In the 19th century, a woman who experienced depression or discontent was likely to be diagnosed as "neurotic" and subjected to treatment ranging from vibrators (to induce orgasm) to clitoridectomy (to ensure that she never had another one again), with various talk, drug and institutional therapies in between. In the 1950s, a neurotic woman might find herself undergoing electroshock therapy, or, if she was lucky, she might be offered the sedation of Valium. Today, the depressed housewife is likely to find herself on one of the new antidepressants such as Prozac, Zoloft, Paxil or Wellbutrin.
Andrea Yates, a reportedly depressed housewife, had, in the years before she killed her five children, been treated with various drugs, including Wellbutrin, Effexor and Haldol. According to her husband, Yates suffered from postpartum depression. According to Bruce E. Levine, Ph.D., author of "Commonsense Rebellion: Debunking Psychiatry, Confronting Society -- An A to Z Guide to Rehumanizing Our Lives," the combination of medicines that Yates reportedly took, particularly if she was taking them at the same time, may well have been a prescription for a tragic psychotic break.
We often think of the history of psychiatry as a story of progress, an evolution from barbaric and invasive treatments to more sophisticated, humane care based on sound scientific principles. And while it certainly seems like progress to move from attacking depression with scalpels and electrodes to treating it as a chemical imbalance with medication, in high-profile cases like those of Andrea Yates and Columbine High School's Eric Harris, who was also being treated with antidepressants, critics like Levine have serious questions about the efficacy and safety of these medications.
Levine, a practicing psychologist for more than 15 years, believes it would be rash and reductive to lay the blame for Yates' and Harris' homicidal impulses at the feet of American pharmaceutical companies. But if we are going to treat depression -- and postpartum psychosis, anorexia, oppositional defiant disorder, premenstrual syndrome and dozens of other illnesses -- with tools from the chemistry set, says Levine, it is fair to ask whether we know what we are doing at all.
Why are we now prescribing stimulants for women who, three decades ago, would have been put on sedatives? Is this a sign of progress, the result of better diagnostic tools and more effective treatments? Or is it a sign of social engineering to accommodate the changing expectations of women in society? Are the cutting-edge psychiatric treatments of today any less arbitrary than those of 30 or even 100 years ago? And if we don't know exactly how a medication works, is it possible that, in rare cases, we might inadvertently give a patient a medication that triggers a psychotic reaction?
"The history of psychiatry is one of nearly unmitigated failure," says Levine, who also is a member of the International Center for the Study of Psychiatry and Psychology, an organization that educates the public on the dangers of psychotropic drugs, electroshock and psychosurgery, as well as argues against the idea that mental disorders can be traced to biochemical and genetic causes.
The theory that depression and other disorders are caused by "chemical imbalances" in the body that can be remedied by psychotropic medication is, according to Levine, "just that: a theory." Not only does he believe that psychotropic medication is, at best, ineffective; he also claims that the rush to solve social problems by medicating individuals is blinding us to the ways in which people are rebelling against an "institutional society" that doesn't meet human needs.
Speaking by telephone from his home in Ohio, Levine addressed the ways in which pharmaceutical companies romance Americans, the effects of the mental health industry on women and children, and the possible role of psychotropic medication in the Andrea Yates case.
(Several days after Salon's interview with Levine, Families USA, a healthcare consumers group based in Washington, published data showing that last year, leading pharmaceutical companies spent more than twice as much money on advertising, marketing and administration as they did on research into new medicines.)
You have written: "One of the greatest marketing feats of the past 20 years is use of pharmaceutical companies' dollars to convince the mass media that psychiatrists who prescribe these companies' drugs are basing their treatment on anything resembling science." What do you mean by this?
Thirty years ago people used to laugh at psychiatry. Since then, the science has not advanced, but the marketing on the part of pharmaceutical companies has. Just like any other corporation, these companies bring out new models and new brands; when people start to notice problems with one product, they bring out another one which may not be any better than the last one, but its problems are less well known. These are multibillion-dollar companies that have made sure that professional organizations and consumer groups hear the same line over and over again. Even lots of doctors don't have the time to do much more than read press releases.
But today, even mainstream psychiatry textbooks will tell you that many of these drugs have no benefit beyond the placebo effect, especially for children. Meanwhile, estimates are as low as half a million to as high as 2 million children are being put on these drugs, which may have no greater benefit than a sugar pill.
All these new antidepressants -- Prozac, Paxil, Zoloft -- are SSRIs [selective serotonin reuptake inhibitors]; they all increase the level of the neurotransmitter serotonin in the brain. The theory is that this increase fixes depression.
But they've changed their theory every five or 10 years of which neurotransmitter fixes depression. So if you look back 20 or 30 years, they were talking about norepinephrine and that's why they were giving out things like Tofranil and Elevil.
People debate whether they decided before or after Eli Lilly came out with Prozac that serotonin was the key for depression. Now they've come out with Wellbutrin -- and that affects only dopamine.
Part of the insanity of psychiatry is that not only is there no real scientific evidence that psychotropic drugs are no better for depression than placebos, but they certainly have a hell of a lot more side effects than sugar pills, and they also mix these prescriptions together -- especially Wellbutrin and Effexor -- routinely.
Psychiatry textbooks admit that these new antidepressants are no more effective than the older ones, but some of them do say that the side effects are less severe. But that, also, is highly debatable.
What are some of the side effects that people taking SSRIs can expect?
What we know for sure is that patients who take Prozac and other SSRIs have sexual difficulty. There is a debate as to how high these percentages go -- but some people say it can be as high as 70 percent. Overall, what these drugs do is anaesthetize you. They numb you. Some people like that feeling, just like some people like to numb themselves with alcohol or other mood-altering drugs. For them, it's like the drug soma, from "Brave New World." But for some people, taking a drug that makes them feel less is really scary.
For example, I have had patients on psychiatric drugs who have had genuine tragedy occur in their lives -- a friend dies, or something like that -- and they have reacted with a robotic response, or if not quite robotic, it's a little less full than it would be otherwise. They have this basic feeling inside that nothing is affecting them.
Another one of the great deceptions is what the drug companies like to call "selective serotonin." People believe that upping serotonin only will only affect their depression. What they don't tell people is that serotonin is everywhere in your body. So when you change the amount of serotonin in the neurosynapses in your brain, you are also changing it in your cerebellum, in your gastrointestinal tract. A lot of people have stomach problems when they are taking these things. It affects your sleep cycles. There is almost no part of your body that serotonin doesn't affect.
A lot of people have withdrawal symptoms when they stop taking these drugs. That was another initial deception: They were trying to tell people that there would be no addiction, and no withdrawal symptoms. That's totally not true. If you take any kind of drug that affects your neurotransmitters, when you stop taking it, your body will have to rebound. There are all kinds of withdrawal symptoms. Their euphemism now is "discontinuation syndrome."
Newspapers have told us quite a bit about the kind of psychiatric treatment Andrea Yates was receiving. What kind of side effects might her treatment have caused?
In the case of Andrea Yates, according to news reports, she was getting Wellbutrin and also another antidepressant, Effexor. The news reports don't say if she was getting them recently, but it's clear she was on both of them sometime in the last couple of years. They all say she was pulled off this antipsychotic Haldol. When people are taken off Haldol, they routinely become really agitated, they feel completely out of control. Sometimes people can't even keep food down; if they haven't eaten for a while, they often experience dry heaving.
But if you add all three of these drugs together, they were playing with three different neurotransmitters. Here's the interesting thing: The Wellbutrin ups dopamine, the Effexor ups the serotonin and norepinephrine. You know what else ups all three of those? It's called cocaine. If you want to be a one-stop shopper, just go ahead and do cocaine. It's a little different, because cocaine gives you a quicker hit, and these things take a little longer.
Haldol suppresses dopamine. If they were giving her the Wellbutrin at the same time -- which is not clear from the news reports -- they were giving her another drug that increased it. When people hear this sort of thing, they immediately conclude that Andrea Yates must be the victim of malpractice. But this sort of thing happens all the time. This is the standard of care, however illogical it may sound.
How do you explain something like postpartum depression? Would you consider it a chemical imbalance triggered by a physical act in the body, or a social phenomenon brought on by the stress of raising a child? How best would you treat it?
Some folks explain postpartum depression by saying that it is rooted in hormonal changes. If that is your argument, then it would make sense that you would want to treat it through drug therapy. But once people have labeled it as a chemical imbalance, they start to treat it with all these psychiatric drugs when it hasn't been proven that serotonin is the cause of these women's problems.
Not everyone will flip out like Andrea Yates, but for a certain percentage of women who are particularly sensitive to these drugs, it may increase their chances of having a psychotic break.
It's a given that these women who are going through this are having a really hard time. They are down, they are really hurting. The issue is whether it is helpful to create a syndrome for it. For some people, it may make them feel better to know that there is a name for what they are going through, and it may make it easier for them to explain their condition to other people.
The downside is not just the drugs and the side effects; it's also that these people are missing out on what human beings are supposed to be doing when they are going through this kind of situation. The No. 1 thing they should be doing is supporting each other emotionally -- validating each other's feelings, building some real trust among people. When you help someone get through a hard time, that's how you build strong bonds and families and communities.
People would rather numb themselves with drugs than admit that we live in a pretty weird society, one in which no one is really around to physically help these women who find themselves suddenly the only person in charge of this kid. Their husband is off at work, their friends have jobs. For some people, that can be a pretty crazy situation. For 99.9 percent of the history of the human race, no one ever raised a kid in that manner. When a child was born, the mother could find plenty of emotional and physical support, and the burden was not resting entirely on one person.
Over the last years, we have seen a huge increase in the number of syndromes. The DSM [Diagnostic and Statistical Manual of Mental Disorders] is now the size of a phone book. More people are diagnosed with depression than ever before. Are there really this many new disorders? Or is this a social rather than a medical phenomenon?
One way you can explain these increases is to look at the kind of marketing done by the drug companies. But that's a little too easy. If it were all a complete sham, you wouldn't see such a huge increase in true problems -- in the United States, teen suicides have tripled since 1960; we have twice as many obese kids as we did 30 years ago. No one is making that stuff up.
Psychiatry is part of the problem in that it is exploiting this situation, but it is also diverting people from taking a true look at what is happening in the culture to cause all of these problems. Our society is perhaps the most economically successful culture in the history of the world, materially. But in our one-dimensional quest for productivity, consumption and efficiency, we have forgotten about a whole bunch of things that people need to stay human -- like community, autonomy, diversity. All of those things have shrunk.
Taken together, this may help to explain why so many kids are being diagnosed with attention deficit disorder and all these other various childhood disorders. The largest increases we have seen in new illnesses are the ones that affect children.
There are real problems out there: You do have kids taking guns to school, you do have people like Andrea Yates, you do have this huge increase in people who think they are in pretty bad shape. But why is this going on?
Is it going on because more people have chemical imbalances? No. It makes no sense to believe that human beings can change biologically in one or two generations. Obviously, something else has changed in our culture, in our society.
But once you start looking at that, you have to start challenging the assumptions of the status quo. And people at the top of society don't want to do that. People who are at the top of institutional hierarchies who are doing quite well don't want to look at that. People on the streets have no problem with what I am saying. To them, it just sounds like common sense.
In general, you can either believe in numbing, or you can believe in healing. It's very hard to do both. You can either believe in grieving over losses, or you can believe in denying losses. You can believe in people supporting and helping one another, that you don't have to have a Ph.D. or an M.D., that if people care about each other that they can provide emotional and physical support better than any so-called authorities. Or you can believe that unless you have a degree or expertise that you can't help anybody.
Looking at the history of drugs that have been marketed to women, it seems that you can make an argument that psychiatrists and drug companies are selecting for socially desirable traits. For example, in the '50s, when women were supposed to stay at home, Valium was the drug of choice. Today, the drug of choice is Prozac. Are we medicating people to fit into society?
Back in the '50s and '60s, they wanted docile women. So if any woman was a little more upset or assertive than average, she would be given librium or Valium. Nowadays, we want good little consumers, we want good little workers. We don't want women to be docile; we want them to be out there shopping and working. So we don't want those old drugs anymore -- they make you sleepy, they make you a little zoned out. But Prozac and Paxil seem perfect for the new woman -- they just make you numb, but you can still shop and work when you are on them.
Clearly, I don't think it's desirable. Part of having a human society is making room for all kinds of people. You don't chemically alter them to make them fit in. And it doesn't work. But that is exactly what they are trying to do -- especially to kids.
With kids, it's really obvious. One hundred years ago, 6 percent of kids graduated from high school. During World War II, it was about 25 percent. Almost nobody went to college. They worked on farms, they worked as apprentices.
Today, if you are a middle- to upper-middle-class parent and your kid doesn't go to college, it means you are a failure as a parent. I work with kids all the time. And some of the smartest kids I've ever had don't belong in college at all. They just aren't academic types. But when teachers come to parents and say, our kid is getting C's and D's, and they aren't interested in Shakespeare, the parents start freaking out and thinking that their child will never get into college, and never get a job.
We have created that. And that is what we, as a culture, don't want to admit: We've created fewer and fewer places for different kinds of personalities to feel good about themselves and to make a living.
Shares