It’s not clear who first quipped “I’d rather have a bottle in front of me than a frontal lobotomy,” but it’s not just a joke. Almost anything would be preferable to a frontal lobotomy. It was a barbarous procedure with catastrophic consequences, and yet it was once widely accepted and even earned a Portuguese doctor a Nobel Prize. In the annals of medical history, it stands out as one of medicine’s biggest mistakes and an example of how disastrously things can go wrong when a treatment is put into widespread use before it has been adequately tested.
A new book by Janet Sternburg, White Matter: A Memoir of Family and Medicine, puts a human face on the suffering of mentally ill patients and their families, and helps us understand why they agreed to lobotomies. It is the affecting story of how her relatives made the difficult but misinformed decision to lobotomize two of her mother’s five siblings, one for schizophrenia and the other for depression, and the consequences of that decision.
Marcia Angell has written a two-part article for The New York Review of Books: “The Epidemic of Mental Illness: Why?” and “The Illusions of Psychiatry.” It is a favorable review of 3 recent books:
and an unfavorable review of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR. It paints a disturbing picture of psychiatry. It raises a number of serious concerns but it borders on psychiatry-bashing, a sport that I deplored in a previous post. (more…)
In the 1950s, 558,000 people were in mental institutions in the U.S. Many were there against their will and were being warehoused or treated badly. Deinstitutionalization was intended to restore their civil rights and improve their lot. Did it? By 2006, there were only 40,000 people in institutions. What happened to the other 518,000?
Some of them are living in the community with supportive family members, taking their medications, and contributing to society. Some of them have been ghettoized in halfway houses or group homes in crime-ridden and run-down neighborhoods. Some of them are homeless, living on the streets and eating out of garbage cans. Some of them are in jail. Some of them have killed family members or have killed multiple people in “rampage” murders provoked by their psychotic delusions.
Accurate numbers are difficult to obtain. By some estimates, as many as 30-50% of the homeless (and even more of the hard-core homeless) and as many as 40-50% of the jail population are mentally ill. There are more mentally ill people in jails than in hospitals. The mentally ill are more likely to be victims of violence and rape and are more likely to be shot by the police in “justifiable homicide” incidents.
Mentally ill people who are adequately treated are no more violent than the non-mentally ill, but a disproportionate number of murders are committed by the mentally ill. The risk of violence increases with past history of violence, substance abuse, anosognosia with medication noncompliance, antisocial personality disorder, paranoid symptoms, and male sex. (more…)
Psychiatry is arguably the least science-based of the medical specialties. Because of that, it comes in for a lot of criticism. Much of the criticism is justified, but some critics make the mistake of dismissing even the possibility that psychiatry could be scientific. They throw the baby out with the bathwater. I agree that psychiatry has a lot of very dirty bathwater, but there is also a very healthy baby in there that should be kept, cherished, nourished, and helped to grow – scientifically.
Common criticisms in the media
- We are over-medicating our children, producing a generation of drugged zombies.
- We are using medication indiscriminately for people who don’t fit the diagnosis (i.e. antidepressants for people who only have normal mood fluctuations and life problems).
- Antidepressants lead to violence and suicide.
- Psychotropic medications all have terrible side effects.
- Antidepressants are no better than placebo.
- Psychotherapies are no better than talking to a friend.
- Electroconvulsive therapy (ECT) is a barbaric, damaging assault with no redeeming value.
- And we all remember how Tom Cruise attacked Brooke Shields on the issue of postpartum depression.
Thomas Szasz: Mental illness is a myth
Thomas Szasz goes even further: he rejects the whole concept of mental illness and considers it a plot to interfere with people’s human rights. He says:
- Psychiatric diagnoses are not valid because they are based on symptoms rather than on objective tests. (Steve Novella has pointed out that there are other well-established diagnoses like migraine that cannot be verified by any objective tests.)
- Mental illness is a myth: unusual behavior does not constitute a disease.
- Psychiatric diagnoses are an arbitrary construct of society to facilitate control of individuals whose behavior does not conform.
- Involuntary commitment is never justified even for the protection of the patient: patients always have the right to refuse treatment even if that means they will die. (more…)