Comfortably Numb: How Psychiatry Is Medicating a Nation

By Onnesha Roychoudhuri, AlterNet. Posted April 17, 2008.

While we've now become accustomed to the barrage of prescription drug commercials on prime-time TV, it's jarring to learn that this advertising is legal only in the United States and New Zealand. The pharmaceutical industry doesn't just target Americans directly, but also spends roughly $25,000 per physician per year. With the aid of information from data mining companies, a pharmaceutical representative knows exactly how many prescriptions for what medication a doctor has written, allowing the industry to individually target them.

How Americans came to this fraught relationship with the pharmaceutical industry and its drugs -- particularly antidepressants -- is the subject of Charles Barber's new book, Comfortably Numb. A veteran of mental health programs in homeless shelters and a lecturer in psychiatry at the Yale University School of Medicine, Barber trains his eye to the confluence of science and culture that have led to the widespread prescribing of medications once reserved for the most serious cases.

While the field of neuroscience continues to churn out new data about the way our brains work, Barber is quick to remind us how much more is yet to be understood. Barber recently spoke with AlterNet about how less sexy treatments like social interventions and therapies can be just as effective in changing the brain.

Onnesha Roychoudhuri: What led you to write the book?

Charles Barber: When I started in the mental health field in the late '80s there wasn't really a name for what I did. If I talked to professional, educated people, they didn't understand psychiatric diagnoses or medications. Then, 10 years later, people were very up on diagnoses, they were sympathetic to what I was doing, and there was now a name for the field: mental health. Many of them were taking the same medications that my clients were. There was a series of events over the late '80s and early '90s that set all that up. The main thing being Prozac and its cousins Paxil and Zoloft, which became totally mainstream; the TV advertising of drugs in the mid-'90s, well-known figures going public with their clinical depression, and a lot of subsequent pop culture stuff: The Sopranos and A Beautiful Mind, for example. All of this brought psychiatry, particularly medications, into the fore.

OR: Can you talk about your involvement in the mental health field and what it has enabled you to observe?

CB: I fell into the field for a lot of different reasons. I worked in psychiatric homeless shelter programs for about 10 years in New York -- Bellevue being the most well-known. So I was working with the really seriously mentally ill, many of whom had been in and out of prisons and state psychiatric facilities and homeless shelters. What I found was that psychiatry, at least for certain diagnoses, has confused the really serious forms of the illness with the far lesser forms. The best example is depression. Many of the folks that I worked with suffered from severe depression. I make the distinction in the book between big "D" depression and small "d" depression. In its severe forms, it's an absolutely brutal, horrific and malevolent illness where people are at dire risk of hurting themselves.

It's jarring to go to a cocktail party and hear people talking about being bummed out or hear that they're going through a divorce, and their family doctor put them on an antidepressant. There has been a confusion and conflation of this diagnosis that confuses serious disorders with far lesser conditions or, in many cases, life problems. We've medicalized a lot of life issues that are not mental illnesses.

OR: Just to be clear, this book is not about medication as a "bad" thing.

CB: Absolutely not. I think I make clear in the book that for serious disorders, I've seen the medications work really, really well. However, there are often side effects that the field has overlooked and is becoming more aware of these days. And these medications still don't work a good percentage of the time for people with serious disorders. My critique is that the further you get away from serious or moderate disorders, where you're treating nondisorders or marginal disorders with medication, the risk/reward calculus of the medications becomes more iffy -- particularly antidepressants.

When the SSRI (selective serotonin reuptake inhibitor) antidepressants like Prozac and Zoloft and Paxil first came out, they were considered pretty much side-effect-free, largely because the previous generation of antidepressants had a lot of side effects. But in the past few years, people have become more aware that they have more side effects. These effects are seen most when people are getting on and off the drugs.

OR: You write that, in 2002, more than 11 percent of American women and five percent of American men were taking antidepressants. I was struck by the high percentages, but also the fact that more than 1 in 10 women are on these medications.

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Onnesha Roychoudhuri is a San Francisco-based writer and editor. She has written for AlterNet, the American Prospect, Salon, Mother Jones, Truthdig, In These Times, Huffington Post, and Women's eNews.

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