The accepted view of American psychiatry as we proceed into the 21st century is that we are on the verge of -- have already performed -- modern medical miracles in ferreting out the sources of mental illness and addiction in the brain.
But what if we're wrong? What if this is a cultural delusion? What would be the consequences?
Marcia Angell has raised this question in the current issue of the New York Review of Books in an essay entitled, "The Epidemic of Mental Illness: Why?" Because, you see, we are underoing a several-decades-long surge in the prevalence of mental illness in America. One of three books Angell (the former editor-in-chief of the New England Journal of Medicine, and now at Harvard Medical School) reviews in the NYRB is Robert Whitaker's Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.
Angell quotes this passage from Whittaker's book: "The number of disabled mentally ill has risen dramatically since 1955, and during the past two decades, a period when the prescribing of psychiatric medications has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate."
How could this possibly be? The greatest medical minds in the country have located the sources of mental illness in the brain, and have devised fabulous anti-psychotic and anti-depressant drugs that fix these things.
But what if the whole way these researchers, and we as a society, think about mental illness is wrong? And, you see, many people don't believe the brain disease model -- including, apparently, Angell, the authors of the three books she reviews in the first article in a two-part series in the NYRB, and, really, to some extent entire Western countries other than our own (for example, most psychiatrists in the United Kingdom).
Let's follow this mind experiment about wrongful thinking through a bit further. When we thought about mental illness differently, we tended to treat it with "rest cures" -- like by sending people to relaxing sanatoriums to get away from stress and to participate in occupational therapy.
I know -- pathetic!
But a funny thing has been happening in the United States. As Angell describes Whittaker's perspective: "Whereas conditions such as schizophrenia and depression were once mainly self-limited or episodic, with each episode usually lasting no more than six months and interspersed with long periods of normalcy, the conditions are now chronic and lifelong."
Have you ever heard of anything more ridiculous? In this viewpoint, once self-ameliorating or vascillating conditions have now become self-exacerbating and permanent because of the way we view and treat them! That, obviously, is crazy.
Are they really allowed to write such tripe in major intellectual journals, like the NYRB?
But, don't worry, psychiatry is plowing on undeterred by devastating epidemiological data on the prevalence of mental illness (a study by the National Institute of Mental Health has found that 46 percent of Americans now have, at one point in their lives, a major mental illness). The best and the brightest psychiatric researchers are currently focusing on tailoring drug treatments to people's individual genetic and neurochemical profiles so as to optimally target drug therapies.
But what if chemical imbalances are not real causes of mental illness, and this whole pursuit is mistaken and futile? You know, some people -- like Angell and others in the U.S. -- are beginning to suspect this possibility, while many researchers and therapists in other countries never believed otherwise.
Then we would be wasting millions of dollars while not addressing the actual sources of mental illness in society and in people's lives; we would be convincing people that formerly temporary conditions are lifelong stigmata that they can never overcome to lead normal lives; and we would be tampering with their brain chemistry in ways that are at best random and erratic, and at worse damaging and permanently scarring.
Here is how Angell introduces this last possibility in her first of two articles (the second to appear within the month):
One well-respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain, and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, "The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."
This point of view leads to a horrfying idea raised by Whittaker: "Could our drug-based paradigm of care (and thus the chemical imbalance idea underlying it), in some unforeseen way, be fueling this modern-day plague?"
Ordinarily, I am very open-minded and I usually oppose censorship. But isn't there any way we can ban Angell from publishing such ideas -- they run so counter to prevailing psychiatric wisdom in the United States? These ideas are dangerous because they stand a chance of upsetting our whole moden American medical-pharmaceutical-neuroscientific paradigm.