Denying mental disorder, demonising psychiatric drugs
Browsing through Facebook, I came across a link posted by a friend. It was an article published in the TIME online magazine titled The ADHD Fallacy: It’s Time to Stop Treating Childhood as a Disease. Written by a psychologist, the article is based on her book A Disease Called Childhood: Why ADHD Became an American Epidemic.
She goes on to say that America is increasingly treating the ordinary naughtiness of children with medication and that these medications are harmful and can cause serious side effects such as “insomnia, decreased appetite, and heart problems, but there are also effects on the child’s personality.”
She does not stop with ADHD but goes on to cite one of her teenage patients who was prescribed Prozac (generic name fluoxetine) for depression who decided to stop his medication because it turned him into a “teenage girl.” I requested my friend to kindly stop posting such articles that might cause real harm if taken seriously by readers.
Why did I say so? Is it correct that psychiatrists are treating normal behaviours of childhood as a disease? ADHD (Attention Deficit Hyperactive Disorder) is not the normal naughtiness of childhood. Psychiatrists do not go around diagnosing every naughty child as having ADHD. There are strict criteria laid down to do so. This issue comes up whenever a disease, at least on some symptoms, is in a continuum with normality.
Taking another example, obsessive compulsive disorder (OCD) is a disease where a person has the urge to repeat certain actions or thoughts in a repetitive manner. For instance a person might check whether he has locked a door 20 times. But then you might say a normal person too might check whether he has locked a door once or twice. At what point does is it become a disease? Just because we cannot draw an exact line demarcating normality from abnormality does not mean OCD is not a disease and has been created by the psychiatrists. In logic this fallacy of thinking is called the continuum fallacy. If one says that no distinction can be made between two extremes simply because they exist on a continuum and there is no distinct point at which the two extremes become separate you have committed this fallacy. It is also called the fallacy of the beard. At what point do you say that a man has a beard? When he has two hairs, three hairs or 100 hairs? Yet I am sure you will not deny that there are men who are clean-shaven and men with beards.
It is also not true to say that the drugs given for ADHD have dangerous side effects. All drugs have side effects (effects other than the therapeutic effects). The drugs given in ADHD are relatively benign and rarely cause serious side effects. Certainly they do not affect a child’s personality. To also imply that antidepressants change a boy’s personality to that of a girl is mischievous and is untrue.
The practice of bashing psychiatric drugs is not confined to non-psychiatrists. In a recent editorial in the prestigious British Medical Journal titled “Serotonin and Depression”, David Healy, a Professor of Psychiatry from North Wales says, that the theory that lowered serotonin levels cause depression is now disproved and drug companies knew this but continued to market the group of antidepressants called SSRIs (for example the famous Prozac is an SSRI) even though they were weaker or even not effective compared to the older tricyclic antidepressants. This article has stirred interest in the psychiatric community and is now quoted in the popular press as well. I am not an advocate for Big Pharma but I fear that such articles if taken at face value might do more harm than good. It is true that lowered serotonin levels (a neurochemical important for nerve transmission in the brain) is not the only cause of depression. Depression has many causes including social and psychological causes. Even the neurochemical causes may differ from person to person and we know that a person who does not respond to one antidepressant responds to another of a different chemical class.
It is also not correct to say that just because we do not understand the exact mechanism by which a drug or treatment acts it is not effective. Lithium carbonate has been used as a mood stabiliser in bipolar affective disorder for over 50 years and it is perhaps the best mood stabiliser but we yet do not know how it works. Electroconvulsive therapy (ECT) is the oldest psychiatric treatment yet in use and one of the most effective treatments for depression and yet its exact mechanisms of action remain elusive.
Many years ago two psychiatrists started a movement that came to be known as the anti-psychiatry movement. They were Dr Thomas Szasz and Dr Ronald Laing, both of whom are no longer living. Dr. Szasz in his book The Myth of Mental Illness wrote, “‘Mental illness’ is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behaviour, such as schizophrenia, as an ‘illness’ or ‘disease’. If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic.”
Dr Laing started a therapeutic community, Kingsley Hall, where therapists and patients with schizophrenia lived together. The patients were not given any antipsychotic medication but were offered free LSD (it was still legal at the time). It was a disaster as patients relapsed and at least two people jumped off the roof of the building.
Dr Szasz later linked up with the Church of Scientology, which carries on a relentless war against psychiatry in the United States. Scientology is a movement based on the books of science fiction writer Ron Hubbard and claims that the notion of mental illness is a fraud. This Church was in the news recently when actor Tom Cruise, one of their followers, criticized actress Brooke Shields for taking anti-depressants for postpartum depression.
Shields in her book Down Came the Rain: My Journey Through Postpartum Depression, writes, “I wasn’t thrilled to be taking drugs. In fact, I prematurely stopped taking them and had a relapse that almost led me to drive my car into a wall with Rowan in the backseat. But the drugs, along with weekly therapy sessions, are what saved me—and my family.”
Dr David Healy, the author of the BMJ editorial, has also been an expert witness in homicide and suicide trials involving psychiatric drugs. Sometime ago the FDA (the American Drug Regulatory Authority) required that drug companies place a black box warning that children and teens given SSRI antidepressant drugs might experience an increase in ideas of suicide. The warning was to ensure that doctors looked more carefully for such thoughts in their patients. Because of the warning doctors in the US, perhaps fearing litigation, reduced their use of antidepressants in children and adolescents by nearly 30 percent. A study led by Christine Lu, a researcher at Harvard Medical School, found that during that same period, suicide attempts rose by 22% in teens and 34% in young adults. She concluded that the decrease in antidepressant use, sparked by worries over suicidal thoughts, may have left many depressed young people without appropriate treatment and that may have boosted the increase in suicide attempts, a tragic consequence of well intentioned but misguided advice.
I will end with the following statement by the American Psychiatric Association.
“Science has proven that mental illnesses are real medical conditions that affect millions . . . As in other areas of medicine, medications are a safe and effective way to improve the quality of life for millions … who have mental health concerns. Mental health is a critical ingredient of overall health. It is unfortunate that in the face of this remarkable scientific and clinical progress that a small number of individuals and groups persist in questioning its legitimacy.”