Monday, March 3, 2008

Domestic Disturbances: Overselling Overmedication

Judith Warner writes in the New York Times:

On the bookshelf behind me at work, I have two new books on the way the pharmaceutical industry is turning us into a nation of hypochondriacal pill-popping zombies: “Shyness: How Normal Behavior Became a Sickness” and “Our Daily Meds.” On the floor, windowsill and shelves of my office at home, I have quite a few more: “Generation Rx” … “The Last Normal Child” … “Toxic Psychiatry” … “Let Them Eat Prozac” … The latest volume, front and center now on my desk, is Charles Barber’s “Comfortably Numb: How Psychiatry Is Medicating a Nation.”

In the book, Barber argues that Americans are being vastly overmedicated for often relatively minor mental health concerns. This over-reliance on quick-fix medication is numbing our nation and dulling our awareness of real and pressing social issues and of non-psychopharmacological therapies and treatments.

Barber is hardly alone these days in this line of reasoning. The notion that American children and adults are being over-diagnosed and overmedicated for exaggerated or even fictitious mental disorders has now become one of the defining tropes of our era.

This storyline persists despite the fact that government research has repeatedly shown that most adults and children with mental health issues don’t get the specialized help that they need. It persists despite the fact that there’s really no way to meaningfully evaluate the degree of over-diagnosis and medication unique to our era, because to do so is essentially to look at the current era in a vacuum. We don’t know how many adults suffered from things like depression in the distant past because no one ever asked. The words and concepts through which we understand common mental health disorders today didn’t exist until the last few decades.

The narrative survives largely uncontested despite the fact, shared by psychiatrist Peter Kramer in his Slate review of Barber’s book, that only tiny numbers of people are receiving mental health services without real, clinical levels of mental health dysfunction or a history of mental illness or trauma. And despite the fact that, contrary to received wisdom, the United States is not a world leader when it comes to the use of psychiatric medications. (The U.S. is “’in the middle’ relative to other countries, and is not an outlier,” a study from M.I.T’s. Sloan School of Management, cited by Kramer, showed last year.)

Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon.

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