our fucked up medical system
By shag carpet bomb • Aug 29th, 2009 • Category: Books & Book Reviews, Our Daily Meds, Researchi finished Melody Petersen’s book, Our Daily Meds, which is an absolute must-read — though as I mentioned before, it will probably be more information than someone wants if they are on medications and just don’t want to hear the bad news.
I brought the book up at LBO, asking people about Petersen’s argument that the “chemical imbalance” theory is an oversimplification pedaled by pharmaceutical companies. I’d mentioned that, in my experience, people who were diagnosed with various mental illnesses — depression, adhd, add, SAD, PTSD — had all insisted that it was a chemical imbalance. So, seeing as I don’t suffer from these things, who was I to question what they said?
But then I read Petersen’s book… The responses were weird. I guess people are getting really defensive if they are diagnosed with depression. Can’t say as I blame then, I’d be annoyed were the topic about heart disease.
But occasionally, I do have to wonder just how much diagnoses are being pushed on people. For instance, many years ago, I went to the emergency room. I was dealing with a couple of major life crises. A call to the crisis hotline was less than worthless: the woman who answered the phone seemed to want to just get rid of me and not, you know, actually help me. Long story short, I was given prozac and reacted badly to it. I hadn’t been suicidal, but became so. Thankfully a friend I knew from the Internet, Ken, helped me through it. I was alone, in a new town, with no friends or family.
I’d almost forgotten about that incident.
But the thing that also bothers me is this: two other times, you could definitely say I was severely depressed. I would say that, during most of 2006, I spent a lot of time thinking about and planning out how best to commit suicide. There was another time when I went through a really traumatic event which I won’t describe for the sake of privacy, that made me terrified to go out of the house.
Looking back on those times, had I had insurance, I would have gone to the doctor’s and been diagnosed with depression in one case. In the other, I might have been diagnosed with depression, PTSD, and/or agoraphobia.
With the leaving the house thing, I was afraid that horrible traumatic event would happen again. Even if it was completely irrational to think this, even though I knew it was irrational, I would still feel terrified. And then I would actually have to get out of the house and go buy groceries, do errands, etc. And once I drove past the gates of the apartment complex and turned down the main thoroughfare, I felt amazingly free, smiley,and glad to be out and about.
I started a regimen of exercise and did that daily. I started making sure I got sunlight, having read that it was bad not to get sunlight.
So, eventually, I never had this terrified feelings again. Similarly with the depression and suicidal thoughts. Obviously, suicidal ideation was deeply connected to my despair that I couldn’t raise my son the way I thought I should. i.e., it was connected to my unemployment and to the feelings of anger I’d get when dealing with clients who felt they deserved $100/hr salaries but that, somehow, I didn’t deserve $20/hr.
So, here I am fine and dandy.
But if I’d had insurance, someone might have diagnosed me with depression or PTSD or agoraphobia or some combination. I would have been put on medication and sent to therapy. But I wasn’t. And here I am. I am now fine.
So, for me, I have to wonder: would a diagnosis of depression, ptsd, or agoraphobia have made sense — since I didn’t actually need that diagnosis and treatment to get well?
YOu see, for me, given those three experiences, I have to wonder if there isn’t some truth to the claim that disease profiles are being ascribed to people who are being treated for the disease with medications they don’t need to get better. In fact, in my case, I have to wonder: would being labeled depressed or PTSD have helped me? I think it might have actually dragged things out and made them worse — but that’s in retrospect, so I don’t know. I’m thinking here of labeling theory in sociological research. A lot of interesting things happen when people are given a label. “If men define situations as real, they are real in their consequences.”
Questioning what would have happened had I been treated with medications for depression, ptsd, or agoraphobia, and thinking that I might have been mistreated as a consequence doesn’t mean that there aren’t legit diagnoses, that ptsd, depression, etc. don’t exist. I do think that overdiagnoses are happening though, and that’s a bad thing.
so, it bothers me when both sides get extreme. The folks like the feminist blogger who started an uproar when she made some pointed critiques about meds … She’s got a point and the research she’s pointing to, some of it is really worthwhile — and applies, I think, to situations like mine. But she carries it way too far by basically saying that everyone is suffering from fabricated illnesses.
On the other side are folks who think that any criticisms of the system of overprescribing and overdiagnosing is a priori a claim that “mental illness doesn’t exist”. But this is bullshit as well.
This response was evident on LBO. The response to quotes from Petersen included the following:
1. claim she was anti-psychiatry — without reading the book, the insinuation was made that, most people who criticize the phenom, are antipsych so… she probably was. oh well.
2. the claim that she and people who have similar views are anti-technology and anti-science. IOW, if you criticize bad science, you are anti-science. *rolls eyes*
3. then there was the interesting claim, which you’d only get from a leftist, that, tra la la la la, the problem with books like Petersen’s is that they probably don’t understand that all they are doing is demonizing a handful of companies. They don’t realize that the drive for profits is the root problem, etc. (Except of course that is exactly Petersen’s point!)
So, I just had to laff at the responses. Instead of do a little homework, maybe watching the Bill Moyers interview with Petersen, or skimming the book on google or something, the inclination was to dismiss whatever she said as bogus — some sort of horrible attack on people with depression who have found that paxil, zoloft, prozac, etc. work for them. That, somehow, it’s anti-psychiatry when a bunch of psychiatrists investigate the research on 9 antidepressants, demonstrating that 52% of the time, a placebo works as good as or better than the antidepressant.
Except, of course, this is what scientists are supposed to do. They aren’t supposed to accept everything as given. They are supposed to test each other’s work. They are supposed to question the results of research all the time. They are supposed to be on the lookout for the uses of research for profiteering purposes and expose those uses — at least theoretically.
anyway, more about Petersen later!
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Am I defensive? Yeah, I’d say so. Because as a person w/ mental illness, I hear it *all the time* from all parts of society that my illness isn’t real. I should just cheer up. I don’t *really* need those meds. I sure as hell don’t need to hear that under the guise of progressive, anti-capitalist whatever. Rail on big pharma all you want but it’s pretty damn insulting to me when people take the extra step of deeming themselves worthy of deciding which conditions are and aren’t “real.”
Also something that annoys me is the apparent need to draw a line between “chemical” depression and “situational” depression - as if it’s always either/or. We don’t do that w/ other types of illness. E.g., you live next door to a coal plant, you develop asthma. You move to a place w/ healthier air, you won’t have as many asthma attacks and it’ll be better for your health overall; but there’s no guarantee that you won’t have an asthma attack, esp. when placed in certain environments. Your body changes based on its surroundings. Why do we throw that rather obvious understanding out the window when it comes to mental illness?
Petersen doesn’t say diseases aren’t real. She says that 1. diseases are so loosely defined that they are being ascribed to people who don’t have them (social anxiety disorder for example) or that they are being ascribed to a wider swath of the population than really has a problem with it (overactive bladder disorder) 2. that people are being treated with drugs on the basis of a over-simplified “chemical imbalance” theory who could be treated with other approaches. it’s well known and has been for decades that talk therapy and drug therapy and placebos perform equally well in treating depression.
so, it’s not that depression, overactive bladder, PTSD, oppositional defiant disorder, diabetes, etc. don’t exist.
Take diabetes as a non mentalillness issue. People are being prescribed drugs when they should probably be prescribed an exercise and weight loss regimen, first.
After reading this book, I figure that when the day comes that my doctor tells me i have to take medicine for my congenital heart disease, I figure I’ll flip a coin. I can’t count on the doctor to not be on the take from big pharma or that my personal reading of all the research about the drug will halp me make a rational decision about whether it will help or harm me.
i asked questions about that issue long ago. If I’m remembering correctly, I was told that the distinction is made because people want to talk about causality.
situational depression is *caused* by life events that make you depressed.
clinical depression is *caused* by a chemical imblance, i was told, and would exist no matter *what* your personal situation.
i have no idea whether this is true or not, but that’s what i was told when I asked about it on a mailing list to folks who were discussion depression and the chemical imbalance theory. not everyone there who was depressed believed in the chemical imbalance theory. in fact, one guy described it as nonesense. useful nonsense, but nonsense nonetheless. what he meant was, the chem. imbalance theory helped people to stop blaming themselves. they could point to something external, over which they had no control, that they didn’t cause or make worse. it allowed them to remove themselves from the shame and moral stigma associated with what, sociologically, we’d call the deviance model of depression (where being depressed is a form of moral deviance) to a medical model of depression where the depressed person can no more control having depression than i can control having congenital heart disease.
at any rate, a couple of years ago i read a really fascinating article in sci am that was an overview of the research on what we do and don’t know about depression. I’ve forgotten much of the article but one thing that stood out was that someone who is situationally depressed — like say they are realy bummed out after a break up or someone dies or they lose their job. the article said that, if left untreated (some form of therapy or drug treatment or both) then the situational depression itself could create the conditions under which situattional depressions _becomes_ clinical depression. the structure of the brain is permanently altered. whereas situational depression, when treated, will be temporary. if left untreated, the research seemed to be indicating, then there was a really high chance that you could end up being diagnosed as clinically depressed where the bouts of depression would have no situational cause that triggers them.
i’ll have to lay my hands on a copy and read it again.
I’m sure she doesn’t come right out and say it’s not real, but it sounds to me (admittedly I have not read the book, I’m just going on your reviews here) that she is appointing herself worthy of deciding what kind of treatment is okay and what is not. When reality is way more nuanced than that.
I too have concerns about big pharma and overdiagnosis. At the same time, the fact remains that these drugs help tons of people. I have stated before and will state again that I wouldn’t be alive otherwise. Is my mind playing tricks on me and would the same thing happen if I were given a placebo and told it was medication? Maybe, btu honestly I find that sort of scenario useless to pursue. It’s so hypothetical and our bodies and minds are extremely complicated.
Doctors being “on the take” is a big concern but at the same time it doesn’t mean they aren’t helping people, too. It’s not a mututally exclusive situation.