Sunday, February 9, 2014

A Drugged-Out Nation

The death of Philip Seymour Hoffman has caused everyone to ponder the devastation caused by narcotics.

But, we do well to consider, yet again, the damage done by a psychiatric profession that continues to expand the definition of mental illness and that continues to prescribe biochemical solutions for whatever ails you.

John Ericson raises these questions in Newsweek, in an article called: “The Rise of Diagnostic Inflation.” (No link available.)

Ericson reports:

"We have more deaths in emergency rooms now for prescribed psychiatric medication than we do for street drugs," [Dr. Allen] Frances explains. And, as broad diagnoses will have psychiatrists and primary-care providers prescribe these pills to younger and younger patients, hospitals across the country may soon face a patient generation that has come to think of the pains of everyday life as treatable ills.

Giving it the best spin, we can say that psychiatrists are trying to help more and more people. Less positively, they are pathologizing behaviors that in the past were considered to be a normal part of everyday life.

By giving medication to younger patients they are ensuring not only that everyday anguish is a medical condition but that the best way to deal with it is through medication.

In the past, psychiatrists classified mourning as a normal reaction to the death of a loved one. Now, grief is called “bereavement-related depression” and is treated with medication.

Some psychiatrists are especially enthusiastic about medication's miraculous powers, but many of them, if they could not write a prescription would not know how to help their patients.

Also, Ericson is correct to point out that many of the psychiatrists who were working on the new Diagnostic and Statistical Manual had financial interests in Eli Lilly, the company that makes the medication that is being used to treat “bereavement-related depression.”

We need not believe that these psychiatrists are engaged in a conspiracy to rip off the public, but clearly there was an appearance of impropriety and an appearance of conflicts of interest.

As the world mourns Philip Seymour Hoffman Newsweek performs a worthy service in asking whether we are pathologizing too much human behavior and convincing ourselves that the only cure is biochemical.

Keep in mind, Hoffman had been taking any number of psychiatric medications at the time of his death. His apartment contained drugs for ADHD (Vyvanse), anxiety (hydroxine) and addiction (buprenorphine). He  also had a muscle relaxer (methocarbamol) and blood pressure medication (clonidine hydrochloride). For now we do not know whether these were prescribed, though one suspects that they were. They are not really street drugs.

For those who have argued that that the best treatment for addiction lies in the new class of anti-addiction drugs, I emphasize that Hoffman was taking one of those. Before he moved on to heroin he had also been taking prescription painkillers.

Ericson quotes Ludwig Wittgenstein, arguably the most important philosopher of the twentieth century, to the effect that the more you see mental acts as symptoms of illness, the less you will have any notion of what it means to have a healthy mind:

when the Austrian philosopher Ludwig Wittgenstein worked as a hospital porter tasked with delivering psychiatric medication to World War I veterans, he would tell his patients not to take the drugs he brought them - supposedly out of a belief that, once illness becomes the norm, no one is really sick anymore. Although the strategy is a bit extreme, the idea behind it goes to the very core of the problem at hand: If there is a pill to cure all ills, will there no longer be such a thing as a healthy mind?

Take it a step further. As psychiatry and neuroscience see things, is there a mind at all? If all human behavior and all human emotion is reduced to brain chemistry, what place is there for a mind? What place is there for free will and responsibility?

Dr. Keith Ablow emphasizes this point in his analysis of Hoffman’s behavior:

Mr. Hoffman was the one who procured the drug, injected the drug and kept injecting the drug.  Mr. Hoffman was the one who risked leaving his girlfriend to deal with her grief and leaving their children, ages 10, 7 and 5, to deal with theirs.

No genetic anomaly can make a person text a dealer, withdraw a stack of bills from an ATM, pick up a supply of 70 bags of heroin, tie a tourniquet around his arm and inject the stuff into his vein.  

No quirk of neurochemistry can make you rate getting high as more important than getting your kids through life.  Only a disorder of character can do that.

Think about what Ablow is saying. No matter what was happening in the folds of Hoffman’s brain, he performed a series of actions. Each action involved some degree of decision-making and agency. Time passed between each of those actions. Since he could only take $200 out of the cash machine at a time he had to wait between his many withdrawals.

At any time in the process, he could have picked up a phone, called a car service and directed it to take him to Silver Hill or some other rehab facility.

The issue is: why did he not at any time during the day or the days leading up to his death pick up a phone and check in to rehab? Why didn’t he call his sponsor?

If these thoughts crossed his mind, he dismissed them. Perhaps he believed that his anguish was merely a function of brain chemistry. Perhaps he believed that he did not have the power to effect change through his own behavior. He might have thought that he just needed a better chemical fix.

If psychiatry and contemporary neuroscience have reduced the mind to the brain, it might also have deprived people of the sense that they should even try to control their behavior.

Paradoxically, when psychiatrists diagnose biochemical imbalances, often they are basing their evaluation on their sense of their patients’ minds.

Ericson quotes Prof. Sheldon Krimsky:

The absence of biological markers - there are no blood tests or scanning techniques to determine the presence of binge eating disorder' or even 'major depressive disorder' - makes the risk of subjective bias stronger and the opportunity for the DSM to play handmaiden to industry even greater."

A strange paradox, indeed.


Sam L. said...

I'm guessing that psychopharmaceuticals are given (in some cases, and maybe many cases) because they can be described and fit into categories for which insurance will pay. I trust you will correct me if I am wrong, as you should know more about that than I do, which is little-to-nil.

The "world" may be mourning him, but I had to look him up, knowing only his name.

Stuart Schneiderman said...

Right... the diagnoses are contained in the DSM, V-- thus, insurance companies will pay for treatment of any condition listed in it. Better yet, if a medication is going to go off patent and it is found to be able to treat a new illness, the patent gets extended.

Anonymous said...

Socrates: "Give a cock to Ascelipus (sp)" (for curing me of Life).

I knew a few druggies in 70s Chicago. V intelligent, insightful, interesting. Slaves to Demon Drugs. Worked at VA Hosp with Tons of VN Heroin Addicts. I was in the boonies, and didn't see it.

I Was, however, a Medic, with total access to morphine & tons of other stuff. Young as I was, I abstained.

David F. Wallace wasn't a druggie. Orwell was suicidal all his life. Many others.

Judging by the amounts, I think Hoffman was trying to kill himself. Talk about family seems smarmy to me. We're born alone, we suffer internal Demons alone, we die alone.

The Prometheus Myth. Original Sin. I see homo sapiens as a "broken creature". Half animal, half not. We'll never understand ourselves, and many can't live w/themselves. IMHO. -- Rich Lara

Anonymous said...

The idealism of medication to solve all problems is attractive, if you're a believer, if you can imagine we're moving towards a brave new world of well adapted human beings playing productive roles in society. There's no point you can "give on" on the vision, just keep saying we've just not found the right medications yet.

Actually I just saw a BBC Brave New World from 1980 recently, and kept wait for authoritarians controlling people, but it was so subtle dystopia, all rationally towards meeting people's "needs" and avoiding discomfort and psychological pain at any cost, which is what we try to do with drugs, legal or illegal.

Its interesting to consider - if you aspire to a harsh world, many people sink under the pressure, and others rise and discover strength in themselves that they'd never know without experience some suffering that had no solution. So in our efforts to reduce suffering's bad effects, we reduce its good effects as well. Character building?

I especially like Scott Peck's view of suffering, that there is legitimate and illegitimate suffering, and we have to distinguish between the two to know how to help people. OTOH, Peck's ideals were perhaps so high than 99% of people will turn away if there are easier paths available to get what they think they want.

Kath said...

I grew up with an alcoholic parent.
What causes addiction? Who knows.
I was told it runs in families which was a terrible burden. I was always afraid it would happen to me. My brother and I escaped the addiction curse much to the surprise of my alcoholic parent.

Does the self loathing of the addict come before or after the drink? I have no idea.

n.n said...

Some people desire to escape reality. While others exhibit a blind, almost religious deference to medical science and experts generally.

Dreams of instant or immediate gratification are rarely ever realized without progressive side effects.

n.n said...


Since the side effects of alcohol are well known, drinking to excess must be considered an effect rather than a cause of dysfunction. Then again, people are notorious for lacking awareness of the function of their own body as it evolves from conception to death.