Great Read: Marcia Angell Reviews Books by Whitaker, Kirsch, Carlat- And the DSM

A few years old, but very interesting articles published in the New York Review of Books.  Dr. Marcia Angell reviews three books that are highly critical of modern psychiatry.

(Marcia Angell - American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine. She is currently a Senior Lecturer in the Department of Global Health and Social Medicine at Harvard Medical School in Boston, Massachusetts).

Her two articles are responded to and criticized by three "prominent" psychiatrists (see third article below).  Dr. Angell's replies to them essentially handing them their heads on a platter (see bottom of same article).  Flawlessly executed. 

"The Epidemic of Mental Illness: Why?" - Marcia Angell - June 23, 2011

http://www.nybooks.com/articles/2011/06/23/epidemic-mental-illness-why/

Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain. The number of people treated for depression tripled in the following ten years, and about 10 percent of Americans over age six now take antidepressants. The increased use of drugs to treat psychosis is even more dramatic. The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US.

What is going on here?

"The Illusions of Psychiatry" - Marcia Angell - July 14, 2011

http://www.nybooks.com/articles/2011/07/14/illusions-of-psychiatry/

In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it.1 Here I discuss the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—often referred to as the bible of psychiatry, and now heading for its fifth edition—and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider’s view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry.

" ‘The Illusions of Psychiatry’: An Exchange"

John Oldham, Daniel Carlat, Richard Friedman, and Andrew Nierenberg

August 18, 2011

http://www.nybooks.com/articles/2011/08/18/illusions-psychiatry-exchange/

In response to:

The Illusions of Psychiatry from the July 14, 2011 issue

The Epidemic of Mental Illness: Why? from the June 23, 2011 issue

To the Editors:

In its June 23 edition, The New York Review chose to review three books that are highly critical of modern psychiatry. We regret that a more balanced approach was not taken.

Dr. Marcia Angell writes of a “raging epidemic” in mental illness, citing the fact that there are more individuals receiving disability payments for mental illnesses than ever before. While this is accurate, her article suggests that this is a false crisis that owes its existence to the discovery of psychotropic drugs starting in the 1950s. This creates the impression that Americans are overtreated for mental illnesses. Nothing could be further from the truth.

Marcia Angell replies:  (Scroll to bottom of above article)

All three of these letters simply assume that psychoactive drugs are highly beneficial, but none of them provides references that would substantiate that belief. Our differences stem from the fact that I make no such assumption. Any treatment should be regarded with skepticism until its benefits, both short-term and long-term, have been proven in well-designed clinical trials, and those benefits have been shown to outweigh its harms. I question whether that is so for many psychoactive drugs now in widespread use. I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.