Reviews - Carolyn Gage

Published on: December 16, 2010

Leeches and Psychotropic Drugs Part Six

This is the sixth part of a blog about Robert Whitaker’s book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America.

Okay… So this blog is about depression. And, of course, those “magic bullets,” the anti-depressants.

Some background: Community surveys from the 1930’s and 1940’s found fewer than one in a thousand people suffered an episode of clinical depression each year. And most of those who did, did not require hospitalization. In 1955, the disability rate from depression was one in 4,345 people. Oh, and it was a disease of the middle-aged and the elderly. Hold that thought.

Study after study from these years showed that folks with depression had great prospects for recovery via spontaneous remission… about half, in fact. And folks recovering from depressive episodes had the same “capacity and prospects” in their work life as before the onset of the illness. In other words, they were not being disabled by depression.

The first generation of anti-depressants got good press... for a while. But then the National Institute of Mental Health noted that the more rigorous the controls for studies, the lower the improvement rates. Turns out that placebos were just as effective.

And then, in 1988, Prozac hit the market with a splash of publicity... for a while. It turned out that the SSRI’s (selective serotonin reuptake inhibitors) were no better than the earlier generation of anti-depressants when compared with placebos.

But there was one area where anti-depressants were having a definite effect.... Patients on long-term anti-depressant use were experiencing depression as a chronic condition. Not only that, but a chronic condition they were stuck with, because when the patients tried to get off their meds, they would have hideous relapses of clinical depression, often accompanied by suicidal ideation. Researchers referred to it as “rapid clinical deterioration.” And the longer the course of medication, the more serious the relapse.

Yep… the anti-depressants were joining the neuroleptics and the benzodiazepines as psychiatric drugs proving to cause more serious conditions than those they purported to cure. And pretty much for the same reason: The drugs were introducing a chemical imbalance to the brain, and the brain was making drastic adjustments to compensate. These adjustments, over time, would become permanent, which is why withdrawal of the drugs had such disastrous consequences. The brain had now become permanently imbalanced.

But the investment in these "magic bullets" was enormous. In response to the evidence of harm, the medical establishment began to circle their theory wagons. They found a way to explain away the earlier, pre-1960 history of depression: Apparently, the reason so many depressed patients seemed to recover so easily in the past was because the doctors back then had inferior systems for describing and classifying mental illness. Depression, they insisted, is, and always has been, a chronic condition requiring medication... and any statistics that would contradict this must be invalid. Why, all you had to do was look at how many patients relapsed when they went off their meds, to see how necessary the drugs are!

So let me recap: Prior to the discovery of anti-depressants, depression was reported as relatively rare, and with good prospects of complete recovery. Children and young people hardly ever suffered from it. Today, one in ten people are diagnosed with depression as a chronic condition, and these folks can expect recurrences throughout their lives. In fact, two-thirds of patients treated with anti-depressants can expect recurrent bouts. In one study, only 6% could expect remission.

In a 1995 study by the NIMH, patients who had been medicated for depression were likely to have become disabled. And children and young people? Today depression is the leading cause of disability for folks between the ages of 15 and 44.

And then, of course, there are the side effects: The SSRI’s can cause sexual dysfunction, suppression of REM sleep (which will cause psychiatric problems), fatigue, emotional blunting, and apathy. And… impaired memory, impaired problem-solving ability, loss of creativity, learning disabilities. All this for a short-term effect often little better than that of a placebo, likely to result in chronic depression, with possible disability. Such a deal.

And here I am departing from a review of Whitaker’s book to take a sidetrip to a website called SSRI Stories . This is not for the faint-of-heart: Here's their self-description: "This website is a collection of 4,300+ news stories with the full media article available, mainly criminal in nature, that have appeared in the media (newspapers, TV, scientific journals) or that were part of FDA testimony in either 1991, 2004 or 2006, in which antidepressants are mentioned."

And the stories are doozies. For the reader's convenience, the website has categorized them by atrocity. Here's the list:

Soldier Cases
School Shootings / Incidents
Most Recent (Last 30 Days)
Workplace Violence
Celebrity Cases
Highly Publicized Cases
Won SSRI Criminal Cases
Women Teacher Molestations
Postpartum Cases
Murder-Suicides
Murders / Murder Attempts
Suicides / Suicide Attempts
Road Rage Cases

If you click on any of these, you can read the details about these cases, with links to corresponding journal or newspaper articles. Is the association with anti-depressants a coincidence? I mean, only people with depression and mental illness are prescribed the drugs, so is it fair to blame these crimes on pharmaceuticals? Check out the narratives from family members, insisting that, prior to the use of medications, the person did not have suicidal ideation, mood swings, erratic behavior. Check out how many times drug companies have paid out claims on these cases... and you know that these settlements are not cheap.

Finally, the FDA has had to admit that the SSRI's are causing children and young people to take their lives, and labels now have to carry warnings about increased risk of suicide among young adults aged 18 to 24. Clearly, the folks who run the SSRI Stories website see this as just the tip of the iceberg, and, at least to me, they make a compelling case.

So, since the anti-depressants have such poor efficacy and such gargantuan risks, why are so many people still taking them? In the US, by 2005, one in ten people were on anti-depressants. By 2008, there were 164 million prescriptions written for anti-depressants.

What the hell is going on? Stay tuned!

Click here to go back to Part 1.
Click here to go on to Part 7.

Published on: December 12, 2010

Leeches and Psychotropic Drugs Part 4

This is the fourth part of my blog on Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Riase of Mental Illness in America.

The previous blog explored the accidental nature of the discoveries of these so-called magic bullets, and this blog will examine how the tail of those discoveries came to wag the dog of scientific theory.

Whitaker notes how psychiatry was viewed very differently from other branches of medicine. Traditionally, the patient would lie on a couch as the psychiatrist led them back through the labyrinthine convolutions of their childhood or provided interpretations for their dreams. This was a far cry from the medical practitioner who diagnosed specific illnesses and prescribed scientifically formulated medicines to correct the condition. With the discovery of “magic bullet” antibiotics, the prestige of doctors rose considerably, and psychiatrists were eager to see their practice achieve the same degree of validation and popularity. If only there was some way to frame these accidentally-discovered drugs as disease-fighting agents!

All they needed was a good theory, and that’s what they got: The Theory of the Chemically Unbalanced Brain. Some mental illness is caused by brains that have too much of something, and other mental illness is caused by brains that have too little of something. Psychotropic drugs work by inhibiting the uptake or production of the thing of which there is too much … or else the drugs provide the thing of which there is too little.

A beautiful theory, easily understood by patients.

The hunt for chemical imbalances in the brain was as unsuccessful as the US hunt for weapons of mass destruction in Iraq. Equally unfortunately, the failure of the hunt for these imbalances was as irrelevant to public policy as was the failure to locate the weapons of mass destruction. When the public is clamoring for action, and when there is a theory so perfectly tailored to justify said action… well, researchers can either get on the bandwagon or risk the stigma and obscurity reserved for party-poopers and whistleblowers.

The twin pillars of the Chemically Imbalance Theory were 1) the low serotonin hypothesis of depression and 2) the high-dopamine hypothesis of schizophrenia. By the late 1980’s, research had shown both theories to be wanting. Whitaker cites hundreds of studies, and my blog in no way does justice to the thoroughness of his research into the testing done on these drugs. As a former founder of a publishing company that reported on clinical testing of new drugs, the author brings a level of professional expertise to his knowledge of the field and analysis of findings.

So… the researchers did not find the Chemically Imbalanced Brain that would be healed by the administration of drugs that had been originally developed for other purposes. But, in studying the psychiatric patients taking these drugs, they did discover something else. In the words of Whitaker:

"Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known 'chemical imbalance.' However, once a person is put on psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function… abnormally.”

The chemical imbalance was turning up after administration of the drugs, and often it appeared to be permanent. Which raises the question: After fifty years of prescribing these drugs, what exactly have been the outcomes?

Click here to go back to Part 1
Click here to go to Part 5

Published on: December 11, 2010

Leeches and Psychotropic Drugs Part Three

I’m blogging my response to Robert Whitaker’s book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Rise of Mental Illness in America. In Part One, I explored the historical disconnect between popular support for a medical treatment and the fact that this treatment may be ineffective or even dangerous, with no supporting research. Part Two reviewed the statistics for the epidemic.

Today’s subjet is “magic bullets.” Medicine does have some. Antibiotics and insulin are examples. Researchers identified a medical condition, like bacterial infection or insulin deficiency, and then they developed a medicine that would fix it… Antibiotics to kill the bacteria, and insulin to provide insulin.

The “magic bullets” of psychiatric drugs evolved from a very different process. It might be more apt to label them “stray bullets.” For example, Thorzine, the drug that, in the author’s words, kicked off the whole psychopharmaceutical revolution, had its origins in a search for a drug that would be toxic to malarial microbes. That search came to a dead end, but... all was not lost, because it was discovered that one of the compounds might be useful as an antihistamine in surgery.

Unfortunately, the blood-pressure-lowering side effect was causing patients to die, and so the application was discontinued. One doctor, however, discovered that the drug produced a “veritable medicinal lobotomy”—and a magic bullet was born. In the 1950’s, chlorpromazine (Thorzine) began to be administered to psychotic patients, and the drug that was rendering patients quiet and manageable spread like wildfire through the asylums. When a drug treatment becomes so widely prescribed, it is difficult to keep in mind that it is not treating any disease.

Thorzine is considered a major tranquilizer. How about the minor ones? Well, they also began with a search for something else. Scientists were looking for a drug that would kill the bacteria that penicillin couldn’t zap, and to that end, they were isolating a compound found in disinfectants. Research showed that this compound produced temporary paralysis of muscles, but, what was even more interesting, is that the mice who were being experimented on, did not seem to be upset when they found themselves on their backs and unable to move. Their heartrate remained steady. They were not stressed. And, low and behold, meprobonate found its way to the market in 1955 as “Miltown,” and the race for anti-anxiety drugs was on. Four years later, chlordiazepoxide made it to the shelves as “Librium.”

How about the magic bullet for depression? Same story: stray bullets. Hydrazine was developed during World War II as a fuel substitute. After the war, the drug companies snatched up the surplus to test the toxic properties for “magic bullet” potential. Two hydrazine compounds were found effective against the tuberculosis bacillus. Good news, but something interesting was happening to the patients to whom it was administered. They were being energized—dancing on their beds, even. By 1957, in spite of alarming side effects, iproniazid was being recommended for long-term use with depressed patients.

Meanwhile… back at the Amercian Medical Association ranch, things were changing. In the 1950’s the Food and Drug Administration took over the job of licensing and approving drugs, and most drugs became available by prescription only. The AMA was no longer the watchdog, but the exclusive purveyors, and by 1960, pharmaceutical ads in AMA publications were bringing in $10 million in annual revenue. The PR rush was on. And as the miracle stories multiplied, the rhetoric began to shift.

Tranquilizers became “antipsychotics,” and muscle relaxants became “mood normalizers.” The psychic energizers were “anti-depressants.” The public began to view these as antidotes to specific disorders, and scientists were under pressure to come up with a theory about broken brains to support the "magic bullets" that were achieving celebrity status.

Click here to go back to Part One.
Click here to go to Part Four.

Published on: December 7, 2010

Leeches and Psychotropic Drugs Part 2

This is the second part of a series of blogs about the book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America by Robert Whitaker.

The book is by a man who founded a publishing company to report on the business aspects of clinical testing of new drugs… an “industry-friendly” enterprise. Baffled by studies suggesting the inefficacy of medications for patients with schizophrenia, he began an investigative journey that resulted in this book.

“Epidemic” is a strong word. How does Whitaker support it?

He starts by looking at the data for 1955, when the disabled mentally ill were primarily cared for in state and county mental hospitals. Today, these folks would typically be receiving SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance) payment, with many of them living in residential shelters or other subsidized living arrangements.

In 1955, 1 out of every 468 Americans was hospitalized from mental illness. In 1987, 1 out of 184 Americans were receiving SSI or SSDI payment for disabling psychiatric conditions. The author concedes that this is an apples-to-oranges comparison, because the increase could be a result of the lowering of social taboos for seeking treatment for mental illness… but, the argument could also go the other way—that the 1987 statistics could be conservative, because they only include folks younger than 65 (older disabled patients are on Medicare and Social Security.) Okay… apples-to-oranges, because SSI and SSDI did not exist in 1955.

So let’s look at a more meaningful comparison, apples-to-apples. Let’s compare the number of folks on SSI and SSDI in 1987 to those in 2007. Why 1987? Because that’s the year that Prozac was approved by the FDA. Twenty years later, the rate for folks disabled by mental illness was 1 in 76 Americans. That’s more than double the rate in 1987.

Whitaker asks us to go deeper. In 1955, comparatively few of the people disabled by mental illness were diagnosed with major depression or bipolar illness. By 2006, 46 percent of young people (18-26 years old) on psychiatric disability were diagnosed with an affective illness, and 8 percent with anxiety disorder.

What about children? In 1987, pre-Prozac, only 5.5 percent of disabled children were diagnosed with psychiatric conditions. Twenty years later, that figure had changed to 50 percent. Today, mental illness is the leading cause of disability in children. And here’s an interesting statistic: Between 1996 and 2007, the number of children on SSI for other reasons (cancer, developmental disorders) declined, while the number on SSI for mental illness more than doubled. In other words, doctors seemed to be making progress in the treatment of other conditions, but losing some serious ground in combating mental illness.

Looking at these statistics, and especially those dating from the entry of Prozac into the marketplace, the author has the temerity to ask about the emperor’s new psychiatric clothes:

Could the current drug-based paradigm of care be causing this epidemic? In other words, is this epidemic iatrogenic in nature? (Etymology: Greek. iatros—physician, genein—to produce.) Is the theory of the “broken brain” actually a broken theory? Are the two decades of psychiatric drugging analogous to the two millennia of bloodletting—a pseudo-scientific practice rooted in the vulnerabilities of human nature, not medical science?

So here was Whitaker’s thinking: Since the general consensus is that millions of people are living better lives because of psychiatric medication, then surely the scientific literature should support this consensus with research into the biological disorders being treated and legions of studies reflecting the success of the new drugs.

In fact, the scientific literature tells an opposite story.

Click here to go back to Part 1.
Click here to read Part 3.

Published on: December 5, 2010

Leeches and Psychotropic Drugs Part One

Did you know that bloodletting was the most common medical practice from the first century AD until the nineteenth century—nearly two thousand years!—even though, in the majority of cases, the practice was harmful and even fatal to patients?

Wow.

Wouldn’t you think that in two millennia, people might have noticed that folks losing pints of blood got worse instead of better?

Actually, I’m sure they did. They would definitely notice when the patient died. So why the extraordinary longevity of such an obviously pernicious therapy?

The answer is simple: human nature. We are emotional, not rational creatures. And we are creatures of habit; our traditions die hard. And we are social animals; shunning by the herd will bring most of us back into line.

Bloodletting was the accepted practice. The patient who challenged it, would be accused of malingering. The parent who refused it for their child would be perceived as negligent, or even malicious. The story is so strong, so rooted in human nature that it hijacks the narrative: The patient who gets worse after bloodletting would have been even sicker without the procedure. The patient who eventually dies from loss of blood was going to die anyway, and the bloodletting came too late to save her.

Who needs science when there is a story as powerful as the story of blood gone bad, blood carrying humors which must be expelled? It is a graphic and compelling story—blood being such a dramatic metaphor for life. Blood is present at the birthing, present on the battlefield, emblematic of the transition to womanhood, and also emblematic of the manhood rite of wounding. Blood ties of kinship, blood feuds to the death. Blood as giver and as taker of life.

And then there is that human tendency to believe that it is better to do something than nothing. And bloodletting had the additional advantage of being quantifiable. Specific amounts of blood could be let at specific intervals. These could be recorded, charted, studied. There could be right ways and wrong ways for the letting-of-blood. Various techniques were developed, each with its own theory. But best of all, everyone has blood.

And, finally, there is an exchange of some sort going on. The bloodletter is receiving payment. The bloodletter is invested in promoting the practice, and the patient and the patient’s family have a disincentive in understanding that they have been hoodwinked… or that they might be responsible for enabling the harm or death of the one they loved. And then, of course, there is the lucrative cottage industry of leech-farming/ leech-harvesting.

Why am I telling you this? Because it might make it easier to swallow the fact that millions of people today are receiving a medically prescribed treatment that is making the majority of them much sicker, shortening their lives, and sometimes killing them… and there is absolutely no research to support the theory upon which these treatments are based.

In this case, the practice is only a few decades old instead of millennia, but the principle behind it is the same: human nature.

This blog is my response to reading Anatomy of an Epidemic by Robert Whitaker. The subtitle is “Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."

The first thing that impressed me about this book was the story of the author’s involvement with the subject. He was not a counter-culture type guy. In fact, he had co-founded a publishing company to report on the business aspects of the clinical testing of new drugs. In his own words, “we wrote about this enterprise in an industry-friendly way.” Clearly Anatomy of an Epidemic is not “industry-friendly.” What changed?

Whitaker stumbled across a story about the abuse of patients in a research setting. He did a series of articles on the subject for the Boston Globe. In one of the stories, he reported on a study which had involved withdrawing schizophrenic patients from anti-psychotic medications. Since the medication for this disorder is likened to “insulin for diabetics,” the author questioned the ethics of a study that would deprive the patient of a medication supposedly known to be essential for their health.

In the course of researching this article, Whitaker ran across two findings that nagged at his conscience:

1) In 1994, Harvard researchers announced that outcomes for schizophrenia patients has worsened since 1974 and were no better than they had been a century earlier… as in 1894.

2) Two separate studies by the World Health Organization which found that schizophrenia outcomes were much better in poor countries like India and Nigeria, where only 16% of the patients were maintained on anti-psychotic medications.

The point of all this is that the author of the book was a solid believer in the conventional wisdom of modern psychiatry. He believed that psychiatric researchers had discovered biological causes for mental illness and that their findings had led to the development of a new generation of psychiatric drugs to “balance” brain chemistry. He was to discover that none of these assumptions were true.

Anatomy of an Epidemic is the story of his awakening.

Click here for Part 2.

Published on: July 7, 2010

Incest: The Ever-Mutating, Ever-Replicating Virus of Denial, Part Four

This is the fourth and final part of my series on incest denial, which has been inspired by reading Lynn Sacco’s long-overdue book Unspeakable: Father-Daughter Incest in American History.

Quick recap of the timeline:

Colonial era: Surprising candor about incest as evidenced by number of reports in the paper, including cases involving middle-class and socially prominent men; civic outrage in favor of victims; packed courtrooms; death sentences and hard labor.

After 1860’s: Steep decline in coverage, scapegoating of immigrant populations and African Americans. Denial of prevalence, disbelief of survivors, medical community discourages using presence of gonorrhea in victims as evidence, insisting that the vaginitis must be non-venereal.

After discovery of gonococcus bacterium: Doctors insist that girls can contract gonorrhea from toilet seats. Focus shifts to mothers and their inattention to hygiene. Infected girls are socially ostracized as carriers of potential epidemics.

1940’s and 1950’s: Theories of Freud enter the popular culture. Reports of incest by girls are interpreted as fantasies based on their desires to have sex with their fathers. Kinsey insists that the damage from child sexual abuse comes from puritanical ideas in the culture, not from the rape itself.

1980’s: All hell breaks lose. The Women’s Liberation Movement empowers women to tell our stories, to trust each other and ourselves. Rape and incest come out of the closet. Epidemic of sexual abuse exposed. Huge boom in academic studies, self-help books, films, novels, memoirs dealing with incest. Feminists theorize that incest is a gender issue and a political issue. Father-daughter incest is framed as “the paradigm of patriarchy.”

So… that was twenty years ago, right? The next bullet point should say: Incest epidemic over. Massive prosecutions and public awareness campaigns. Culture arrives at “zero tolerance” attitude.

Nope. That didn’t happen. There was a backlash. Amazingly enough it was fueled by pedophiles and perpetrators, and the culture sided with them.

In 1993, the New York Times Book Review ran a front page article by a woman about the “cult of victimhood” fostered by the women’s movement. She made reference to the “incest survivor machine.” During the 1990’s, feminism became the “f” word, as postmodernism took over the academy, declaring that “woman” was a social construct and that anyone relating it to anatomy or biology was something called an “essentialist.” “Essentialism” was framed as a mystical term, when, in fact, there has never been a more more tail-swallowing, self-referentially obfuscating philosophy than postmodernism. Interestingly enough, and NOT coincidentally at all, two of the founders of postmodernism, Foucault and Derrida, had taken public, pro-pedophilia stances for abolishing age of consent altogether in France.

Women began to believe that it was empowering to ignore gendered oppression. Something called the False Memory Syndrome Foundation (FMSF) was established. It was founded in 1992 by Pamela and Peter Freyd, shortly after their daughter Jennifer privately confronted them with her memory of father-daughter incest. At least one member of their board had connections with pedophilic organizations. The scientific community has never endorsed or validated this so-called syndrome, and memory repression is a documented response to trauma, especially in childhood. Peter Freyd, interestingly, was an admitted alcoholic with a history of multiple hospitalizations and psychiatric care.

This foundation, with its pseudo-scientific theories, launched a huge media campaign. Carefully, they framed incest accusations as attacks on the families, protecting the fact that the perpetrators were overwhelmingly fathers. Not stopping there, they accused therapists of encouraging the revenge fantasies of their clients, or even suggesting and implanting memories. They began to sue. The fact that so many incest survivors were seeking help from therapists began to be used against them, “proof” that False Memory Syndrome was taking place.

They sued the authors of Courage to Heal , a book that has saved lives and given hope to thousands. They did not win the suit, but they were successful in getting legislation passed to limit insurance benefits for psychotherapy. They demanded that, in order to prove the validity of an incest memory, the survivor would need to remember every detail with complete accuracy. Not surprisingly, no survivor could meet their standards.

How does Sacco sum up her studies on father-daughter incest in American history? With this statement: “… shoring up the social power of certain men has, at every turn, been more important than protecting the physical and emotional integrity of girls, who have paid dearly to keep the fabric of American society, its ideologies and social hierarchies, intact.”

But… I want to add a postscript. Postmodernism is waning. The priesthood scandals (where boys constituted the majority of victims, by the way) have raised international outrage about the issue of child sexual abuse. The wars in Iraq and Afghanistan have brought the issue of PTSD to the forefront of veteran care, and with it, a validation of the impact of trauma. Military Sexual Trauma has been identified and been the subject of a Congressional investigation. (and my blog!) Sadly, little has changed, but it has been validated. The global economic and environmental crises are waking people up to the consequences of our rapacious attitudes of entitlement. Young women, saddled with staggering student loans and increasing pornographifying of the culture, are beginning to realize that ignoring their oppression is not empowering, but just foolish.

I encourage all of us to write the post-backlash chapter. To tell the truth. To confront perpetrators. To stop having Thanksgiving dinner, or Hanukkah, or Christmas, or Kwanzaa across the table from our rapists. To stop letting the enablers off the hook. Get the support to name it, confront it, demand accountability, and respond appropriately when that accountability is not forthcoming. Find good therapists, therapists who can identify Complex PTSD and who know how to treat it. Read Judith Herman, take responsibility for your health care. Arm yourself with knowledge, including knowledge of incest history, books like Unspeakable.

Never, ever let anyone or any voice in your head tell you that incest is not that big a deal, not that important in light of the world’s “real problems,” not significant in your own history. Never abandon your truth. Never abandon yourself. And, in the words of survivor Marilyn Van Derbur:

“We must say to every member of our society: If you violate your children, they may not speak today, but as we gather our strength and stand beside them, they will, one day, speak your name. They will speak every single name.”

Click here to read "Incest Denial Part 1"
Click here to read "Incest Denial Part 2"
Click here to read "Incest Denial Part 3"

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