Death Grip (40 page)

How I hated that message. The idea of scheduling time with Dr. Porridge, of setting foot in his office and, even if only for fifteen minutes, taking on the mantel of “patient” again—not to mention giving him the opportunity to review my writing—sent cold sewage through my veins. This man had no claim over me, but he still acted as if he did. Now I understood how Alison felt:
These pills have already taken enough of my life.
It's scary being just one person against something as ironclad as the pharmaco-medical hegemony. Truth be told, even after St. Martin's Press accepted the proposal for this book, I thought of pulling the plug for that very reason. This is the context in which we find ourselves. Psychiatrists and Big Pharma have no interest in anyone going
off
their pills, yet at the same time anyone outside the system who dares to offer guidance or an alternative point of view is subject to harassment and prosecution, creating a culture of fear, suspicion, and paranoia. I don't offer advice or even Web site links to people who cold-call or e-mail me, having read my story in
Outside
and professing that they want to get off benzos. I'm not willing to take that risk, to be lured that way, to fall victim to some mole for the doctors.

The real question is, how did things get so messed up? Well, if you can answer that one in five thousand pages or less, you can probably unpack other issues of pressing global import like the financial collapse of the First World, America's endless, deficit-incurring warmongering, the failed war on drugs and America's booming prison economy, the corporatization of politics, man's wanton exploitation of Earth's natural resources, and so on. Basically, you would need to pen a treatise explaining cowardice, evil, power-lust, arrogance, and greed, and then in metaphysical terms reveal how and where humanity went wrong. Maybe it was at an apple tree somewhere in the Garden of Eden, or maybe it was in a chemist's lab at some pharmaceutical company. Or maybe it was both.

Despite what you've read, I don't believe that psychiatry is categorically evil (maybe only 98 percent!) and I'm no mental-illness denier. There
are
dark anomalies in perception and mood that we might, if we must, label “illness.” I've seen antipsychotics help a good friend and one family member, by marriage, come back from psychosis and resume meaningful lives. For them, it's a delicate balancing act between side effects like weight gain and sluggishness and the torment of their condition. I've met people on lithium who, while they detest the drug's mood-flattening effects, also laud the stability it's imparted. And I've had climber friends come up to me, knowing my story, and ask what I think about the ADHD and antidepressant drugs they're considering for their children. I try not to be dogmatic—I tell them that my story has so many twists and turns that it's not likely this will happen to their kids. And I remind them that my central problem was dependence on benzodiazepines, by far the worst drug I've withdrawn from. And I do concede that for years the low dose of Paxil I was on helped me, at least as a placebo, through depression … until like a beloved dog gone rabid it turned, baring its fangs. I would never judge anyone for taking psych meds, just as I hope they wouldn't judge me for choosing not to. It's hard enough facing the darkness without a chorus shouting criticism in your ear.

But what I do tell my climber friends is this: Don't rely solely on the meds, but also (or only!) engage with a good therapist. Educate yourself about the complications and side effects and withdrawal syndromes of every last pill, because they all have their cons and they all have washout periods persisting potentially much longer than per the official literature. They all, precisely because they act on neurotransmitter systems, exact changes in the brain that are slow to reverse. And I say, Keep your eye on the dosage and number of pills your child is taking because it is not something to let snowball. And finally, a piece of advice I would give anyone, adult or child alike: If you're considering a psychiatric medicine, make sure you and your prescribing physician develop an exit plan that you both sanction, because someday you might want to go off the medication, at which point you may find your doctor is your worst enemy. You might get pregnant and not want to court the possible birth defects that come with taking SSRIs. Or you might realize that any pain you feel as a course of nature is preferable to that caused by psychiatry—you might realize, like me, that the depression and anxiety you feel
on
the drugs are orders of magnitude worse than they would be au naturale. You might realize, as the journalist Robert Whitaker postulates in his book
Anatomy of an Epidemic
, that the drugs are creating “chronicity”: relapsing, downward-spiraling mental illness in fact caused by drug-induced changes in neural receptors and a concurrent rebound in your original symptoms every time you try to quit that has your doctor—and hence you—convinced that you must never, ever stop. Or you might develop philosophical objections, concluding that, as with so many pillars of our quick-fix McCountry, psychiatry has metastasized into an untrustworthy, all-devouring Leviathan and you don't want its tentacles wrapped around your skull another millisecond.

One thing I
don't
tell my friends, not wanting to sound like a crank, is that based on my interactions, I've found psychiatrists on the whole to be arrogant, power-mad bloviators who will dig in like a muddy dog being dragged to the bathtub if you so much as question the efficacy of their tools. I don't tell them that the profession, in staking chemical claim to an organ as infinitely complex as the human brain, seems to attract mountebanks, charlatans, and voodoo witch doctors more interested in pharmaceutical tinkering than people. I don't repeat the classic quote of a fellow ward of Hopkins as we watched a gaggle of doctors breeze past officiously one evening, white coats flapping in their wake: “I've come to realize they aren't gods.” And I don't bother mucking about with a discussion of “chemical imbalances,” which I must assume my friends have been told is the cause of their children's woes. I heard this hypothesis trotted out again and again at the hospitals, an assertion as misleading, simpleminded, and jingoistic as a first-grade teacher drilling into her students' heads that it was Columbus, and only Columbus, who discovered the Americas. “Take your meds,” the doctors and nurses would urge us. “It's just like a diabetic needing his insulin.” I even have a worksheet, “Brain Chemistry and Mental Illness,” from Hopkins that frames the idea in grasping, idiot-manchild verbiage: “In mental illness, there is a chemical imbalance similar to diabetes. If you don't have certain chemicals in your brain, it doesn't work right and you have mental illness. In diabetes, a person needs insulin to live for the rest of his/her life. In mental illness, you need certain medicines to replace the chemicals in your brain for the rest of your life.”

The rest of your life.
As if from cradle to grave a person is no more than the sum of his neurochemical activity. As if, as per Hopkins' incomplete metaphor, your brain like a malfunctioning pancreas isn't producing enough Paxil.

So much of modern psychiatry's—or more aptly, psychopharmacology's—drug-mongering can be traced back to this theory of a chemical imbalance, which arose in 1965 when Dr. Joseph Schildkraut published “The Catecholamine Hypothesis of Affective Disorders” in the
American Journal of Psychiatry.
To sum up what has become known as the “monoamine hypothesis,” depression is supposedly caused by a deficiency of certain neurotransmitters—in particular the monoamines serotonin and norepinephrine, as well as dopamine. This was deduced by the fact that antidepressants, proven effective in clinical and drug-trial settings, are known chemically to increase the amount of neurotransmitters available in the synapses. Thus, it was surmised, the drugs work by addressing a preexisting deficiency of those neurotransmitters. There are two main problems with this hypothesis, however: First of all, no direct diagnostic test has ever been devised to measure brain levels of neurotransmitters, or that shows any chemical link between a specific mental illness and a specific neurotransmitter system. The best psychiatrists have mustered is such indirect observation as, writes Daniel Carlat in
Unhinged
, measurements of neurotransmitter “breakdown products in the blood, urine, or cerebrospinal fluid (CSF).”
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A half-century after Thorazine, despite any perception of psychopharmacologists as supreme neural alchemists, you still cannot walk into a shrink's office, have your neurotransmitter levels measured like car fluids at Jiffy Lube, and then walk out with the perfect, chemically tailored prescription.

The second problem with the monoamine hypothesis is that antidepressants might, as demonstrated convincingly in Irving Kirsch's
The Emperor's New Drugs
, work mostly through the placebo effect anyway: Kirsch's meta-analysis of forty-two clinical trials (including negative trials proprietary to the drug companies that were buried in the FDA archives and which Kirsch obtained through the Freedom of Information Act) of the six antidepressants most prescribed between 1987 and 1999 showed that placebos were 82 percent as efficacious as the drugs.
2
Kirsch had reached similar findings through another meta-analysis, of thirty-eight studies, he and Guy Sapirstein undertook in 1998:
3
that “improvement in patients who had been given a placebo was about 75 percent of the response to the real medication,” meaning that “only 25 percent of the benefit of antidepressant treatment was really due to the chemical effect of the drug”—a clinically meaningless difference and one that pointed to antidepressants performing little better than sugar pills.
4
(As Kirsch frames it, the placebo effect, or the difference between a placebo and no treatment, was double that of the drug effect, or the difference between response to the placebo and response to the drug.
5
) Given all the troubling side effects, then, of antidepressants, it would seem to make little sense to take them. Moreover, Kirsch has postulated an “enhanced placebo effect” in the perceived effectiveness of antidepressants—namely that by causing noticeable side effects that cause patients to “break blind” in the classic double-blind, placebo-controlled studies used to bring the drugs to market, antidepressants convince a patient that he's receiving an effective treatment, and hence not the placebo. The depressed subject, being in psycho-spiritual hell, of course wants to feel better and will, thus cued, go on to “get well.” Kirsch supports his case by arguing that active placebos—pills with side effects—that aren't antidepressants like barbiturates, benzos, and synthetic thyroid hormone have produced similar findings.
6

With the monoamine hypothesis firmly in place from the mid-1960s on, psychiatrists quickly began to extrapolate the notion that
all
psychiatric illnesses were caused by similar neurochemical imbalances, using the known chemical action of psychoactive drugs as their proof. Therefore, if an antipsychotic like Thorazine or Haldol was known to suppress dopamine activity, then schizophrenic psychosis surely was caused by an excess of dopamine. And if an SSRI antidepressant like Prozac increased serotonin activity, then depression surely was caused by a deficit of serotonin. And if an anxiolytic like Valium augmented GABA activity, then anxiety surely was caused by a deficiency of GABA. And later, as happened to me, if you have a bad reaction to an SSRI (a class of drugs known to induce mania in those not formerly manic!), then surely you must be bipolar. This pseudoscientific approach attempts to reverse-engineer the root causes of mental illness using man-made molecules as diagnostic tools; it has also, conveniently for Big Pharma, evolved in lockstep with an explosion in new, “ever-better” psychiatric chemicals over the past half century. However, the flawed, reductive lens that is the chemical-imbalance theory needs to be tossed on the scrap heap. Again, even though decades of research have not come up with a single direct diagnostic test to provide any evidence, the hypothesis has been continually touted by psychiatry and accepted at face value by the mainstream. Yet as Dr. Ashton once said of the initial enthusiasm for the theory, “Of course these naïve and simple hopes turned out to be in vain. Fifty years later we still do not know the cause of schizophrenia or depression or even how the drugs work.”
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And as Dr. Peter Breggin has famously written, “… the only biochemical imbalances that we can identify with certainty in the brains of psychiatric patients are the ones produced by psychiatric treatment itself.”
8

Another contributing factor to psychiatry's current overreach is the
Diagnostic and Statistical Manual of Mental Disorders
, a tome with sixteen different groups of disorders that psychiatrists use to diagnose and hence prescribe for various conditions.
9
Compiling all official mental illnesses and their symptoms, the
DSM
has metastasized to the point of pathologizing normal variances in personality, if not personality itself. The
DSM
was once but barely a pamphlet: The first edition, from 1952, was a small notebook, while its second iteration, in 1968, contained 134 spiral-bound pages and 182 diagnoses. Both had a quaint, archaic flavor, with an emphasis on Freudian notions like neurosis. Then came
DSM-III
, published in 1980, the field's attempt to apply scientific rigor to the diagnosis of mental illness.
DSM-III
reached 494 pages and offered a vast menu of 265 different diagnoses, thanks largely to its then editor, the psychiatrist Robert Spitzer, who held raucous editorial gatherings at Columbia University during which fifteen psychiatrists, handpicked by Spitzer, hollered out symptom checklists and pet names for new disorders.
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To qualify for a specific disorder, a patient now had to evidence a certain number of symptoms—for example, five of the nine symptoms for major depression, a number picked more or less at random. (As Spitzer told Daniel J. Carlat, the author of
Unhinged
, “… four just seemed like not enough. And six seemed like too much.”
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) The goal with these checklists was to introduce reliability into the profession—to increase the odds that a patient presenting with a certain set of symptoms to one psychiatrist would receive the same diagnosis from another. Because psychiatry has long been the redheaded stepchild of the medical world, its treatments and biological underpinnings shaky at best, this was the field's big chance for self-legitimization. Writes Robert Whitaker, “With the publication of
DSM-III,
psychiatry had publicly donned a white coat.”
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