Tag Archives: anxiety

Gender Wage Gap and Depression/Anxiety

In their January 2016 issue, the journal Social Science and Medicine published Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders, by Jonathan Platt, MPH, Seth Prins, PhD candidate, Lisa Bates, PhD, and Katherine Keyes, PhD, MPH.  All the authors work at Columbia’s Department of Public Health.

Here’s the abstract:

“Mood disorders, such as depression and anxiety, are more prevalent among women than men. This disparity may be partially due to the effects of structural gender discrimination in the work force, which acts to perpetuate gender differences in opportunities and resources and may manifest as the gender wage gap. We sought to quantify and operationalize the wage gap in order to explain the gender disparity in depression and anxiety disorders, using data from a 2001-2002 US nationally representative survey of 22,581 working adults ages 30-65. Using established Oaxaca-Blinder decomposition methods to account for gender differences in individual-level productivity, our models reduced the wage gap in our sample by 13.5%, from 54% of men’s pay to 67.5% of men’s pay. We created a propensity-score matched sample of productivity indicators to test if the direction of the wage gap moderated the effects of gender on depression or anxiety. Where female income was less than the matched male counterpart, odds of both disorders were significantly higher among women versus men (major depressive disorder OR: 2.43, 95% CI: 1.95-3.04; generalized anxiety disorder OR: 4.11, 95% CI: 2.80-6.02). Where female income was greater than the matched male, the higher odds ratios for women for both disorders were significantly attenuated (Major Depressive Disorder OR: 1.20; 95% CI: 0.96-1.52) (Generalized Anxiety Disorder OR: 1.5; 95% CI: 1.04-2.29). The test for effect modification by sex and wage gap direction was statistically significant for both disorders. Structural forms of discrimination may explain mental health disparities at the population level. Beyond prohibiting overt gender discrimination, policies must be created to address embedded inequalities in procedures surrounding labor markets and compensation in the workplace.”

In other words, when women were receiving less pay than men for the same work, they were about two and a half times more likely to “have major depressive disorder”, and about four times more likely to “have generalized anxiety disorder” than their male counterparts.  But when women were earning more than men, the odds were 1.2 and 1.5 respectively.

The use of psychiatric terminology (“major depressive disorder” and “generalized anxiety disorder”) constitutes something of a barrier to communication here, but the general message is clear:  people (in this case women) who are routinely treated unfairly and discriminately are more likely to be depressed and anxious, than those not so treated.

This is hardly surprising.  Depression and anxiety are not illnesses.  They are adaptive mechanisms – messages from our bodies alerting us to the need to make changes.  So, for instance, a person living in a high crime neighborhood might experience depression and anxiety.  These feelings are not symptoms of an illness.  Rather, they are the normal and appropriate emotional concomitants to the knowledge that one’s living arrangements are not safe, wholesome, or comforting.

The feelings of depression and anxiety are, in effect, a “nudge” from the body to move to safer surroundings, analogous to the urges that animals feel to move to higher ground in time of flooding, or to move to warmer latitudes as winter approaches.

But in a great many cases, the individual is unable to move, either because of family ties, lack of means, or other reasons.  So the urge to move lies unrequited, where it grows stronger, and saps the person’s energy and will.  The feelings of hopelessness, anhedonia, worthlessness, and guilt, codified in the DSM as “symptoms” of the “illness, major depressive disorder” are in fact the eminently appropriate response to being trapped in an untenable but inescapable situation.

And in this regard, gender wage discrimination is an extremely fast-holding trap.  Even if the victim can manage to find another job, there is every likelihood that the wage discrimination will be as strong as it was in her previous position.

Platt et al found that women in a large US nationally representative sample were earning only 54% of men’s pay.  This figure, when adjusted for productivity, was increased to 67.5%.  But even by the latter reckoning, this is an enormous difference.  For every man earning $30,000 per year, his matched female counterpart was earning about $20,000.  Over a forty-year working career, this amounts to a $400,000 disparity.

Quoting again from Platt et al:

“In sum, there are robust and long-standing gender disparities in depression and anxiety disorders, in addition to persistent gender disparities in wages. Although the latter are somewhat reflective of differential individual-level attainment of characteristics conducive to productivity, a large proportion of this gap remains after accounting for these factors and is likely the result of discriminatory processes operating at structural, institutional, and individual levels. This ‘unexplained’ portion appears to be increasing.”

So what we’re seeing here is one more piece of evidence that depression is not an illness to which women just happen to be “prone”.  Rather, it is an entirely appropriate and realistic response to an intolerable situation.  And when the situation can’t be escaped, the depression becomes, understandably, an abiding and persistent sense of joylessness and unfulfillment.  And when this kind of discrimination is combined with the fact that many employed women come home to another five or six hours of housework and childcare, the joyless treadmill factor increases enormously.

Psychiatry then enters the picture, proclaiming with its customary unsupported assurance, that episodes of depression and anxiety that cross arbitrary and vaguely-defined thresholds of severity, frequency, and duration, regardless of their source, are illnesses – just like diabetes.  These illnesses are caused by deficits of neurochemicals for which, by great good fortune, psychiatry has “very effective” remedies in the form of pills and high voltage electric shocks to the brain.

Psychiatry also has an “explanation” for the gender gap disparity in depression.  On the NIMH website you will find a page called Depression in Women.  There’s a section headed “What causes depression in women?”  Here’s the section quoted in full:

“Several factors may contribute to depression in women.

Genes—women with a family history of depression may be more likely to develop it than those whose families do not have the illness.

Brain chemistry and hormones—people with depression have different brain chemistry than those of people without the illness. Also, the hormones that control emotions and mood can affect brain chemistry.

During certain times of a woman’s life, her hormones may be changing, which may affect her brain chemistry. For example, after having a baby (postpartum period), hormones and physical changes may be overwhelming. Some women experience postpartum depression, a serious form of depression that needs treatment. Other times of hormonal change, such as transition into menopause, may increase a woman’s risk for depression.

Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression in some women.”

So there it is:  genes, brain chemicals, hormones, and stress.  Stress, of course, is a valid consideration here, but note how the NIMH has worded it:  “Stress…may trigger depression…”  Trigger is a firearms analogy and denotes a relatively minor event that initiates a major event in a system that is already prepared and primed.  So, the loss of a loved one – to use the NIMH’s own example – doesn’t cause feelings of despondency and depression; rather, it triggers these feelings in “some women”, presumably those already primed with “different brain chemistry” and depression-prone genes.

The Platt et al study is thorough and meticulous and was picked up by several mainstream media, including the Wall Street Journal, the New York Times, and the Guardian.  But I have not been able to find a single mention of it on any psychiatry-promoting site.  This is the same psychiatry that consistently asserts its commitment to a biopsychosocial perspective.

Benzodiazepines: Disempowering and Dangerous

I recently read an article by Fredric Neuman, MD, Director of the Anxiety and Phobia Center at White Plains Hospital, NY.  The article is titled The Use of the Minor Tranquilizers: Xanax, Ativan, Klonopin, and Valium, and was published in June 2012 by Psychology Today.  Thanks to Medicalskeptic for the link.

Dr. Neuman opens by telling us that benzodiazepines are “…very commonly prescribed for any sort of discomfort.”

“They are called anxiolytics, and they are prescribed for any level of anxiety and more or less to anyone who asks for them.”

Dr. Neuman has been working at the Anxiety and Phobia Center for 41 years, first as Associate Director and then as Director.  So when he says that benzos are routinely given to “anyone who asks for them,” it’s probably safe to say that he’s being accurate.

He tells us that the benzos have a “modest tranquilizing effect” in the doses at which they are “usually prescribed.”  But –

“…I see patients all the time who feel they cannot manage ordinary situations in life without taking one of these pills.”

and

“…I think these individuals suffer a loss of self-confidence. Their ability to rely on themselves has been undermined by their reliance on these drugs.”

Dr. Neuman asserts that benzos

“…are the most commonly prescribed drugs in the world. They are for the most part safe, but even safe drugs can sometimes cause problems.”

He provides a list of those adverse effects that concern him most.

  1. They are addicting.
  2. They effect coordination, particularly in the elderly.
  3. They compound the effect of other drugs and alcohol.
  4. They interfere to some extent with memory. 

And to this list he adds the dangers of abrupt discontinuation and

“…the fact that I think something is lost, as I indicated above, when someone relies on something make-believe to get through the day.”

Dr. Neuman concludes:

“…these drugs are sometimes helpful a little, and in some ways hurtful a little.  But I don’t wish to give the impression that they are really bad. If a patient demands them, I will usually acquiesce, assuming the dose is small. I always encourage patients to take less as time goes on.  If they won’t, I don’t usually argue with them.”

and

“I know most doctors give these drugs much more readily than I do.”

 DISCUSSION

In the article Dr. Neuman comes across as a reasonable and helpful person.  He prescribes benzos, but he recognizes and articulates the disempowering aspect of relying on drugs, and I think it is reasonable to assume that in his practice he encourages people to pursue genuine resolution of fears and anxieties rather than chemical masking.  But what struck me most forcibly in the article was the sentence:

“If a patient demands them, I will usually acquiesce, assuming the dose is small.”

Dr. Neuman is to be commended for his honesty, but it is a truly amazing admission – particularly his use of the word “demand.”  It has long been my contention that there is very little essential difference between psychiatric “prescribing” of psychoactive drugs and the illegal selling of drugs on the street.  Dr. Neuman’s use of the word “demand,” his admission that he usually acquiesces, and his credible assertion that most doctors prescribe these drugs more readily than he does, lends support to this contention, at least as far as benzos are concerned.  It is difficult to reconcile his statements with the notion that these drugs, when used in a psychiatric context, are medications being prescribed to treat illnesses.

MORTALITY HAZARD

The same day that I read Dr. Neuman’s piece, I also read an article in the BMJ:  Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study, by Weich et al.  Here are the conclusions:

“In this large cohort of patients [34,727 participants and 69,418 matched controls]  attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality [hazard ratio: 3.3] over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding.”

The increased risk for those participants who had taken only benzodiazepines was slightly higher at 3.68.  Risk ratios were adjusted for age, gender, and the following health problems:  “arthritis, asthma, cancer, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, diabetes, epilepsy, gastrointestinal disorders, hypertension, musculoskeletal disorders, anxiety disorders, sleep disorders, other (non-anxiety), psychiatric disorders, and prescriptions for non-study drugs.”  The association followed a dose-response pattern.  Participants who had taken benzos at the highest doses had a hazard ratio of 5.1.

Even allowing for the standard disclaimer, the study raises serious doubts as to the oft-claimed safety of these products, especially as other studies have produced similar findings.  It should also prompt us to question Dr. Neuman’s somewhat cavalier approach to these products – an approach which in my experience is widespread in psychiatry.  A three-fold increase in mortality rate over seven years is not a trivial matter.

Benzodiazepines – Adverse Effects

On November 25, Mad in America posted a link to an article in the Journal of Neurological Sciences.  The article is by Harnod et al, and is titled An Association between Benzodiazepine Use and Occurrence of Benign Brain Tumors.  The authors studied the records of  62,186 individuals in Taiwan  who had been prescribed a benzodiazepine for at least 2 months between 2000 and 2009.  They compared the incidence of brain tumors in these patients with the incidence in patients in a matched-pairs control group.  The hazard ratio for benign brain tumors (benzo group vs non-benzo group) was 3.15 (95% confidence interval: 2.37-4.20).  The hazard ratio for malignant brain tumors was 1.21 (95% confidence interval: 0.52-2.81).  What this means essentially is that one can be 95% confident that the benign tumor association is real, but that the malignant tumor result might have arisen by chance.

The authors also discovered that dosage is an important factor.  The hazard ratios for benign brain tumors increased with dose.  At doses between 36 and 150 mg/year the hazard ratio was 2.12 (1.45-3.10); at doses above 150 mg per year, the hazard ratio was 7.03 (5.19-9.51).

The study in question is a matched-pairs cohort study, rather than a randomized controlled trial, so one can’t state with absolute certainty that the drugs caused the tumors, but given the large number of participants, the meticulous control of confounding factors, and the magnitude of the hazard ratio (three-fold), the results need to be taken very seriously.

There might also be a tendency to dismiss these results on the grounds that the tumors are benign.  But benign tumors can have serious implications..  Here’s what the American Brain Tumor Association says:

“…the location of a benign brain tumor can have a significant impact on treatment options and be as serious and life-threatening as a malignant tumor.”

HISTORY

The first benzodiazepine, Librium, was introduced in 1960, followed in 1963 by Valium.  Today there are dozens of benzodiazepine-class drugs in regular use.

The Harnod et al study is by no means the first time that researchers have drawn attention to the dangers of long-term benzodiazepine use.

Here is a short list of studies that found significant adverse effects for benzodiazepines:

Lader MH, Petursson H, 1981: Benzodiazepine derivatives–side effects and dangers.

“A range of paradoxical effects can occur of which release of aggressive and hostile feelings has excited most attention.”

Lader MH, Petursson H, 1984: Computed axial brain tomography in long-term benzodiazepine users. 

“The mean ventricular/brain area measured by planimetry was increased over mean values in an age- and sex-matched group of control subjects but was less than that in a group of alcoholics.” [Benzo users had more brain shrinkage than controls, but less than alcoholics]

Tata PR, et al, 1994: Lack of cognitive recovery following withdrawal from long-term benzodiazepine use.

“Despite practice effects, no evidence of immediate recovery of cognitive function following BZ withdrawal was found. Modest recovery of certain deficits emerged at 6 months follow-up in the BZ group, but this remained significantly below the equivalent control performance.”

Burke, KC et al, 1995: Medical services use by patients before and after detoxification from benzodiazepine dependence.

“Although a retrospective record review suffers from a range of limitations, the findings suggest that detoxification from benzodiazepines may be effective in reducing use of outpatient medical and mental health services and presumably in reducing costs of care.”

Cohen, SI, 1995: Alcohol and benzodiazepines generate anxiety, panic and phobias.

“In almost half the patients seeking advice for anxiety, panic and phobias the cause was alcohol or benzodiazepines.”

Barker MJ et al, 2004: Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis.

“Results of the meta-analyses indicated that long-term benzodiazepine users do show recovery of function in many areas after withdrawal. However, there remains a significant impairment in most areas of cognition in comparison to controls or normative data.”

Stewart SA, 2005: The effects of benzodiazepines on cognition.

“In an attempt to settle this debate, meta-analyses of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur in patients treated long term with benzodiazepines, and although cognitive dysfunction improved after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched benzodiazepine-free controls.”

Berger A et al: 2012: Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study.

“Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.”

Kao CH et al, 2012: Benzodiazepine Use Possibly Increases Cancer Risk: A Population-Based Retrospective Cohort Study in Taiwan. 

“In the group with benzodiazepine use, the overall risk of developing cancer was 19% higher than in the group without benzodiazepine exposure…”

Other studies can be found that dispute details of the adverse effects spectrum, but there is general agreement that these effects are wide ranging and, in many cases, serious.

DRUG DEPENDENCE

Benzodiazepines were initially promoted as non-habit-forming, but in fact reports of dependence for each of the various products emerged, usually within a few years of its launch.  Withdrawal reactions from Librium were noted in a 1961 article (Withdrawal reactions from chlordiazepoxide (Librium), in the journal Psychopharmacologia 1961, 2: 63-68).  Reports of addiction to Valium were noted in a letter to the BMJ in 1967 (Addiction to diazepam (Valium), Br Med J 1967;1:112.1).  In 1976, a report of withdrawal symptoms in newborns who were exposed to benzodiazepines in utero appeared in the American Journal of Obstetrics and Gynecology.  In 1977, a similar report appeared in the Journal of Pediatrics.  In 1986, Professor Heather Ashton, DM FRCP, of the University of Newcastle, UK, wrote a comprehensive account of the benzodiazepine withdrawal syndrome in an article titled Adverse Effects of Prolonged Benzodiazepine Use.  Here are some quotes:

“The syndrome can be of considerable severity and has similarities to abstinence syndromes associated with alcohol, opiates, and barbiturates.”

“Agoraphobia, other phobias, and depression are common during withdrawal…”

“Perceptual distortions (sometimes hallucinations) and feelings of depersonalisation and unreality are characteristic. Acute psychotic episodes occur occasionally, but obsessions, intrusive thoughts and memories, and paranoid feelings are not uncommon. Irritability, rage, and aggression are also frequent…”

“Neurological symptoms include episodes of paraesthesiae and numbness, tremor, muscle pains, stiffness, weakness and fasciculation, ataxia, and blurred or double vision…”

“Major convulsions or temporal lobe seizures sometimes occur on abrupt withdrawal.”

“Gastrointestinal symptoms are very common…”

“Cardiovascular symptoms (palpitations, flushing, chest pain), hyperventilation, urinary symptoms (frequency, urgency, incontinence), and loss of libido are similar to those seen in anxiety states. An influenza-like syndrome with prostration and increased upper respiratory tract secretion may occur and resembles that seen after narcotic withdrawal, although it is more protracted.”

In an American Journal of Psychiatry editorial in 1991, Carl Salzman, MD, Chair of the APA Task Force on Benzodiazepine Dependence, Toxicity, and Abuse, acknowledged that:

“True physical dependence can arise from chronic therapeutic use, defined by the appearance of a constellation of discontinuance symptoms following abrupt withdrawal.”

Some individuals withdrawing from benzodiazepines experience protraction of withdrawal symptoms for months, and in some cases more than a year.  Lader M et al (2009), in Withdrawing Benzodiazepines in Primary Care, state:

“No clear evidence suggests the optimum rate of tapering, and schedules vary from 4 weeks to several years.”

Prescriptions for benzodiazepines continue to rise.  Alprazolam (generic Xanax) is the most prescribed psycho-pharmaceutical product in the US today.  The number of prescriptions written for this drug increased 9% from 2009 to 2011 (PsychCentral).

Psychiatrists claim that anxiety is an illness, and that the prescription of benzodiazepines is a legitimate medical intervention.  The reality is that anxiety is the natural consequence of the relentless, stressful, isolative, unfulfilling kind of lifestyle that is becoming increasingly common in the US and other industrialized countries.  Benzodiazepines are a fast-acting, addictive drug that dulls the pain, but often at enormous cost.  Their effects, including long-term adverse reactions, are similar to alcohol, but they can be used discreetly in situations where alcohol use would attract disapproval (workplace) or even legal consequences (public places).

Popping a benzo to cope with life’s difficulties and challenges is essentially on a par with taking a nip from a hip flask filled with whisky.  It might get one through the day, but it’s not an effective or personally fulfilling way to tackle life’s problems, and the adverse consequences can be truly horrendous.

 

Withdrawal from Benzodiazepines

Important updates on this subject can be found at the posts listed at the bottom of the post.

. . . . . . . . . . . . . . . .

I’ve recently come across an article by Matt Samet called Social Vacuum.  It’s dated March 2013, and was published on Robert Whitaker’s website Mad in America.

Matt had been taking a benzodiazepine for some time, and while on a tapering withdrawal, he experienced some distressing symptoms, including some acute social discomfort.  (For a full account of benzo withdrawal – click here.)

He describes the withdrawal symptoms in detail, and also outlines some of the strategies he used to cope with these.  I think the article would be helpful for people who are going through these kinds of withdrawals, and also for counselors, etc., who are helping/supporting clients through this.

When benzodiazepines were initially launched in the early 1960’s, the psychiatrists and the manufacturers stated categorically that they were non-addictive.  Eventually it became impossible to maintain this fiction, and the addictive potential of these products is now recognized.  Some people manage to come off these products, but large numbers of people worldwide continue to use these drugs as an integral part of their daily routine.  Benzos are sedatives and are sometimes called minor tranquilizers.

Withdrawal from these drugs is potentially dangerous, incidentally, and medical supervision is a good idea, especially if the dependence is marked.  Try to find a physician other than the one who got you hooked on them in the first place.  In severe cases, hospitalization is required.

The following drugs are in the benzodiazepine category:  Valium; Librium; Xanax; Ativan; and Klonopin.  For a more comprehensive list of brand names, see this site on Wikipedia.

. . . . . . . . . . . . . . . .

Important updates on this subject can be found at the following subsequent posts:

More on Benzodiazepine Withdrawal

Benzodiazepine Withdrawal

Benzodiazepine Withdrawal: A Dilemma

Obsessive Compulsive Disorder Is Not An Illness

Recently I was listening to NPR on the car radio.  The program was about so-called obsessive compulsive disorder, and a woman was describing her difficulty in this area.  I didn’t record her actual words, but it went something like this:

I have all these checks and rituals that I have to do each day.  And it’s beginning to put a strain on my marriage.  Sometimes my husband wants to go somewhere but I can’t go until I finish my checks.

I was immediately struck by the possibility that either this woman doesn’t want to go out, or doesn’t want to go out with her husband.  These avenues certainly warrant exploration, but within the present mental health system, all she is likely to get is a “diagnosis” and a prescription.  (“You have an illness, takes these pills.”)  It would be very rare nowadays for anybody to take the time to explore what payoffs might be involved in the pursuit of the rituals.

The psychodynamics of rituals are self-evident.  Most rituals are simply repetitive actions that we can do without effort, and in which we can almost always be completely successful.  And we all have them.  We get out of bed in the morning; comb our hair (those of us who have any left); shave (those who care to); wash; brush teeth, etc..  And so on at various points of the day.

In my experience, the people who get into rituals to a disturbing degree fall into two groups.

Firstly, people who are very anxious/fearful.  The rituals have a calming effect.  They’re not the best way to deal with anxieties, but they work after a fashion.  I have dealt with more effective ways to cope with anxieties elsewhere in this blog.

Secondly, people who are not feeling generally successful in their everyday lives.  This is truly the modern malaise.  So many people are stuck in jobs from which they derive no feelings of accomplishment.  In my view we all need daily doses of feelings of success.  The subject area doesn’t matter.  Raking the lawn; building a fence; writing a letter; cooking a meal; teaching a child to ride a bike; painting a door; fixing the car; etc., etc..  Many people manage to get feelings of success through their jobs – this is great.  But those who don’t need to organize their leisure time in such a way as to ensure a steady flow of these kinds of feelings. There just isn’t time for rituals when you’re teaching your daughter how to change the oil in the car or helping a neighbor fix his porch or whatever.  And everyone can find something that they can do and do well.

Obsessions and compulsions do not constitute an illness.  Rather they are ways in which people deal with sub-optimal circumstances.  They can be replaced by more effective activities through the normal methods of behavioral change.

There are no mental illnesses.

Business As Usual

Christopher Lane, author of Shyness has written an interesting post.  The gist of the matter is as follows.

There’s a class of drugs known as benzodiazepines (benzos for short) that are promoted by Pharma and prescribed by psychiatrists to “treat” anxiety.  (As if anxiety were an illness!)  See my post on the So-called Anxiety Disorders.

Benzos include such household names as Valium, Librium, Ativan, Xanax, etc..  When introduced in the 1960’s, these drugs were widely touted as “safe” tranquilizers.  Readers may remember Valium as “mother’s little helper,” so called because it was marketed to millions of harried housewives as they struggled to adapt to an increasingly complex and multi-faceted lifestyle.

Almost immediately it began to be recognized in certain circles that these products were strongly addictive, but Pharma consistently denied this, and the psychiatrists went on prescribing.  A psychiatrist I met in the 80’s once remarked: “You don’t take people off Xanax.  Once you’re on it, you’re on it.”  About the same time, I heard another psychiatrist say:  “The only difference between Xanax and true love is that Xanax is forever.”

Within the addiction “treatment” field, benzos are described as “dry alcohol.”  And indeed, they resemble alcohol in many ways.  They have a sedating effect, they produce intoxication, and in fact, in hospital settings benzos are widely used to detox cases of chronic alcohol abuse.

Now all of this is well known.  What’s new?

Well apparently in 1982, Malcolm H. Lader, Professor of Clinical Psychopharmacology, Institute of Psychiatry, University of London, demonstrated measurable brain shrinkage in individuals who had taken these products, and that the shrinkage was similar to that found in long-term alcohol abusers. Surprise!

But the plot thickens.  It has recently come to public attention that Britain’s Medical Research Council (MRC) agreed – back in 1982 – that further large-scale studies were needed to explore and confirm Dr. Lader’s findings.  But – and this is almost beyond belief – they marked the file “closed until 2014”!  And the further investigations were never done.

Why not, you might ask?

Well here’s a clue.  Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA) is funded entirely by fees derived from the very industries they are supposed to regulate.

Remember – there are no mental illnesses, and the products sold to “treat” these fictitious illnesses are drugs.  And the one abiding feature of all drugs – no matter how pleasant they may seem in the short run – is that they are dangerous.  Drug dealing – whether it’s on the streets or in the local mental health center – is a dirty business where human life and human welfare are routinely sacrificed on the altar of corporate profit.

DSM and Disability

Every society in every generation makes errors.  Some of the errors are minor.  Some are major.  One of the great errors of the 20th century was this:  we accepted the spurious notion that a wide range of life’s problems were in fact illnesses.  This spurious notion was initiated with good intentions – to provide shelter and humanitarian care for a relatively small number of individuals whose plight was truly dreadful.  But then the concept of mental illness took off, fuelled largely by the efforts of psychiatrists to legitimize their status as “real” doctors.

And then came the drug companies, who formed an alliance with the psychiatrists.  These mutually enchanted partners have been dancing heel-to-toe ever since, accumulating wealth and power to the great detriment of individuals and society.

Once it was firmly established that a wide range of ordinary problems of living were “really” diseases, it was a relatively easy step to conclude that individuals manifesting these problems might qualify for disability benefits under programs established by various governments.  In the United States the government entity involved is the Social Security Administration, and at the present time the following “diagnostic” categories are grounds for a disability determination.

Organic mental disorders

Schizophrenic, paranoid, and other psychotic disorders

Affective disorders

Mental retardation and autism

Anxiety related disorders

Somatoform disorders

Personality disorders

Substance addiction disorders

Now it needs to be acknowledged that some of the problems embraced in the above list are genuine medical problems and are definitely disabling.  These include:  serious brain damage and mental retardation.  But the vast majority of the so-called diagnoses listed are not genuine illnesses in any meaningful sense of the word.  They are problems of living.  They are problems of living that have been artificially medicalized for the benefit of psychiatrists and their allies the pharmaceutical companies.  These spurious “diagnoses” include:  schizophrenia, depression, bipolar disorder, anxiety disorders (including post-traumatic stress disorder), substance addiction, etc.. All of these problems are remediable, but under the bio-psychiatric system of pseudo-care, the individuals concerned receive little or nothing in the way of genuine help – in fact, they receive little more than a steady supply of mood-altering drugs.

Paying disability benefits to these individuals is an insult to the genuinely disabled people who have real medical problems which restrict so severely their ability to function.

In addition, the payment of disability benefits to the so-called mentally ill is a great disincentive for these individuals to try to resolve their problems and learn functional ways of living.

All of the “symptoms” of the so-called mental illnesses can be fabricated.  A diagnosis of schizophrenia, for instance, is based entirely on what the individual says and does during an examination interview.  There is no lab or clinical test for schizophrenia.  Occasionally an examiner may question family members, but the “diagnosis” decision rests on the individual’s self-report.  That’s how the system works.  If you don’t mind the stigma of being considered “crazy,” you too can acquire a diagnosis, and with a little help from the mental health services, you can be awarded disability status and a modest monthly income.

And it doesn’t end there.  If you go to college, you may qualify for a variety of academic accommodations.  Michael Rose, PhD, writing in the July/August 2010 issue of the National Psychologist says:

“With the proper documentation, students may qualify for a wide range of learning aids, such as extra time to take tests, use of a private room for tests, word banks, use of a word processor with spell check and help from a proofreader.  A specific documented disability, typically made within the past three years, has been the basis for approved accommodations at most institutions of higher learning.

Besides qualifying for extra help that will likely improve grades, students may qualify for a range of vocational rehabilitation services (paid tuition, books, dormitory costs, computers) that are not dependent on family or individual income.” (pg 18)

I cannot think of a better way of trapping people in a dysfunctional state than providing them with multiple rewards and benefits contingent on their continued dysfunctionality.  As I have noted elsewhere:  Is this a great country or what?

Back in the 1990’s there was a great push to get people off the welfare rolls.  It is an open secret that Social Services departments in many areas were encouraging their welfare clients to enroll at the mental health center and establish a “diagnosis” so that they could then apply for a disability determination from Social Security.

I could never prove this, but I know of a number of parents who were actively coaching their children in attention-deficit and other kinds of dysfunctional behavior so that the child would qualify for a Social Security income.  It’s a simple fact in America today that if you teach your child to misbehave seriously from an early age, and take him regularly to the mental health center for “help,” you stand an excellent chance of having him qualify for a Social Security income.  I have known families with more than one child receiving Social Security “disability” payments for no other reason than chronic misbehavior and lack of discipline.

I discussed the spurious nature of Attention Deficit Hyperactivity disorder in an earlier post, but I’m repeating the diagnosis “symptoms” below for convenience.

The APA’s eighteen criteria for this fictitious illness are:

Inattention

a)      often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b)      often has difficulty sustaining attention in tasks or play activities
c)      often does not seem to listen when spoken to directly
d)     often does not follow through on instructions, and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
e)      often has difficulty organizing tasks and activities
f)       often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
g)      often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
h)      is often easily distracted by extraneous stimuli
i)        is often forgetful in daily activities

Hyperactivity/Impulsivity

a)      often fidgets with hands or feet, or squirms in seat
b)      often leaves seat in classroom or in other situations in which remaining seated is expected
c)      often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults may be limited to subjective feelings of restlessness)
d)     often has difficulty playing or engaging in leisure activities quietly
e)      is often “on the go” or often acts as if “driven by a motor”
f)       often talks excessively
g)      often blurts out answers before questions have been completed
h)      often has difficulty awaiting turn
i)        often interrupts or intrudes on others (e.g., butts into conversations or games)

I have only one question for my readers.  How hard would it be to train a child to function in this way?

Next Post:  Another Interesting Book

Anxiety Disorders

Fear is the normal human response to imminent danger. It is an adaptive response, in that it is helpful to survival, and it occurs in almost all animal species. When our cave-dwelling ancestors were attacked by mountain lions, they probably experienced acute fear. This fear gave them an extra burst of energy to flee the danger, or, if flight were impossible, to turn and fight.

Today in most parts of the world, there is little danger of attack from wild animals. As areas develop economically and culturally, these kinds of acute dangers are systematically eliminated or at least drastically reduced. Close encounters with tornadoes, hurricanes, rattlesnakes, car accidents, etc., can still arouse full-blown fear responses, but most people in developed countries can go months – even years – without experiencing these kinds of situations.

Anxiety, however, is a different matter. Anxiety is essentially a fear response that doesn’t quite take off. It is a constant feature of modern life. Just as industrial and commercial development entailed the systematic reduction of acute dangers, it involved an equally systematic increase in situations that provoke anxiety. Indeed, it could be argued that the production and maintenance of anxiety is an integral component of modern marketing.

The purpose of commercials is to generate within people feelings of insecurity and concern. The range of worries that are exploited in this way is limited only by the imaginations of the marketers. From all quarters we are bombarded with anxiety-producing messages, such as: you are not attractive; your television set is too small; your car is too old; your clothes are out of style; your hair is too gray (or oily, or dry); your libido is inadequate; your kitchen is outdated; your breasts are too small (female); your penis is too small (male); your computer is too old; your house needs to be painted; you have too little hair on your head; you have too much hair every where else, etc., etc… The purpose of these messages is to generate within us feelings of anxiety and insecurity so that we will buy more stuff. Of course the “fix” is only temporary, and the process continues pretty much from cradle to grave.

It is not being suggested that the marketers invented anxiety. Our ancestors in the caves probably experienced concern and anxiety if they heard unusual noises from outside the cave at night. This kind of anxiety is useful in that it increases vigilance and prepares the organism for a rapid response should this become necessary. In modern life there are many situations in which a certain amount of anxiety is appropriate and adaptive. On the highway, for instance, a sudden increase in the traffic density usually elicits a measure of anxiety. This anxiety sharpens our attention and helps us avoid mishaps. Similarly, most people will experience some anxiety if caught out in a severe storm, especially in tornado country. These are natural stressors and the anxiety they provoke is appropriate and helpful.

In addition, people who have had unpleasant experiences will likely feel some anxiety if exposed to similar circumstances later in life, and, in fact, will generally go to considerable pains to avoid such circumstances. People, for instance, who were teased and taunted during childhood will often in later life avoid situations where they might be exposed to criticism or ridicule.

What the marketers have done, however, is they have taken this natural adaptive mechanism and exploited it endlessly for their own gain and to the detriment of the public. In this they have been extraordinarily successful, so that at present we experience worry and anxiety – not only with regards to genuine concerns – but also with regards to an enormous range of matters which are truly trivial and inconsequential. What used to be the land of the free and the home of the brave has degenerated into a nation of worriers and fretters. But the fundamental point is that anxiety, in and of itself, is normal – it is an integral part of our normal day-to-day existence, and serves a useful purpose. What the American Psychiatric Association and the pharmaceutical companies have done, however, is redefine anxiety as a pathology – an illness – that needs to be treated by taking pills.

The DSM lists the following anxiety disorders:

Panic disorder without agoraphobia
Panic disorder with agoraphobia
Agoraphobia with out panic disorder
Specific phobia
Social phobia
Obsessive compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalized anxiety disorder
Anxiety disorder due to a general medical condition
Substance induced anxiety disorder
Separation anxiety disorder
Sexual aversion disorder

And of course,

Anxiety disorder not otherwise specified (n.o.s.)

The list is self-explanatory and is designed to cover as wide a range of anxiety-provoking situations as possible. The inclusion of the n.o.s. diagnosis at the end of the list ensures that anyone experiencing anxiety or worry concerning any matter whatsoever can be assigned a diagnosis and can enter the ranks of the “mentally ill.” DSM specifies that for a diagnosis to be made, the anxiety has to “interfere with the person’s functioning” or “cause marked distress”. In practice, these qualifiers are sufficiently vague that virtually anyone can be given an anxiety diagnosis. People who go to counselors for help with stress or life choices are often assigned a diagnosis of Generalized Anxiety Disorder. They are “enrolled” in the ranks of the mentally ill, and their numbers swell the already inflated statistics quoted in the first post (Proliferation of Mental Disorders)

Consider, for instance, a person who for several years has succumbed to the Madison Avenue hype. This individual has bought a new house, a big car, an entertainment center, membership at an expensive country club, etc. Although apparently wealthy, he actually has no money in the bank and is completely dependent on his paycheck to remain solvent. He now receives information that his company is considering lay-offs, and he fears that his name may be on the list. Meanwhile, he discovers that his sixteen-year-old son is doing drugs, his fourteen-year-old daughter is sexually active, and his wife has been “seeing” someone else. Understandably, he is becoming somewhat anxious. In fact, he is beside himself with worry. He’s not sleeping well. He’s gone off his food, and he’s beginning to make serious mistakes in his work. He doesn’t actually see much of his family, but when he does, he finds himself being increasingly irritable and grouchy.

Although this is a purely hypothetical case, there are a great number of people in our society who are living variations of this kind of scenario – sometimes for years on end. Their lives have become untenable, and their anxiety and worry are entirely appropriate. Things are out of control. They need to be worried, and they need to be taking corrective action.

If our hypothetical worrier goes to a mental health practitioner, however, he will be given a diagnosis of Generalized Anxiety Disorder (an invented illness) and a prescription for anti-anxiety pills. He is given the false and destructive message that the problem is simply an illness – a chemical imbalance – and that taking the pills will correct the imbalance in the same way that insulin injections enable a diabetic to function normally. The notion that his life is out of control and that certain fundamental changes need to be made is seldom even addressed.

For an excellent account of how a drug manufacturer promoted generalized anxiety disorder to market a new drug, see Brendan Koerner’s article “Disorders Made to Order” in the July/August 2002 issue of Mother Jones.

The APA’s criteria for a diagnosis of Generalized Anxiety Disorder are listed below:

A. Excessive anxiety and worry (apprehensive expectations), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children

(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of [another mental disorder]

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance…. or a general medical condition ….or [another mental disorder].

The reader will readily appreciate that our hypothetical worrier described above, and the millions more in the same boat, are easily embraced within the above criteria. If this individual goes to a mental health center, he will be given a “diagnosis” and a prescription for an anxiolytic. The chances are slim that he will receive any counseling with regards to stress reduction, relationships, or lifestyle. The essential message he receives is that his life and his habits are fine, but that he has a “chemical imbalance” in his brain that is causing him to feel upset and worried, and that the pills will take care of it.

In this context, it is important to remember that the vast majority of mental health diagnosing is based on the uncorroborated self-reports of the patient. If you tell a psychiatrist that you are very tense and anxious and that you can’t sleep, can’t focus on your work, and are irritable with your family – and if you make it sound convincing – you will be given a diagnosis of Generalized Anxiety Disorder and a prescription for an anxiety-reducing drug.

The APA and the pharmaceutical companies have jointly developed this spurious system in which all human problems, including normal reactions to stress, are declared mental illnesses which need to be “treated” with drugs. These tactics are focussed on people of all ages and all walks of life. Notice in the criteria for generalized anxiety disorder cited above, how much easier it is to assign this diagnosis to a child (one item instead of three).

Next Post: Posttraumatic Stress Disorder