Posted on 06/13/2011 6:10:37 PM PDT by TheDingoAteMyBaby
In a New York Review of Books essay, Marcia Angell, former editor of The New England Journal of Medicine, considers three books that take skeptical looks at "the epidemic of mental illness" sweeping the country:
The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades....
A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives.
Angell poses some questions about this epidemic:
Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn't we expect the prevalence of mental illness to be declining, not rising?
As those questions suggest, Angell seems to share the skepticism of the authors whose books she reviews: University of Hull psychologist Irving Kirsch, who in The Emperor's New Drugs shows that antidepressants are only slightly more effective than placebos, so slightly that the difference may be attributable to stronger expectations of improvement primed by the drugs' side effects; the journalist Robert Whitaker, who in Anatomy of an Epidemic argues that the "astonishing rise of mental illness if America" can be understood largely as an outgrowth of the desire to sell psychiatric drugs; and Daniel Carlat, a Boston psychiatrist who confesses his profession's shortcomings in Unhinged: The Trouble With Psychiatry. Angell notes that "none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain." She adds that "the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed."
That may come as a surprise to uncritical viewers of pharmaceutical commercials or credulous readers of the APA's Diagnostic and Statistical Manual of Mental Disorders. But it is a truth acknowledged even by many psychiatrists, including the chief editor of the current DSM, who recently despaired that the attempt to define mental disorders is "bullshit." Despite psychiatry's medical pretensions, the equation of mental illnesses with brain diseases remains little more than an assumption. In fact, as Thomas Szasz observes in the preface to the 50th anniversary edition of The Myth of Mental Illness, once a particular pattern of behavior can be confidently ascribed to a physical defect, such as the brain damage caused by advanced syphilis or Alzheimer's disease, it is no longer considered a psychiatric issue. "Contemporary 'biological' psychiatrists tacitly recognized that mental illnesses are not, and cannot be, brain diseases," Szasz writes. "Once a putative disease becomes a proven disease, it ceases to be classified as a mental disorder and is reclassified as bodily disease."
Angell does not mention Szasz in the first installment of her essay, and I suspect he will be absent from the second part as well. It is OK to agree with Szasz about psychiatry's lack of scientific rigor as long as you do not acknowledge that you are agreeing with him. In an upcoming book review for Reason, I note that the renegade psychiatrist's ideas are is routinely dismissed as obsolete at a time when they seem more relevant than ever.
I’m unhinged thank you.
The other half are Liberals.
Gotta love that. The DSM is a pretty respected publication and its editor is calling it like it is.
Good thing she is talking about New England.
And the third half are editors.
Someone coined the term, “pathologizing normal.” You aren’t just shy, you have social anxiety disorder.
I’ve been a Szasz since 1978. Have gotten into several arguments, especially with school social workers because of it.
Basically, people either have an organic issue, which with fMRI’s is getting easier to find, or thy have learned inappropriate behavior.
There is no such thing as ‘mental illness”
It ain’t rock science, just common sense.
"Congressman Weiner, please pick up the white courtesy phone..."
I wonder how many porn addicts get SSI for being porn addicts. so then they sit home, and , you know...
“Half of Us Are Mentally Ill”
Close—Obama won by 52.9%.
The country always gets more of what it subsidizes. It doesn’t take long to have a crowd gathering for “free” money.
Well, the other 2.9% can be attributed to cheating at the polls.
My father has a similar opinion. The brain can be ill, but the mind is not a physical organism subject to illness.
very convenient way of arriving at “none of us can have a gun”
I disagree with that. Schizophrenia is caused by genetic abnormalities. I think that, as we learn more about the human genome, we will find more mental disorders that have a genetic basis.
That does not rule out, however, that many so-called mental disorders are, in fact, results of enviromental factors. Parents who don't know how to tailor discipline to their child, for example, may have their child diagnosed with "oppositional defiance disorder." And I'm firmly convinced that ADHD is well within the range of normal; it's just a personality type that requires a little more effort to engage than the typical teacher droning along in a classroom cares to expend.
Judging from what I have seen of humanity, normal is a pretty vague term.
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