PR Newsletter July 05

Tom Cruise, the preeminent actor and public spokesperson for Scientology has been in the press recently calling psychiatry a pseudoscience and that psychiatrists have never helped anybody. He says “there is no such thing as chemical imbalance in the brain” and what people need to do is explore the underlying reasons and then move beyond their problems. Presumably Scientology is a way to do that. To the actress Brooke Shields, who suffered from serious postpartum depression and took medication which helped her significantly, he said, she was doing terrible things to her body.

Tom Cruise is wrong, there are serious mental disorders that are dramatically helped by pharmacologic intervention. And even if we can’t always explain how they work psychiatrists and neuroscientists are learning more and more about those mechanisms. But it is also true that psychiatry may be moving beyond its arenas of expertise. And I say this as a psychiatrist, not an actor, I believe we are prescribing too many drugs and defining too many behaviors as diseases.

The results of a just-published, governmental-sponsored survey of the nation’s mental-health predicted then in a decade, more than half of Americans will develop a mental disorder in their lifetimes. The apparent good news is, that at the moment, only one quarter of all Americans is suffering from mental illness. How did we get so many sick people, you may ask? It has something to do with how we define mental illness.
The American Psychiatric Association, first defined mental illnesses in a manual printed in the 1950s. This first Diagnostic and Statistical Manual (DSM I) included 60 disorders. In the last 40 years, there have been four editions, the current DSM IV, includes 300 disorders. Everything from sexual arousal disorder , excessive shyness, hypersomnia (sleep too much), hypersexuality (too much sexual activity), dozens of shades of depression, bipolar disorders, borderline disorder and being hyperactive.
Psychiatrists developed the DSM, in the hope it would refine our understanding of mental illnesses. What happened however, was that we defined problematic feelings and behaviors as diseases, and in so doing we implied that because we named these manifestations, it meant that we knew how to treat the problem. We often don’t know how to best treat behavioral problems, and even when we do, what we prescribe for them often causes as much harm as good.. What we have done is to re-define what is ordinary in the human experience, and turned it into drug-taking conditions.
In most parts of the world, if you feel anxious, sad, can’t sleep, lose your appetite for food or sex, you’re not defined as mentally ill. Families gather, healing rituals are performed, support is mobilized and people generally pull themselves together. What’s happening in contemporary America is that we are defining lots of people as mentally ill, for diseases they may not have and over-prescribing drugs with all of their complications.

Consider this, there are close to 4 million children in the United States diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), representing 7 ½ percent of school-age children. Millions of prescriptions are written for these children every year for potent drugs. These drugs always come with a price; they are aimed at a specific constellation of symptoms, but they invariably cause others. A child diagnosed with the ADHD may get better focus but get more depressed, aggressive, sleepless, even suicidal. Today, 25% of all overdose deaths are from prescription drugs. According to the Substance Abuse and Mental Health Service Agency(SAMHSA) over the last decade there has been a 63% increase in emergency-room visits tied to the abuse of prescription drugs. SAMHSA estimates that 9 million people are now abusing prescription drugs, 3 million of them are kids between the ages of 12 and 17.

Often, these ADHD drugs don’t even work. In a recently completed national study, The New York University Child Study Center reported that 28% of parents with kids between the ages of five and 18 who gave their ADHD kids these drugs on a daily basis, said it didn’t work. Parents gave them anyway, because mental-health professionals teachers and administrators encourage it as the most expedient solution to the child’s problems. Furthermore, the medication is often covered by insurance, and it certainly easier then a commitment to counseling which is often not covered, or in the best of circumstances, is quite limited.

We need to stop defining the ordinariness of the human condition as a mental illness for which prescribing potent drugs is the best solution. When it comes to children’s behavioral problems let’s not use drugs as the first choice in changing their behaviors and consider other options:

Talk to somebody who can help you look at yourself and your children from another perspective. A therapist who doesn’t believe that drugs are the only tools to change behavior

Set limits, it’s an ego corrective experience. Saying “no” or “you can’t have it” is critically important if we are to survive as people and planet.

Restore the evening meal to a central family ritual. Gather around the dinner table with good food, sharing traumas and joys, things that are important to each member.

Watch less TV, limit phone use, take vacations somewhere you can suspend yourselves from all the ordinary expectations and demands and appreciate the awesome.

Exercise, eat more nutritional food, laugh and make connections with others who share your enthusiasm.

Tom Cruise doesn’t know much about psychiatry, and his certainties about its uselessness relegated to religious zealotry. But that doesn’t mean we ought to ignore the demoralizing trend toward the psychopathologizing of the human condition.