NY Review - ‘The Illusions of Psychiatry’: An Exchange
The medical profession has always had a poor record of disciplining itself. This is due, I am sure, to the duplicity of the human race itself – it demands that its doctors be superhuman. Anyone knows many instances of medical incompetency from their personal experience – but this does change our respectful, worshipful attitude towards them.
Now that we have the Internet, it would be easy for patients to evaluate their doctors publicly to give other patients the benefit of their experience. This will never happen, because doctors will not permit it – and, I think, their patients will not permit it either.
The one outstanding exception is doctors who are also writers, not an uncommon combination. They take pleasure in debunking their colleagues – often in venues such as the London Review of Books, and the New York Review. These are not read by the general public, but by more discriminating readers, who are better able to evaluate what they read.
As one of those readers, I would like to add my own evaluations of the Psychiatric profession. These have not been frequent, because I could not afford them. But psychologists in the US often form partnerships with them, and refer patients to them to get their medical prescriptions. Since this only requires 10-15 minutes of the Psychiatrist’s time, this is much cheaper. In Costa Rica, I had to pay for a whole hour for one fluent in English, for which he charged American prices.
All of the psychiatrists I worked with were of some of the nicest people imaginable. They could make cogent evaluations quickly. But looking back on it, I have to say they had poor understanding of psychotropic medicine – exactly what they should know the most about.
The story of Prozac is the perfect case in point. When it was first discovered, it created a sensation, and true believers quickly lined up behind it. Religious indignation was also strong – depression was God’s judgement, and should not be defeated! Its manufacturer made millions – and prompted careful clinical trials to judge its effectiveness (after the fact!)
My psychologist back in Silicon Valley, one of the nicest I had ever known, put me on Prozac, with the cooperation of his psychiatrist partner. It was supposed to work miracles – as he assured me and my long-suffering girlfriend at the time.
The standard dosage was 20 milligram, but they started me at 10 mg – since I didn’t seem to be a severe case. This was upped to 20 mg when the magic failed to happen. When I moved to Costa Rica, I was still on 20 mg per day. I was referred to a psychiatrist who spoke Spanish, English, and German fluently. Again, I was very impressed. He increased my dosage to 40 mg, but did not switch me to another medication, as my psychologist expected.
By now, they were many drugs for depression, some of them with entirely different ways of working. Evidently, he did not believe in them. I was suffering from culture shock at the time, which contributed to my perceived depression. He then upped the dosage to 50 mg, a very high dosage that bothered my doctor at the time.
Then the results of the large-scale clinical trials began to come out – Prozac was no more effective than a placebo! By then, I was becoming accustomed to living in Costa Rica, and decided, on my own, to discontinue Prozac entirely – not without some trepidation! I never missed it. Now that I have had my say, I return to the article in the New York Review.
The original article provoked an official rebuke from the American Psychiatric Association itself! They do not like being criticized. Dr. Angell defended herself admirably, I thought. Her main point is that psychiatrists are in bed with the pharmaceutical industry – a charge that can be leveled against doctors in general.
They say they are helpless to combat the pharmaceutical industry, with all its advertising and its helpful representatives, who are willing to give out free samples. I am not impressed – the medical profession cannot combat the pharmaceutical industry? What kind of profession is this?
I was once a member of another profession: the engineering profession, which at time (perhaps a hundred years ago) had some independence. Not any more – they are only employees of a corporation, which they dare not criticize. The same is true, by and large, of the legal profession – they are also working for the man.