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Comfortably Numb: How Psychiatry Is Medicating a Nation By Charles Barber ( Pantheon )
Release Date: 2008-02-05
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Product Description
Public perceptions of mental health issues have changed dramatically over the last fifteen years, and nowhere is this more apparent than in the rampant overmedication of ordinary Americans. In 2006, 227 million antidepressant prescriptions were dispensed in the United States, more than any other class of medication; in that same year, the United States accounted for 66 percent of the global antidepressant market. In Comfortably Numb, Charles Barber provides a much-needed context for this disturbing phenomenon.
Barber explores the ways in which pharmaceutical companies first create the need for a drug and then rush to fill it, and he reveals that the increasing pressure Americans are under to medicate themselves (direct-to-consumer advertising, fewer nondrug therapeutic options, the promise of the quick fix, the blurring of distinction between mental illness and everyday problems). Most importantly, he convincingly argues that without an industry to promote them, non-pharmaceutical approaches that could have the potential to help millions are tragically overlooked by a nation that sees drugs as an instant cure for all emotional difficulties.
Here is an unprecedented account of the impact of psychiatric medications on American culture and on Americans themselves.
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 An Anti-antidepressant book by a person who takes one--go figure ( gpera )
I read this book after hearing the author interviewed on Terry Gross' "Fresh Air." I was intrigued by his seeming hypocrisy. He admits on air that his OCD symptoms were so bad he dropped out of college and drifted aimlessly into working in community mental health in what sounded like a low-wage position. Now he deplores the alleged overabundance of Americans taking anti-depressants even as he now takes one himself.
Maybe I missed something. (It does get a little tedious reading the same old litanies in these henny-penny anti-psychiatry diatribes). But he fails to mention any of this background in the book.
So, what the reader doesn't know is Barber's secret message: An antidepressant is good for him but not for you, because he obviously need it but you are obviously a lazy drone pulled by the ring that a pharma magazine ad has placed in your nose.
Barber has it so wrong on so many counts, it'd take me too long to list them--and who's interested, anyway. People have their minds made up, and don't let the facts (or compassion) confuse 'em. I am appalled at the "literary" reviews of this book; they betray the reviewers' abysmal lack of neurophysiology. And it sickens me to see that Library Journal has recommended this as a "blockbuster." That just means that more vulnerable people will be taken in by his adamant arguments.
I make the effort because it's important not to let dangerous messages stand unquestioned, no matter how seemingly contrarian or "paradigm-shifting" they might superficially sound at faculty cocktail parties. There is simply nothing new here--and much that is better left in the past.
Maybe Barber's self-disclosed OCD is the type that obsesses on avoiding pleasure (anhedonia, I think it's called), in which case who would blame him for taking medication? Who would tell him, "No, you must get yourself to useless group therapy for 10 years and suffer suffer suffer"? So, why would he argue for depriving other people of a chance for happiness? Is there something scarily anhedonic about that? Are Barber's personal demons at play here? One wonders.
Page after page, he makes the case for taking us all back to the days of dangerous psychological guesswork. Back to therapy's Dark Ages, when pompous practitioners of unproven theories scarred millions of people with their misattributions, creating great animosity between parents and children, among other fallout. Neuroscience has explained a lot about why we humans do the things we do -- and given us more solid tools for change. We've barely started to implement what we've learned, and already it's time to go back to the 1950s???
Barber holds up studies showing that therapy is as effective as medication. Well, sure, in some well-chosen cases and in conditions highly controlled by the researchers. But the average therapy, especially in the small Iowa town he lambastes for having so many citizens on anti-depressants? My guess is, success rates are much much lower. The evidence: So many people are willing to try the antidepressants, despite stigma, despite side effects, etc. He also fails to mention the harmful effects on the body and the brain of prolonged depression, including a weakened immune system and increased chances of deepening depression -- or that many cases of depression simply cannot be "talked away," especially with a therapist who never took a biology class.
The irony? Even as he promotes therapy and laments brain science, he uses the same old quacky assessments to judge people who fail to show up on time to group therapy. He says they simply aren't motivated. Here we go...It's gotta be some dark, deep, subconscious motive, inevitably from childhood conditioning. Or passive aggression. Or, they're just lazy, expecting a quick fix. Or they just don't want help badly enough. Talk about blaming the victim! Talk about having no empathy for the very real biological challenges these people might be facing. Talk about an ego! "If I can't fix it, it's YOUR fault. It can't be that I'm using the wrong methods."
It can't be, um, uh, that the BRAINS of these "therapy failures" create difficulty being organized or tracking time? As for motivation, the author fails to understand that's a function of the brain, too. In fact, motivation, along with the other Executive Functions, is impaired with frontal lobe disorders, including ADHD, bi-polar disorder, anxiety, eating disorders, addictions, and many others.
For many of these people the author labels as lazy or unmotivated, medication will be the key to their ability to successfully pursue therapy. And for some, therapy alone might turn the key. But it won't be standard "talk therapy" that takes no account of brain science. That can make these neurocognitive disorders worse. What's been shown, in double-blind studies, is that the therapy must be geared for their neurobiology and it's usually most successful in combination with medication. But this author refuses to let even one molecule of neuroscience cloud his thinking--except, it seems, when he gets his refills at the pharmacy.
He complains that so many people take antidepressants because it sounds "sexier" to say that you're taking an antidepressant than taking fish oil and getting more exercise. I don't know who Barber's talking to. But I deal with many people who will bathe in vats of fish oil and exercise to the point of injury before even admitting that they might need some outside help with their neurotransmitters.
The author even mocks "social anxiety disorder," saying it's what most people would call shyness. Is this all a theoretical, egotistical romp for the author? Where is his compassion for people who actually do suffer paralyzing anxiety when it comes to interacting with people -- perhaps because they are highly distractible and can't follow a conversational thread, perhaps because their brain biology hinders their ability to read facial expressions and other cues. To me, it is nothing short of cruel and inhumane to deprive these people of the chance to have social ease and make stronger interpersonal connections.
I don't know one person who leaps at the idea of taking a psychotropic medication. It usually comes after years of trying every other alternative, including therapy (multiple times). They don't like the side effects usually, but the positive effects often outweigh the bad. And a careful physician can help minimize the side effects--if only insurance companies would allow time to work with the patient. (Why don't more authors write about the squeeze that insurance companies puts on effective mental healthcare and how insurance lobbyists have fought mental-health parity? Why is it always Attack the Meds? Perhaps because it's easy and obvious, and to go deeper into the subject and be truly helpful would require critical thinking and compassion.)
I would agree with Barber, though for different reasons, that many docs are too quick to give out antidepressants. Physicians simply too often fail to screen for bi-polar (a disaster on SSRIs) or ADHD. SSRIS can make ADHD symptoms worse, but the trouble is, the SSRI also means they don't care! And I would also agree that most docs are prescribing antidepressants at too high a dose--perhaps resulting in a "comfortably numb" feeling. But Dr. Jay Cohen addresses this so much more cogently in Overdosed: The Case Against the Drug Companies.) It's also up to the patient to be pro-active in their care and not submit themselves so passively to the doctors.
Obviously, all is not perfection, but we're a lot better off than a few decades ago, when millions more people self-medicated with alcohol and cigarettes or stayed home with their crippling agoraphobia. Of course, good therapy helps many people; that's not up for debate. But the author obsessively carries its value too far into disorders with serious deficits that have been shown to be largely resistant to therapy.
News flash: The brain is a physical organ, just like the kidney, heart, lungs, etc. And it is the most vulnerable organ of all. What we used to think of as "harmless" bumps on the head can have lasting effects. Yet, the author derides the import of landmark brain discoveries, such as that of mirror neurons, going so far as calling news reports "unprecedented and relentless." (I've followed the reports, and they are modest, at best, considering the magnitude of the discovery.) Why the whining resentment? Why is the author apparently so afraid to admit that yes, the brain is an organ? Because, for him, it somehow would mean loss of control?
If you want to be one among the vigilante gaggle demanding the electric chair for a killer because "he showed no remorse!", then you, along with the author, will shun discoveries about mirror neurons in the brain, which enable humans to have empathy. It's a remarkable discovery, because we now know that humans are not created equally in the empathy department, and for many, no amount of therapy is going to make them more empathetic. That alone can go a long way towards understanding other people, and putting their behavior in context, instead of being hurt by their actions or attributing it to willful behavior -- as the old-time therapy emphasized to a dangerous degree. As a result, many families and former couples still nurse long-simmering hurts. That's helpful???
The author tries to paint brain scientists as taking positions as extreme as his, but they don't. They are much more reasonable in acknowledging that these issues are extremely complex. For a fascinating read by a scientist who was part of the team that discovered mirror neurons, read Marco Iacoboni's Mirroring People.
Sorry, but I see nothing compassionate or helpful about Comfortably Numb. The author is obviously threatened by neurobiology's role in everything we think, do, or say. He is taking an extreme anti-science stance, seeing no gray area. In fact, in a previous book, writing about his work with patients, he says he loves "the stories, the improbable and voluminous and twisted narratives that pour out of the men within minutes of their taking a seat in the black chair." So, I guess he needs these patients' pathologies for self-medicating, or entertaining, purposes? Perhaps he could see a therapist about that.
Gina Pera, author
Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder
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 A Message That Needs More Attention
I get the feeling that Americans, especially Americans who take these drugs, won't respond well to Barber's book.
I did. I really enjoyed it. I was browsing the books on the New Releases shelf at my local library, picked this up (the title attracted me), brought it home, and haven't put it down since.
Yet, when I try to discuss it with people, I hit a defensive wall:
"I don't have any side effects with mine."
"Maybe some people abuse these drugs, I don't."
"My condition warrants drug therapy."
"I (or people I've known) have gone on and off benzos and SSRIs and never had any withdrawal symptoms."
"I know lots of people who have been helped by these drugs. Barber does a disservice."
These aren't actual quotes, but offer a flavor of the reaction I'm getting.
Honestly, I didn't even know so many people I knew took any. I'm sure others just kept quiet. It's still not something, at least among the people I know, that's discussed at any length. I agree with Barber that some of the stigma has gone away, but apparently, not all.
Has anyone else run into this?
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An Important Book ( paulocal )
Here, Barber has basically expanded his Winter 2008 Wilson Quarterly article entitled "The Brain: A mindless Obsession," into a full-length book. In the article he gives an excellent summary of the history and present status of the nation's mental heath system, including a history of the various therapies. Both are excellent, but the article is, arguably the more focused and robust. In it Barber takes us across the rather long and sordid history of the study and practice of mental illness: From the medieval practices and forms of treatments that led to electro-shocks and lobotomies (euphemistically referred to as psycho-surgey), to talk therapy, corporate dispensing of antipsychotic drugs, to the present field of brain-imagery.
The book focuses on one of the more important issues: How mental health is managed through drug and insurance company manipulation and thus it is about how mental illness has been "Corporatized," making the drug and insurance companies filthy rich and U.S. the most mentally ill of all nations - that is, if one is to judge national mental health by the number of doses of antipsychotic drugs dispensed per capita.
Now, the mentally ill are literally "turned out" from mental institutions onto the streets according to convenience of the insurance schedules and financial bottom lines. And then patients are administered drugs according to the drug company schedules and their financial bottom lines. Both have become multi-billion dollar industries as a result. It gives a whole new meaning to drug trafficking.
The problem with all of this is not just the built in cynicism of having a profit-driven health system run amok, mostly by the insurance and drug companies, but also the fact that scientists still do not seem to have a clue as to why antipsychotic drugs work?
Even the brightest light in a very dim field, the area of neuro-imagery, has a huge down side too: There is no one-to-one correspondence between brain mechanics and brain content, or thoughts.
The upshot of the book is that we don't know nearly as much about mental illness as we pretend to, and this lack of knowledge, when coupled with corporate greed, becomes a lethal combination that is likely to bring unintended surprises in the future.
Five stars for the article, four of the book.
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Comfortably Numb
Comfortably Numb: How Psychiatry Is Medicating A Nation
Charles Barber
ISBN 978-0-375-42399-4
Charles Barber was educated at Harvard and Columbia and worked for ten years in New York City shelters for the homeless mentally ill. The title essay in his first book, Songs from the Black Chair, won a 2006 Pushcart Prize. His work has appeared in the The Washington Post, the New York Times and Scientific American Mind, among other publications, and on NPR. He is a senior administrator at The Connection, an innovative social services agency, and a lecturer in psychiatry at the Yale University School of Medicine. He lives in Connecticut with his family.
The experiences Barber shares are eye openers. Until I read this book, I didn't realize just how doctors were indeed over prescribing medications -- not that there are not real cases of mental health problems that benefit from medications, but should the same pill to help a real case of depression also be used for someone suffering an adjustment issue? I was surprised to learn that this is the case. Medication has an important role in the treatment protocol for severe metal health issues - schizophrenia and major depression, but we are lead to believe that drugs are an effective way to relieve the normal episodes of life, as well. The drugs may get you over the hump of occasional depressing days, but it will do little or nothing to help you learn ways to get over the humps without prescription drugs. This book confirms for me that it's easier for Americans to pop a pill than address the real issues.
With fast food, fast cars, and fast computers - it's no wonder we have settled for nothing less than a quick fix to the inevitabilities of life - losses, changes, etc. While many of us cope and work through the issues, there are some that would prefer to take a pill - quick relief being only a prescription away. And what is startling is that at least half of those in need of real assistance with real mental health issues are not receiving it. The physicians who are prescribing the quick fixes for normal adjustment issues remind me of a mechanic and their customer who has a flat tire - instead of the mechanic showing you how to change the tire or sending you to someone that can instruct you, he hands you a can of his special fix-a-flat-tire. Instead of learning to help yourself and getting the spare out of the trunk, rolling up your sleeves and changing the bloody thing, you whip out the can of the mechanic's special fix-a-flat-tire and you go on your marry way. However, the next morning, you're saddened to learn that once again your tire is flat - and the mechanic is closed. You have not learned to remedy life's flat tires and are totally dependant on the mechanic to solve your flat tire dilemma.
I also didn't know that "Americans account for two-thirds of the global antidepressant and psychiatric drug market," and "227 million antidepressant prescriptions were dispensed to Americans in 2006 - more than any other class of medication." In does not surprise me that in the fast paced nation we live in with the technology, food, and remotes, we would be depressed. We are alienated from each other - where are the days we spent with our family and friends instead of in virtual chat rooms and watching the latest reality show? A quick fix, easy solution and depressing.
I learned about the "little D" depression and the "big D" depression - one is in response to life's adjustments and the other is a mental illness. Both are frequently treated the same - medication, instead of using cognitive-behavior therapy or other alternative, non-medication approaches. It's has become the norm to take a pill for help over the humps of everyday life instead of learning to realize the triggers for our "little D" depression. But everyone seems to play along. The pharmaceutical companies make the happy pills, the doctor is happy to prescribe the happy pills, and the insurance companies are happy to pay for the happy pills. In one instance, an insurance company was happy to pay for a prescription - why not, since alternative therapy is more costly. Patients are less likely and may be less able to pursue therapy. Barber says, "...the vast majority of antidepressant prescriptions are written by family doctors." And, "as a result, after starting antidepressants and taking them for three months, ¾ of adults and over half of children do not see a doctor or therapist specifically for mental health care. Another report found that only 10% of people who take antidepressants have any kind of follow-up appointments to monitor the medication."
When I look at the homeless situation, I automatically think alcoholics and drug addicts. It rarely occurs to me that many of the homeless have serious mental health issues - and I never realized that many go untreated. When I learned that the "little D" depression was treated in the same manner as severe depression, I was appalled. Why should a homeless or less fortunate person not receive treatment for a mental illness - but the movie stars and college kids can get medications to get them over that last depressing movie or through the woes of college exams?
While pharmaceutical companies are skilled at marketing their wares, Barber ultimately blames the doctors - they are the ones who have taken an oath to "do no harm." And just how safe are these drugs being prescribed? "Major drug companies have been in the news for blatant violations." For example, "under a marketing campaign called "Viva Zyprexa." Eli Lilly pushed Zyprexa, indicated for biopolar and schizophrenia, on patients who did not suffer from either condition. The patients were actually suffering from dementia, a condition for which Zyprexa is not approved. In fact its use for dementia is warned against by the FDA, which has stated that Zyprexa can increase the risk of death for older patients with dementia-related psychosis. In the last few years, Lilly has paid $1.2 billion to settle claims for patients who said they developed diabetes or other diseases after taking the drug." And "Lilly is not alone."
This is a tough subject but Barber speaks out and tells it like it is - from experience. I highly recommend this book.
Sue Vogan
BookPleasures.com
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Missing the Logical Conclusion? ( gatsbyandphoebe )
There is much in this beautifully written book to commend it, especially the cautionary message of how risky and ill informed the rampant overmedication of emotional ills is in America -- and why it might be occurring. The discussion of alternative psychotherapies is inspiring and informed. Critics, including Peter Kramer, author of Listening to Prozac, who claim Charles Barber is exaggerating the true scope of the increase by using the dollar value of prescriptions that includes price increases as opposed to simple pill numbers seem to be missing the forest for the trees. Just ask your acquaintances. There is hardly a family in America that hasn't been touched by psychopharmacology. Almost every other person is on or has been on antidepressants or even stronger medications. There really is something wrong with this picture, as Barber astutely argues, given our lack of knowledge about how these drugs work, what their long term effects are, and the conflicts of interest that permeate drug research.
Given all this marvelous insight it's a disappointment that Barber doesn't take his analysis to its logical conclusion and realize treatments for serious mental illnesses are as flawed as those for minor ones. Barber gets very tangled up trying to distinguish between "true" mental illness and what he thinks are lesser disturbances. This is because he understands how ill informed treatment paradigms are for what he calls "little d" depression but somehow thinks all these same medications are just fine for "big D" Depression because he has observed them "work". Barber gets a lot of credit for speaking from firsthand experience with seriously disturbed individuals but in those whom he has seen return to functioning it is not clear he has attributed the cause to the right place. Every mental disturbance, whether it's serious or not, cannot be segregated from the story that precedes it. To do so is to be dismissive and arrogant; it marginalizes that person's suffering. Whatever one's genetic predisposition or ability to tolerate stress is, ultimately every mental illness is situational in one way or another. The only road to true healing is by dealing with that situation. This turns out to be even more important for serious mental illness -- mania and psychosis -- than it is for psychosocial ills. Medication alone can never "cure" mania and psychosis and may only exacerbate it over time.
Barber recently appeared on Fresh Air (NPR) and admitted to the astonishment of many, given his views, that he takes Prozac. Perhaps this is why he gets tangled up and doesn't really have an entirely consistent point of view on these medications. Maybe he hasn't been able to withdraw. He must believe he has a "true" mental illness yet he indicated in the interview that the way he took control of his OCD [Obsessive Compulsive Disorder] was through behavioral and lifestyle steps (i.e. the situation), not medication. Mental illness is on a continuum from minor to major; it is presumptuous to assume that there is some magic point on this continuum where suddenly it's all right to use possibly toxic and addictive medications even if they do provide a benefit due to their stimulant or sedative effect. While there are surely situations in which a psychotropic medication may be life saving over the short term, using them long term and dismissing the importance of situational issues is probably always dangerous, not just sometimes, as Barber implies.
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Addiction
