Key Messages
How Mental Health Services Got Where They Are Today: Understanding The Influence Of Psychiatrists, Institutions, And Money
When it comes to medical treatments and services, most of us assume that the standards are upheld, but unfortunately psychiatric medicine takes a much different approach.
Despite its expensive research facilities and highly qualified doctors, psychiatry is rooted more in the realm of religion than science.
You can thank huge pharmaceutical companies for this apparent corruption – by throwing advertising dollars at mental health institutions and psychiatrists alike, they have succeeded in weaving a dogma around psychiatric care that is often treated without question.
This book goes in-depth de-constructing the strange approaches, assumptions and even harms done to those seeking mental health help by exploring how preferences of psychiatrists and institutions were ultimately influenced by money.
Thankfully, there are steps we can take as a society to turn this system back into one that benefits everyone instead of just the big corporates.
Despite Efforts To Standardize Psychiatric Diagnoses, There Is Still No Objective Method For Determining Mental Health Issues
Psychiatrists today face a major problem when it comes to making accurate diagnoses on their patients.
Despite having the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a reference, psychiatric diagnoses vary greatly between psychiatrists, with only 32-42% agreement between them in many cases.
Moreover, psychiatry still relies heavily on subjective assessments when it comes to diagnosing mental health issues, with regional practices and whim also playing a role.
This was demonstrated by Dr.
David Rosenhan who sent eight people with no real mental health disorder to various hospitals in the US and found that all of them were falsely diagnosed with one condition or another.
Furthermore, there are wider trends within diagnosis where psychiatrists from the US and Russia are much more likely to diagnose their patients with schizophrenia than those from Europe.
This shows that often experts can agree on general labels for mental illnesses but may differ widely on the specifics due to individual biases coming into play when diagnosing patients.
All in all, it is clear that discrepancies in diagnosis remain a major problem for psychiatrists despite the availability of the DSM manual – something which needs to be addressed if psychiatry is to be treated like any other medical science where doctors agree based on evidence presented before them.
How The Flawed Methodology Behind The Dsm Undermines Its Legitimacy
When it comes to diagnosing psychiatric disorders, the DSM (“Diagnostic and Statistical Manual of Mental Disorders”) has become the accepted standard.
Unfortunately, when developing this manual, basic scientific rules are violated thanks to a small committee known as the Taskforce.
The decisions made by the Taskforce are based on personal opinions and preferences, not objective science or evidence-based analysis.
In fact, psychologist Renee Garfinkel even went so far as to describe the process as “like a group of friends trying to decide where they want to go for dinner!” As if that weren’t bad enough, the research used for inclusion of disorders in the DSM-V is full of methodological errors that further discredit any trustworthiness these diagnoses may have had in the first place.
Take Self-Defeating Personality Disorder (SDPD): its inclusion was based on only two flawed studies and an unimpressive “yes” response rate of just 11%.
Despite this lack of evidence, Dr.
Robert Spitzer forced SDPD’s inclusion due to his own conviction that it was right thing to do; he later admitted that there wasn’t enough research available to back up their decision.
The Controversial Rise Of Psychiatric Diagnoses And Big Pharma
Integration of new mental disorders into the DSM and its misuse have caused an alarming increase in the number of diagnosed mental illnesses, a phenomenon commonly referred to as medicalization.
Around 26.2 percent of all Americans suffer from one or more disorders outlined in the DSM in a given year; this is in stark contrast to rates from the 1950s, which were below 1 percent.
The greater number and lenient definitions of mental health disorders mean that healthy people are being misdiagnosed with mental illness.
This has been highlighted by studies such as one published in March 2011, which showed an increased incidence of ADHD among children born at the end of year due to age-based comparisons with older classmates.
Misdiagnoses invariably lead to mistreatment, with prescription medications becoming increasingly common for tackling mental health issues.
Unfortunately, antidepressants – one type oft prescribed medication – don’t fare much better than placebos when compared to clinical studies dealing with success rates.
This hasn’t dampened their usage however; 235 million prescriptions for antidepressants were filled out over the United States alone during 2010!
Big Pharma companies are contributing to this issue too: they’ve been engaged in various activities that involve obfuscation and profit making from psychiatric medicalization.
The Chemical Imbalance Theory: A Closer Look At How Psychiatric Drugs Work
Big Pharma has been heavily influenced by inconsistent psychiatric diagnoses and the Diagnostic and Statistical Manual of Mental Disorders (DSM).
To combat this, they promoted something called the “chemical imbalance” theory in order to boost their drug sales.
This model attempts to explain all psychiatric problems as being a mismatch or imbalance of neurotransmitters in your brain, i.e., a chemical imbalance.
They marketed their drugs, such as GlaxoSmithKline’s anti-smoking drug Zyban, using slogans that suggest that their drugs can affect the part of the brain associated with addiction.
Serotonin-specific reuptake inhibitors (SSRIs) were said to “correct” any chemical imbalances by manipulating neurotransmitters with antidepressants such as Prozac, suggesting that low serotonin levels were associated with depression and raising these levels could help stabilize mental health.
But this isn’t necessarily true – Big Pharma just uses this theory to justify medicalization and make more money in the process.
The Pharmaceutical Industry’S Chemical Imbalance Theory Is Not Enough To Explain Psychiatric Disorders
The chemical imbalance theory is a popular concept when it comes to attempting to explain the causes of psychiatric disorders.
Unfortunately, this theory isn’t actually very conclusive.
There are no definitive studies that show we can accurately measure chemical imbalances in patients with mental health issues, and what’s more, results from research conducted in this area have been too contradictory for us to make any definite statements about the role that neurotransmitters play in certain mental health conditions.
Dr.
David Kaiser from Psychiatric Times summarised this issue clearly: “Patients have been diagnosed with chemical imbalances, despite that no test exists to support such claim, and that there is no real conception of what a correct chemical balance would look like.”
What’s more, looking solely at biological causes isn’t enough to explain mental disorders either.
Former president of the American Psychiatric Association Carol Bernstein goes as far as stating “We still don’t know the relationship between biology and the mental disorders.” Even though some diseases may be caused by genetic factors – Huntington disease being an example – depression is likely more influenced by family environment than by biology.
The Placebo Effect: How Our Expectations Influence The Efficacy Of Drugs
When it comes to psychiatry, its approach to drugs, particularly antidepressants, is fatally flawed.
The chemical imbalance theory, that the drugs are supposed to address, has been found to be misplaced – the effects of the drugs go far beyond just correcting negative emotions.
For example, recent studies have shown that taking SSRI antidepressants often results in a general reduction of emotion – not only of unhappy and anxious feelings but also feelings of happiness, love and even excitement.
In addition, people tend to feel emotionally cut off from others and care less about what were once important aspects of their lives; as if their personality has changed and they don’t recognize themselves anymore.
These effects are startlingly similar to the way alcohol affects us – alcohol can make us feel better for a short time by getting our minds away from reality but it does not help solve our problems in any permanent way.
Furthermore, research has shown that much of a drug’s effectiveness depends on our expectations; with often nothing more than sugar present in pills in some experiments yet positive effects still reported due to participants expecting certain outcomes based on different colors used for the pills!
Big Pharma’S Influence Makes It Difficult To Separate Medicine And Money
The influence of the pharmaceutical industry is pervasive, and their deep pockets and unscrupulous tactics are evidence of this.
Big Pharma has shown a tendency to suppress or ignore research with unfavorable results in order to boost positive ones, which can mislead consumers and distort the truth.
Money also plays a major role in the industry’s efforts to influence opinion leaders, universities, researchers, and even those who develop criteria for diagnosing illnesses that demand drug treatment.
Then there is Big Pharma’s substantial marketing budget – billions spent annually in many countries around the world – which allows them push their products despite inadequate research.
The Physician Payment Sunshine Act was created to bring more transparency to the industry regarding funding, but truly combating this powerful entity will require much more effort.
It’s clear that the pharmaceutical industry’s coffers are as deep as its manipulative powers are wide.
The Social Myths Of Mental Illness: How A Focus On Biology Denies The Complexity Of Psychological Suffering
When we question what’s behind mental health issues, the answers that psychiatry provides are often built on dangerous social myths.
Psychiatry tends to focus only on biological explanations for psychological disorders, which fails to consider the bio-psycho-social model of suffering.
This suggests that ailments may be caused by a combination of genetics, environmental factors, and trauma.
Rather than treating each of these causes individually for the best results, psychiatrists are increasingly relying upon a ‘bio-bio-bio’ model — medicating with pills and neglecting long-term psychotherapy or social interventions.
Unfortunately, this greatly reinforces widely accepted opinions and judgments about those facing a psychiatric diagnosis, as studies from places like Auburn University have demonstrated more severe punishments being meted out to those labeled ‘sick.’
By relying so heavily upon biological causes in an effort to explain psychological pain without any attempt to find balance through understanding it form all angles, psychiatry is using dangerous social myths in order to answer our mental health questions.
Big Pharma Is Using Culture-Specific Mental Disorders To Expand Its Global Reach
The pharmaceutical industry is pushing its mental health products, treatments and ideas into more and more countries around the world.
This can have a damaging effect because each country has different cultures, symptom pools and disorders.
For example, some places experience Koro – feeling that their genitals are retracting into their body – while this isn’t an issue elsewhere.
The spread of western psychiatry practices is leading to problems in “non-western” countries as they’re now beginning to experience conditions such as anorexia which were typically Western mental disorders.
In Hong Kong, for example, the disorder rarely existed until a high profile death of a 14-year old girl due to the condition led to massive media coverage.
Today drug companies are doing anything they can to convince people around the world that the only way they will find relief from their problems is to take a pill – marketing differently depending on what cultural associations would resonate with potential consumers.
Even in Argentina where there was serious economic turmoil in the 90s, one company used ads portraying oppressed individuals from around the world with depression as a way to link state of mind to globalisation and ultimately sell their antidepressant drugs.
Clearly, western psychiatry practices are becoming increasingly exported and this can cause terrible damage when applied without considering each country’s culture or symptom pool.
Needed Change In Psychiatry: A Shift From Diagnostic-Based Toward Patient-Centered Treatments
Many people are skeptical of psychiatry, believing that it is not a science, but rather a means for doctors to sell drugs.
However, this negative view of psychiatry is fading as the field shifts toward a patient-centered attitude that emphasizes individualized treatments.
For example, a non-diagnostic approach to ADHD treatment has been shown to be far more effective than traditional “diagnosis XY drug XY” approaches.
In this kind of approach, psychiatrists focus on understanding the social context in which the disorder developed and prioritize relationships with their patients over formulas and drugs.
Psychiatryhas a lot to prove if it wants to gain greater legitimacy as an evidence-based scientific discipline.
To do this it must become more modest in admitting what it can’t explain instead of continuing to cling to outdated diagnostic methods.
Additionally, better regulations are needed regarding researcher/pharma company relationships and psychiatrists should be encouraged to challenge existing assumptions about their field through self-critique.
Lastly, public education is key since when people understand their mental health dilemmas better and recognize promotional tactics from Big Pharma they will be more open to alternate treatments beyond those currently available.
Wrap Up
The Cracked Book provides a powerful message on the truth behind mental illness and psychiatry.
It reveals how psychiatric diagnoses are far too subjective, with flaws that lend to overdiagnoses and overmedication of people.
It also explores how pharmaceutical companies have created an industry catered to over-prescribing mental health drugs, to the profit of these wealthy industries while the true needs of individuals remain unaddressed.
The final summary is clear: think twice before taking any prescription medication for mental health problems.
Mental issues are not as simple as drugs can make them out to be and it is often our wallets that benefit from taking pills rather than us as individuals.
