May 08

“No One Cares About Crazy People”: As True As Ever

[Ron] Powers intends for the book to comfort families dealing with severe mental illness, to shock general readers with examples of atrocities befalling the mentally ill, to show that “crazy people” are rarely dangerous to anybody but themselves, and to push for significant reform. “I hope you do not ‘enjoy’ this book,” he writes in the preface. “I hope you are wounded by it; wounded as I have been writing it. Wounded to act, to intervene.” Kirkus Reviews, about No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America (2017)

No One Cares About Crazy People was written before all the recent outrageous attempts to decimate the Affordable Care Act. Just imagine the additional things author Ron Powers could say now.

Powers writes about his two sons afflicted with schizophrenia. “For his son Kevin, that struggle ended in suicide, and the heartbreak of that experience (among others) permeates every impersonal date and statistic in the book with sorrow and rage” (Shelf Awareness). Son Dean is still in treatment.

As told to Terry Gross (NPR), “There is no greater…feeling of helplessness than to watch two beloved sons deteriorate before [your] eyes, not knowing what to do to bring them back.”

A brief explanation for the title as well as a book synopsis, per Publishers Weekly:

This resounding rebuke to scornful attitudes toward the mentally ill takes its title from a notably insensitive 2010 email exchange between high-level staffers of Scott Walker during his run for Wisconsin governor. Using that moment as a touchstone of indifference, Powers…weaves a dual tale of the personal and the political. In one thread, he traces the history of public efforts to ameliorate (or, more often, hide) the plight of those living with mental illness, from London’s infamous Bedlam in the 18th and 19th centuries, where wealthy visitors were charged admission to gawk at the inmates, to America’s present-day prison-industrial complex. In the other, he tells his own family’s heartrending story of grappling with disease…

Although drug therapy can be helpful, Powers believes, “(h)e recognizes that ‘Big Pharma’ has made money distributing drugs of questionable usefulness” (Margaret Quamme, The Columbus Dispatch).

A couple things Powers deems pointedly not helpful:

  • Deinstitutionalization: Many inpatient facilities closed in the 1960’s in favor of caring for patients in community mental health centers. If well-meaning, it also failed many who wound up in prisons.
  • Anosognosia (“The false conviction within a person that nothing is wrong with his mind”) is ignored by laws that prevent involuntary commitment to mental health facilities.

If indeed “no one cares about crazy people,” Powers means people other than their loved ones, of course. From Shelf Awareness: “For the families of the mentally ill…caring about ‘crazy people’ is a necessity. In roughly alternating chapters, Powers allows us to watch his sons grow up, dealing with the challenges of incipient schizophrenia as well as tragic events that shape their young minds. All the while, Powers movingly relates the joys of raising creatively gifted children.”

The critique by Ron Suskind, New York Times, offers a fitting conclusion for this post:

No doubt if everyone were to read this book, the world would change. But its clumsy title…is painfully correct. The mentally ill are still viewed with fear or suspicion, as broken, as damaged goods or objects of pity. Still, Powers will surely help to correct that perspective; it’s impossible to read his book without being overcome by empathy for his family, respect for his two beleaguered boys and, by the end, faith in the resilience of the human heart.

Aug 31

Fifth Anniversary of “Minding Therapy”: Part Two

Part Two of the fifth anniversary commemoration of “Minding Therapy” offers excerpts from the most-viewed posts of the last three years. See Part One here.

I. Andrew Solomon: Recent TED Talk “Forge Meaning, Build Identity” (2014)

“I’m lucky to have forged meaning and built identity, but that’s still a rare privilege, and gay people deserve more collectively than the crumbs of justice. And yet, every step forward is so sweet.”

II. Frozen: What Are the Meanings and Messages in the Film? (2014)

Catherine Bray, Time Out: “The standout song, ‘Let It Go’, feels like Disney’s most inspired coming-out anthem yet (‘Conceal, don’t feel, don’t let them know. Well, now they know’).”

III. Psychiatry and Big Pharma: James Davies, Author of Cracked (2013)

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.

IV. The Procrastination Equation By Piers Steel: Don’t Put Off Reading It (2014)

So, Steel says right there in the title of the book that he has an equation, which, according to Kirkus Reviews, is Expectancy x Value / Impulsiveness x Delay = Motivation. “Simply put, the equation means that the motivation to perform a particular task declines when the expectancy or value of a task’s reward declines or when there is an increase in impulsivity or in the delay of the task’s reward.”

Or not so simply put. More simply is something like, we’re not as committed as we’d like to be, it feels hard, we want what we want now, and besides, other stuff gets in the way. (If my paraphrasing is lacking, my apologies to Steel.)

V. Childhood Disrupted: ACES and Your Physical Health (2015)

What doesn’t kill you makes you stronger?
Not quite. Far more often, the opposite is true. Donna Jackson Nakazawa, author of Childhood Disrupted

Two-thirds of American adults are carrying wounds from childhood quietly into adulthood, with little or no idea of the extent to which these wounds affect their daily health and wellbeing. Something that happened to you when you were five or 15 can land you in the hospital 30 years later, whether that something was headline news, or happened quietly, without anyone else knowing it, in the living room of your childhood home. Donna Jackson Nakazawa

VI. Birdman: Does He Fly? (Reviews of the Film and A Non-Answer) (2014)

Tom Long, Detroit News: “Can Riggan really fly? Can any of us? ‘Birdman’ doesn’t offer the answer, but revels in the question. Soar with it.”

VII. Single People Have a Strong Voice in Bella DePaulo (2016)

I defend single people because we are relentlessly demeaned by myths and pseudoscientific claims that say our lives are second-rate. But I’m not advocating singlehood for all. Some people live their best lives married, and others find more meaning and fulfillment in single life. This is the 21st century. We don’t all have to choose the same life path. Bella DePaulo, PhD, “Everything You Think You Know About Single People Is Wrong” (Washington Post)

VIII. Patrick Kennedy Portrays A Common Struggle in His New Book (2015)

So far, notably, it seems that news about A Common Struggle has focused more on the family’s negative reactions to it and less on reporting or reviewing its actual contents. The Boston Globe, however, calls the book “strikingly raw and emotional,” while other readers have applauded this Kennedy’s courage and openness.

IX. Lucy van Pelt of “Peanuts”: Her Best Psychiatric Advice (2015)

From 1984: By the time I’ve grown up, we’ll probably have a woman president. You know what that means, don’t you? It means I won’t get to be the first one. BOY, THAT MAKES ME MAD!! 

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: