We’ve Been Misled by the Drug Industry
I have recovered from schizophrenia. If that statement surprises you — if you think schizophrenia is a lifelong brain disease that cannot be escaped — you have been misled by a cultural misapprehension that needlessly imprisons millionsunder the label of mental illness.
In the last 20 years, the pharmaceutical industry has become the major force behind the belief that mental illness is a brain disorder and that its victims need to take medications for the rest of their lives. It’s a clever sales strategy: If people believe mental illness is purely biological, they will only treat it with a pill.
Drug companies have virtually bought the psychiatric profession. Their profits fund the research, the journals and the departments of psychiatry. Not surprisingly, many researchers have concluded that medication alone is best for the treatment for mental illness. Despite recent convincing research showing the usefulness of psychotherapy in treating schizophrenia, psychiatric trainees are still told “you can’t talk to a disease.” This is why psychiatrists today spend more time prescribing drugs than getting to know the people taking them.
Fisher is right to decry these trends — the pharmaceutical industry’s ‘ownership’ of the psychiatric profession; the woeful deemphasis on investing in talking with our patients in modern training — but he surely comes to his conclusions for the wrong reasons. He appears to be stuck in the dichotomous world of ’60’s psychiatry in which the debates raging about whether psychiatric illnesses were “either or” were the most important preoccupation of academic psychiatry and psychology. To be as polemical as he is — “schizophrenia is more often due to a loss of dreams than a loss of dopamine” — ignores the agonizing futility of the efforts of many with this disease to make anything work in the world, the daily terror of their existence, and the very real attenuation of their distress modern treatment, with antipsychotic medication, affords. While he is right in suggesting there should be more research into how people recover, the disease is often characterized by a progressive deterioration of intellect and personality and usually an inevitable downhill course, without ‘cure’. The trends of the past twenty years have arisen mostly from the vast progress in neuroscientific understanding of this — yes, I’ll say it — brain disease. Throw in for good measure a society that, continuing to stigmatize and marginalize the mentally ill, devalued the severity of their distress and became increasingly unwilling to pay for the expertise and experience generations of psychiatrists had had with the severely mentally ill, instead hiring cheaper allied health professionals to do the talking to the patients and relegating psychiatric physicians to the role of hired guns writing prescriptions and consulting instead of doing direct treatment. To dismiss the entire profession as misguided, as Fisher does instead of grasping the more complicated picture, does psychiatry — but, moreso, our patients — an enormous disservice. Washington Post
Fisher appears to be cast somewhat in R. D. Laing’s mold. The father of British antipsychiatry, Laing provided what remains one of the most accessible and profound descriptions of the subjective and existential experience of schizophrenia in The Divided Self. He then went on, however, to romanticize sufferers as cultural heroes resisting dehumanizing and oppressive societal programming, and cast madness as a consciousness-raising experience. In attempting to counter the stigmatization of the mentally ill and its contribution to their social suffering, he rejected the notion of their patienthood. Indeed, the altered functioning in mental illness is, mostly, the source of their dehumanization. Laing was one of my inspirations, and you can hear his influence in my resonance with the existential crisis of my patients and my anti-stigmatization polemics. But — and this is a big ‘but’ — the empathic physican’s ability to use physiological as well as psychological-emotional means at her/his disposal is not a baby to be thrown out with the bathwater.
For those with further interest, Janus Head‘s Spring 2001 issue was devoted to a consideration of the legacy of Laing.
