On July 28, I published a post called Simon Says: Happiness Won’t Cure Mental Illness. The article was essentially a critique of a post written by British psychiatrist Simon Wessely, who is the current President of the Royal College of Psychiatrists. In his post Dr. Wessely had stated:
“…you can come at this from the other direction i.e. that by treating their mental illness, patients will inevitably become happier as their suffering is alleviated. And I certainly can’t argue with that.”
To me the meaning of this statement, particularly the use of the word “inevitably,” is clear: all psychiatric treatment alleviates suffering and makes people happier. The falsity and self-serving aspect of this contention is glaringly obvious, and I drew attention to this:
“The word ‘inevitably’ strikes me as grandiose. What of the people who have been so damaged by SSRI’s that they are virtually incapable of feeling normal joy? What of those people whose lives have been destroyed by neuroleptic-induced tardive dyskinesia and akathisia? What of the people whose lives have been ruined by benzodiazepine withdrawals? What of the victims of electric shock treatment who can’t remember that they went to college and got a degree? The notion that “psychiatric treatment of mental illness” will inevitably make people happier is the very height of psychiatric arrogance. In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization.”
This drew the following Twitter response from Georgia Belam, a GP working in the UK, and a member of the International Health Humanities Network.
“Crikey. ‘In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment & stigmatization.’ that’s a pretty awful thing to say, doesn’t take any notice at all of the people who have been helped.”
Dr. Belam’s contention, that the drugs help at least some of the people who take them, is often heard in this debate, and warrants some discussion. It is certainly the case that a great many people who take psychiatric drugs say that they find the products helpful. In fact, all evidence of efficacy of psychiatric drugs, whether the evidence is derived from research trials or from practice feedback, hinges ultimately on the self-report of clients.
And the issue here is not that the clients are lying. The point is that there are two huge inducements to endorse the products. The first is what’s known as the placebo effect: the good doctor has given me these nice pills, so, of course, I’m going to say they’re helpful. The second is that if I want a refill, I’d better say that I’m doing better. Not too much better, mind – but sufficiently improved to warrant continued treatment.
But – and this is a much more fundamental question – have the individuals been truly helped as Dr. Belam so strongly contends?
To put this question in perspective, let’s focus briefly on illegal drugs – cocaine, for example. The popular perception is that people who use cocaine descend inevitably and quickly into a quagmire of dependency, dysfunctionality, and unmitigated wretchedness. The reality is different. Many, perhaps most, cocaine users, in fact, show few signs of dependency, and most of them express the belief that the drug helps them. They will say that it enhances their enjoyment of special occasions; that it gives them “an extra edge”; that it makes them more competitive at work; enhances sexual pleasure; etc…
Most of the people who use alcohol or marijuana moderately also endorse their products of choice. They say that the drug helps them “mellow out”, or helps “break the ice” at social gatherings. Smokers say that nicotine helps them concentrate. And so on.
Alcohol and nicotine are interesting in this context, because they have been used by humans for centuries, and their effects, both short-term and long-term, are well known. But imagine if these products had not been discovered centuries ago. Imagine, instead, that they had been developed synthetically in a pharmaceutical lab in the 80’s or 90’s.
The chemists would have injected these drugs into rats and mice, and studied the outcome. They would have noticed that the alcohol seemed to have an anxiety-reducing effect, and that the nicotine seemed to sharpen the animals’ concentration. Cries of “eureka” would have been heard; randomized, controlled trials would have been conducted (with pharma’s customary rigor, of course); FDA approval would have been given; the marketing people would have come up with brand names (Alcolium and Nicotin come to mind), and the pantomime would quickly have gotten into full swing.
Psychiatrists would be writing prescriptions, and vehemently denying that these “medications” were addictive – unless, of course, people exceeded the prescribed dose!
And the great majority of “patients” would say that they were really helped by these “medications.” And when cantankerous, old geezers like me protested that these drugs ultimately damaged people, physicians like Dr. Belam would retort: “What of all the people who have been helped?”
The analogy is precise.
. . . . . . . .
My essential point is this: psychiatric drugs; illegal street drugs; alcohol and nicotine, all have in common that they confer a temporary good feeling. That’s why people use them. But they also have in common that they are toxic substances, and if taken in sufficient quantity over a long enough period, they will inevitably cause organic damage.
But it is only within psychiatry that the temporary good feeling is deceptively and self-servingly adduced as evidence that the drugs are not only benign, but are medicine necessary to treat illnesses!
So Dr. Belam is absolutely correct. My statement that: “…the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization” is indeed an awful thing to have to say. But the much more fundamental question is: Is it true? My position is that it is indeed true, and awful as it is, it needs to be said. And it needs to be said strenuously and repeatedly to combat the false assertions of psychiatry.
In this context, it is worth asking why Dr. Belam did not take exception to Dr. Wessely’s obviously false and, I suggest, very damaging and misleading assertion that psychiatric treatment “inevitably” alleviates suffering and makes people happier. No legitimate medical specialty would make such a grandiose claim.
It seems fitting to leave the last word to Joanna Moncrieff, another British psychiatrist:
“The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases. We have seen that for the three main classes of drugs used in psychiatry there is no evidence to substantiate this view. Instead, the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects.” (The Myth of the Chemical Cure, 2009, p. 237)