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When 25-year-old Stephanie Moulton was murdered in a Boston group home in November 2010 by Deshawn James Chappell, a psychotic man off his medication with a history of violence, people wondered whether the system had failed both the suspect and the victim. An article written by Deborah Sontag for the June 16, 2011, issue of the New York Times asked, “How had Mr. Chappell been allowed to deteriorate without setting off alarms? Should he have still been living in a group home, or did he need the tighter supervision of a hospital?”
The murder occurred days before Massachusetts Governor Deval Patrick released the proposed budget that would slash mental health spending for the third year in a row. And it raised the timely but uncomfortable question of whether such continuous spending cuts played a role in Ms. Moulton’s death in a state that has been in the mental health vanguard since it opened the country’s first large public asylum in the early 19th century. More than any other state, Massachusetts has established a robust community system — group homes, outpatient clinics, day treatment centers — to replace its shut down hospitals.
Such budget cuts have forced the mentally ill into crowded emergency rooms, homeless shelters and prisons. For treatment, the sick have to now depend on recent social work graduates and workers who do not have even own the college degree that Ms. Moulton earned.
Her murderer was diagnosed and prescribed antipsychotic medication years ago, but he did not take his medication consistently because the side effects bothered him, his mother reported. With the advent of psychoactive drugs in the 1950s, states began deinstitutionalizing seriously ill patients so as to offload considerable expense to the federal government. Institutional care was never covered by Medicaid, although community care is often insured.
An Epidemic
Mental illness is now a plague that infects every community in the nation. Forty-six percent of adults met criteria established by the American Psychiatric Association for having suffered at least one mental illness during their lives, according to a survey conducted between 2001 and 2003 by the National Institute of Mental Health.
Americans who are disabled by mental disorders and who qualify for Supplemental Security Income or Social Security Disability Insurance increased nearly two and a half times – from one in 184 to one in 76 — between 1987 and 2007. In that same 20-year period, the rate of mental illness among children soared 35 times, making it the leading cause of childhood disability today. What caused this epidemic?
Psychiatry is Unwittingly Promoting This Epidemic
Psychiatry grew out of medicine, which is odd as so little behavioral malfunction can be traced to physiology. Medical education and training do not provide for a broad view of human behavior. A lab rat does not have an ego, which is a psychological organ unique to humans. Psychosis generally refers to players on the social stage who refuse to — or are unable to — perform according to our cultural plot due to a damaged or broken ego, a severely impaired or ravaged sense of “I.”
Dr. Ernest Becker, the noted cultural anthropologist, called psychiatry a pseudoscientific discipline dealing largely with behavioral styles that are formed socially and culturally. Because behavioral malfunctions rarely have physiological causes, medical professionals are not trained to treat most of the broad categories of mental illness. These are (1.) anxiety disorders, such as phobias and post-traumatic stress disorder; (2.) mood disorders, such as major depression and bipolar disorders; (3.) impulse-control disorders, including behavioral problems and attention-deficit/hyperactivity disorder; and (4.) substance abuse disorders, including drug and alcohol abuse.
Medical doctors treat mental illness now with psychoactive drugs. Some of their patients take as many as six psychoactive drugs every day. Few psychiatrists practice psychotherapy. If they believe that psychotherapy is required, they may refer the patient to a psychologist or a social worker.
Why Talk Therapy is a Treatment of the Past
For the past 40 years, the predominant theory has been that chemical imbalances cause mental illness, and these imbalances must be corrected by drugs. The medical profession came to this belief along with the media and the general public back in 1987, when Prozac came to the market as the remedy for a deficiency of serotonin in the brain.
Over the next ten years, the number of people treated for depression tripled. Today, some 10 percent of Americans over age six take new antidepressants such as Risperdal, Zyprexa, and Seroquel. These drugs have replaced cholesterol-lowering agent as the stop-selling drug class in the U.S. If they actually worked, the pervasiveness of mental illness would be declining, not rising.
A Brief History of Psychoactive Drug Development, Marketing, and Prescription
In 1954, Thorazine, a tranquilizer, was the first psychoactive drug introduced to calm down psychotic patients in mental hospitals. Miltown, a milder tranquilizer, followed as an outpatient treatment for anxiety. To treat depression, Marsilid was marketed by the pharmaceutical industry as “a psychic energizer.”
None of these drugs were developed to treat psychosis, anxiety, or depression; yet they forever changed the nature of psychiatry. All three were derived from drugs designed to treat infections. Later, they were found to affect the levels of certain chemicals in the brain.
Your Brain’s Neurotransmitter Functions
Here, it helps to understand something about how your brain’s billions of nerve cells, called neurons, all arrayed in complicated networks, are in constant communication with one another. Research showed that depression results when the brain’s neurons reabsorb too much of the serotonin they release. Drugs like Prozac and Celexa prevent too much of this reabsorption so that more serotonin remains to activate other neurons in the synapses.
Neurotransmitter function appears to be normal in mentally ill people before drug treatment begins, suggesting that rather than developing a drug to treat some abnormality, the pharmaceutical industry chose an abnormality to fit the drug. In his book, Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations About a Profession In Crisis,” Dr. Daniel Carlat implies that this proposal is similar to deciding that fevers are the result of not taking enough aspirin.
How FDA Approval May Contribute to the Epidemic
If two trials conducted by a drug company show that a drug is more effective than a placebo, the U.S. Food and Drug Administration will usually approve it. Companies are free to sponsor all the trials they like when most fail to show the desired effects. They just need to present two positive test results. These successes are published in medical journals. Negative tests are filed away and ignored.
Irving Kirsch, conducting research for his book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, employed the Freedom of Information Act to study the FDA reviews of all 42 placebo-controlled clinical trials, positive and negative, for the six most used antidepressants approved between 1987 and 1999 — Paxil, Prozac, Celexa, Zoloft, Serzone, and Effexor.
Results: The Placebos versus Antidepressants
Overall, as measured by the Hamilton Depression Scale (a widely used score of depression symptoms) placebos were 82 percent as effective as the drugs. The average difference between placebo and drug was a mere 1.8 points on the HAM-D, which is statistically important, but clinically meaningless and unimpressive. The positive studies were publicized. The negative studies were hidden away. Doctors and their patients became convinced that the six drugs were powerful antidepressants.
All six drugs produce side effects, such as a dry mouth. Therefore, patients taking the drug, not the placebo, could probably guess that they were being treated, making them more likely to report improvement.
In his book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Dr. Robert Whitaker concludes that these drugs are not only ineffective. They may be harmful. The evidence is in the dramatic rise of those disabled by mental illness since 1955, when the prescription of psychiatric medication began to skyrocket. Schizophrenia and depression, once episodic, became lifelong and chronic.
Anyone who has experienced the breakup of her extended family through death, illness, or divorce has also experienced depression. Any individual at any time may affirm a continuous identity by turning it into a negative one in some last ditch effort to sustain his life’s meaning even if it requires self-denunciation.
Is it best to treat this illness, which may disappear like a bad cold the moment the sufferer’s self-esteem comes to the rescue or a new object appears to be willingly held and fondled, with a drug? Or with tender, loving care?
And what about the patient with a history of violence who has been diagnosed a paranoid schizophrenic, who refuses to stay on his meds due to their side effects, and who appeared to become even sicker after being medicated? Should he be left alone in the care of a petite, young female social worker? Or should he be housed as he would have been so long ago — in a special hospital, where he may actually have felt somewhat comforted, staffed with trained professionals who knew how to protect him and all those around him?
Resources:
Carlat, Daniel, Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About A Profession in Crisis, Free Press, New York, 2010
Kirsch, Irving, The Emperor’s New Drugs: Exploding the Antidepressant Myth, Basic Books, New York, 2009
Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown Publishers, New York, 2010
Becker, Ernest, The Birth and Death of Meaning: A Perspective in Psychiatry and Anthropology. Free Press of Glencoe, New York, 1962
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