Comfortably Numb: How Psychiatry Is Medicating a Nation
Pantheon - Pantheon
Release date: 2008-02-05
Hardcover
Author: Charles Barber
Drugs - Adverse Effects, Psychiatry (Specific Aspects), Medical, Medical / Nursing, Medical / Psychiatry / Psychopharmacology, Psychiatry - Psychopharmacology, Pharmacology, Chemotherapy, History, Marketing, Mental illness, Moral and ethical aspects, Psychotropic drugs, Psychotropic drugs industry, United States
average reviews
0 vote
0 vote
React and review
Comfortably Numb: How Psychiatry Is Medicating a Nation
Date undefinedI 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
Comfortably Numb: How Psychiatry Is Medicating a Nation
Date undefinedI 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?
Comfortably Numb: How Psychiatry Is Medicating a Nation
Date undefinedHere, 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.
