One of the most concerning aspects about psychotropic medications, aside from the astounding number of Americans on them, is how the psychiatric community arrives at diagnosis of who should receive them. This is a critically important question, particularly in light of the alarming number of people swelling those ranks in recent years. As I asked in Part One of this series, what society-wide cataclysm has occurred in recent memory to precipitate such a need for tens of millions of Americans to require mind-bending drugs in order to cope? It’s a stubborn question, and no answer is forthcoming.
Marcia Angell, former Editor in Chief of the New England Journal of Medicine (NEJM), wrote recently in the NY Review of Books that:
The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades.
Two and a half times within twenty years?!! Did our American existence experience some psychic apocalypse, or is it just possible that the criteria for mental disorders has been grossly expanded in that time? A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were “anxiety disorders,” including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); “mood disorders,” including major depression and bipolar disorders; “impulse-control disorders,” including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and “substance use disorders,” including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment — up from a fifth in a similar survey ten years earlier.
Clearly something has changed in diagnosing and treating psychiatric disorders in the last few decades, and that change has led to a 600 percent increase in persons on government (Social Security) disability due to “mental illness”! This becomes more understandable when you consider that with a positive diagnosis comes not only a medical prescription for “coping”, but often a regular government paycheck for doing absolutely nothing. There is a built-in incentive to claim a psychological disability when the Nanny state is doling out free money. When government subsidizes these medications and treatment sessions, both the psychiatric community and the pharmaceutical industry also become beneficiaries of the “epidemic”. It has ballooned into a mega billion dollar industry, all with the government’s blessing and funding. Simple math and common sense render the dictate that “If you fund it, they will come.” But at what price?
How can we understand what these chemical cocktails do in our bodies if we don’t know what the underlying problem is? The human psyche is certainly complex, and a pill that renders some results is a quick and easy panacea without necessarily being good for the individual. This mode of treatment is reminiscent of the mother who doses her toddler with cough medicine to make him drowsy, rather than to quell a cough. I want to re-emphasize again that this is not a blanket condemnation of the use of psychotropic meds, but rather a hard look at their rampant overuse by the field of psychiatric medicine.
The genesis of many of these drugs is murky or haphazard. Marcia Angell addressed this type of “reverse research” (author’s term) when describing the development of many medications in this class.