September 9, 2009

"Are there really so many people with such troubles in your country to make such medicine such an important matter?"

flag.jpgA reader writes:

"I'm from Europe, speak about a medicine intended to declare/sell that medicine as "mood stabilizer"... However, are there really so many people with such troubles in your country to make such medicine such an important matter? I didn't think of America as being such a sad/depressed country and a medicine called "mood" something seems to me such a stretch..."

How I wish I had made this up.  The email closes:

I'd be glad if I knew you'd think about it for a moment... how sick your country appears from the outside when one reads about so many medicines and so many disorders and about medicine for .... anything slightly uncomfortable. And how all these trendy things migrate to other countries, where people don't even know that their moods, sadnesses, uncomfortable moments, their life in a word, is a disorder.
Here's my answer:

The short answer to your question is: yes, there are many such patients here in the U.S.  However, most of these "patients" do not need these medications, most do not need psychiatry at all.  Of course many do, they are truly sick and but for psychaitry their lives would be chaos.  But the majority do not.

But they come to psychiatry because they are told, almost constantly, that there is something wrong with them.  That the fatigue they feel, the emptiness, the lack of interest or sexual appetite or sadness or irritability-- all of these things could be helped by medications. 

It happens that these "symptoms" occur in the absence of a clear cause, and medicines do help.  But the majority of the time these are symptoms only because they are compared to someone else.  Testosterone patches are the new big thing in psychiatry.  No, I'm not kidding.

I'm not sure what a lack of sexual interest in a 40 year old is-- but certainly in comparison to any TV show, it's going to seem low.  That preys on people-- a man worries that his wife is judging him, even as she is worried he is judging her; so both are worried, essentially, that the other person has agreed to accept TV as normal and feels consequently inadequate.  Etc.  If you doubt this, watch two married people try to sit through a sex scene in an episode of Sex In The City, or Mad Men, etc, together.  They're both going silently insane.

They are handed images of life-- TV, etc-- and they think that they are supposed to be that.

The complicated answer to your question is that American society isn't really capitalist, it's mercantilist.  Americans don't want riches, they want what they are told to want.  They don't want a nice car: they want a Lexus.  They don't want a nice house; they want a Viking refrigerator, granite counters.  They don't want nice things: they want things that represent nice things.  Americans want brands.  While everyone was orgasming over The Tipping Point, they should have been reading this.

As such, psychiatry isn't a field serving a need; it is a product creating a market.  They didn't need treatment; they were told they needed treatment.  Just like you don't need Nike shoes, you're told you do.  Granted, having Nike shoes or psychiatric treatment can still be helpful, but most can certainly get along without it and, dare I say it, neither is worth the price.

And when someone says, "I didn't really want Nike shoes, I just got them because they were on sale," they have inadvertently proven my point.  You bought them and you didn't even want them, they were the default.  "But I needed to buy some kind of shoe."  Think it through...

Psychiatry-- medicine-- is too gigantic of an industry to bend to the whims of reality.  It will create a market because too many people's economies depend on it.  It's too big for Obama or anyone else to change it.  Fox News and MSNBC can yell at each other all they want, it's already been decided: Wellpoint's stock has soared since Obama rolled in.  The "public option" is now Aetna.

This is how it has always been throughout history.  Did Europeans really blast cannons at each other in the 16th-17th centuries because people desperately needed more spices?  Yes, they actually did.  A third of the Triangular Trade was rum.  People died over rum.  Not depleted uranium or alien artifacts or the Spear of Longinus: rum. 

You ask whether it is worrisome that the rest of the world might see American as a bunch of invalids.  Well, that maybe true: but what do we care?  We're the only people that matter, all other people are supporting cast.

Your final point is the most important:  All of this is coming to a town near you.  All of this nonsense talk about whether American is losing its global dominance is a ruse.  As long as America remains the largest current market, it sets the standards.  The Chinese are going to want to need Viking refrigerators.

True power rests in the hands of those who define our cultural models and decide what we want to need or who we want to pretend to be.

The history of the world is the history of mercantilism; the history of men bending government to fight to the death for things they don't really need and only barely want.


As such, psychiatry isn'... (Below threshold)

September 9, 2009 5:11 PM | Posted by Anonymous: | Reply

As such, psychiatry isn't a field serving a need; it is a product creating a market. They didn't need treatment; they were told they needed treatment. Just like you don't need Nike shoes, you're told you do.

Yeah, but other people can't actually see your medication usage. Shoes and cars fit into your model of buying visible artifacts, but drugs, until fairly recently (post Listening To Prozac maybe), have been seen as a personal weakness or failing. Even if that's changed, it's still not quite the same as buying the Viking, which will visibly dispense ice to their impressed visitors.

I see the rise of psychiatry more as an attempt at a quick fix than a status symbol. Drugs will help you lose weight without exercise or make you happy without personal change. It gives people a simple answer/excuse for complex things they don't understand, like the TSA fixing terrorism by disallowing liquids, or the Democrats solving poverty by raising the minimum wage.

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5:11 anon... it is not impo... (Below threshold)

September 9, 2009 5:29 PM | Posted by Anonymous: | Reply

5:11 anon... it is not important people see your artifacts just to have seen them, it is important because the "other seeing your artifacts" creates a feeling of success for the owner of the artifact. In other words, the goal is to achieve the feeling of achievement.
We are seeking feelings.

Therefore, medication use does not necessarily require a witness to produce such similar gratification... it just needs to produce some kind of feeling (either placebo- psychological reaction or actually a direct effect of medication) . It is enough to have your psychiatrist tell you "this will help" (produces a good feeling), to pick up your script, to take the pill every day. You are buying hope that 1) something physically is wrong and 2) it can be fixed and 3) you are fixing it. Having a diagnosis is also gratifying; it defines and quantifies the problems in your life. No job? Failed relationships? Lack of motivation and initiative? Must be the bipolar V. It's a comfortable, reassuring sort of knowledge that you don't have to worry too much about present and past failures because you're now "mentally ill".

I went to a psychiatrist a few times. I'm really embarrassed about that now. I wanted an honest opinion of whether or not I was sick because of some experiences I have had. I quickly figured out that psychiatrists are not in the business of separating the sick from the healthy - they are in the business of creating clients. Therefore they make everything seem much worse and try to retain as many people as possible whether or not they actually need psychiatric services. I was very angry about this for a long time, because it took a lot of effort for me to go to a doctor and to even make a small attempt to trust... I discovered this is, more or less, legal drug dealing. A drug dealer tries to create clients, to create dependency, a drug dealer creates or worsens problems. These psychiatrists do the exact same thing when they prescribe drugs and diagnose relatively mentally healthy people with illnesses.
I don't know why I am so surprised, but honestly I am.

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<a href="http://www.hipster... (Below threshold) Anonymous: I feel for you. ... (Below threshold)

September 9, 2009 7:23 PM | Posted by Paula: | Reply

Anonymous: I feel for you. I had a therpaist not tell me a partners borderline dx so I could be the Ip and pay her- alot of money_ (175$) with my insurance, to be working on my relational disorder. One i never had before. She sent him to a doctor friend of hers who did not tell him either and gave him- what- what? Perscriptions- valum, anti-depressents. All for his increadible ins. and money as well. I almost commited suicide- I have never even attempted before- due to his abuse his doctors lies and her abuse. Not even a "Hey, I want you to look this up- borderline- and tell me what you think". Her and the doctor where psychodynamic and i think that is a whole crock of shit as well.
Believe me- it was the worst time in my life and i would never, ever see a therapist again. It is my friends and family and I look at professionals in this field with deep suspicion.
I mean, really, I almost killed myself. My best friend saved me.

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By the way- threre is a gre... (Below threshold)

September 9, 2009 7:53 PM | Posted by Paula: | Reply

By the way- threre is a great video on CNN about South American men bying skin whitening cream to be more- well -you know- white!

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<a href="http://funkychicke... (Below threshold) I think the marketing of ps... (Below threshold)

September 9, 2009 10:37 PM | Posted by Anonymous: | Reply

I think the marketing of psychiatry is symptomatic of a larger marketing issue--the myth of happiness. The classic disney story, now typefied in every non-CSI-type television show is of complete stories with enough dramatic tension to get your attention, but with ultimate resolution to the happily ever after.

What's being marketed is the idea that people around you are in some state of ongoing happiness, with goals accomplished, and some sort of terminal bliss that occurs after the curtain falls. Somewhere out there, the Friends cast is enjoying lattes in a well-lit, trendy, happy coffee bar. Everyone is happy--except you.

This is doubly damning. Not only are you unhappy, but you're also defective. Everyone else is happy, what's wrong with you?

Enter psychiatry. Enter another damn Cymbalta or Abilify commercial. Unhappy? Does your life not have technicolor? Talk to your doctor.

To be fair, this didn't start with pharmaceuticals. There's blame to share with psychodynamic crowd ("everybody needs to be analyzed," "weller than well"), the antibiotic revolution (idea that pills can cure, rather than ameliorate), and the general spread of nihilism with loss of a logocentric world view (i.e., loss of power of priests/shamans).

Psychiatrists, like it or not, are the modern shamans. Not voluntarily, but by default. Psychiatric medications are symbols of the interaction, the transaction of healing, maybe even new versions of the eucharist. And this is a western creation, and it is insidious, and maybe Al Qaeda has a point about us.

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What really scares me is th... (Below threshold)

September 10, 2009 12:55 AM | Posted by acute_mania: | Reply

What really scares me is that the people who do reasonably well with the help of psychiatry are those who would have done just as without it. It's those who actually need psychiatry's help who aren't getting better. Who wouldn't want an easy success story.

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That's a very good point. ... (Below threshold)

September 10, 2009 1:05 AM | Posted by Anonymous: | Reply

That's a very good point. The tragedy of western psychiatry is that the majority of resources are used by people who are not mentally ill, people who have life problems, people who are looking for some kind of meaning, people who need a puppy. These people don't get a whole lot better with medications (see 40-50% response rate to antidepressants)because they're not really sick. But they do benefit from the interaction, from the expectation of help, from the validation, from the sense that someone connected to the great truth understands them and gives meaning to their unhappiness.

But the people who are genuinely mentally ill, whose symptoms actually do respond to medication, frequently don't have the resources, the access, the luxury of having problems.

I'm sure there are any number of political points to be made here. I'm going to stick with the aesthetic point that there's something tragic and darkly ironic about the situation.

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Let us then consider, first... (Below threshold)

September 10, 2009 1:19 AM | Posted by Common Reader: | Reply

Let us then consider, first of all, what will be their way of life, now that we have thus established them. Will they not produce corn, and wine, and clothes, and shoes, and build houses for themselves? And when they are housed, they will work, in summer, commonly, stripped and barefoot, but in winter substantially clothed and shod. They will feed on barley-meal and flour of wheat, baking and kneading them, making noble cakes and loaves; these they will serve up on a mat of reeds or on clean leaves, themselves reclining the while upon beds strewn with yew or myrtle. And they and their children will feast, drinking of the wine which they have made, wearing garlands on their heads, and hymning the praises of the gods, in happy converse with one another. And they will take care that their families do not exceed their means; having an eye to poverty or war.

But, said Glaucon, interposing, you have not given them a relish to their meal.

True, I replied, I had forgotten; of course they must have a relish-salt, and olives, and cheese, and they will boil roots and herbs such as country people prepare; for a dessert we shall give them figs, and peas, and beans; and they will roast myrtle-berries and acorns at the fire, drinking in moderation. And with such a diet they may be expected to live in peace and health to a good old age, and bequeath a similar life to their children after them.

Yes, Socrates, he said, and if you were providing for a city of pigs, how else would you feed the beasts?

But what would you have, Glaucon? I replied.

Why, he said, you should give them the ordinary conveniences of life. People who are to be comfortable are accustomed to lie on sofas, and dine off tables, and they should have sauces and sweets in the modern style.

Yes, I said, now I understand: the question which you would have me consider is, not only how a State, but how a luxurious State is created; and possibly there is no harm in this, for in such a State we shall be more likely to see how justice and injustice originate. In my opinion the true and healthy constitution of the State is the one which I have described. But if you wish also to see a State at fever heat, I have no objection. For I suspect that many will not be satisfied with the simpler way of way They will be for adding sofas, and tables, and other furniture; also dainties, and perfumes, and incense, and courtesans, and cakes, all these not of one sort only, but in every variety; we must go beyond the necessaries of which I was at first speaking, such as houses, and clothes, and shoes: the arts of the painter and the embroiderer will have to be set in motion, and gold and ivory and all sorts of materials must be procured.

True, he said.

Then we must enlarge our borders; for the original healthy State is no longer sufficient. Now will the city have to fill and swell with a multitude of callings which are not required by any natural want; such as the whole tribe of hunters and actors, of whom one large class have to do with forms and colours; another will be the votaries of music --poets and their attendant train of rhapsodists, players, dancers, contractors; also makers of divers kinds of articles, including women's dresses. And we shall want more servants. Will not tutors be also in request, and nurses wet and dry, tirewomen and barbers, as well as confectioners and cooks; and swineherds, too, who were not needed and therefore had no place in the former edition of our State, but are needed now? They must not be forgotten: and there will be animals of many other kinds, if people eat them.


And living in this way we shall have much greater need of physicians than before?

Much greater.

And the country which was enough to support the original inhabitants will be too small now, and not enough?

Quite true.

Then a slice of our neighbours' land will be wanted by us for pasture and tillage, and they will want a slice of ours, if, like ourselves, they exceed the limit of necessity, and give themselves up to the unlimited accumulation of wealth?

That, Socrates, will be inevitable.

And so we shall go to war, Glaucon. Shall we not?

Most certainly, he replied.

Then without determining as yet whether war does good or harm, thus much we may affirm, that now we have discovered war to be derived from causes which are also the causes of almost all the evils in States, private as well as public.


And our State must once more enlarge; and this time the will be nothing short of a whole army, which will have to go out and fight with the invaders for all that we have, as well as for the things and persons whom we were describing above.

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This is not related to the ... (Below threshold)

September 10, 2009 2:05 AM | Posted by Anonymous: | Reply

This is not related to the article, but more of an idea for your site. I think it would be cool if you posted a list of books that you found interesting.


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Speaking as a psychiatrist ... (Below threshold)

September 10, 2009 3:43 AM | Posted by Meat Robot: | Reply

Speaking as a psychiatrist who does a lot of emergency work, and not in the US (so I answer no paymaster but rather my own conscience), one of the most important and gratifying aspects of my work is telling people they're ok and furthermore, it's perfectly fine to feel crazy or even have a crisis which leads to an ER visit.

I think Douglas Coupland really hit the mark in "Life After God" where one of the narrators describes psychopharmacology as "cosmetic neurosurgery for the mind." David Healy adds that this isn't necessarily a problem, as long as the consumer is fully and fairly informed of risks and benefits.

Maybe we'll all eventually come around to a Buddhist point of view and realize that all happiness or unhappiness has nothing to do with things in themselves but rather in our state of mind, a situation which can and does respond to right thinking.

P.S. Psychodynamics isn't as problematic as some commentators above suggest. In my experience, it's got a lot more to do with the psychodynamicists themselves rather than the theory which allegedly informs them.

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Given the myriad blog posts... (Below threshold)

September 10, 2009 10:10 AM | Posted by Anonymous: | Reply

Given the myriad blog posts here about who doesn't need psychopharmacology, it would be instructive to read about who does. What drives people into the pdoc's office? Are they well, but bored? Are they hypochondriacs? Did they cry in front of too many people?

I went because I truly couldn't function. The world had suddenly become unreal and confusing. I couldn't do my job. I couldn't hold a thought in my head. I couldn't sleep, and had hallucinations. I lost a striking amount of weight. My stomach was in constant pain. I cried and trembled. This went on for many months, and I lost hope that it would ever change. I didn't care if I lived or died.

Drugs fixed this. I didn't expect them to. I am grateful.

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Psychiatric medications ... (Below threshold)

September 10, 2009 10:31 AM | Posted by Anonymous: | Reply

Psychiatric medications are symbols of the interaction, the transaction of healing, maybe even new versions of the eucharist. And this is a western creation, and it is insidious, and maybe Al Qaeda has a point about us.

What? Eucharist? Al Qaeda? I think you're using a much broader brush than is needed. The eucharist (speaking as a Catholic) isn't all that exciting or transformative, and Al Qaeda shouldn't be deferred to out of fear.
Psychiatry isn't going to ruin us any more than rock and roll or orthodontia. Stupidity and chance, as always, will handle that.

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I think you may be using th... (Below threshold)

September 10, 2009 11:19 AM | Posted by Joe: | Reply

I think you may be using the term mercantilism incorrectly. Mercantilists believe the global market does not grow and, as such, the countries should protect themselves with tarriffs, etc. I understood mercantilism to be a type of capitalism. Anyway, to me it sounds like you are describing globalization.

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There is this story in Murp... (Below threshold)

September 10, 2009 1:57 PM | Posted by bitpunk: | Reply

There is this story in Murphy's "Listening to Prozac" that cuts to the heart of this. Wonsoponatime it was noticed that the rate of schizophrenia in NYC was way off the charts when compared to the same thing in London. After much sociological theorizing (more urban violence, unfettered capitalism, etc. in the USA led to more wackiness), cross-examination was eventually made (the british doctors diagnosed the american patients and vice-versa) and the differences disappeared. It turned out that with the then-prevalence of psychodynamic models in american psychiatry (this is the 1940s, IIRC) doctors tended to mark anyone who wasn't within the threshold of "neurosis" as "psychotic" -- i.e. schizophrenic.

"I'm from Europe, Romania" is a bit of an euphemism. Romania is as much borderline european as is Turkey; they beheaded a dictator not long ago. We tend to associate "Europe" with "moderation in capitalism", as opposed to the american variant, considered to be much more savage. Romania is no Paris, though. About half of its 22M people live outside urban areas; it has the 117th position in life expectancy in the whole world, and this whole world includes the so-called "third world".

I'm not saying all this to put down Romania, but to tone down the critique of "american values" stemming from the perceived difference towards the more cultured "european values". A great deal of the "Romania effect" might simply stem from the way local norms deal with behavioural differences; whereas in the USA (or in the large cities of Brazil) someone might be diagnosed as bipolar or ADHD, they might just become outcasts in a semi-agricultural society with 25% of its population below the CIA World Factbook poverty line (as opposed to 12% in the USA and 6% in "European" France).

I think many psychiatric patients feel the always-impending threat of poverty and exclusion from society, no matter how well-off they are. I know I'm afraid I might just snap off and never be able to complete my work assignments, and be cast off into mendicancy in a matter of one or two years (after my savings and social contacts wear off). What's more, I know I only managed to get and hold a job because of psychiatry – and that's because I have countless years of education and one well-connected contact.

I'm all for universal health coverage, but let's not hold any random country as a gold standard for social values just because it happens to lie in Europe. The very way the comment is phrased betrays how contrived it is – I never say "I'm from South America, the tropics, Brazil".

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Thank you for following ... (Below threshold)

September 10, 2009 2:41 PM | Posted, in reply to Joe's comment, by Alone: | Reply

Thank you for following me down this road:

Two important tenets of mercantilism are that the amount of wealth in the world is fixed, e.g. so accumulate bullion, capital, etc; and that government is formed specifically in order to protect the interests of "merchants" (domestic monopolies especially) at the expense of nearly everyone else in the world. Governments benefited by the tax revenues from these merchants, or from being outright shareholders in key industries (tea, spices, AIG, Ford, etc.)

Many of the differences in current mercantilism and older versions are explained by the changed definition of the "nation." In the 16th century tariffs would be used to protect the interests of domestic industries. Today, these industries are "multinational" even though they really they are American, so tariffs would fail. (Consider the controversy over double taxation of foreign profits.) Subsidies, tax credits, are used to "protect" the industries instead.

So "nation" now isn't a group _of people_ of the same culture or race (e.g. France=French); nation represents a collection of business interests, and the government of these business interests will protect those businesses.

Consider examples in which the U.S. government and not the Chinese govt. protects the interests of the music industry; American goes to war "for oil" (companies); America is changing the healthcare industry such that it will protect the insurance industry, etc.

The main difference between this and ordinary capitalism is that in this system, only companies profit; individuals have a much harder time of it. e.g. private practice doctors are being phased out, working instead for salaries for larger companies etc. See my post on Cleveland Clinic.

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The main difference betw... (Below threshold)

September 10, 2009 3:31 PM | Posted by Anonymous: | Reply

The main difference between this and ordinary capitalism is that in this system, only companies profit; individuals have a much harder time of it.

What does it mean to say that only companies profit? Executives? Shareholders? Are individuals excluded from chartering companies? I agree that those in power cull an advantage from it, but in what system is this different? Could government be made equitable?

Two important tenets of mercantilism are that the amount of wealth in the world is fixed

So who is advancing such an agenda? Merchantilism isn't just protectionism. Even China appreciates this. Productivity is the key. Are you saying that we're becoming merchantilist or that we think like merchantilists? That methodology isn't feasible anymore, regardless of want. The system is too interconnected for anyone to detach from. It is de facto capitalist, regardless of fears or desires. It's the "no one knows how to make a pencil" world.

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I can see where people migh... (Below threshold)

September 10, 2009 9:06 PM | Posted by Ba'alserrum: | Reply

I can see where people might get the idea that Psychiatrists are modern Shaman (though I see this as an insult to Shaman, who generally actually care about their people). For one thing, I think the rise in Psycodynamics came about in the 20th century, which was the beginning of the end for the idea (in pop culture, anyway) that religion in any stripe had anything productive to say about the world.

In the past, when someone was having trouble with personal problems, you'd go to your local church/temple/synagogue/mosque, and talk to the religious leader about how best to solve the problem. It wasn't necessarily a quick fix, but he's have some helpful advice, quote a few scriptures about how to live. But the priest wasn't there to keep you as a client, in fact in many cases, the supplicant is perfectly normal, that everyone has these feelings at times, and that it will pass.

I think a little religiousity is healthy for just that reason. First off, It's not easy answers. No religion that I'm aware of would say that the problem is easy to fix, and that after eating/drinking a potion you'll never have that problem again. Secondly, religion tends to paint the heros of the faith as flawed people. Gilgamesh crying over a ball and mallet that fell into the underworld, David and Bathsheba, Muhammad and the "Satanic Verses", any of the Greek or Roman myths. I think that's healthy, to see that even the best of us have problems, and that you can suceed despite them. Secondly, it gives you a publicly available, no middleman way to work through the problems -- pray and observe the religion, search you soul and deal with any baggage you have, help the less fortunate. The third benefit of most religions is that it gives a person a more "global" perspective on their problems. If all of the universe is dancing to the music of higher powers, then you are where you are for a reason.

But I think you get my drift. Psychiatry is a replacement for religion, therapists are the new high priests. When we stopped looking to religion for answers or at least cosmic perspective, we created something else to fill those roles. We've gone from "The LORD is my shepard, I shall not want" to "Prozac is my drug, I shall not want", in about 2 generations. i can't help feeling that there is a connection between the decline of religion and the rise of Psychiatry.

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To Anon: September 9, 2009 ... (Below threshold)