Comments for Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Unfortunately the field of Psychiatry is still in the dark ages in comparison with the rest of the medicine. And like a somatic patient 200 years ago may have fared better untreated than treated with blood letting and leaches. So are the mentally ill patients today may be better not taking crude psychiatric medicine.

Yet denying that the brain dysfunction is the basis of all mental illnesses strikes as anti-intellectual.

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First of all the absence of evidence is not evidence of absence. The function of brain and how it relates to mental illnesses is still a black box for us. However there is an effort to trivialize mental illnesses to a cultural phenomenon and that strikes as intellectually dishonest as defending status quo.

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Actually "Absence of evidence is not evidence of absence!" was also said by Carl Sagan, my favorite scientist and an atheist. Simply put, it means that if we don't know that something exists, it doesn't mean that it doesn't; It only means we don't know one way or the other, we just haven't been made aware of it yet so it's not part of our knowledge.

And by status quo I mean using INEFFECTUAL methods to treat mental illnesses like depression. And unfortunately there is enough evidence to strike down just about all the tools in the mental health arsenal as statistically ineffectual compared to the placebo. These includes: drugs like SSRI; even the most esteemed forms of "talk therapy" like CBT & alternative medicine remedies like St John Wort. The only reason talk therapy & St John Wort is promoted is due to fewer side effects, not proven effectiveness, as the author Irving Kirsch of the "Emperor's New Drugs" wrote. 

At the same time should we just deny the existence of mental illness as the biological anomaly, just because we can't effectively treat it? And that's what I mean by turning it into a cultural phenomena. Yes: the stresses of modern culture do acerbate the manifestations of the mentally illnesses. But just like let's say with stomach ulcers: it's wasn't the type "A" personality or the stress of the daily existence at the root of their formation, but bacterial infection like H Pylori. So it could be the "Toxoplasma gondii" and/or a combination of genetic and environmental factors at the root of Schizophrenia and other mental illnesses. 

Just because we don't know the origin and effectual treatment of mental illnesses doesn't mean we should either apply ineffectual treatments towards it, or deny it's biological basis. We should invest massively and effectually to unlock the mysteries of mental illnesses, like we did in uncovering the causes and treatments for AIDS. Throwing our hands in defeat and solely blaming the modern culture for the cause of mental illnesses, is akin of South African beliefs of AIDS being caused by spirits and supernatural forces.

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Well I always read (or rather listen as audio) books I review, including this one. And while it's true he did not state point blank that mental illnesses are not biological in nature, he did review very sympathetically "The Myth of Mental Illnesses" and it's author Thomas Szasz. I haven't read any of the Dr Szasz books but he did said that: "mental illnesses are not real in the sense that cancers are real. Except for a few identifiable brain diseases, such as Alzheimer's disease, there are "neither biological or chemical tests nor biopsy or necropsy findings for verifying or falsifying DSM diagnoses". There are no objective methods for detecting the presence or absence of mental disease" 

And these kind of arguments from ignorance are what frustrate me, someone who suffers from mental illnesses (severe depression) from very young age, and know that mental illnesses must be grounded in biology and genetics as my family history of mentally illnesses clearly indicates.

I agree that many mental illness may go into remission and seemingly fully disappear for a period of time. And probably treating depression with SSRI, it's like treating common cold with antibiotics: not only useless but potentially harmful. But as with common cold, just because we recover from illnesses such as depression, doesn't mean it's not grounded in biology.

Perhaps, even better (although far from perfect) analogy is that with the oral herpes: like depression it's chronic and incurable, most remedies are useless and it goes into dormancy by itself without any treatment. Environmental factors like stress and lack of sleep may trigger the formation of cold sores, but they don't by themselves cause oral herpes. 

A possible genetic links is described in Peter's Kramer's "Against Depression. And while I am skeptical now about the authors enthusiastic embrace of antidepressants. I still find very convincing his explanation of the possible genetic link to one's response to stress and depression. For example those with two long forms of a gene are very resilient in the face of stressful environment: such people will get through Holocaust and lose everything and survive without a debilitating psychological scar. On the other hand those with two short forms of a gene interpret relatively minor setbacks very painfully, for them a failed job interview or a romantic relationship may merit contemplation and even execution of suicide. People with one long and one short version of the gene fall somewhere in between. 

So while the author of this books and that of the "Manufacturing Depression" and others, may blame current social and economic pressures, alienation and discontent as the causes of the depression epidemic. However, the reason a segment of the people succumb to this, and others don't, is due to their genetic makeup leading them to be less resilient in the face of persistent stress, which in turn triggers in vulnerable individuals depression and other mental illnesses.

So yes, I am all for increasing social net, closer community bonds and more "hugs". But I am also for better genetic screening to reduce births of individuals predisposed to pernicious mental illnesses. And that's were I agree with Peter Kramer: we shouldn't neither glorify nor demonize mentally ill people. Rather we should treat them with care and respect, yet recognize that their suffering is real and their illness is real. And being mentally ill in the modern time, is much more debilitating & maladaptive than during our ancestral past when we lived in close-knit communities. And considering all that we should take a firm stand against depression, like we are firmly against cancer and other somatic illnesses.