May 08

“No One Cares About Crazy People” (Book)

[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)

Ron Powers has written 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 Big Pharma distributes some medications that may not be up to the task.

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.

Sep 10

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

Cracked: Why Psychiatry is Doing More Harm Than Good is by British therapist and researcher James Davies. In it he takes on psychiatry and Big Pharma.

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.

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

The 2007 book Shyness: How Normal Behavior Became a Sickness, by Christopher Lane, revealed how a pharmaceutical company can use pathologizing towards unscrupulous ends. Lane concludes, “Before you sell a drug, you have to sell the disease. And never was this truer than for social anxiety disorder.” Paxil anyone?

Also on the topic of Paxil, Alison Bass wrote Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial, which Arnold S. Relman, M.D., from Harvard Medical School called “a richly detailed account of the disgraceful self-serving ties between drug companies and the psychiatric profession.”

A 2010 article by Tyler Woods, Ph.D., reports that 68% of members of The American Psychiatric Association’s task force writing the next (2013) edition of the DSM admit to “economic ties with drug companies.” How do you think this might affect their opinions regarding whether something belongs in the DSM as a mental disorder?

As therapists and clients become increasingly aware of the implications of pathologizing as well as the actions of Big Pharma, perhaps we can be more careful ourselves about not “buying into” the costly and misguided labeling of our problems.