Head Games

Is the world coming to an end or does it just feel that way?  In the age of bubbles, trillions of debt, tea parties, eroding privacy and trust, the Taliban and Tiger Woods, IMS Health reports that in 2008 a 164 million prescriptions were written for antidepressants in the U.S., with sales of $9.6 billion.  That's a lot of pills.

As posited in my DSM IV post last week, there's a debate about whether more people are depressed because, well, they're clinically depressed, or because there's a psychiatric diagnosis, pharmaceutical company and pill ready to make them "better than well."

The New Yorker stirs the pot this time with an article Head Case which reports on two new books: Gary Greenberg’s “Manufacturing Depression” and Irving Kirsch’s “The Emperor’s New Drugs."

"Within the profession, the manual that prescribes the criteria for official diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, known as the D.S.M., has been under criticism for decades. And doctors prescribe antidepressants for patients who are not suffering from depression. People take antidepressants for eating disorders, panic attacks, premature ejaculation, and alcoholism.

 "The National Institute of Mental Health estimates that more than fourteen million Americans suffer from major depression every year, and more than three million suffer from minor depression (whose symptoms are milder but last longer than two years). Greenberg thinks that numbers like these are ridiculous—not because people aren’t depressed but because, in most cases, their depression is not a mental illness. It’s a sane response to a crazy world.

"Greenberg basically regards the pathologizing of melancholy and despair, and the invention of pills designed to relieve people of those feelings, as a vast capitalist conspiracy to paste a big smiley face over a world that we have good reason to feel sick about. The aim of the conspiracy is to convince us that it’s all in our heads, or, specifically, in our brains—that our unhappiness is a chemical problem, not an existential one. Greenberg is critical of psychopharmacology, but he is even more critical of cognitive-behavioral therapy, or C.B.T., a form of talk therapy that helps patients build coping strategies, and does not rely on medication. He calls C.B.T. 'a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment.' "

I've spent my time "on the couch" and value the insights I've learned over the years as I've coped with modern life, but the cynic in me feels like there's always something corrupt and profit-oriented about the process.  So exercise has long been my default treatment.

"Psychiatry has also been damaged by some embarrassing exposés, such as David Rosenhan’s famous article “On Being Sane in Insane Places” (1973), which described the inability of hospital psychiatrists to distinguish mentally ill patients from impostors. The procedure used to determine the inclusion or exclusion of diagnoses in the D.S.M. has looked somewhat unseemly from a scientific point of view. Homosexuality, originally labelled a sociopathic personality disorder, was eliminated from the D.S.M. in 1973, partly in response to lobbying by gay-rights groups. The manual then inserted the category “ego-dystonic homosexuality”—distress because of the presence of homosexual arousal or the absence of heterosexual arousal. Further lobbying eliminated this category as well. Post-traumatic stress disorder was lobbied for by veterans’ organizations and resisted by the Veterans Administration, and got in, while self-defeating personality disorder was lobbied against by women’s groups, and was deleted.

"The recommendation from people who have written about their own depression is, overwhelmingly, Take the meds! It’s the position of Andrew Solomon, in “The Noonday Demon” (2001), a wise and humane book. It’s the position of many of the contributors to “Unholy Ghost” (2001) and “Poets on Prozac” (2008), anthologies of essays by writers about depression. The ones who took medication say that they write much better than they did when they were depressed. William Styron, in his widely read memoir “Darkness Visible” (1990), says that his experience in talk therapy was a damaging waste of time, and that he wishes he had gone straight to the hospital when his depression became severe."

I'll look for something to post soon about Tiger's sex addiction and treatment.