Editor’s Note: With this column, Mad in America is launching a media-watch column. Here, MIA editor and contributing writer Miranda Spencer will be reporting on press coverage and pop-cultural depictions of mental health topics.
We don’t usually think that it is the news media’s job to “scold” a presidential candidate for their opinions, and do so while expressing the certainty in their own “knowledge” of a subject. Yet, that is what happened recently in press coverage of longshot presidential hopeful Marianne Williamson.
In their review of the Democratic debates, several progressive pundits and journalists praised Williamson, a best-selling self-help author, for her forceful comments on social problems including racism and poverty. She was described as “really compelling” and “surprisingly eloquent,” and praised for her “meaningful answers.”
However, after Buzzfeed’s AM to DM podcast held a wide-ranging interview with Williamson that included questions about mental health issues, the media’s tune noticeably changed.
Buzzfeed News, MSNBC’s The Beat with Ari Melber, The New York Times and CNN* all published or aired interviews with Williamson that criticized her for stating that the way we look at and treat “depression” today might be problematic. Anderson Cooper, for his part, was openly belligerent toward her, which in turn triggered recaps and/or scathing commentary from Rolling Stone, Vox, The Daily Beast, Yahoo Finance, RealClear Politics, Fox News, and HuffPost.
So what had she said? As Maggie Astor’s interview in The New York Times put it, “In books, interviews and posts on social media, Ms. Williamson has criticized the widespread use of antidepressants; suggest they were to blame for some celebrities’ suicides; characterized treatment guidelines for postpartum depression as a way for pharmaceutical companies to make more money; and called the distinction between ordinary sadness and clinical depression ‘artificial.’”
The news media, in response, called her “dangerously wrong,” an “irresponsible” “menace to public health” whose “fringe ideas” were akin to climate-change denial. Continuing to give her a news media platform, several suggested, would only encourage the spread of flaky or poisonous ideas the way the spotlight on Donald Trump in 2016 helped usher White Supremacism into the Oval Office. Such comments, asserted CNN’s Joe Lockhart a few days later, amount to “throwing away the science.”
A Closer Look
In this column, we are not concerned with assessing the merits of Williamson’s comments about other health issues (such as vaccine safety), or the merits of her candidacy. What we are focused on is the media’s response to her comments on mental health, and how those who interviewed her wrapped themselves in the cloak of science to chastise her.
So let’s check the facts.
Overprescribing of Antidepressants
Since the launch of Prozac in 1988, antidepressant use has quadrupled in the United States, and more than one in 10 Americans now takes antidepressants, according to the Centers for Disease Control and Prevention. In a recent report, the health agency told of how the percentage of Americans 12 years and over who are taking antidepressants rose from 7.7% in the 1999-2003 period to 12.7% in 2011-2014.
In a recent blog on Mad in America, attorney Kenneth F. McCallion, citing studies from the Rand Corporation, American Psychological Association and in JAMA, described how much of the explosive growth in the prescribing of antidepressants was due to their being given to patients who don’t meet the established criteria for depression. The 2016 JAMA study found that nearly half of all prescriptions for antidepressants were for other conditions.
This extraordinary rise has stirred debate in the British Medical Journal and other scientific forums on whether the drugs are being grossly overprescribed. Some defend the increase in prescribing, while others argue that the growth reflects the success of drug company marketing more than medical need.
For the purposes of this review, it is immaterial which side is presenting the most compelling argument. Williamson’s comments about the “overprescribing of antidepressants” clearly fall within the bounds of reasonable societal discussion about an important issue.
Overdiagnosis of Depression
Williamson has expressed concern about the “medicalization of normal human despair.” As she told The New York Times:
“People go through personal loss. That’s not a mental illness. People go through a breakup. That’s not a mental illness. . . . Traditionally, people recognized that grief was a part of life. These days people talk like, ‘Your mother died, it’s been a month, aren’t you over it?’ . . . the term [depression] is used so loosely today that people who I have seen experiencing what I consider a normal spectrum of human despair have been termed ‘clinical depression’ as though that is supposed to shut down the subject.”
Williamson is not alone in questioning the medicalization of normal human despair. This is the very concern that prompted Allen Frances, who chaired the task force that created the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, to write a book titled Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis.
Here is how one reviewer summarized Frances’ book:
“Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. These challenges are a normal part of being human, and they should not be treated as psychiatric disease. However, today millions of people who are really no more than ‘worried well’ are being diagnosed as having a mental disorder and are receiving unnecessary treatment. In Saving Normal, Allen Frances, one of the world’s most influential psychiatrists, warns that mislabeling everyday problems as mental illness has shocking implications for individuals and society: stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, misallocation of medical resources, and draining of the budgets of families and the nation.”
In other words, Williamson’s opinion on this subject of medicalization of normal human despair echoes that of the architect of the DSM-IV.
Nevertheless, the media critics went on the attack. The New York Times reporter asked whether she believes “clinical depression doesn’t exist.” Similarly, Vox said, “She has repeatedly cast doubt on the idea that clinical depression is real.” MSNBC’s Ari Melber inquired, “should people take [it] that you don’t believe in real, clinical depression, and how would you approach what doctors and science says is depression… if you were President?” Though Williamson apologized for a past “glib” comment on the topic, Anderson Cooper insisted, “It does seem like, again, you’re suggesting that clinical depression is a scam.”
The media, in their response, was doing just what Williamson had said it would do: shut down the subject. The irony of this particular criticism is that when Allan Frances published his book, the media treated him with respect, and as something of a brave “truth-teller.”
Is Depression a Disease?
Williamson has stated “there is no blood test” for depression and once quipped that clinical depression is when “someone in a clinic says so.” There is, she has said, “no particular scientific evidence to prove” that depression is due to a chemical imbalance.
She is correct that there is no blood test for depression. Indeed, though she’s admitted to being “glib” about the topic, the diagnosis of depression, as set forth in the DSM, is based on a construct. There is a checklist of symptoms to be assessed, and a diagnosis of Major Depressive Disorder is to be made when the required number of symptoms are present. There is an arbitrary aspect to it, and in clinics, prescribers may just listen to a person’s story and conclude, “you’re depressed.”
Williamson is also correct in stating that there is no scientific evidence to prove that depression is due to a chemical imbalance. Numerous Mad in America posts have addressed this myth, and such mainstream figures as Ronald Pies, former editor in chief of Psychiatric Times, and Thomas Insel, former director of the National Institute of Mental Health, have acknowledged that the hypothesis never panned out.
However, Anderson Cooper—like many in our society—failed to get that message. He asserted that “clinically depressed people are not depressed just because the world is depressing. They have a chemical imbalance.”
As he told Williamson, “I don’t hear you saying, I encourage . . . everybody to talk with a medical provider.” A couple of days later, Chris Cuomo endorsed his approach: “You can’t let it go when somebody is confusing emotion and illness.”
Cooper, Cuomo and others were assuring viewers that depression is a disease and that people suffering from it need medical treatment for it, and thus were depicting Williamson as one who would discourage people from getting it—in essence, chastising her for not repeating the marketing campaigns that have been used to sell antidepressants to doctors and consumers.
Do Antidepressants Work?
Williamson has argued that people often are healed by experiencing and working through their pain rather than by muting its symptoms via prescription drugs, which she’s described as “masking” or “numbing” emotions:
“Normal human despair… traditionally was seen as the purview of spirituality and religion; that which gave people comfort and gave people hope and inspiration in their times of pain. And with the advent of modern psychotherapy, a lot of the baton sort of passed from religion and spirituality to modern psychotherapy . . . And then over the last few years, very, very quickly, the baton was passed again to psychopharmacology.”
Here, Williamson is arguing that there may be non-drug methods that are effective for treating people who are in despair, and that our society should not discard useful approaches from the past. At the same time, she has not argued against prescribing drugs for deeper depression: “If anyone is helped by an antidepressant, I’m happy for that.”
Hers is a perspective shared by many mental health professionals as well as philosophers. There is a long history of cultures relying on religious beliefs for support prior to the Freudian era and the advent of Prozac. She is also correct that non-drug treatments may be effective. The UK’s National Institute of Clinical Excellence guidelines for depression states that antidepressants should not be a first-line treatment for mild depression.
As for antidepressants deadening emotions, studies have found that they blunt empathy and flatten affect in many people. A large survey of nearly 2000 antidepressants users found that 60% reported that the drugs made them feel numb.
However, once again, Cooper and many others were quick to denounce her for this perspective. “Isn’t the fact that depression numbs you and masks you, and telling a seriously depressed person that taking an AD they’re going to be numbed, isn’t that not a good message?” Cooper said. “If you’re on an antidepressant, you’re not numbing your pain, you’re actually trying to feel again, no?”
Vox warned against “the potential damage she can do to real lives by . . . convincing a person with depression that they don’t need to take their meds.”
Rolling Stone put it this way:
“There is established consensus within the scientific community that [antidepressant drugs] pose relatively low risk for most people. Further, there is significant evidence that antidepressants are beneficial to those suffering from Major Depressive Disorder, which affects nearly 7 million adults in the US, according to the NIMH.”
A “2018 meta-analysis,” Rolling Stone wrote, “found that antidepressants were uniformly more effective for treating MDD than placebos.”
Rolling Stone was the one media outlet that cited a study to support its assertion that antidepressants were effective, but, not surprisingly, it misunderstood the study’s findings and the larger context for the debate. In short-term studies funded by pharmaceutical companies, antidepressants have been shown to reduce symptoms slightly more than placebo (by two points on the HAM-D scale for measuring depressive symptoms), although that difference is not understood to be clinically significant. (See the MIA Report “Do Antidepressants Work?” for an in-depth review of this topic.)
The 2018 meta-analysis by Cipriani, which is the study cited by Rolling Stone, just reaffirmed that this was the case. The “effect size” Cipriani and colleagues reported in their analysis of antidepressant trials told of the same bottom-line: The benefit of drug over placebo didn’t rise to a clinically noticeable difference. Moreover, if the Cipriani study is carefully deconstructed, it shows that seven out of eight people treated with an antidepressant receive no benefit from the drug: either they are non-responders, or would have responded to placebo. Yet, this group that doesn’t benefit—88% of all patient— is exposed to the adverse events caused by the drugs.
Studies in real-world patients have found even lower response/remission rates with antidepressants, and there are numerous studies, including this one and more recently this one, that have found that the medications worsen long-term outcomes.
In sum, Williamson was chastised for not “knowing” that antidepressants were beneficial to most people, even though the scientific literature tells of drugs that are of questionable efficacy over the short term, and may expose long-term users to a litany of harms.
Do Antidepressants Protect Against Suicide?
Williamson has drawn attention to a possible link between antidepressant use and suicide, once tweeting a Citizens Commission on Human Rights article with the comment “helpful to some, harmful to others,” which suggested at least some celebrity suicides were due to their use of the drugs. And in her interview with Anderson Cooper, Williamson asked why—if antidepressants were so effective—suicide rates have climbed steadily over the past 20 years.
Cooper’s reply: “But you’re relying on the Church of Scientology for factual background to your argument. When I read people saying ‘well all these drugs caused suicide,’ I mean, that’s just not true.”
Cuomo made a similar statement: “It is one of the biggest diagnoses in the country, depression. And when you mess with people taking medication and you stigmatize it . . . the suicide rate goes up.”
The press also took issue with Williamson’s citing the Food and Drug Administration’s black-box warning on the risk of suicidality in people under 24 who take antidepressants, one of the few times they cited any scientific sources. According to The New York Times, “Its warnings . . . also show no similar risk in people over 24, and that untreated depression is itself a risk factor for suicide.” Cooper said the same, and Rolling Stone also dismissed it: “The FDA issued the black box warning in 2004 for . . . SSRIs, not all antidepressants; in 2007, it revised the warning after receiving backlash from the scientific community.”
However, if Cooper, Cuomo and others writing about Williamson were informed about the scientific literature, they would acknowledge that this suicidal risk with antidepressants remains a controversial subject. Here is a quick review:
- The black box warning on the risk of suicide in youth prescribed SSRIs remains on the label; the FDA has not rescinded it.
- As biologist Patrick Hahn wrote in his MIA blog on antidepressants and the suicide epidemic, a July 2019 meta-analysis of randomized control trial data for fourteen antidepressants published in the journal Psychotherapy and Psychosomatics reported that these drugs caused a near-tripling of completed suicides compared to placebo.
- Earlier this year, an MIA report told of how suicides in the United States have steadily increased since 2000, and that this steady increase has come during a time of increased prescribing of antidepressants.
Fighting Against Stigma
Williamson has stated that “depression wasn’t stigmatized until it was medicalized.” And the topic of stigma is the one reporters seemed most concerned about, suggesting that she shouldn’t raise questions about depression rates and the relative value of antidepressants in a public forum because it will stigmatize those so diagnosed.
There is, of course, a long history of stigmatizing the “mentally ill.” But the media suggested that her comments would further stigmatize those who are depressed, and that would, in turn, prevent them from getting needed medical treatment.
Cooper demanded, “I’ve never heard you express, though, real concern for the stigma surrounding depression,” later hammering the point: “What I care about is people who are dying, and there’s a stigma for people actually seeking medical help for something that could save their life.”
The Times article noted that despite Williamson’s “claim that ADs are overprescribed,” unnamed “experts say [this] stigmatizes mental illness.”
Vox’s Zack Beauchamp, who has a depression diagnosis, wrote that “this type of rhetoric could serve as depression’s agent, worming into a depressed person’s brain in a way that might cause them to avoid something that could literally save their life. This isn’t just my anecdotal experience but the view of [unnamed] actual mental health professionals.”
All of these reporters were repeating a talking point long promoted by the pharmaceutical industry and the American Psychiatric Association: Depression is a disease, not the person’s fault—the message of ongoing anti-stigma campaigns devoted to telling that message (and selling antidepressants.)
However, research has shown that such anti-stigma campaigns may increase negative attitudes toward people struggling with psychiatric or emotional difficulties. A 2019 article in Annual Review of Clinical Psychology, for example, documented how stigma and discrimination linked to the biomedical model of mental health. Previous studies have shown similar findings, including this one in the American Journal of Psychiatry, which showed that pro-treatment sentiment among the public has not reduced stigma against people diagnosed with mental illnesses.
Like Vox’s reporter, I should share my personal history here. I once suffered debilitating depression and anxiety and duly tried hospitalization and many different drug cocktails, which didn’t help and led to horrific side effects. So I find the idea that people in emotional crisis need to be protected from those who would talk about possible problems with medical interventions paternalistic at best. There are thousands more who’ve shared stories of iatrogenic harm from antidepressants on MIA and elsewhere, and yet the media, in scolding Williamson for her comments, seems to want to erase these experiences from public discussion.
What we see in the comments by Cooper, Cuomo and others is an air of superiority: They are the ones who supposedly know the science and consider it their public duty to castigate Williamson for challenging those “facts.”
What we see from this review, however, is that it is Williamson whose “opinions” on depression are more in line with the science, and it is the “know-it-all” assertions by Cooper and colleagues that are belied by it.
Moreover, in their bottom-line assessments of Williamson’s view on psychiatry, many in the media portrayed Williamson as not just inaccurate on mental health issues, but as a conspiracy theorist influenced by anti-science ideologues. Both Anderson Cooper and Ari Melber asked Williamson who would guide mental and physical healthcare policies in her administration: a cult, or the Surgeon General?
As Joe Lockhart summed it up on CNN’s “New Day”:
“We can’t have a president who goes on gut and is anti-science, and is anti-data. And you know, takes information from… with Trump from white nationalists. With Williamson, from you know, the… the Scientologists. That’s very dangerous. We have to get away from this sort of anti-intellectualism of ‘It’s all about how I feel,’ and you know, this spiritual sense and throwing away the science.”
One wishes that reporters would spend time reviewing the scientific literature—or at least interviewing experts who have—before denouncing a candidate in this way. Unfortunately, the media’s treatment of Marianne Williamson is an example of how press reporting on mental health often reinforces conventional wisdom and, in so doing, misinforms the public.