Overselling Overmedication
On the bookshelf behind me at work, I have two new books on the way the pharmaceutical industry is turning us into a nation of hypochondriacal pill-popping zombies: “Shyness: How Normal Behavior Became a Sickness” and “Our Daily Meds.” On the floor, windowsill and shelves of my office at home, I have quite a few more: “Generation Rx” … “The Last Normal Child” … “Toxic Psychiatry” … “Let Them Eat Prozac” … The latest volume, front and center now on my desk, is Charles Barber’s “Comfortably Numb: How Psychiatry Is Medicating a Nation.”
In the book, Barber argues that Americans are being vastly overmedicated for often relatively minor mental health concerns. This over-reliance on quick-fix medication is numbing our nation and dulling our awareness of real and pressing social issues and of non-psychopharmacological therapies and treatments.
Barber is hardly alone these days in this line of reasoning. The notion that American children and adults are being over-diagnosed and overmedicated for exaggerated or even fictitious mental disorders has now become one of the defining tropes of our era.
This storyline persists despite the fact that government research has repeatedly shown that most adults and children with mental health issues don’t get the specialized help that they need. It persists despite the fact that there’s really no way to meaningfully evaluate the degree of over-diagnosis and medication unique to our era, because to do so is essentially to look at the current era in a vacuum. We don’t know how many adults suffered from things like depression in the distant past because no one ever asked. The words and concepts through which we understand common mental health disorders today didn’t exist until the last few decades.
The narrative survives largely uncontested despite the fact, shared by psychiatrist Peter Kramer in his Slate review of Barber’s book, that only tiny numbers of people are receiving mental health services without real, clinical levels of mental health dysfunction or a history of mental illness or trauma. And despite the fact that, contrary to received wisdom, the United States is not a world leader when it comes to the use of psychiatric medications. (The U.S. is “’in the middle’ relative to other countries, and is not an outlier,” a study from M.I.T’s. Sloan School of Management, cited by Kramer, showed last year.)
Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon.
People have been unofficially drugging themselves for as long as they’ve had the capability to do so. They smoked cigarettes to boost their concentration. They drank cocktails with lunch and dinner — and more — to deal with anxiety and despair. Prior to the modern era of F.D.A.-regulated prescribing practices, they slugged down untold quantities of tonics and bromides.
All of which suggests that what social critics now identify as the signature event of our time (the urge to manage psychic pain through substance use) may, in fact, almost always have been a facet of the human condition. It may just be that we’re better at it than ever before – with cleaner, safer, less addictive and debilitating tools at our disposal.
Is that a terrible thing to say?
And what if, examined in the light of basic facts, and with a perturbing bit of common sense thrown into the mix, the popular storyline of our fatal corruption by Big Pharma turns out to be, if not utterly baseless, then at least greatly exaggerated?
Kramer, the author of the 1993 bestseller “Listening to Prozac” and, more recently, “Freud: Inventor of the Modern Mind” and “Against Depression,” makes a quite compelling case in his Slate review that the received wisdom about psychiatric drug use today is ahistorical, narrow in its cultural understanding and factually, often wrong.
To illustrate his point, he details research he did for the Carter administration to investigate the then deeply-held belief that a generation of women were being over-medicated with “mother’s little helpers” like Valium. “This inquiry occurred in the context of a broader discussion about whether America was becoming an overmedicated society – whether we were peculiarly averse to discomfort and enamored of the quick fix,” he writes. Yet, after convening a team of experts from the National Institute of Mental Health and other government agencies and studying women’s drug use and physicians’ prescribing patterns, Kramer’s group found that “little in the scientific literature suggested a crisis or even a uniquely American response to anxiety.”
Searching the data didn’t produce a convincing narrative about women being drugged into submission. But the belief that they were was itself deeply meaningful.
“The worries expressed about Valium were our worries: women were being given these more diverse responsibilities, weren’t being given their due, their voices weren’t being heard, the culture in general had a sort of oddness about it, we had a general sense of anxiety or unease and these issues were being explained through the idea that we’re just giving medication to women and not talking to them,” Kramer told me in an interview this week. “There was a sense that something was being covered over. Those issues found their symbol in Valium.”
There’s a lot in this little parable that’s relevant today.
Let’s get beyond statistics, percentage changes in diagnosis rates and billions earned off human suffering by Big Pharma. And let’s just try for a moment to get real.
Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them – happy-go-lucky types who essentially make a wrong turn on their way to Starbucks or soccer and end up in the consulting room – are being medicated for largely fictitious concerns.
But search your minds and memories: Have you, or people close to you, ever taken medication in a lazy or thoughtless way? Eagerly? As a lark? Ask around a bit; find out what kind of desperation led others to the point where they had to accept psychopharmacological help.
(Write and tell me. Tell us all. But please don’t send abstract social observations or share stories about people you don’t actually know. First-hand knowledge and real life only, thanks.)
The psychiatrists I’ve interviewed over the course of the past four years say that they have yet to be swamped by frivolous patients showing up in their offices looking for pills to help them tweak troublesome little aspects of their personalities. “Not only have I not encountered many [such patients], I haven’t encountered any in my office or even in detailed phone calls,” Kramer, most recently, told me.
There are good reasons to harbor considerable distrust about whether some psychiatrists’ prescribing practices really have patients’ best interests in mind. The Times has repeatedly and extensively covered the pernicious gravy train of payments from the pharmaceutical industry to psychiatrists who help promote their latest products; studies have indicated that receiving drug company money does influence doctors’ prescribing habits.
This is a disturbing, even disgusting, state of affairs. But it’s a fixable situation: Doctors and universities could in the future just say no to the drug money that is believed to corrupt them. They could be required to say no by law. Provided, of course, that the government stepped in to fund more and better research.
Harder to fix is the current social malaise that drives the belief that we have become a Prozac (and Concerta and Zyprexa and Effexor) Nation. What is its cause? How has it spun itself into a storyline about mentally vulnerable children and adults that is largely at odds with the facts?
What purpose does that narrative serve? What do we gain – or lose — through its continuation?
The downside is stigma, misunderstanding, and a lot of righteous indignation. I’m still working on figuring out the upside.
