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Talking Back to Prozac
The New York Review of Books ^ | December 6, 2007 | Frederick C. Crews

Posted on 12/03/2007 4:19:00 PM PST by neverdem

The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder

by Allan V. Horwitz and Jerome C. Wakefield

Oxford University Press, 287 pp., $29.95

Shyness: How Normal Behavior Became a Sickness

by Christopher Lane

Yale University Press, 263 pp., $27.50

Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression

by David Healy

New York University Press, 351 pp., $18.95 (paper)

1.

During the summer of 2002, The Oprah Winfrey Show was graced by a visit from Ricky Williams, the Heisman Trophy holder and running back extraordinaire of the Miami Dolphins. Williams was there to confess that he suffered from painful and chronic shyness. Oprah and her audience were, of course, sympathetic. If Williams, who had been anything but shy on the football field, was in private a wilting violet, how many anonymous citizens would say the same if they could only overcome their inhibition long enough to do so?

To expose one's shyness to what Thoreau once called the broad, flapping American ear would itself count, one might think, as disproof of its actual sway over oneself. But football fans knew that Ricky Williams was no voluble Joe Namath. Nevertheless, there he was before the cameras, evidently risking an anxiety attack for the greater good—namely, the cause of encouraging fellow sufferers from shyness to come out of the closet, seek one another's support, and muster hope that a cure for their disability might soon be found.

Little of what we see on television, however, is quite what it seems...

--snip--

As for the frequently rocky initial weeks of treatment, a troubling record not just of "suicidality" but of actual suicides and homicides was accumulating in the early 1990s...

(Excerpt) Read more at nybooks.com ...


TOPICS: Business/Economy; Crime/Corruption; Editorial; Government
KEYWORDS: bigpharma; bookreview; depression; disorders; health; medicine; mentalhealth; pharmaceuticals; prozac; psychiatry; ssri
Genetic Markers of Suicidal Ideation Emerging During Citalopram Treatment of Major Depression

new FReebie

1 posted on 12/03/2007 4:19:01 PM PST by neverdem
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To: neverdem

bump


2 posted on 12/03/2007 4:24:13 PM PST by VOA
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To: neverdem

Would this be a new way to obtain more of the population’s DNA for ulterior motives? I confess, I did not read the whole article.


3 posted on 12/03/2007 4:25:50 PM PST by Snoopers-868th
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To: neverdem

The Liberal doctrine of victimology dovetails nicely with the economic incentive to sell a cure for victimhood. If the lefties aren’t being duped by hard core Marxists, they’re being duped by Madison Avenue. Their enthusiasm for acting like idiots is inexhaustible.


4 posted on 12/03/2007 4:27:04 PM PST by Spok
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To: El Gato; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; LadyDoc; jb6; tiamat; PGalt; Dianna; ...
Radio Waves Fire Up Nanotubes Embedded in Tumors, Destroying Liver Cancer

Key gene involved in Lupus identified

Ebola outbreak spreading

FReepmail me if you want on or off my health and science ping list.

5 posted on 12/03/2007 4:31:31 PM PST by neverdem (Call talk radio. We need a Constitutional Amendment for Congressional term limits. Let's Roll!)
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To: neverdem

Psychiatry adopted the biological model for mental illness due, in large part, to medical economics and also because psychiatrists want to be counted among “real doctors.” The biological model allows treatment of all psychiatric disorders with medicine and dramatically increases the number of billings per day. (Medical economics)


6 posted on 12/03/2007 4:32:27 PM PST by Rudder
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To: Snoopers-868th
Would this be a new way to obtain more of the population’s DNA for ulterior motives?

If you have prior military service, don't worry. They already got your precious bodily fluids. How else are they going test for adverse reactions with these SSRI antidepressants?

7 posted on 12/03/2007 4:39:08 PM PST by neverdem (Call talk radio. We need a Constitutional Amendment for Congressional term limits. Let's Roll!)
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To: Spok
The Liberal doctrine of victimology dovetails nicely with the economic incentive to sell a cure for victimhood. If the lefties aren’t being duped by hard core Marxists, they’re being duped by Madison Avenue. Their enthusiasm for acting like idiots is inexhaustible.

LMAO!

8 posted on 12/03/2007 4:42:51 PM PST by neverdem (Call talk radio. We need a Constitutional Amendment for Congressional term limits. Let's Roll!)
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To: neverdem

Prozac, Zoloft, Paxil, Luvox, and Similar Drugs
https://secure25.securewebsession.com/painstresscenter.com/mall/Prozac.html


9 posted on 12/03/2007 4:45:16 PM PST by XeniaSt (you shall know that I, YHvH, your Savior, and your Redeemer, am the Elohim of Ya'aqob. Isaiah 60:16)
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To: XeniaSt

Thanks for the link. At least the drug approval process has been updated. The FDA now demands to see all trial results.


10 posted on 12/03/2007 5:12:22 PM PST by neverdem (Call talk radio. We need a Constitutional Amendment for Congressional term limits. Let's Roll!)
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To: Rudder
You don't think any of them might have actually thought that there was a biological contribution to some kinds of mental illness and then pursued and examined the evidence to see if there was anything which might support that notion?

Like, for example the abnormal EEGs associated with some affective disorders, the ways some drugs can cause clinical depression or greatly exacerbate it, or the remarkable responses (reported, often, not by the patient but by the family, friends, and associates of the patient) to some medications?

Or, on a larger scale, Are all opinions determined not by evidence but by the desire for some kind of gain? And if so, is the opinion that opinions are so determined itself so determined? Certainly the opinion that opinions are determined by economic gain and power would fallunder the genral classification of "Marxism", and while there are many problems with Marxism, the first is the problem of how does Marxism explain Karl Marx?

And what is "Psychiatry" that "it" can adopt or reject models?

Having said all that, I will eagerly agree that medical insurance companies sure wish that all psychiatric problems would respond to medications which are often cheaper (and more effective, maybe) than "the talking cure".

11 posted on 12/03/2007 5:22:57 PM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: Spok

There’s also a huge liberal doctrine of equating mental illness with physical illness. The result is that medication is viewed as much more effective than it really is. The same liberal doctrine decrees that it’s politically incorrect to point to anyone and say they’re crazy, and to deprive them of their “freedom” on that basis. So when someone is obviously crazy, we say they’re “ill”, give them medicine, and send them on their way. The fact that they continue to send up clusters of red flags indicating that they’re suicidal or homicidal is ignored, as long as they’ve gotten pills and “counseling”.

I really think it’s this phenomemon — pretending people aren’t crazy when they really are — and not effects of the various medications, that accounts for the suicide and homicide rates. If the Virginia Tech mass murderer/suicider had been on Prozac, etc, he’d be added to the stats of the drugs correlating with suicide/homicide. But the simple fact is that despite his profound insanity being perfectly obvious to everyone who came into contact with him, he was allowed to continue living unsupervised in a college dorm, coming and going from campus as he pleased, going to classes of his own choosing, ordering whatever he wanted off the Internet and receiving packages without screening, playing violent Internet games all the time, and turning in disturbing and violent writings for his school assignments (and getting passing grades for them, despite their being completely incoherent!). Most people probably assumed he was getting some medication and counseling, but apparently he wasn’t. Not that it would have made any difference.

There are lots of kids on Prozac and other common drugs who are exhibiting similar (though in most cases milder) signs of insanity, who were exhibiting the same signs before they were on the drugs. Sooner or later some of them are bound to snap, and sooner or later — usually at some point before they snap — somebody takes note that they’re “ill” problem and gives them some pills and “counseling”, and lets them go right back to what they were doing. Once upon a time, people who were obviously crazy were locked up. Now they aren’t. The fact that many of them are also given pills while not being locked up isn’t why so many are acting on suicidal and/or homicidal urges — they’re just getting the opportunity to act on those urges because they’re not locked up!


12 posted on 12/03/2007 5:37:16 PM PST by GovernmentShrinker
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To: Mad Dawg
And what is "Psychiatry" that "it" can adopt or reject models?

Well, as a psychiatrist (ret) I would use "pursue" instead of adopt. You raise legitimate points and psychiatry has the data you mention and is doing that type of research you mention. It is also abandoning "talking therapy," (too time-consuming) and making unwarranted diagnoses all for the sake of increasing the bottom line. For example, Personality disorders are rarely diagnosed and are replaced with bi-polar affective disorder--why? Because you cannot treat personality disorders with medicine. Virtually all of the research in Psychiatry pursues the "Nature" (biological) side of mental illness while ignoring the "Nurture" (life's experiences and learning) side---that in and of itself is pursuit of the biological model.

13 posted on 12/03/2007 5:37:40 PM PST by Rudder
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To: Rudder
Well, I guess you're showing psychiatrists ain't philosophers!

As a long time consumer of psychiatry and a pastoral counsellor (who tries to keep a stable of good shrinks for referrals and as an anchor to windward) I'd say that certainly all of us care-givers can get seduced by any number of things, including the curious satisfaction of a fat bank account.

For example, Personality disorders are rarely diagnosed and are replaced with bi-polar affective disorder--why? Because you cannot treat personality disorders with medicine

Humongo 10-4 here. At a guess, I'd suggest that a generally lousy prognosis would also play into the desire to write a scrip, collect the fee, and get it over with.

I was a chaplain a million years ago (1974-1975) at Mass General and the Psych wing then was entering the pursuit of the "organic" etiology of God, the universe and everything, and they didn't think much of chaplains. (Not that I blame them. A lot of us were pretty flakey.)

But I was very taken, when they would allow me to converse with some of their patients, with what seemed to me to be clear signals of organic aspects to some of the illnesses. Untrained as I was, though, I couldn't make much of a scientific case.

However if I had any doubts about the organic aspects of some affective disorders, they were dispelled when I had 3 out of 4 of the suite of bad neuro reactions to lovastatin. - Loss of taste and smell, lost of memory, and depression like unto wading through a universe of pudding. I finally figured it out when I realized that if somebody came to me and "presented" the way I felt, I would drop everything and drive him or her to a hospital.

Now every major decision in my house is prepared for with coffee and prayer. So I went to the coffee maker and, Lo, there was my bottle of pills. And a lightbulb lit over my head as I said to myself,"You don't suppose ...." A few phone calls to some mental health professionals later and I had my diagnosis.

I bet that treatment of some personality disorders would be assisted with some of them thar serotonin re-uptake inhibitors or whatever, but my own personal pet theory is that personality disorders are in the same family as (a lot of) substance abuse and need the same kind of approach -- and that therefore drugs just won't do it.

My philosophy crack was that speaking of "psychiatry" as pursuing something might border on the "fallacy of misplaced concreteness". I would suggest, for discussion and not as a final word, that there is no "psychiatry", there are only lots o' psychiatrists.

Thanks for your response.

14 posted on 12/03/2007 6:22:18 PM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: Mad Dawg
That was a very thoughtful post.

However, you might consider the idea that outside stimuli might also have the ability to re-wire the brain.

15 posted on 12/03/2007 6:26:25 PM PST by durasell (!)
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To: durasell
Oh yeah. What about "Conditioned reflex" as at least a metaphor for how some of what we technically refer to as "wackiness" might as well be organic even if the initial cause was environmental?

Anyway, the idea of meds alone without at least SOME kind of "talking cure" or other therapy seems silly to me. If I've been depressed for most of my life (which I have), even if HOW I got that way isn't especially relevant, certainly I have formed, as it were, habits or responses that I could use some help in understanding. And then new behaviors are almost certainly going to make me anxious and perhaps unearth some other "knots" (R. D. Laing - great book) in the old puhSighKey.

But then, I've always liked talking .....

16 posted on 12/03/2007 6:39:49 PM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: Mad Dawg
No psychiatry, just psychiatrists---LOL (and too close to the truth). I favor Adolph Meyer's psychobiology.

Personality disorders are intractable and, as such, not comparable to addiction. Their long-term prognosis can be good for the very short run; long-term is always "back to square one"--if suicide doesn't intervene. But meds, at times, can bring relief and safety, but only for a short period. Compliance is a huge problem with personality disorders.

17 posted on 12/03/2007 6:59:21 PM PST by Rudder
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To: Mad Dawg

Just my opinion — but I’d say talking cure along with spiritual guidance. Again, just my opinion — but the goal of meds in many, many instances should be to not need the meds. Get the person up on their feet with the pills, then address the problem in other ways.


18 posted on 12/03/2007 7:00:09 PM PST by durasell (!)
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To: Mad Dawg

p.s.

Obviously, if there’s some major problem then the meds are forever. But from my observations, there couldn’t possibly be as many major problems as there are people taking meds these days.


19 posted on 12/03/2007 7:02:30 PM PST by durasell (!)
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To: Rudder

If you tested of govt employees, 95% if them would have some kind of personality disorder. And I’m not joking, either.


20 posted on 12/03/2007 7:04:47 PM PST by darkangel82 (And the band played on....)
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To: darkangel82

That itself is depressing.


21 posted on 12/03/2007 7:19:38 PM PST by Rudder
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To: Rudder

Yes, it is. The inmates truly are running the asylum.


22 posted on 12/03/2007 7:34:26 PM PST by darkangel82 (And the band played on....)
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To: neverdem; AdmSmith; Berosus; Convert from ECUSA; dervish; Ernest_at_the_Beach; Fred Nerks; ...

“Williams was there to confess that he suffered from painful and chronic shyness.”

Typical Oprah fare — a sports/showbiz figure goes on TV in front of a live audience, meeting an intimidating public figure, to tell everyone he’s painfully shy. :’) Thanks neverdem.


23 posted on 12/03/2007 8:56:05 PM PST by SunkenCiv (Profile updated Friday, November 30, 2007____________________https://secure.freerepublic.com/donate/)
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To: durasell
Rudder, durasell,

I'm enjoying and profiting from both of your comments, so I thought I'd bring us all together.

Please sit in a circle now and repeat after me:
Ommmmmmmmm

Rudder: The last I heard was that Substance abuse per centage of payability was about 20% Are there any new numbers? What prompted my conjecture about PDs being like substance abuse was the way (as it seemed to me) that SOME people who had been in AA for a decade or more seemed to be describing a rebuilding of their personalities, the slow and painstaking adoption of a new armamentarium of defense mechanisms, reactions, "tapes", and like that.

My very limited experience with Substance abusers was that compliance was pretty low there as well. The non-compliant, though, tend to drop out of sight and die, and drop from the data pool.

Could be I'm just being cynical. But, clergy being free and all, we get a lot of abusers and their codependents long after they quit with the medical help (or, more frustratingly to me, as a quick and dependent "fix" - in all senses - INSTEAD of the slow deliberate process of getting better.)

Germane here is the great Cheech and Chong line: I used to be all messed up on drugs, but now I'm all messed up on the Lord.

Durasell: Yeah, it seems to me a decent pastoral counselor can be a very useful adjunct from a medical POV to a good pshrink, just as a good pshrink can be mutatis mutandis.

Rudder, my hunch is you would agree with durasell that these drugs are WAY over prescribed.

Both of y'all: I'm not sure what to do with this thought but it seems to me in some intractable cases where the patient is reluctant to do the work of cure, meds are still appropriate for the sake of the family of the presenting person AND because, sometimes, little by little, if the presenting person isn't, say, depressed all the time, maybe some other family issues will rearrange themselves - benignly or not - around the "new" person.

24 posted on 12/04/2007 4:50:36 AM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: Rudder; darkangel82
You guys should see the Sheriff's office where I was for a while! 15% plus on their FOURTH marriage!

Can you say "Stress junkie"?

One problem with my chaplaincy there was that these folks were omnicompetent -- just ask 'em -- and could take care of God just fine without some dorky former clergy-dude being imposed upon them.

25 posted on 12/04/2007 4:54:19 AM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: Mad Dawg

I’ve known quite a few substance abusers. The thing that seems to help them most is some kind of mechanism — a lot of different elements coming together.

However, I do have a problem with the way the medical profession is handing out psych drugs like after dinner mints these days.


26 posted on 12/04/2007 5:56:21 AM PST by durasell (!)
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To: neverdem
As for the frequently rocky initial weeks of treatment, a troubling record not just of "suicidality" but of actual suicides and homicides was accumulating in the early 1990s...

And earlier, including the 1970s suicide of one of the Eli Lily research chemists who developed the stuff, long before it was available as a prescription drug.

He went into Indiana's Hoosier National Forest, stripped naked, built a little bonfire with his driver's licence, company ID card and other wallet contents, and hanged himself on the spot.

I have no idea whether it was a result of the effects of the compound he was helping create, guiltr over what it would do when unleashed on an unsuspecting public, or both.

27 posted on 12/04/2007 7:48:07 AM PST by archy (Et Thybrim multo spumantem sanguine cerno. [from Virgil's *Aeneid*.])
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To: durasell; Mad Dawg

I think that this “happy pills” have become an easy out for far to many people. There are those who need them, but many doctors will prescribe them at the drop of a hat.


28 posted on 12/04/2007 3:11:22 PM PST by redgolum ("God is dead" -- Nietzsche. "Nietzsche is dead" -- God.)
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To: redgolum

Many of the doctors prescribing them are not qualified to judge someone’s mental health, nor do they follow-up with the patients.


29 posted on 12/04/2007 4:38:21 PM PST by durasell (!)
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To: durasell; redgolum

Durasell’s observation seems right to me. A lot of internists and so forth really are clueless about psychology - their own or anybody else’s. It seems to me bordering on malpractice for some of them to prescribe these drugs.


30 posted on 12/05/2007 6:16:48 AM PST by Mad Dawg (Oh Mary, conceived without sin, pray for us who have recourse to thee.)
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To: neverdem
This is just anecdotal, but here is my story.

My dad died a few days before Christmas (nine years ago). He had been ill, but his passing was totally unexpected. I spent about two straight days at the hospital, then had to make the funeral arrangements, and still try and make a nice Christmas for my grieving children. From stress and lack of sleep, what started as a simple cold excelerated into pneumonia quickly. My husband had to take me to the doctor (I was too sick to drive). Our family doctor quickly prescribed an antibiotic; expectorant; wrote a script for a chest series, etc. This took about five minutes. The next 15 minutes or so were used to deal with my 'depression.' I had about 8 straight days of He%% I was recovering from, grieving over. I left the doc's office w/scripts for what I really needed (meds to clear my chest) but I had, in my possession samples of Paxil (to get me thru). I didn't take the Paxil, but I thought (at the time and still do) 'aren't we allowed to just grieve?' Why the rush to medicate. I trully know people who have had long term problems that SSRIs have helped, but I was taken aback by the quickness of handing the samples (unrequested) over to me.

31 posted on 12/05/2007 6:34:14 AM PST by PennsylvaniaMom (I do not want people to be agreeable, as it saves me the trouble of liking them. Jane Austen.)
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To: Mad Dawg

The drug is a crutch — it gives the patient a little breathing room and time for treatment. For the vast majority of patients, the drug isn’t the end of the line as far as treatment is concerned.


32 posted on 12/05/2007 7:26:01 AM PST by durasell (!)
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To: neverdem

I was in medicine BEFORE prozac, and even before the older anti depressants.

Suicide was a common problem during the recovery phase of depression, before these medicines were around. Indeed, the rates of suicide in teenagers has gone down since we docs started using them on depressed kids (of course, when the suicide occurs, often they are on prozac). Yet with the increase in societal disintegration (drugs, divorce, neglect) one should expect an increase in suicide for teens.

Prozac makes some people jittery/angry. When I found this in my patients, I usually referred them to a psychiatrist: Many were not “depressed” but bipolar (manic depression) or had a severe problem with anger turned inward (women who had been abused, homosexuals who hated the world’s rejection, men who had a problem with their father).

Mild depression responds well to counselling, but unless you have suffered from biochemical depression, you have no right to dismiss the use of prozac.


33 posted on 12/05/2007 3:18:38 PM PST by LadyDoc (liberals only love politically correct poor people)
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To: Rudder
personality disorders

Borderlines - (((( shuddderrrr ))))!!!

34 posted on 12/05/2007 3:25:54 PM PST by Hardastarboard (DemocraticUnderground.com is an internet hate site.)
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To: PennsylvaniaMom
). I didn't take the Paxil, but I thought (at the time and still do) 'aren't we allowed to just grieve?'

Grieving is a normal reaction, and helps a person cope with their loss. Avoiding the grieving period can have bad repercussions down the road.

35 posted on 12/05/2007 3:42:15 PM PST by Jaidyn
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To: LadyDoc
Mild depression responds well to counselling, but unless you have suffered from biochemical depression, you have no right to dismiss the use of prozac.

I'm not dismissing the use of prozac. Look at the links in comments one and nine. Between Serotonin syndrome and Serotonin (withdrawal or discontinuation) syndrome, I'm just saying that SSRIs have a potential for suicide and homicide that merit very close follow-up when they are started or the dose is changed.

ANTIDEPRESSANT CASUALTIES


36 posted on 12/05/2007 4:59:59 PM PST by neverdem (Call talk radio. We need a Constitutional Amendment for Congressional term limits. Let's Roll!)
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To: neverdem
I'm just saying that SSRIs have a potential for suicide and homicide that merit very close follow-up when they are started or the dose is changed.

This "threat" existed long before SSRI's.

37 posted on 12/05/2007 9:02:29 PM PST by Rudder
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