I just finished Whitaker’s “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.” I thought I would probably take few weeks to read it, as I have so much other stuff going on, but it kind of took over my weekend. While Whitaker can be faulted with at times making things seem simpler than they really are, I think his overall thesis, that psychiatric medications in general are on average making long term outcomes worse instead of better, is accurate and well supported (you can browse the evidence for his thesis at his website.)
What I am struck by is the similarity between the dynamics around the delusions of those who get psychiatric labels, and the delusions of the mental health system itself.
Why does the mental health system think medications are routinely helpful, when the long term data suggests they tend to be harmful? Let me list the reasons:
- Medications seem to work great in the short term
- There is a lot of pressure to decide something quickly, to resolve a crisis, so thinking about the possibility that long term results may be the opposite of short term results doesn’t happen
- Choosing medication creates secondary gains for various people and groups within the mental health system, and the existence of these secondary gains leads to a distorted examination of the evidence
- Quitting medications very often quickly leads to problems, and these problems are seen as “proof” that the drugs are helping long term
- Once medications are believed in as “the way” then evidence to the contrary is discounted or not examined. It would be too painful to even consider the possibility that so much has been invested into something that not only doesn’t help, but makes things worse.
These of course are the same reasons our clients hold on to delusions in general. Let me again list the (pretty much the same) reasons:
- The delusion “works” in the short term, to resolve some kind of dilemma or unbearable situation for the person
- The decision to believe in the the delusion is made during a crisis, when the person’s mind is ready to jump to any conclusion that resolves the crisis without looking at it carefully; and the possibility that believing in the delusion may lead to long term problems is not even considered
- There are secondary gains to various parts of the person from believing in the delusion. These secondary gains are never looked at objectively, but their presence leads to a distorted examination of the evidence.
- Even starting to question the delusion is scary & upsets psychological equilibrium, as even considering that one might have been so wrong about something creates a sense of “losing one’s grip on reality.” This loss of equilibrium when one starts to question the delusion is taken as evidence that it should not be questioned.
- Once the delusion has been invested in, contrary evidence is ignored, as first of all this evidence just seems wrong (since of course the delusional belief seems so obviously true) plus it would be very painful to even consider that one has been wrong about the belief for so long.
One difference of course is that with a mental health consumer, the parts gaining from the delusion, and the parts suffering from it, exist within one person, while with the mental health system many people are involved, and even if the some people such as the “patent” may be suffering from the mental health system delusion, other persons may be making large profits in both dollars and prestige.
In cognitive therapy for psychosis, the idea is to notice the distress the person may be experiencing, and then to use the distress as a justification for reviewing the beliefs that may be distorted. It is unlikely the parts of the system that are profiting will want to engage in such a dialog, but many parts of the system are not profiting from the current arrangements, and may be open to dialog. This includes:
- The mental health consumers
- Allies of consumers
- The public, which doesn’t want to pay money to make problems worse
- That portion of mental health professionals that care more about helping people than they do about their own prestige or “keeping the peace” with those in power.
If we can create an effective dialog, we can eventually change the system. But the idea that a medication that seems to “help” short term will also help long term is a very entrenched delusion, and replacing it may take a lot of work! Still, given that it is likely that there are probably more mental health problems being created by the mental health system currently than are being resolved by it (hence the current “epidemic”) it seems unethical for any professional, such as myself, to just work in the field and not speak out about needed changes.