Friday, August 12, 2011

Important new article on the crisis of contemporary psychiatry

by Frank Brenner

The last three issues of The New York Review of Books has carried an important article (in two parts) by Marcia Angell about the abysmal state of contemporary psychiatry and an exchange between Angell and some of her critics. Thankfully all these articles are available on line and I cannot recommend them highly enough. Angell is a Senior Lecturer in Social Medicine at Harvard Medical School and former editor-in-chief of The New England Journal of Medicine. The links to the two parts of her article and the exchange are as follows:

Angell's article is in the form of a review of a number of new books highly critical of the current state of psychiatry. As someone who addressed some of the same issues over a decade ago in an article originally posted on the World Socialist Web Site (See "Mental Illness and the American Dream" Part One: ,
Part Two:, I was familiar with many of the issues that Angell raises, but even so I was taken aback by some of the revelations she discusses. For instance, in the first installment of her article, she cites convincing evidence, in a book by British psychologist Irving Kirsch, that antidepressants (the most widely prescribed drugs in America) are no more effective than placebos. She also cites journalist Robert Whitaker, who argues that many psychiatric drugs not only have negligible effect in terms of curing patients but actually intensify and prolong mental illness. In the second part of her article, Angell shows how infested the psychiatric profession in America is with drug company money, to a greater extent than any other medical profession, and how diagnoses are often tailored to promote drug sales. Worse still is the way that psychiatry and the drug companies have preyed on children, subjecting hundreds of thousands of them - particularly in poor working class families - to harmful and even potentially lethal drug 'therapies'. These articles add to the vast evidence that psychiatry is far less a science than a means for social control. The inconvenient truth is that mental illnesses are really social diseases, outgrowths of the increasingly pathological state of capitalist society.


Overthrow said...

The most important illusion Marcia Angell mentions seems to be that Mental illness is a purely biological condition that can be reduced to a chemical imbalance in the brain.

In contrast to that illusion, the author seems to be pointing to social and economic conditions as playing a larger role than many psychiatrists will admit. Albeit, there are limitations to the authors explications of these conditions. In other words, her solutions are thoroughly liberal and she misses the causes.

She mentions A.D.D. and the school system. She writes, "Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions—such as one-on-one tutoring to help parents cope or after-school centers for the children—should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive."

So, the problem: she never investigates these conditions. She alludes to poverty, and want to make it seem as if there simply aren't enough tutors (which completely overlooks the fact that schooling is set up as a competition with winners and losers, and the whole point of school is to sort people). Nor does she question the profit principle. The only criticism that she can put forth is that pharmaceutical companies make "too much." There is nothing against the profit principle as such that she seems to object to, rather it is the magnitude presumably. But what criteria she uses to decide when profit becomes "too much" isn't so clear. And then, she slips in that non sequitur that "in the long run it would be cheaper." This is an odd contradiction. Earlier in her series she goes on about how doctors make use of medication instead of talk-therapy because it is cheaper, faster, and they can make more money that way. If this is the case, then I don't see why it would be any different with the school system. If expedience and profit are the principles that are operative here, then it seems unlikely that schools would be "fixed" by hiring more tutors.

Also, there is something completely amiss in her formulation that poverty is merely "bad luck" or "trouble" that otherwise has nothing to do with the capitalist system. Her whole perspective is centered around helping people "cope" -- not with getting people to understand the causes of their misery (this economic system) and to fight against it.

Thomas Cain said...

Although this article is older than Angell's, I thought this was pretty informative as well:

The strongest part is where the authors detail their correspondence--or lack thereof--with numerous reporters and pharmaceutical spokespeople who uncritically subscribe to the so-called "chemical imbalance" theory. This snippet sums it up:

"Considering the media’s inability, or unwillingness, to cite evidence in support of their own statements, can the same group really be expected to go one step further and actively investigate these issues? The solution is not simply for the media to modify, or tone down, their own statements about the chemical imbalance theory, but is for them to take a more analytical approach with those who promote the chemical theory as ineluctable truth. In other words, rather than us questioning the media, shouldn’t the media be doing the questioning? It’s almost as if these reporters are blinded by the term, “peer reviewed,” and operate under the mistaken assumption that the words are some sort of stamp declaring that the results are unquestionable and that they can check their skeptical radars at the door when given a press release mentioning a peer-reviewed article."

I hope that somebody finds it of use, as I did.