological causes of mental illness and that this knowledge had led to the development of a new generation of psychiatric drugs that helped ‘balance’ brain chemistry.” Many of you may believe the very same thing — not surprising, since it’s the story that has been given to us by the medical profession and regularly repeated in the media.

After painstaking research, Whitaker found that there is absolutely no scientific evidence to support the theory that mental illness is a result of an imbalance in brain chemistry. Let me repeat that: there is absolutely no scientific evidence to support the theory that mental illness is a result of an imbalance in brain chemistry.  As an example, let’s take the best known theory, that depression is caused by low serotonin levels in the neural synapses.  An entire class of drugs — the “selective serotonin reuptake inhibitors” (SSRIs) inhibits the removal of serotonin from those synapses and thus ( in theory) restores normal serotonin levels.  So, if this theory is true, depressed people should have below-normal levels of 5-HIAA (serotonin is matabolized into 5-HIAA) in their cerebrospinal fluid.

Study after study has failed to find any significant difference in the 5-HIAA levels of depressed and non-depressed patients.   No correlation has been found between 5-HIAA levels and severity of depressive symptoms.  Whitaker is thorough and devastating on this particular point, exposing flawed research designs and statistical analysis in the very few studies that purport to show even a very small link between serotonin levels and depressive symptoms.  Furthermore, no correlation has been found between levels of 5-HIAA in cerebrospinal fluid and degree of response to anti-depressants.  This widely accepted theory has absolutely no basis in fact:

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Different Types of Depression

As I discussed in an earlier post, most people use the word “depression” to describe many separate and distinct experiences — grief, disappointment, mild forms of unhappiness, etc.  When I use the word here, I mean clinical depression, the sort of mental and emotional suffering that sends people into therapy or to their physician for prescription-based relief.  I’ve seen many depressed men and women over the years; from my experience, the roots of their suffering usually lie in three common areas.  I’d like to offer some thoughts about these types of depression and their origins.  I don’t view them as necessarily distinct; they often overlap and mingle in various ways.

1.  Post-Apocalyptic Rage:

Beginning with Freud, psychotherapists have noted the frequent connection between anger and depression; you may heard depression described as “anger turned inward.”  I’d take this a step further and say that explosive and violent rage often lies at the heart of certain severe forms of depression.  I use the phrase “post-apocalyptic” because, with many severely depressed clients, I have felt almost as if a nuclear bomb has gone off inside them, devastating their minds and laying them waste.  Such clients might make it to session but lie inert and mute on the couch; they might say they feel nothing, or describe their body as feeling numb, weighted down by a pressure that flattens all emotion.  In the room with these clients, I often feels as if meaning has been completely destroyed and the emotional realm is void.  Such clients might describe themselves as feeling no interest or motivation to do anything.  They often mention intense pressure around their eyes or face.

Re-creating the emotional events that led to this state of devastation takes time and patience.  The task is complicated by the fact that the rage is almost always unconscious:  the client has no idea that he or she has been raging.  Sometimes you might hear hints of it in the client’s material when he or she begins to speak; more often, you see it in dreams or simply feel it by intuition.  The landscape of the apocalypse often appears in the dreams of depressed people: bleak ghettoes, vast lifeless deserts or scorched terrain borrowed from movies such as The Terminator.  If you have a strong empathic link with your client, you may find feelings of rage rising inside you during the silence, for no reason you can understand.

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Merger Fantasies in Psychotherapy

Certain clients, especially those with personality disorders or issues related to bipolar disorder symptoms, often idealize their therapists, putting them up on a pedestal and worshipping every word they say.  Behind these feelings often lies a desire to merge with the therapist and to take part in that ideal life as a means of escape from personal torment.  These ideas of merger represent a kind of growth-by-annexation where, in fantasy, the client wants to get inside of and take complete control over the therapist.  This wish usually goes hand-in-hand with a belief that the client’s own internal world is so damaged as to be beyond repair; they believe this magical usurping of the therapist’s identity represents their only hope to get better.

As a therapist, you might notice that the client starts talking like you, echoing your phrases and speech patterns or developing a collegial manner in your relations.  Such fantasies of merger are especially visible in dreams, however.  Two dreams from one of my clients, someone I saw many years ago, illustrate the dynamic very well.  He entered treatment because of occasional but severely debilitating depressions in which he felt unable to work.  On the surface, Jim (mid-20s) appeared extremely appreciative; he was always telling his friends that I was a wonderful therapist and every week he’d repeat to them my “brilliant” interpretations.  He’d been in treatment for a few months when he brought in the following dream.

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Psychotherapy Issues Arising from Bipolar Disorder Symptoms

In this video, I use the film ‘Limitless’ to illustrate some of the clinical issues addressed in this post:

<a onclick="javascript:pageTracker._trackPageview('/outgoing/www.linkedtube.com/CEqrDZLd20U264a6079ac9269aceb65df276b591c78.htm');" href="http://www.linkedtube.com/CEqrDZLd20U264a6079ac9269aceb65df276b591c78.htm">LinkedTube</a>

[NOTE: IF YOU HAVE BEEN DIAGNOSED WITH BIPOLAR DISORDER, BEFORE YOU CONSIDER TAKING PSYCHIATRIC MEDICATIONS, PLEASE EDUCATE YOURSELF ON THE DANGERS OF SUCH DRUGS AND LOOK INTO ALTERNATIVE FORMS OF TREATMENT. I’ve written a series of posts concerning (1) the dubious theory that mental illnesses such as bipolar disorder and bipolar ii disorder result from an imbalance in brain chemistry, (2) the fact that widespread use of antidepressants and other psychiatric medications can be linked to an explosive increase in the length and severity of many mental illnesses, and (3) the false claim that psychiatric drugs correct chemical imbalances in a way analogous to taking insulin for diabetes. Another post discusses the role of psychiatric medication in the increase of the symptoms of bipolar disorder in our culture.]

In an earlier post, I discussed the core problem in bipolar disorder or manic-depressive illness:  a feeling that the internal damage is so pervasive that there’s no realistic hope for improvement, leading to a search for “magical” solutions instead.  IN this post, I’d like to give a case example, a young man in his 20s who might have been considered “cyclothymic” rather than receiving a full diagnosis of bipolar disorder, though his mood swings demonstrate the same high/low dynamics.  If you haven’t read it already, you might want to take a look at my post on hopeless problems and perfect answers before reading on.

Jeffrey was an extremely bright and talented young man, recently graduated from college, who aspired to be a writer.  He came to me because of depressive episodes so severe he felt barely able to function.  He managed to hold down a clerical job to support himself despite his depression, attempting to write in the evening after work and on weekends.  If he were feeling deeply depressed, he couldn’t write a word. After work, he’d often collapse into a state of inertia, barely able to feed himself, watching mindless TV.  He suffered from extreme insomnia and often slept but a few hours.

Jeffrey badly wanted to have a relationship but felt completely worthless, as if everything about his adult functioning self was a facade, and that as soon as anyone got close to him, they’d find out he was a fraud.  He would describe himself as a loser, “damaged goods,” or “a worthless piece of shit.”

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