I am in dismay and almost unhinged by this revelation and all the corollary issues that this essential fact raises. These facts make me wonder about the efficacy of psychopharmacology altogether. I bought into the chemical imbalance theory, which states that a person with mental illness is suffering from a biochemical imbalance in the brain. Now I find out that this is just a convenient metaphor, which destigmatizes the condition and makes mental illness not the sufferer's fault. I learned from a quote by Dr. Hyman of Harvard University cited in the "Anatomy of an Epidemic" that:

"The chronic administration of the drug(s) then causes substantial and long-lasting alterations in the neural function." As part of this long-term adaptation process, there are changes in intracellular signaling pathways and gene expression. After a few weeks, the person's brain is functioning in a manner that is qualitatively as well as quantitatively different from the normal state."

In other words, psychotropic and anti-depressant drugs don't make the brain normal, they muck it up. Robert Whitaker asserts this view. He also asserts that prescription of these drugs for schizophrenia, bipolar disorder, and depression may be altogether unnecessary. He cites evidence from the past and European mental hospitals that the recovery rate for un-medicated patients is better than for medicated patients. I do not support that view--perhaps I can't because of my commitment to using these drugs--but Whitaker has raised an issue that bears further analysis.

I have been taking these drugs now for over ten years, and I must say that the modest cocktail of medications I take seems to work for me just fine. However, I did take other ones in the beginning and they really screwed me up. From Depakote and Seroquel, I had massive side effects. These were the first drugs I was given upon hospitalization, and I was on them for a long period of time, until I was able to say no longer would I take Depakote that made me gain 100 lbs, nor would I take Seroquel that made me feel like a zombie. I was lethargic and in a kind of mental haze. (To be fair, there are other patients who did not have the same reaction that I did.) Neurontin was given to me at some point and now I find out from my reading that this drug developed for epilepsy was foisted on the medical community by the drug company working with the FDA even when it was found this drug had little or no effect on bipolar disorder. Trileptal (Oxcarbazepine), Klonopin (Clonazepam) are two drugs, first developed to treat epilepsy, I also took. Why don't we hear more about the relationship of epilepsy to mental illness? Rozerem (Ramelteon), Artane (Trihexyphenidyl), Lithium, and Risperdal (Risperidone) are others drugs I have gone through to my latest concoction. I feel like a walking pharmaceutical advertisement.

Yet I am a success story. Lamogrine, Abilify, Lunesta, Carbidopa/Levodopa, and Primidone work for me. My current psychiatrist, who is much more than merely a psycho-pharmacologist, provides therapy, too. From what I hear from my fellow customers of psychiatry, my situation is not the usual. Those I know who go to an insurance-sanctioned practitioner or who must rely on public programs are universally confronted by pill pushers. If the drug is not working, they prescribe more. If the drug has too many side effects and the user balks at taking it, they prescribe something else. The cycle goes on until something is found that works for the patient. If not, the patient usually gives up and goes un-medicated. Psychiatry is not a profession that leaves the client satisfied all the time.

Psychiatry as a medical profession is in crisis according to Carlat. First, it is not like the other medical specialties, which can correct real physical problems with an exact procedure. There is no brain operation, like a heart operation, that can cure mental illness. Maybe the closest it can come to is electro-shock therapy, a medical last resort to break deep depression; but even this procedure is not like cutting out a tumor. It is more like giving the brain an external blast for which no one knows why or how it really works. Some psychiatrists, in order to cloak themselves in the medical model, have come to depend on medication as the proof of effectiveness of their treatments. Because of this, doctors have played into the hands of and become part of the pharmaceutical industry.

Both these books, "Unhinged" and "Anatomy of an Epidemic," provide great insights into the origins of this state of affairs. They cite how psychiatrists acquired by law the sole right to prescribe medication blocking out pharmacists and psychologists. They cite the power of the DSM (The Diagnostic and Statistical Manual of Mental Illness), formulated by a committee of psychiatrists, that has over the years increased the number of types of mental illness almost to the point of over abundance, and that has became a vehicle for companies to create drugs that responded to these many different kinds of diagnoses. One illustration of this move to excessive diagnosis is Carlat's comments about the creation in DSM-IV of a condition called social anxiety disorder--a fear of social or performance situations resulting in distress. This condition, he says, was formerly called shyness. I am sure a drug will be invented to control this situation. Wait a minute, there is already a drug for this situation. It's called alcohol.

Alcohol is not medically approved today, but as I remember from watching Westerns a drink of alcohol was the elixir given by a doctor prior to removing a bullet. Maybe Seagram or Johnny Walker can get alcohol approved by the FDA for social anxiety disorder because it appears pharmaceutical companies have great success in approval for even the most dubious of drugs for mental conditions--Neurontin is a good example--or ones whose side effects are severe. Carlat mentions Paxil. Whitaker and Carlat claim the whole process of drug approval is polluted. The kinds of results wanted can be fabricated by the way a drug company does its tests. Patients who might color the outcome, such as those with prior experience with a drug or are considered too old are eliminated from tests. Even a double blind test (one that uses a placebo as an alternate) can be manipulated to provide positive results. Since in our country the drug companies and not Federal Drug Administration (FDA) do the tests, we have a biased system for starters. There is no budget for the FDA to actually conduct the tests. Thus we rely on the drug companies and the universities for the testing. University testing is tainted too, since many of the doctors who carry out the tests are paid consultants to the drug companies. This issue of testing and approval is enough to make your hair stand on end. Or mine anyway.