Benzodiazepines and Dementia

ValiumI haven’t written about my opposition to the widespread use of psychiatric medications in quite some time, mostly because I feel I’ve already said most of what I have to say on this issue. (See the collection of posts under the heading “The Medicalization of Mental Health,” to be found at the lower right of this page.) But a new study was recently released which demonstrates a link between the use of benzodiazepines and the risk of developing Alzheimer’s disease. While this study says nothing about the long-term effects of SSRIs, the history of benzodiazepine usage offers a cautionary tale as to how little we truly understand about a drug’s side effects during the years immediately after psychiatrists and physicians begin prescribing it.

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The Shame in Mental Illness

DSM5My recent posts got me to thinking about the term mental illness and how stigma-laden it remains to this day. As a society, we’ve come a long way from the bad old days when most people were too ashamed to admit going to a psychiatrist, when families kept those members with obvious psychological problems hidden from view. Back then, a moralistic aura surrounded mental illness, as if having one implied that you (as well as your family) were morally defective and therefore to blame for your emotional difficulties. This view of mental illness still prevails on the religious right — as in the claim that homosexuality is a “lifestyle choice,” for example, and that gays are obviously making the “wrong” one.

In society at large, the easing of stigma has a lot to do with the marketing of psychiatric medication to address “chemical imbalances” over the last few decades. Nowadays, you don’t suffer from mental illness, you have a mood disorder, a result of faulty brain chemistry rather than a moral defect and of course, not your fault. While I strongly object to the widespread overuse of anti-depressants, I do believe that removing the shameful stigma surrounding depression and manic-depressive illness has been a good thing. It’s difficult enough to struggle through depression without feeling you’re a bad person to boot for being “abnormal.”

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Antisocial Personality Disorder: The Sociopath Next Door’ve been reading The Sociopath Next Door by Martha Stout — an excellent and yet frustrating book about antisocial personality disorder. Stout’s engaging style and in-depth clinical experience with victims of sociopathic predators bring the subject to vivid life. The vignettes read more like suspense novels: as the character of the sociopath gradually unfolds, your sense of foreboding grows. You continue reading with a mixture of dread and fascination, wondering what will happen to Stout’s clients, whether they will extricate themselves from the manipulative grip of an unfeeling spouse or parent, whether the unsuspecting people who surround the sociopath will wake up in time. I found the book a gripping read.

It’s a practical book, too: Stout explains with great clarity how to recognize sociopaths, placing special emphasis on their efforts to arouse your pity in order to manipulate you. She has a set of thirteen rules for dealing with the sociopath, useful advice for the person who may be under the spell of someone with antisocial personality disorder. Although she doesn’t normally recommend avoidance as a coping device for her clients, Stout believes that steering completely clear of the sociopath is the most effect mode of self-defense. Because sociopaths have no “conscience,” as she describes it, there is no way to appeal to their sense of justice or fairness. Because they apparently lack all human feeling for other people (empathy), you can’t appeal to their compassion. Because sociopaths will do anything in order to win, once you enter into their game, you’re bound to lose. Her observations seem trenchant, her advice on point.

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Childhood ADHD: Over-Diagnosed or Under-Treated?

Ritalin2I was planning to write an overview of the recent controversy in this area concerning frequency of childhood ADHD diagnosis and treatment with stimulant medication.  This very lively exchange of expert and personal views was touched off by a New York Times article citing a Centers for Disease Control and Prevention telephone survey of many thousands of parents.  However the latest issue of one of my favorite magazines scooped me.  I can say it no better than the two-page article in Scientific American, Are doctors diagnosing too many kids with ADHD? by Editors Scott Lilienfeld and Hal Arkowitz.  It’s the most comprehensive presentation of good science concerning the important issues.

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ADHD Symptoms Revisited

Last week, I reviewed an article by L. Alan Sroufe that had appeared in the New York Times, seriously questioning the effectiveness of Ritalin, Adderall and other stimulants used to treat children with ADHD symptoms. Two site visitors, including my friend Dr. Bob Dick, raised some strenuous objections to my post, and more importantly to Dr. Sroufe’s piece in the NYT. Both of their comments convinced me the issue deserved another look, and that because of my basic anti-medication bias, I’d been too quick to accept Sroufe’s report at face value.

Shortly after Sroufe’s article appeared, Harold S. Koplewicz MD, President of the Child Mind Institute, wrote a point-by-point rebuttal of it; if you’re interested in this issue, the article by Koplewicz bears reading. I won’t bother to summarize the whole piece, but suffice to say that he brings some fairly persuasive evidence in support of the effectiveness of stimulants to treat ADHD symptoms in children and raises important questions about the validity of the studies cited by Dr. Sroufe and the conclusions drawn from them.

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