- A fascinating (albeit very long) piece in The New Yorker by Gary Greenberg on psychiatry that delves deeply into many of the key issues, including whether the key issues are just made up or exaggerated by a profitable industry. Excerpt:
In “The Loss of Sadness” (2007), Wakefield and Allan Horwitz, a sociologist at Rutgers, argue that the increase in the number of people who are given a diagnosis of depression suggests that what has changed is not the number of people who are clinically depressed but the definition of depression, which has been defined in a way that includes normal sadness. In the case of a patient who exhibits the required number of symptoms, the D.S.M. specifies only one exception to a diagnosis of depression: bereavement. But, Wakefield and Horwitz point out, there are many other life problems for which intense sadness is a natural response—being laid off, for example. There is nothing in the D.S.M. to prevent a physician from labelling someone who is living through one of these problems mentally disordered. The conversion of stuff that people used to live with into disorders that physicians can treat is not limited to psychiatry, of course. Once, people had heartburn (“I can’t believe I ate the whole thing”) and bought Alka-Seltzer over the counter; now they are given a diagnosis of gastroesophageal reflux disease (“Ask your doctor whether you might be suffering from GERD”) and are written a prescription for Zantac. But people tend to find the medicalization of mood and personality more distressing. It has been claimed, for example, that up to 18.7 per cent of Americans suffer from social-anxiety disorder. In “Shyness” (2007), Christopher Lane, a professor of English at Northwestern, argues that this is a blatant pathologization of a common personality trait for the financial benefit of the psychiatric profession and the pharmaceutical industry. It’s a case of what David Healy, in his invaluable history “The Antidepressant Era” (1997), calls “the pharmacological scalpel”: if a drug (in this case, Paxil) proves to change something in patients (shyness), then that something becomes a disorder to be treated (social anxiety). The discovery of the remedy creates the disease.
- An interesting piece on Freakonomics about a family who pretends to be Christian for social reasons. Feel free to make analogies to Purim on one end and living in a frum community on the other...
- Sometimes, I really want to do something like this.
Thursday, February 25, 2010
EZ Reads 2/25
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Orthodox Judaism you believe in, but psychiatry's just a load of bunk, huh? :-)
ReplyDeleteFirst, this is just not true:
what has changed is not the number of people who are clinically depressed but the definition of depression, which has been defined in a way that includes normal sadness.
I think it's likely that more people today are diagnosed with depression that wouldn't have been diagnosed that way 25 years ago. However, many of those people are actually depressed, and "normal sadness" is clearly <a href="http://www.mhsanctuary.com/depression/dsm.htm>NOT included</a> in the DSM's definition of depression.
Psychiatry saves lives and depression is one of its success stories. SSRIs and psychotherapy reduces suicide attempts and successes (there is some debate w/r/t to SSRIs and children and adolescents, but the benefits appear to outweigh the risks) and improves lives. This is measurable and has been demonstrated in double-blind experiment after experiment.
And this is just stupid:
<i>Once, people had heartburn (“I can’t believe I ate the whole thing”) and bought Alka-Seltzer over the counter; now they are given a diagnosis of gastroesophageal reflux disease (“Ask your doctor whether you might be suffering from GERD”) and are written a prescription for Zantac.</i>
Heart burn may or may not be a symptom of GERD. People with GERD may or may not have heartburn. They are not the same thing.
Spreading this kind of disinformation makes it more likely that people do not get the help they need. Depressed people may try to tough it out, and may be more likely to commit suicide and/or live lives of quiet desperation. Even GERD, left untreated, could lead to esophageal cancer and other problems.
Similarly, social anxiety disorder is not the same as shyness. (And even if it were, if we can help with it, why not?!)
It's possible that some diseases like depression or GERD are overdiagnosed, although neither the author nor you present any evidence that this is the case. We know for a fact, though, that psychiatry and medicine have saved many lives and improved many more.
Let's be a little more responsible with spreading FUD (fear, uncertainty, and doubt) about medicine. It's hard enough to get depressed people into treatment without this garbage about how it used to just be called sadness.
I have a friend who suffered from serious depression and was successfully treated for it. A few years later he relapsed and it took months and months of convincing him to seek more treatment because one of the more insidious effects of depression is that it often convinces the person that it's hopeless and nothing will help.
Finally, he went back into treatment and after trying a few new medications found one that worked. And I mean WORKED. The difference in his mood, suicidal thoughts (which had been very frequent), his ability to do his job, his social interactions -- were unbelievably improved.
And on the other hand, I've known other people who've remained depressed for years because they think that psychiatry's a bunch of pseudo-scientific mumbo-jumbo.
Imperfect as they are, psychiatry and psychology are vastly more successful than any alternative and spreading this kind of FUD is dangerous.
An interesting piece on Freakonomics about a family who pretends to be Christian for social reasons. Feel free to make analogies to Purim on one end and living in a frum community on the other...
ReplyDeleteUgh. It sucks that religious people feel the need to shun non-religious people, especially children. It sucks in Christian Texas and it sucks in Orthodox Judaism.
Re: xkcd - Funny - I thought that about you when I first read it! (That you'd want to do something like that)
ReplyDelete