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I am absolutely raging now, at this article.
This is an article supposedly reviewing a book on mania by a medic who has frequently blew the whistle on shoddy research into psychiatric medication by Big Pharma. All well and good. But that’s not what it is. This article is yet another attack on the mentally ill for taking medication.
It’s a hatchet job, from the arts and entertainment section of the Times – specifically, the Literary Supplement – of the diagnosis of manic depression, done by being quite selective about what is actually mentioned about the book in question.
Here’s a quote early on:
the entity we have learnt to call manic-depressive psychosis, or bipolar disorder, a disease (if such it be) that afflicts a large and growing segment of the population from the smallest children to the ranks of the now ageing baby boomers.
First of all, no-one has referred to it as “manic-depressive illness” in 25 years, and the term “manic-depressive psychosis” is quite simply inaccurate – it isn’t used in English-language psychiatry. Psychosis or a psychotic episode as part of the illness, certainly, but not “manic-depressive psychosis”. That’s the French term for the disease (le psychose maniaco-depressif), but this isn’t Le Monde, would would probably produce a much more balanced article.
Also, there’s the implication that the patient population is growing. As far as I’m aware, the estimate of the proportion of the population suffering from manic-depression has remained static at 1%. It was 1% when I first started reading about this stuff years ago, and it’s 1% now. Maybe the author means that more people are going public about it, but anyone with half a brain can distinguish between occurrence and disclosure, and even if they don’t have half a brain, there are plenty of excellent resources (PubMed for starters) that can assist them in that task.
But no, we’re supposed to view it as a fiction of big pharma, an epidemic of over-diagnosis that is threatening to overwhelm us all, and of course, by implication, the pathologisation of normal human behaviour. (BTW, the rest of the article does bear this out as being the author’s intention so I am not reading too much into a paragraph early on. I can do this as I’m not writing my article for any publication so can take a few short cuts).
I love “a disease (if such it be)”. Because of course, here we get to the nub of the matter. I’m not really ill, it’s not really a disease, I’m just either a poor wee victim of the evils of big pharma, or alternatively, a malingerer who needs a kick in the arse, or again someome who has caused themselves problems in their life and needs some therapy so I can talk about how I feeeeeeel.
“few if any” mental patients in the Western world were held to be suffering from manic-depressive disease before 1920, and in the United States, the epidemic did not begin to emerge until as late as the 1960s, when drug companies began to market the disease.
No you moron, the increase in diagnosis occurred because instead of consigning the nutty to an asylum as in the 20s, doctors in the 60s actually took an interest in what might be ailing their patients, considered it might be curable and came up with a taxomony of illness. No-one was “marketing” mental illness in the 60s, people still didn’t even tell their spouses when they went into hospital, for chrissake. And there wasn’t any treatments available other than Chlorpromazine and ECT, as far as I’m aware.
I find it rather strange that someone smart enough to have a job writing for the Times would not work the above out.
We go on to be told about how lithium came to be used:
“Healy provides an entertaining and sobering account of the vicious disputes that then emerged between Schou and Michael Shepherd at the Institute of Psychiatry in London, centring on Shepherd’s contention that the enthusiasm for lithium was a therapeutic bubble, the product of poorly designed clinical trials. Controlled studies, he insisted, would soon puncture the bubble. ”
The article does not, as it should, point out that the effectiveness of lithium as a mood stabiliser has been proved in countless of trials many times over since then – instead they want the uninformed reader to feel sceptical about its effectiveness entirely.
Then we go on to Big Pharma being evil, tampering with research, that mood stabilisers do not work blah blah blah. You can read the rest.
What bothers me is not the book that is reviewed, it is the tone of the review. (And in fact I’m pretty sure the book is actually pretty rigorous and a lot less biased than the article).
Why is it so damned important to people at the Times that I happen to take medication for my disorder? Why do we see article after article in the media, on one pretext or another, that promotes the view that mental illness is not real, that mental illness is not as severe or not as big a deal as sufferers say it is, or that taking medication for it is evil, or a crutch, or an excuse for not wanting to “confront” one’s issues because therapy is so much work etc etc etc?
Why do the people at the Times CARE so much about this? We don’t see endless articles going on about coronoary heart disease, and how statins are eeeeevil and people shouldn’t be taking them, and that if you have heart disease it’s much better not to take any medication at all? Or that if you use your asthma inhaler or take hay fever medication, you are somehow weak-willed, using a crutch and not willing to face up to the realities of life which include pollen?
I mean, I am not going to insist that you take your Fluoxetine if your GP prescribes it for you. Feel free to handle your own mental illness with denial and self-blame if you so wish. Why does the existence of a small (percentage-wise) group of people in society who are sufferers of severe and enduring mental illness offend your sensibilities so much? I haven’t done anything to you.
My theory is that the existence of mental illness is proof positive that no matter how strong your personality or how hard you try in life, bad things can happen to you, and this includes mental illness, heart attacks and flatmates who like Michael Jackons’s Thriller and play it over and over. The Back to the Future ideology, “If you put your mind to it, you can accomplish anything” just isn’t true.
You CANNOT make your way out of severe mental illness, paraplegia or collapsed lungs by virtue of a healthy work ethic and an unwillingness to be beaten. Even in the privileged first world, sometimes life just shits on you for no good reason and there is nothing you can do about it. NOTHING. At least for mental illness, there are a range of medically-proven treatments available that can give you your life back, and it appalls me that so much effort goes into trying to presuade people not to access them or wishing that they could not.
Meanwhile, I get to be patronised, criticised or disparaged as a weakling so that people can entertain their own particular brand of philosophical sophistry. Nice.
[...] journalist is qualified to discuss mental illness in such a frank and demeaning way. Luckily, a guest post is up over at Mental Nurse which does a much better job: It’s a hatchet job, from the arts and [...]
Thanks for that. Now you’ve got me angry! If only there were a way to bitchslap such writers over the internet…
I thought that was what blogs were for? Sadly it’s only a metaphorical bitchslap rather than an actual one.
[...] has made me very angry. I don’t even know where to start, so I will just let DeeDee Ramona on mental nurse explain. Or you can read it on DeeDee Ramona’s [...]
I just want to add that, following feedback on facebook, this bit:
‘I mean, I am not going to insist that you take your Fluoxetine if your GP prescribes it for you. Feel free to handle your own mental illness with denial and self-blame if you so wish.’
is aimed specifically at the cretin who wrote the article and not a broad swipe at mentally ill people who choose, for various reasons, not to take medication.
From my experience with the intersection of Evangelical Christians and mental illness, I think that some of them simply don’t believe mental illness exists. Even some mental health care professionals who are Evangelical Christians. They think you can pray it out, and if you can’t, then you must be possessed by the devil.
I think there are a lot more people who have similar beliefs about the extent of human suffering. They don’t think that it is possible for a human to suffer so much that suicide makes sense. I can understand not wanting to believe that that sort of suffering exists, it is a painful reality, but then they act on that belief, making life even more miserable for those who are suffering more than they believe possible.
I think maybe this is what is behind a lot of people who stereotype all mentally ill people as just being whiners: they simply don’t believe such suffering is possible. That doesn’t make what they say hurt us, who suffer more than they believe possible, any less, but it does help me understand them. It is the only way I can explain the words and actions of people like this without assuming they are sadists. Otherwise, sadism is more rampant than I, or probably most people, ever thought or feared.
My experience with Evangelical Christians is that there is a strong intersection with being a complete twat.
Since religion is all about constructing airy-fairy castles in the air to make you feel better about the fact that life is shit, they are hardly in a position to judge (Christians who feel offended by my remark – please take your remarks to someone who gives a shit about that fact).
Any mental health professional who mentions religion to me in a professional context is getting a big fat lawsuit. I don’t have any time for sectarian crap. Yes, I am angry and vindictive enough to do that just to teach them a lesson.
Why yes, I am hypomanic and very very angry.
Um, Z, it might be best to get rid of the above comments other than the first sentence that reads “My experience….complete twat”. Pretty please?
And I resolve not to go online while full of unspeakable hypomania-induced random anger today…
It may amuse some of you that I dealt with this hypomanic rage by filling out my 08-09 tax return….
you should’ve got the train to London to have it out with him in person… what better use of the manic phase?
speaking as someone who is mentally disabled, not mentally ill, I would suggest Big Pharma have had absolutely nothing to do with the diagnostic criteria for PDD’s (autism).
in fact despite many attempts to prove we need neuroleptics, SSRI’s, lobotomies, ECT, &c., they have failed spectacularly to push their drugs on us (except in the US where children are cheaper than lab rats).
No need to want your impressive rant edited out DeeDee speaking as the token Mental Nurse evangelical Christian.
You make a good point as does Jessa before you.
One of the main things about Christianity is that the world is terribly broken and not a good place. People that see the world this way very possibly have a more accurate view of reality
But please remember gibbering idiots are exclusive to evangelical Christianity but we may have a higher percentage than the general population.
I meant to say not exclusive to evangelical Christianity.
Hmmmmm. Some kind of slip there.
Agreed. My CMHT is like this!
I had the audacity to not have psychosis and need their help. What did I get? Dependent Personality Disorder, and the note “X risks accidental suicide if he continues to take overdoses”.
There was absolutely no accident about the attempt whatsoever.
I like your criticism of the “oh just get on with it” approaches to mental health: medications do work for a lot of people. But the way that drug companies have hijacked diagnostic criteria is dangerous and well pointed out by this article. For me, the vaccuum that there is in the article is more like the one I got from reading Szasz’s “Myth of Mental Illness”: are you really saying all those people in hospital are faking it? If not, then what is it? Can’t we have something a bit more holistic please?
This is the thing. I mean, it’s one thing to go on and on about how evil medication is, but in that case, there had better be a good, well-proven alternative that they can point towards. Am I supposed to just go jump off the nearest bridge then in order to maintain my ideological purity.
I think, as one the commentors on your original site stated DD – medication may not be the answer for everyone all the time for everything – but it’s the closest thing going.
I agree with that – yet even tho I’m patently anti-pharma; I am not anti-whatever-works.
What I don’t like about pharma is the moulding of the MH construct around the (purp[orted) available treatments.
Many a prozac was given for placebo effect.
Now they’re marketing Risperidone or something for bi-polar in under 5yr olds – FFS – that’s shite.
Yes psychoses is a real experience and a nasty one for many.
Yes drugs alleviate – they improve functioning
None of the drugs in psych ‘cure’ – they contain symptoms.
Pharma loves this – it’s a lifelong prescription for them – so the more the merrier.
Oh I agree there Mr Ian. As I said, the actual book that was being reviewed is probably a good read, well-thought-out and probably doesn’t contain anything I would disagree with.
It was the review in the Times that got my goat – that this journo latched on to the book as if it were proof positive that mental illness is somehow not real.
Glad you are able to put the hypomania to good use. How come I can never do that?
D’oh! Comment in the wrong place. DeeDee – glad you filled out your tax return. Please don’t jump off the nearest bridge.
MM
Nah, it wasn’t that traumatic. It’s done now and this year they won’t be fining me 100 quid for being late about it!
I just wanted to reply to Jessa’s comments about some Evangelical Christians (even MH professionals) not believing in Mental Illness, since I am an Evangelical Christian with bipolar (on a cocktail of meds). I can completely believe that you have experience of Christians like that, but Ijust want to reassure everyone that we are not all like that. At my very big church I have only met one person who has questioned my diagnosis, noone else has a problem with it at all, or the fact that I take psychiatric drugs, or that I am frequently suicidal.
DeeDee – not offended at all by your remark. I have also met plenty of Christians (Evangelical and otherwise) who are twats. Actually, I have met plenty of people generally who are twats.
MM
Thanks. I realised I had gone way overboard in my comment because I was gripped by an inappropriate hypomanic rage caused by withdrawal from venlafaxine, which is currently necessary but not pleasant. I have a habit of being really offensive and sometimes nasty to people when in that state, something I am not proud of.
And yes, I believe Mr Ian said that there was a mathematical law of twattage that said that the total number of twats who can occupy 1 sqm of space is unbounded in polynomial space….
I did?
What a twat.
I wasn’t necessarily trying to get in punches at the Evangelicals, just to say, “here is an example of people who don’t believe in mental illness because it would stain their worldview or something, maybe this journalist has a similar problem that causes the denial of the existence of mental illness.”
I know that not all Evangelical Christians are twats (look at that masterful use of British slang!). I used to be one. But it is also very easy for me to slip into an attitude of “I hate them all” in the same way I slip into that attitude toward mental health care professionals.
And BTW, none of those Evangelicals who I met that seemed not to believe in mental illness would be likely to admit to not believing in mental illness. It was like they didn’t really believe in depression as a serious mental illness, but they did believe in “depression lite” (which is just the new moniker I came up with for the situation that gets diagnosed as depression but really doesn’t fit the criteria: being sad for a few days, post break-up blues, a mild case of homesickness, etc.) and similar “mental illnesses”. If you asked them if they believed in mental illness, they would probably say, “of course”, but be thinking of “depression lite” type mental illness; but if you present them with a serious mental illness, as I did with my depression et al., they say, “that’s not mental illness (because that other thing, “depression lite,” is mental illness), that is demonic possession.” I definitely don’t think this is true of all Evangelical mental health care professionals, but it is true of all the ones I met.
I have a book by Healy, although not the one reviewed. Psychiatric Drugs Explained (2009). Am only up to about chapter two but so far it seems pretty well balanced…eg. in a discussion about side effects of antipsychotics:
“In practice it seems that many individuals are prepared to tolerate the interference with daily living that some of the side effects listed…may cause, in exchange for peace of mind. The reason for listing these…is not to deter prescribers from prescribing or takers from taking but rather to involve takers and carers in making the trade off rather than having it imposed insensitively on them; and to give prescribers some feel for the nature of that trade off”
So far, I like what I’ve read. Seems to be more healthy scepticism than outright rejection of medication. Not reached the chapter about Big Pharma yet…
Yep – I’m pretty sure the book reviewed in the article is just fine! It’s the reviewer I had a problem with.
I agree CD, Healy is far more balanced a writer (and psychiatrist) than much of the journalistic froth that surrounds him might lead one to believe.
I have, through bitter experience of nasty undesired effects and limited efficacy. become very suspicious of using meds when I’m unwell, but the last time I was unwell it was reading Healy’s description of the dangers of untreated depression that led me to try meds again.
I didn’t get on with the meds, I felt they were unhelpful, and have found other ways to deal with depression, but I did gave the pharmaceutical option a proper try first.
It is important that people learn to differentiate between those of us who are scathing about Big Pharma, cynical about their “research”, disappointed by their product range aswell as being dismayed by side effect profiles and L Ron Hubbard.
It is important that people learn to differentiate between gentle Anglicans and Non Conformists as opposed to Evangelicals devoid of objectivity and rather too pious Catholics.
It is also important that people follow my lead and read the Mail rather than the Times.
Writing honest, and well balanced, histories of psychopharmacology will not have made David Healy especially popular with his psychiatrist peers. Nor will it have made him anything like the money he could have earned if he had jumped into bed with Big Pharma. For me, he`s a bit of a hero.
Yep, I agree with every word of that (apart from the bit about reading the Mail rather than the Times).
the Mail? oh dear OSB, you’re dumped.
OSB, you surprise me. I thought I’d got you pegged as through-and-through Daily Telegraph.
I do the Torygraph ranting around here.
And DD, I thought you’d like to know this message is brought to you by Lynx on a Unix Bourne Shell. *sigh* it’s like 1989 all over again.
Ooh I remember Lynx. But considering we’re talking about Evangelicals in places, shouldn’t you be using bash() (the Bourne Again shell)?
I write all my shell scripts in bash()…..
I had a paper round for over 5 years. Sadly, kids can`t be arsed these days so I don`t have a paper delivered. Mostly I buy the Mail but I flit about a bit. I have bought the Guardian precisely once as MN / Z were featured and I couldn`t find one to lend. I have yet to forgive myself. Currently, I don`t think it`s wise to read the revelations on MP`s expenses in the Telegraph and own a shotgun.
They won’t let me have a shotgun
My GP literally laughed when I asked him if he’d sign my ticket.
Commie, bunny hugging bastard.
More likely he couldn’t take the competition at the range
.
Bipolar in the under 5’s?
Isn’t that just what kids are like?
One minute they’re jumping on their bed or climbing up the fridge [cos the biscuit tin is on top, and KIDS NEED COOKIES], the next they’re crying for a hug or absolutely knackered, or quietly curled up on the sofa [plotting their next move].
GG
xxx
it’s like the recent study that said Mirtazipine (sp) reduced excessive masturbation in boys with Asperger Syndrome.
LMAO
like, can we have the definition of excessive masturbation in a boy with Aspergers and a laminated signed photo of “7 of 9″?
Going back to DD’s vitriol at the reviewer… I understand your PoV on it – and fully agree with it for those with a genuine psychotic disorder and those with a debilitating neuroses.
But for the last 20 years we’ve grown into a dependent population who expect everyone else to cure our ills – even down to complaining if govt don’t get it right with policy on kids health (psst… hint – that’s the parent’s job) or offering treatment for obesity or smoking… (psst…hint – u need to get off yer ass and go do something else – and I’m a fat smoker remember).
We had a referral to the team – ‘depression’
Cause?
Her boyfriend caught her sleeping with his mate and kicked her out.
She’s been “depressed” ever since…. which means, he hasn’t forgiven her, she’s made an arse of herself and everyone thinks she’s a bit of a slut.
Diag: Stupidity (F223)
Tx – 2 slaps upside the head t.d.s and a course of psyhcological therapy from the GTFU* manual
Review in 3 boyfriends.
There is some value in what he says if you consider he’s writing for the general public of the like described above.
If he was writing in the BMJ or PsychTimes or One in Four or something – then perhaps I’d think it more inappropriate – but nudging the general public to get off the mental band wagon and stop believing the big pharma hype is a better thing than all those mildly dysthymics running for a prozac and tissue-therapist.
It would also mean resources wouldn’t get sucked up by the walking worried well.
They got (proper) private psychotherapy for that and I refer 40% of my referrals on to them (HCPs qualified only need apply) which leaves the team to work with genuine need.
*originally marketed simply as ‘GU’ therapy – or ‘Grow Up’; GTFU is a more direct approach to dealing with life’s problems
I definitely agree that there are a lot of people who need your GTFU therapy more than anything else, and I do agree that they need this sort of kick in the pants. However, if this was indeed the goal of the reviewers review, he should have made that explicit. Otherwise it sends a pretty clear message to people like DD and myself: all mental illness is just whining.
Mmmhmm. I’m getting very sick of this whole “Prozac won’t fix your life” meme. Yes, and in other news, antibiotics don’t cure colds, and misusing them can make matters worse. It does not therefore follow that they are evil and no-one should take them; merely that they need to be used for the right reasons, and correctly.
*applause*. Antibiotics are a good comparison.
In the meantime, I’m listening to the uplifting sounds of Bush’s “Razorblade Suitcase” where they are extolling the virtues of Red Stripe and Vicodin.
I actually don’t mind the whole “Prozac won’t fix your life” meme. This would probably be different if I had people trying to apply it to me. Most people who know me well knew me well enough to know that I wasn’t just one of the whiners. I did have a couple aunts who thought I just had “a bad case of the growing ups,” but it didn’t really bother me too much because I didn’t see them very frequently. And maybe there were people who were pretty much strangers who would have thought that, but I seem to have scared people off from talking to me much. I didn’t speak much and people said that just looking at me hurt sometimes.
I actually appreciate the “Prozac won’t fix your problems” thing sometimes. When it is directed at all people with mental illness, it is really frustrating. But when it is directed at the “worried well,” that is when I appreciate it. Those people Need a kick in the pants. They give those of us who really aren’t well a bad reputation as whiners. They take services away from those who really do need them.
It’s a double edged sword.
Problem with that, though, is that we are members of the general public, and also people don’t tend to differentiate when they’re gleefully telling us what they read in the paper.
I nearly punched a friend after she told me “studies have shown antidepressants don’t work!” There is so much stigma and disapproval attached to taking meds – everyone and his dog wants to know when you’re coming off them, because obviously you are, and soon – and this stuff really doesn’t help. I mean, there was a thread not that long ago on self-destruction despite ‘insight’, and crappy med compliance in general, and people wonder why!
Mind yuo I find hypomanic rage has its place. Being able to say, “when you stop sticking your fucking nose into things that are none of your fucking business” is so much nicer than just getting upset when depressed, which is what I used to do when asked about when I was coming off the eeeeeeeeevil meds.
No no no… GU therapy is a reference to the heavenly chocolate deserts called Gu that you can find in your local sainsburys. The idea is to flip wankers the finger and have another desert…. mmmmmm.
Perhaps instead of blaming the “general public” for their high expectations of “a pill for every ill” we should be examining the motives and morals of the marketing peeps who created these expectations.
I don’t think anyone here would deny that the drug companies have ulterior motives.
I work in child and adolescent mental health services. I see the ADHD drug reps coming round on a regular basis. On my more charitable days, I take the view they should all be tossed into the deepest pit of Hell. When I’m feeling less charitable, my view is that they should all be tossed into the deepest pit of Hell, and then the pit should be submerged in pig faeces.
But accepting that the drug companies have ulterior motives does not mean one has to deny that some people experience deeply distressing psychiatric symptoms – mood swings, hearing voices, thought disorder etc – and that medication can often help these people. There is a middle ground that can be trod,.
DeeDee Ramona’s views are very much in that middle ground. Likewise so it seems are those of the author being reviewed by the TLS.
I’ve no problem with the author. Just the journo. WHen you think about it, telling me I’m not actually sick is really fucking insulting. It’s implying I would have caused all the disruption to the lives of my loved ones and the upset and worry because I can’t be arsed getting my finger out and sorting my life out, so to speak.
I felt a lot less shit about it when I realised I was within my rights to act as angry and insulted and that I didn’t have some sort of duty to make people understand. You don’t want the information and won’t read the books or wrbsites? Tough shit, I’m going to rip you a new one then.
I need to break here though, as I have to make yet another trip to the toilet thanks to venlafaxine withdrawal. I don’t LIKE taking these meds. But I have to.
btw folks I won’t be able to respond to comments for a week now as I am off to sit in the baking hot sunshine in Egypt on the Red Sea
. All-inclusive. I expect to be several pounds heavier when I return 
.
“I expect to be several pounds heavier when I return”
probably not if you’ve stopped the Venlafaxine. It’ll probably even out. Especially if you stick to falafels.