Continuing my new obsession of mental health reform, I read this book detailing research done on anti-depressants, specifically SSRIs.
The first thing I have to say about this book is…man oh man does this guy have a boner for CBT therapy.
I have no personal experience with CBT therapy. I’ve only done DBT.
I just didn’t like how the solution to all the conflicts of interest and pharma influence on doctors and mental health treatment as a whole was “let’s do psychotherapy instead!” He didn’t delve into how even the basis of most therapy today is a model that greatly benefits pharma: the biomedical model.
He did explain a bit about the history of the biomedical model and why the biomedical theory doesn’t make sense. He actually got pretty deep into the scientific nitty gritty-explaining neuroplasticity theory and neurotransmitters. That part was really good, but I don’t see how he can be so pro-therapy when the basis of therapy is the biomedical model. The “brain disease” model, as Ethan Watters calls it. How can therapists truly treat the root of a patient’s negative mindset or self-destructive behavior, if the theory behind all mental illness is that it’s nothing more than a chemical imbalance?
That would be my biggest criticism of that book: that he didn’t get into how drug influence may affect patient treatment, even when it is treatment of psychotherapy without drugs. Therapy and drug treatment go hand in hand today, so to criticize SSRIs without shedding any critical light or therapy, or at least looking into how patient care may be compromised in psychotherapy due to the insidious influence of pharmaceutical companies, it feels incomplete. He didn’t go far enough with his criticism. I’ll say it once and I’ll say it again: you can be pro-therapy and also pro-make therapy better.
All of that being said, it was still a very strong book. This is a doctor who has done a good deal of research into SSRIs and other psychiatric drugs. Through his research (which he does a wonderful job of explaining in the book) he found that the positive effects of SSRIs may be nothing more than a placebo effect-and holistic treatments such as exercise or even taking St. John’s Wort may be safer and more effective.
He addressed some of the most common criticisms of his work; one of them being the argument that even if patient recovery on SSRIs IS a placebo effect, shouldn’t doctors keep prescribing them? If they work, they work, right?
Kirsh explains that this is not an acceptable answer to the question of whether or not SSRIs are effective, because these drugs come with terrible side effects. These side effects can include PSYCHOSIS. Drugs like Prozac can actually cause hallucinations and delusions in people. Several heartbreaking stories were recounted, including a teenage boy who shot and killed his grandparents after Prozac induced psychosis in him, and a woman who shot her own jaw off.
If anyone is interested in reading more stories of violent psychosis induced by SSRIs, I highly recommend checking out the advocacy site psychrights.org.
These drugs can cause people to become violent or suicidal. They can cause a lifelong condition known as Akathisia (to learn more about this, I highly recommend the Russia Today documentary ‘Overpill.’ It is available for free on youtube).
In short, these drugs HARM people. So if, as Kirsch’s research indicates, the positive effects of SSRIs are a placebo effect, and they come with so many horrible negative effects, then no, continuing to prescribe them because “they work for some people” is not acceptable. All of that “working” is a mental illusion. As Kirsch explains, these patients get better only because they expect to get better, and if you gave them a sugar pill, they will still get better.
Kirsch also explains many of the terrible conflicts of interest in the mental health field, and how his fellow researchers and doctors are bullied into silence by those in power. Doctors who start to talk about the negative effects of psych drugs are told “be quiet if you ever want funding for a clinical drug trial again” and when they are not tenured professors, but independent researchers whose livelihood depends on funding, it’s true that they can’t “bite the hand that feeds them.”
Despite the flaws in this book, it is an incredibly in-depth look at the myriad of problems with SSRI research and a scathing commentary on why more doctors aren’t talking about this. Kirsch takes shots at everyone from pharma to the FDA and I’m so here for it.