Let me say at the start that I take very seriously the idea that many things we count as “mental disorders” may be in large part the result of society’s finding ways to express pain. There may be a sense in which they are not “real” the way a burn or a burst appendix may be real, for example. But I also think that there may be a very genuine underlying pain and that, more generally, some so-called mental problems can ruin lives. Further, I’m pretty sure some lives have been saved from ruin by medication. I hope this counts as a nuanced take on the issues addressed below.
The topic of discussion is an article in the current New Yorker. It is by Louis Menand, and it is on the current state of psychiatry.
I take it that the New Yorker is undeniably a high-class publication. Among other things, it is supposed to have really good fact checkers. So what should one say about the following quote?
There is little agreement about what causes depression and no consensus about what cures it. Virtually no scientist subscribes to the man-in-the-waiting-room theory, which is that depression is caused by a lack of serotonin, but many people report that they feel better when they take drugs that affect serotonin and other brain chemicals.
I think Menand’s comment is really difficult to understand, but it seems to imply that the fact that people feel better is not indicated by the scientific evidence. Well, that’s not the evidence I saw coming from many, many journals. If that’s what he was saying, it is startlingly false.
Having heard of the article because of Dan Weiskopf’s tweet, I went on the web to my university library’s Web of Science and decided to search for “depression” and “serotonin” in the titles. And what I found were thousands of articles on depression and serotonin. A lot of them were about gene-evironmental interactions, and quite frankly beyond my understanding, though almost all of them seemed to be looking at the positive correlation between serotonin irregularities and depression, along with other ‘mobidities’. So after wading through about 30 abstracts, I went over to Academic Search, where I expected to find less technical articles. Representative of what I was reading is this from (Pharmacology; 2010, Vol. 85 Issue 2, p95-109, 15p):
Serotonin (5-HT) is a monoamine implicated in a variety of physiological processes that functions either as a neurotransmitter or as a peripheral hormone. Pharmacological and genetic studies in humans and experimental animals have shown that 5-HT is important for the pathophysiology of depressive disorders. The 5-HT system is thus already a main target for the therapy of these diseases.
So why care about this? Unfortunately, severe depression, panic disorder and social anxiety disorder run in my family. We are not here talking about some shy people. Rather, we are talking about people who will stay away from all social gatherings, or people who sit in movies and can’t hear the movies because they think their bodies are being so noisy. In fact, most of my relatives are ordinary, fairly cheerful people, but then there NN, who had for some time a life blighted by severe depression. Until around the mid-80s, most psychiatrists NN saw believed what the New Yorker article is suggesting; anti-depressants may not be exactly a placebo, but they really shouldn’t have much of a role in mental health. So, because people move around and so on, NN saw three different doctors for severe depression and a pattern eventually became clear. Severe depression then pills then recovery then tapering off then horrible breakdown. Of course, it would be said that the breakdown was due to the failure of the previous psychiatrist, but to recover, pills were prescribed. And once NN recovered, tapering off started, to be followed by severe breakdown, etc. NN was typically impaired for most of a decade, since we need to add that since no one really believed in the pills effectiveness, he didn’t get the dose he needed.
Severe depression is very, very horrible, and it can include quite disordered thinking that too often can lead to suicide. It is very alarming that Menand article will reinforce the beliefs of the doctors whom NN saw and who are probably still practicing.
But what is Menand going to say to someone like NN, who is a very gifted, creative artist who has put his life back together finally? He does consider people just like that:
The recommendation from people who have written about their own depression is, overwhelmingly, Take the meds! It’s the position of Andrew Solomon, in “The Noonday Demon” (2001), a wise and humane book. It’s the position of many of the contributors to “Unholy Ghost” (2001) and “Poets on Prozac” (2008), anthologies of essays by writers about depression. The ones who took medication say that they write much better than they did when they were depressed. William Styron, in his widely read memoir “Darkness Visible” (1990), says that his experience in talk therapy was a damaging waste of time, and that he wishes he had gone straight to the hospital when his depression became severe.
This is his comment:
What if your sadness was grief, though? And what if there were a pill that relieved you of the physical pain of bereavement—sleeplessness, weeping, loss of appetite—without diluting your love for or memory of the dead?
I’d say that counts as changing the topic. However, perhaps we should say that the article has many topics. One is whether we should try to medicate ourselves out of the human condition, with its ordinary pains, even the very severe ones. What I am concerned about, though, is NN and others like him, who still are fortunate if they can get adequate treatment. Their state is not simply ordinary; it is more horrible than humans should have to endure, though hospitals have had, and do have, many who do. We do not need an article that appears to say no scientist thinks pills are a good response to depression.