Sep 10

Psychiatry and Big Pharma: James Davies, Author of “Cracked”

While the voices of DSM-5 critics responded inside my head, I tried to listen to a dry reading last week of the changes the APA (American Psychiatric Association) has made to the manual, something I thought I should know more about. Although it’s a tool I don’t support very much, I do need to use it for clients’ insurance claims.

So today I’m trying to offset that experience with the thoughts of British therapist and researcher James Davies, who’s written the new book Cracked: Why Psychiatry is Doing More Harm Than Good.

According to the author’s literary agency, Davies set out to answer three puzzlers:

  1. Why has psychiatry become the fastest growing medical specialism in history when it still has the poorest curative success?
  2. Why are psychiatric drugs now more widely prescribed than almost any other medical drugs in history, despite their dubious efficacy?
  3. And why does psychiatry, without solid scientific justification, keep expanding the number of mental disorders it believes to exist–from 106 in 1952, to 374 today?

Cracked‘s publisher states that these questions “can be explained by one startling fact: in recent decades psychiatry has become so motivated by power that it has put the pursuit of pharmaceutical riches above its patients’ well being.”

From the author’s website, some of the ways Big Pharma has affected psychiatric care:

The charge sheet is damning: negative drug trials routinely buried; antidepressants that work no better than placebos; research regularly manipulated to produce positive results; doctors, seduced by huge pharmaceutical rewards, creating more disorders and prescribing more pills; and ethical, scientific and treatment flaws unscrupulously concealed by mass-marketing.

A relevant excerpt from the Publishers Weekly review of Cracked:

On the pharmaceutical front, Davies takes aim at Big Pharma’s tendency to ‘cherry pick’ positive clinical trial data to suit its needs. The results are drugs whose curative efficacy is questionable and which sometimes come with serious side effects (such as the ’emotional blunting’ that occurs in about half of all Prozac users). Further undermining the integrity of the psychiatric profession is the fact that many doctors, having received grants and/or speaking and consulting fees from Big Pharma companies, are essentially prescribing from within the deep pockets of their benefactors. The consequences for patients and the profession are obvious.

Some reviews of Cracked:

  • “An eye-opening and persuasive work,” concludes Publishers Weekly.
  • “Builds a disturbing picture of a profession that is in thrall to pharmaceutical companies,” states Michael Mosley of BBC Focus.
  • ‘If, in the world of psychiatry, the DSM is Holy Scripture, Cracked is set to become a heretical text.” Robert CramptonThe Times Magazine.

Others within the ranks of psychiatry who’ve been protesting the connection between their field and the pharmaceutical industry includes such notables as Irving KirschPeter Breggin, and David Healy. But it’s not only disgruntled psychiatrists who aren’t enthralled with the drug-related hijinks—others are catching on too. Some relevant and recent news reports:

  • Deborah BrauserMedscape (March 2013): “Once again, psychiatrists top the updated Dollars for Docs list of large payments from pharmaceutical companies to individual US clinicians.” 
  • CCHR International (“The Mental Health Watchdog”) stated this not long ago: “With the U.S. prescribing antipsychotics to children and adolescents at a rate six times greater than the U.K., and with 30 million Americans having taken antidepressants for a ‘chemical imbalance’ that psychiatrists admit is a pharmaceutical marketing campaign, not scientific fact, it is no wonder that the conflict of interest between psychiatry and Big Pharma is under congressional investigation.”

Below, a cautionary news report from last year regarding Big Pharma and mental illness diagnoses:

Aug 01

“Falling into the Fire” By Psychiatrist Dr. Christine Montross

Psychiatrist Christine Montross is both an academic and a clinician—she teaches at Brown University and has experience treating inpatients. Falling Into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis, her new book, comes out today.

The Writing

In his review in Brown Alumni Magazine, colleague Peter Kramer leads with the fact that Montross was a poet before she was a doctor. He says it shows—via such traits as “self-awareness, an eye for detail, a tolerance for ambiguity, and, above all, a talent for juxtaposition, for movement from perspective to perspective, so that we see each disturbed patient in changing lights.”

The Book Structure

Meehan Crist, Los Angeles Times: “Each chapter begins with an encounter between Montross and a patient, then launches into an investigation of medicine and history inspired by that patient’s illness. Montross seamlessly weaves together history, reportage and memoir while reflecting on the difficult questions that arise as she digs into psychiatry’s past and interviews experts from its present.”

Julia M. Klein, The Boston Globe: “One weakness of ‘Falling into the Fire’ is Montross’s insistence on alternating her case studies with passages of memoir. Descriptions of her life as a happily partnered lesbian with two healthy children seem tacked on, even if they do give her an opportunity to wax literary and celebrate the randomness of luck.”

Kirkus Reviews: As an antidote to her daily coping with extreme behaviors, Montross writes serenely of a home life with her family.”

The Patients

Julia M. KleinThe Boston Globe: “The pseudonymous characters she describes in ‘Falling into the Fire’ are (among other complaints) catatonically depressed, consumed by homicidal thoughts, given to ingesting knives and scissors, or prone to seizures that resemble epilepsy but have no neurological cause. Montross’s thoughtful, discursive musings on their conditions and her sometimes faltering attempts at treatment evoke Oliver Sacks’s chronicling of neurological oddities.”

Kirkus Reviews: “The cases are bizarre: a woman repeatedly admitted for swallowing objects—light bulbs, pens, nails; a man who keeps tearing at his skin and hair, spending thousands on treatments to correct his ‘ugliness’; a woman so able to feign an epileptic seizure that staff feared she might die from status epilepticus; a mother terrified she would kill her infant, so she ‘hid all the knives.’”

Phyllis Hanlon, NY Journal of Books: “Be prepared to learn about some unusual conditions, including Jerusalem syndrome—’an acute ‘psychotic decompensation’ that afflicted 1,200 tourists to the Holy Land from 1980 to 1993’—and Stendhal syndrome, in which victims are overcome by beauty related to art and architecture.”

 

A Key Metaphor

Peter Kramer, Brown Alumni Magazine: “This sense of the enterprise’s imperfection leads Montross to her most constant metaphor for patient care: child-rearing. We meet her partner, playwright Deborah Salem Smith, and their young son and daughter.’It turns out,’ Montross writes, ‘that parenting and caring for psychiatric patients have their fair share of similarities. I mean that in all the ways in which that sentence can be interpreted: with love, and frustration, and gratification. With fear, and awe, and ineptitude.’

The Mentor

Phyllis Hanlon, NY Journal of Books:

…(A)s the author struggles with effective ways to treat these troubled patients, she seeks advice from a notable neuropsychiatrist who, instead of supplying a surefire treatment option, explains, ‘. . . you must abide with your patient.’ Basically he emphasizes the importance of creating a cooperative relationship in order to establish a reasonable path to recovery.

In time, the author comes to understand what ‘abiding with her patients’ entails. ‘I must face with them the uncertainty of what lies beyond. I must stand at the edge with them and peer over into the fathomless depths. If I tell my patients, as I do, that this life can be a tolerable one, that they can face their fears and their traumas, their visions and voices, their misery, then I must look at what I am asking them to endure and I must look at it full in the face,’ she writes.

Psychiatry

Meehan Crist, Los Angeles Times: “Montross repeatedly steers straight toward ambiguity and doubt — about herself as a doctor and about psychiatry in general. This approach echoes the ambiguity of an inherently uncertain medicine.”

Publishers Weekly: “It becomes abundantly clear that in the field there are rarely simple solutions: it is often difficult to untangle a patient’s symptoms from environmental factors, and what some might consider destructive behavior may provide the patient with genuine relief. On top of all that, Montross must also contend with wearying anxiety, uncertainty, and doubts regarding the efficacy of her aid. ‘Try as we might,’ she writes, ‘we simply cannot predict which of our patients… will leave the hospital healed, never to return.’”

Phyllis Hanlon, NY Journal of Books: “Dr. Montross explains the profession best when she writes, ‘Medicine asks its practitioners to confront the messy, unsatisfying, nonconforming human mind. As psychiatrists, we see the mind while it careens and lists, and we are not always sure how—or whether—we can right it.'”

Overall

Meehan CristLos Angeles Times: (Headline) “‘Falling Into the Fire’ a piercing portrait of psychiatry: Psychiatrist Christine Montross’ encounters with patients in crisis thoughtfully weaves history, medicine and memoir.”

Phyllis HanlonNY Journal of Books: “Well written and quite readable, the story takes readers into the life of a psychiatrist and all the positive, frightening, and downright disturbing events that take place in a single day.”

Publishers Weekly: “Her accounts of the complexities of mental illnesses encountered in the field stand in stark contrast to the tidy descriptions of those illnesses presented in the Diagnostic and Statistical Manual of Mental Disorders, and her intriguing analysis is anchored by the humble and empathetic voice of a psychiatrist working in a field wherein ‘every diagnosis is an act of faith.’”

Nov 01

“Crazy Like Us” By Ethan Watters: Mental Health Globally

American journalist Ethan Watters, in his book Crazy Like Us, argues that American psychiatry is launched on a campaign of world domination, as cultures all over the world have their mental lives distorted and traditional ways of coping eroded by the spread of DSM categories, and the conceptual and clinical repertoire that comes with it. Dominic Murphy

The full title of the above-cited book is Crazy Like Us: The Globalization of the American Psyche (2010). In the words of its author (in The New York Times): “We may indeed be far along in homogenizing the way the world goes mad.” And this is neither a good thing nor appropriate.

Some of the reviews offer other ways to rephrase his thesis:

Boston Globe:

Americans are a generous people. We donate riches to needy countries. We send our troops abroad. We have exported some of history’s most influential cultural, scientific, and social inventions: democracy, fast food, and Britney Spears.

Whether that generosity is helpful to other nations is another question. And so it goes with mental health.

Publishers Weekly: “If you thought McDonald’s and strip malls were the ugliest of America’s cultural exports, think again.”

In its book description, publisher Simon & Schuster suggests a change of course: “By setting aside our role as the world’s therapist, we may come to accept that we have as much to learn from other cultures’ beliefs about the mind as we have to teach.”

An excerpt from the opening of Crazy Like Us shows some of the significant ways, in addition to the American-bred DSM‘s far-ranging influence, in which the U.S. has been “the world’s therapist”:

American researchers and organizations run the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western universities train the world’s most influential clinicians and academics. Western drug companies dole out the funds for research and spend billions marketing medications for mental illnesses. Western-trained traumatologists rush in wherever war or natural disasters strike to deliver ‘psychological first aid,’ bringing with them their assumptions about how the mind becomes broken and how it is best healed.

More from Publishers Weekly about the author’s argument that Americans’ way of doing psych business often doesn’t translate well to other cultures:

In this well-traveled, deeply reported book, Watters takes readers from Hong Kong to Zanzibar, to Tsunami ravaged Sri Lanka, to illustrate how distinctly American psychological disorders have played in far-off locales, and how Western treatments, from experimental, unproven drugs to talk therapy, have clashed with local customs, understandings and religions. While the book emphasizes anthropological findings at the occasional expense of medical context, and at times skitters into a broad indictment of drug companies and Western science, Watters builds a powerful case.

Shelf Awareness elaborates on two striking examples from Crazy Like Us:

Watters’s report on mental health practitioners arriving in Sri Lanka after the 2004 tsunami with very little understanding of the country and culture is particularly disturbing. The generally accepted Western course for effective healing from PTSD is to process the trauma experience with the help of a trained therapist. Watters views the wholesale application of Western treatments in Sri Lanka (without taking account of the culture and recent brutal 30-year-long civil war) as having been a monumental waste of energy and resources.

That well-intentioned failure is still not as disconcerting as the story Watters has to tell about GlaxoSmithKline (manufacturers of Paxil) in Japan. ‘The psychiatric category of depression was not a widespread public concern, and the capacity to experience great sadness was considered not a burden but a mark of strength and distinction,’ Watters writes of Japanese beliefs before 2000. Despite Japanese thinking to the contrary, GlaxoSmithKline saw a huge potential market for Paxil and mounted a massive marketing campaign that combined savvy marketing and questionable scientific research. That campaign eventually bulldozered cultural resistance and long-held beliefs–by 2008, GlaxoSmithKline was selling $1 billion of Paxil annually in Japan.

Watters speaks with Jon Stewart in 2010:

Sep 12

David A. Levy Spoof Gives a Label for Over-Labeling

In the spirit of recognizing that things often defy easy categorization, á la yesterday’s post about extraversion/introversion/ambiversion, I present today a “diagnosis” proposed years ago by psychologist and professor David A. Levy in an article called A Proposed Category for the Diagnostic and Statistical Manual of Mental Disorders (DSM): Pervasive Labeling Disorder.” The main symptoms and features of PLD are as follows:

(1) an uncontrollable impulse, drive, or temptation to invent labels and to apply them to other people, (2) a repetitive pattern of trying to fit people into preconceived categories, (3) an increasing sense of fear or inadequacy before committing the act, (4) an experience of overwhelming triumph or relief at the time of committing the act.

Furthermore:

Persons with PLD operate under the fallacious belief that, by having named
something, they have therefore explained it. Research indicates that many persons with PLD are exceptionally adept at seeing in other people the flaws they cannot see in themselves…

…(M)any people have found a means to obtain reinforcement for this disorder in socially acceptable ways by becoming psychiatrists, psychoanalysts, psychologists, astrologists, Scientologists, evangelists, cult
leaders, authors of self-help books, politicians, and interview guests on radio and television shows.

Usually people with PLD remain undiagnosed until they’ve reached “a position of social power.” Furthermore, “(r)ecovery from PLD rarely occurs once the person’s annual income exceeds six figures.”

Other David A. Levy Quotes

On a somewhat related note, David A. Levy is also known to have said, “There are two types of people in this world — those who think that there are two types of people in this world, and those who don’t.”

And let’s not stop there. Here’s a collection of other quotes from Levy’s lectures on “Humor in Psychotherapy” (2007):

  • There are three things needed to eliminate human misery. Unfortunately, nobody knows what they are.
  • When a psychoanalyst takes on the role of a blank screen, all he really learns is how the patient responds to people who try to act like they’re a blank screen.
  • When it’s bad, I get depressed; when it’s good, I get nervous.
  • To the optimist, pessimists are neurotic; to the pessimist, optimists are deluded.
  • I used to fear that taking medication would change my personality; now I fear that it won’t.
  • To be neurotic is to spend one’s life perpetually replacing one worry with the next.
Mar 20

Is Your Boss a Narcissist? (Is She Like Miranda Priestly?)

Is your boss a narcissist? Well, does his or her behavior resemble that of fashion magazine editor Miranda Priestly (Meryl Streep), the demonic boss in The Devil Wears Prada (2006)? Because almost everyone seems to believe she’s a really good example of a narcissist.

Marco R. della Cava, USA Today, writes about asking Dr. Paul Babiak, co-author of Snakes in Suits: When Psychopaths Go to Work, about the Priestly character“As the ability to diagnose psychopathic behavior has improved, we find there are more women who fit this profile,” he states.

Or perhaps she’s a psychopathic narcissist? A narcissistic psychopath? A psychopath who’s also a narcissist? This sort of parsing is precisely what the DSM folks were getting at with their thoughts about eliminating NPD in the next edition—and placing it instead under Antisocial/Psychopathic Personality Disorder. But this has been dismissed for now.

(Charles Zanor reported on this for the New York Times in his aptly titled “A Fate That Narcissists Will Hate: Being Ignored.”)

But, do we really care that much about how to diagnose Miranda Priestly? We just don’t want her as our boss.

Andrea, Anne Hathaway‘s character, does, of course, wind up experiencing the misfortune of getting hired after all. And of course is wildly mistreated by boss Priestley.

If you are unlucky enough to have a boss who’s a bully or a manipulator or a puppetmaster, these just happen to be the three types of psychopaths Babiak and Hare, authors of Snakes in Suits, believe exist. Constructive advice is provided in the book about how to deal with them.