Reading Robert Whitaker’s Anatomy of an Epidemic,1 as well as Irving Kirsch’s proof that antidepressants are placebos,2 emboldened me to finally come out with the anti biological psychiatry sentiments I had harbored for years. I agreed with each word in Whitaker’s book, until he proposed that patients mostly worsen due to chemical effects of their meds. I wondered: He showed that ‘mental illnesses’ aren’t chemically caused, so why suggest that their worsening when ‘treated’ is mainly chemically caused?
Why embrace and legitimize psychiatry’s medical model by joining its hunt for biological causes of human experiences? Since mental illnesses are actually reactions to psychosocial issues, why not instead focus on psychosocial causes of their worsening? Here’s my psychosocial explanation.
In seeking psychiatric treatment, clients transfer responsibility for dealing with life’s struggles to medical authorities. By relinquishing their right to choose how to cope, they become like inmates in asylums: As in asylums, free will is replaced by passive, helpless submission to doctors’ orders, the main one being to take pills to control their feelings, thoughts, and actions. As in asylums, they are assigned a humiliating, dehumanizing ‘mental illness’ identity — its acceptance also leads to their eternal withdrawal from the challenges of life in society and thus their removal/alienation from it.
They thus commit to and get locked into lifelong dependence on psychiatry. As years go by, their ability to use their free will and brains to adaptively cope with life and their feelings will get lost due to disuse. They’ll thus find it increasingly difficult to ever reclaim independence/functionality in the outside world. Labeled/treated kids aren’t even given a chance to learn how to use their free will and their adaptive brains; they thus fall increasingly behind their peers, and never become functional or independent.
So psychiatry didn’t really stop institutionalizing people; it just found new ways to do it.
Even if one day they stop suppressing their brains with ‘meds,’ they may not really break free of psychiatry’s spell; they may still believe that they’re brain disease victims. But now they’ll view their struggles (which will be harder due to having become institutionalized) as symptoms of drug-impaired rather than genetically-impaired brains. This will needlessly deter them from trying to break out of the asylum (use their brains to regain control of their lives), just as faith in having a mental illness had misled them to needlessly give up on their resourceful capabilities in the first place.
Increasing institutionalization explains clients’ downhill course over time. Drug impairment does not, since it’s usually steady, unless the dose is steadily raised due to addiction/withdrawals, or if there’s progressive brain atrophy. But even atrophy in sedated clients’ brains may be due to disuse (as occurs in other body parts not used for long periods) rather than direct chemical effect. In fact, studies suggest that cognitive3 and physical4 exercise (things zombified clients can’t do) prevent brain atrophy in seniors. So psych clients’ brain atrophy may be due to institutionalization instead of drug toxicity. Disuse of their brains and bodies may also slow their metabolic rate, while their inactivity can lead to using food to fill time and stuff down feelings. So weight gain might also be a result of asylum life rather than a direct drug effect.
Institutionalization also best explains why clients get even sicker after going off meds: Since their coping skills have been largely forgotten due to disuse, or never even developed, their only coping tool is using mind-numbing pills. Hence they’ll flounder without them. If drug effects were the main cause of their decline, then they would improve, not worsen, after coming off them.
And drug effects can’t explain why antidepressant users decline over time, since they’re placebos. Their mood-lifting isn’t from their chemical effect, so how could their mood-lowering be from it?
A more likely explanation is: Since people can make themselves extremely happy (manic), clients who trust that antidepressants work can also make themselves manic by the power of suggestion. After all, most people who are fooled into thinking they drank alcohol still act drunk.5 Since the crash from self-induced mania can be saddening, a crash from the high of thinking all one’s woes were solved by pills (once placebo effects fade) can also be saddening. Repeatedly and fruitlessly trying to cure one’s feelings, instead of patiently addressing and mastering the challenges that elicited them, will of course ultimately be demoralizing. How can seeking quick fixes to life’s struggles end well?
Billions of antidepressants were sold, so placebo effects, including extreme or fading ones, must be very strong. In support of this explanation, an extensive review of randomized controlled trials for all modern antidepressants in kids found “many adverse events reported in clinical trials for both active medications and placebos (such as mania, suicidality, and aggression)… Only a handful of these events occurred significantly more frequently in the treatment subjects versus the control subjects.”6 So there’s no need to medicalize antidepressant users’ worsening, just as there was no need to medicalize their emotions in the first place. Institutionalization is instead likely to blame.
Talk of drug-induced brain-chemical aberrations reminds me of the infamous Zoloft commercial, in which brain chemicals travel from one neuron to another while a voice says: “depression is due to a chemical imbalance.” It implanted the cancerous medical model into our culture. Why further nourish this harmful myth by teaching that worsening depression is due to a drug-induced chemical imbalance? Though comforting, since it lets people hold onto the victim role that psychiatry reinforced and trapped them into, it upholds the very premise that psychiatry’s based on — that our woes aren’t life struggles that we can capably, responsibly work on; they’re diseases beyond our control. It thereby continues and strengthens what psychiatry started, by further leading people down the path of learned helplessness, further negating their free will and resilience, and thus further institutionalizing them.
So maybe clients who deteriorate over time aren’t really hopelessly, permanently brain-disabled. Maybe there’s some hope of recovery, albeit not a quick or easy one. Why not tell them that if they choose to, they can awaken from hibernation and re-learn the skills needed to effectively manage their lives? Instead of trying to invent new iatrogenic diseases to add to the DSM, why not discard it and its medical model approach altogether? Why not become truly anti biological psychiatry, by re-examining psychosocial explanations of human experience like those offered by great thinkers such as Freud, Laing, Skinner, Maslow, Erikson, and Goffman (who wrote of institutionalization’s harmful effects7)?
But don’t just take all this on my authority — think it out for yourself!
- Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Whitaker, R. 2010, Crown Publishers, New York. ↩
- The Emperor’s New Drugs: Exploding the Antidepressant Myth. Kirsch, I. 2010, Basic Books, New York. ↩
- Can Cognitive Exercise Prevent the Onset of Dementia? A Systematic Review of Randomized Clinical Trials with Longitudinal Follow-Up. Valenzuela, M, Sachdev, P, Am J Geriatric Psych, 2009 Mar 17(3)179-87. ↩
- A Randomized Controlled Trial of Multicomponent Exercise in Older Adults with Mild Cognitive Impairment. Suzuki, T, et al, PLOS/One, April 2013, Vol 8(4)e61483. ↩
- A New Device for Administering Alcohol Placebo. Mendelson, J, et al, Alcohol, 1984 Sep-Oct (5)417-19. ↩
- Review of the Efficacy and Safety of Antidepressants in Youth Depression. Cheung, A, et al, Journal of Child Psychology and Psychiatry, Jul 2005, 46(7)735-54. ↩
- Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Goffman, E, 1961, Anchor Books, NY. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.