Letters from the Front Lines

Dear Bob–

Here’s a story of stark contrasts.

I saw a man for a physical recently, mid-50’s.  He was the picture of health, on no medications or supplements.  He was an avid biker and outdoorsman, conscientious of his diet, great relationship with his wife and kids.  He laughed easily, and when I talked to him about his mental health, he said, “You know, life is great.  I always thought getting older would be no fun, but every day is an adventure.  I feel really blessed.”

Less than an hour later, I saw another man, also mid-50’s, overweight, dour, emanating a negative energy the moment I walked in the room.  He was there for a refill of his Prozac and Ambien, which he had been on for years.  His blood pressure was high, and his recent labs showed a disturbing slide towards diabetes.  He was not exercising, ate poorly, was divorced and lived alone, and watched five hours of TV every night.  He said to me, “Life sucks, but what are you going to do about it?”

The first man seems to be living life to the fullest, and the second seems to be living in a state of cynical despair.

I’m not trying to draw any firm conclusions about the effectiveness of (or need for) meds in these two cases.  Their stories are much more complex than just the information I’ve presented here.

But what I want to remark upon is the stark contrast in these two men’s lifestyles and outcomes.

The first man is living in a way that promotes mental wellness.  Some of this may be his aptitude, genetic predisposition, happy childhood, fortunate circumstances, social supports, as well as consistent healthy choices.  But whatever it is, the combination is working well for him.

The second is living in a way that is antithetical to mental wellness.  Sedentary, poor nutrition, lack of social interaction or engaging activities, negative thinking patterns.  Again, much complexity and history to unravel, and his genetics and circumstances certainly loom large, but even by his own admission, this combination is not working well.  And in this millieu, the medicines are clearly not curing anything.

So what are they doing?  Are they preventing him from becoming worse?  This is what he thinks.  This is what most psychiatrists and family doctors would assume, that the prozac is propping him up, the only thing keeping him from total mental collapse, perhaps suicide.  How could a doctor consider stopping a medicine for someone who was so clearly diseased?  Conventional wisdom–and all of my formal training–says that a doctor should consider changing medications here, or adding more, searching for some technological intervention that will bring a better result.

But what if the medications are actually making him worse?  What if for twenty years his brain has become sensitized, now altered by the meds, and they are now a net drain on his brain physiology and thus on his mental wellness, not to mention the accumulation of physical, compounding side effects such as weight gain and hypertension?  What if, because he was labeled as diseased twenty years ago and offered the allure of a simple pill fix, he has neglected to pursue those healthy habits that would lead to sustainable mental wellness?

This is of course the central conclusion of Anatomy of an Epidemic, that the psychopharmaceutical model of mental illness has created a state of worsening, chronic mental illness and disability, not only in America, but in every country that has followed America’s lead through DSM diagnoses and psychotropic medications.

If this is all true, then it speaks to a cataclysmic failure of the specialty of psychiatry, so awash in pharmaceutical dollars, and also the abdication of the medical profession’s oath to Do No Harm.  Do not hurt your patients.  Even if you can’t help them, do not hurt them with your pills or your surgeries.  The evidence for the net ineffectiveness and harm of psychotropic medications is fast becoming incontrovertible.

This failure is not theoretical, but was sitting in front of me yesterday in the form of this unhealthy, cynical man who twenty years ago was distressed and trusted his doctors to help him feel better.  But rather than trust his doctors, what if he’d had as a friend the first man, and tried to follow his lead of exercise, healthy eating, and engagement in meaningful activities and relationships?  No doctors, no diagnoses, no drugs.  Where would he be today?

Time to turn things around, for him and for all of us.

Mark

Editor’s note: These letters are selected from an exchange that Dr. Foster and Robert Whitaker have had since he read Anatomy of an Epidemic. They describe his interactions with his patients, and his changing thoughts about the prescribing of psychiatric medications. In all of these letters, the specific patient situations he describes are real, but all identifying characteristics have been changed, or permission has been given, in order to protect patient privacy.