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Are Prozac and Other Psychiatric Drugs Causing the Astonishing Rise of Mental Illness in America?

An interview with investigative reporter Robert Whitaker, about the dramatic increase in mental illness disability and its surprising cause.

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BL: Let’s get to the issue of psychiatric medications fixing “chemical imbalances.” This idea was absolutely crucial in making Prozac and other antidepressants attractive to depressed patients. However, these days even much of the psychiatry establishment has backed off the idea that depressed people have too little serotonin between their synapses and that antidepressants fix this chemical imbalance. Maybe it’s just me, but I can’t help but see the comparison between Big Pharma and the Bush Administration, which told Americans that the U.S. needed to invade Iraq because Saddam Hussein had weapons of mass destruction and he was connected to Al Qaeda. Of course, the Saddam Hussein-Al Qaeda connection was simply a lie, and the WMD rationale proved to be false. Do you believe that Big Pharma and establishment psychiatry were lying about this chemical imbalance theory at the time Prozac hit the market in 1988, or do you believe that they had hoped this theory was true because it sold drugs -- and it just turned out to be wrong?

RW: The low-serotonin theory of depression was first investigated in the 1970s and early 1980s, and those studies did not find that people diagnosed with depression had “low serotonin.” As the NIMH [National Institute of Mental Health] noted in 1984 at the conclusion of such investigations: “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” So why was the public told differently? 

The answer is a bit complicated. In the late 1970s, the market for psychiatric drugs declined and psychiatry suddenly saw itself as a profession under “siege,” having now to compete with a burgeoning number of psychologists and other non-physician therapists for patients. In response, the profession -- at its highest levels -- decided to sell the public on a biomedical model of mental disorders, as that model would naturally emphasize the importance of taking “medications” for a disease and it was only psychiatrists who could prescribe those drugs.

This storytelling began with the publication of DSM-III in 1980, which the American Psychiatric Association (APA) heralded as a grand “scientific achievement,” and then soon the APA was announcing that great discoveries were being made about the biology of mental disorders. And once psychiatry began to tell a story that wasn’t science based, but rather was best described as a marketing campaign, I think it began to believe its own marketing slogans. I don’t know this for a fact, but I am willing to bet that Bush, Rumsfeld, Cheney and others began to believe their own public pronouncements about weapons of mass destruction and a Saddam Hussein-Al Qaeda connection, and I think something similar to that happened in American psychiatry when Prozac came to market. The field stopped looking at the science that showed that the low-serotonin theory of depression had basically already flamed out, and instead began to believe its own propaganda.

Moreover, the chemical-imbalance story did more than just spur sales of drugs. It provided psychiatrists with a desirable public image. They were now like doctors in infectious medicine and other respected specialties, their medications “like insulin for diabetes.” The chemical-imbalance story told of medical progress, of a discipline that was unlocking the mysteries of the brain. Indeed, when Prozac came to market, there were newspaper stories about how psychiatry now had a new reason to “feel proud,” and how its public image had improved. So in the late 1980s and early 1990s, the chemical imbalance story is not one that tells of how lying moved into the heart of the field, but rather how professional delusion did. 

 
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