Wednesday, July 13, 2011

Psychiatric Drugs and the State of Mind

Recently in The New York Review of Books there appeared two insightful review essays by Marcia Angell.  In these articles Angell reviews a number of books calling into question the current cultural rampage for psychiatric drugs.  I can't begin to do justice to Angell's reviews of these books but a few select quotations might be enough enticement to go see her articles.  Angell begins her first article with the following facts about the amount of "mental disorder" that is being "diagnosed" in our time:

It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.
A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were “anxiety disorders,” including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); “mood disorders,” including major depression and bipolar disorders; “impulse-control disorders,” including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and “substance use disorders,” including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment—up from a fifth in a similar survey ten years earlier.
Later, in the second part of her series, she ends with the following practical consequences that are already being seen and will, in all liklihood, be more prevalent.

As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive. It is more generous than welfare, and it virtually ensures that the family will also qualify for Medicaid. According to MIT economics professor David Autor, “This has become the new welfare.” Hospitals and state welfare agencies also have incentives to encourage uninsured families to apply for SSI payments, since hospitals will get paid and states will save money by shifting welfare costs to the federal government.
Growing numbers of for-profit firms specialize in helping poor families apply for SSI benefits. But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.
In December 2006 a four-year-old child named Rebecca Riley died in a small town near Boston from a combination of Clonidine and Depakote, which she had been prescribed, along with Seroquel, to treat “ADHD” and “bipolar disorder”—diagnoses she received when she was two years old. Clonidine was approved by the FDA for treating high blood pressure. Depakote was approved for treating epilepsy and acute mania in bipolar disorder. Seroquel was approved for treating schizophrenia and acute mania. None of the three was approved to treat ADHD or for long-term use in bipolar disorder, and none was approved for children Rebecca’s age. Rebecca’s two older siblings had been given the same diagnoses and were each taking three psychoactive drugs. The parents had obtained SSI benefits for the siblings and for themselves, and were applying for benefits for Rebecca when she died. The family’s total income from SSI was about $30,000 per year.
Along the way through her essays, Angell speaks about neurotransmitters, placebos, and the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  The DSM-V is being worked on now and is set to be released in 2013.  The list of disorders will be increasing.  You've heard of ADHD. Well that led to "juvenile bipolar disorder" which was so over diagnosed that there was backlash.  The new DSM-V is set to give us a new childhood disorder--"temper dysregulation disorder with dysphoria"--TDD, for short.  You watch for it.  In a few years this will be the new code ("TRR") bandied about much the same way ADHD was, and still is.

Angell's two review essays are important reading in that they direct us to important literature and facts not widely known to the populace at large.  You can find her two articles linked below.

"The Epidemic of Mental Illness: Why?" June 23, 2011

"The Illusion of Psychiatry" July 14, 2011