Mentally ill tied to trees and left to die in Somalia

Source: Thomson Reuters Foundation – Mon, 7 Oct 2013 01:28 PM

Men walk on a beach in front of a building destroyed during a war in Mogadishu June 27, 2012. REUTERS/Goran Tomasevic

    

 

In Somalia there’s a belief that a mentally ill person can be cured by shutting them in a room with a hyena.

Mentally ill people in the war-ravaged country are often chained or locked up. Others are tied to trees and abandoned when their families are forced to flee fighting.

In one of the most moving radio interviews I’ve heard in a long time, psychiatric nurse Abdirahman Ali Awale, who is commonly known as Dr Habeeb, told how he was reduced to tears every day by what he sees.

“I have saved many, many patients who have been left to die. They have been tied to a tree and abandoned simply because they are mentally ill,” he told the BBC World Service.

Somalia has one of the world’s highest rates of mental illness with one in three people affected, according to the World Health Organisation (WHO).

But there has traditionally been almost no help. Somalia’s health sector was destroyed over two decades ago as the country descended into civil war.

The relentless shelling, fighting, killing and maiming, along with the repeated displacement of communities, has taken such a toll that Habeeb is on record as saying he doesn’t believe anyone in the whole of southern and central Somalia has good mental health.

The psychiatric nurse was spurred to set up the first of his six clinics in 2005 when he saw five mentally ill women being chased down the road by small boys.

He says his centres have since treated more than 15,000 patients. The most prevalent condition is post-traumatic stress disorder.

“This is usually what we see with many of our younger patients who come in,” says Habeeb. “We also see depression. A lot of our patients are very sad. They exclude themselves from society and they are very quiet and sad and stay in a corner.”

After the war, he believes the second biggest contributor to mental health issues is the widely used stimulant khat. The plant, which is chewed for its euphoric effects, has been linked to psychosis and depression.

HYENA “CURE”

But Habeeb doesn’t just treat people. He is on a mission to dispel the myths and stigma surrounding mental illness and end harmful practices.

This is done through radio broadcasts, lectures and classes.

“We tell them … that mental health illness is just like any other illness,” he told the World Service’s Outlook programme.

Many Somalis attribute behavioural problems to bad spirits and seek help from religious leaders or traditional healers. One of the most extreme treatments involves locking a person up with a hyena.

“In Somalia, there’s this belief that hyenas can see everything including the thing that causes mental illnesses,” says Habeeb.

“Two hyenas were brought from the bushes and brought to Mogadishu. Patients were locked in a room with the hyena with the belief that when the thing that caused the mental problem sees the hyena it would leave the body of the patient and the patient would be fine after that.”

This treatment is not cheap – the cost can be around $560, according to Habeeb. It’s also highly dangerous. Patients are left with long lasting trauma, physical injuries and even die, according to a WHO report on mental health in Somalia.

 “I CRY EVERY DAY”

WHO says most mentally ill people in Somalia are chained up or imprisoned.

Habeeb told the BBC more than 170,000 people have been “locked and … left to die”.  And no one in authority is talking about it.

You don’t have to look hard to find numerous images on the internet showing people chained to trees, rocks and beds. Many are chained for years on end, leading to long-lasting trauma and physical harm. Some commit suicide.

But the use of chains is often an act of desperation by families rather than cruelty, according to WHO. Families may believe they are preventing the person harming themselves or others, and that this is their only option.

Habeeb’s organisation, together with WHO, is pushing for an end to chaining.

But addressing mental illness is a very low priority in a country so devastated by fighting and hunger. It has also been ignored by international agencies.

Habeeb believes this is because treating mental health illness is expensive and does not bring quick results.

Not surprisingly, the work is exhausting.

“I’ve seen countless patients locked and left to die and that takes a toll mentally,” Habeeb says.

“I am alone. I am one person and I’m dealing with big, big, big problems that no one is ready to admit. Personally, I cry seven to eight times a day. I’m a big man, I’m a grown-up man, and in this society it is not common to see a grown man cry.

“I’ve cried on TV, I’ve cried in public places, I’ve even cried in front of presidents for them to speak about this problem, even for one day.”

 

http://www.trust.org/item/20131007132825-oupwe/?source=hpblogs

Why ARE so many people being labelled bipolar? More and more celebrities say they have it, but here a top psychiatrist warns the disorder is far too readily diagnosed, leaving many trapped on ‘zombie’ pills

  • What it means to be bipolar has undergone  a transformation
  • Once seen as rare and disabling, it now  vaguely refers to ‘mood swings’
  • The drugs used to treat the condition are  powerful, harmful – and profitable

By  Dr Joanna Moncrieff

PUBLISHED: 16:08 EST, 23  September 2013 |  UPDATED: 16:12 EST, 23 September 2013

Bipolar disorder has become the  ‘fashionable’ mental health diagnosis – helped, no doubt, by the fact that many  celebrities, including Catherine Zeta-Jones and Stephen Fry, have said they,  too, are sufferers.

But as a new book reveals, the readiness  with which so many people are being diagnosed as bipolar means they’re  needlessly prescribed heavy-duty drugs – with serious consquences for their  health…

Psychiatrists are interested in drugs because  we use a lot of them. Most people who visit a doctor for a mental health problem  will come away with a prescription for at least one.

Celebrity sufferer: Stephen FryCatherine Zeta-Jones

Celebrity sufferers: Both Stephen Fry and Catherine  Zeta-Jones are bipolar, contributing to its increasing vogue as a  diagnosis

 

The most powerful and controversial are the  antipsychotics. Heavyweight tranquillisers, they transformed the treatment of  schizophrenia 60 years ago.

But remarkably for drugs designed for a  relatively small number of very disturbed patients, antipsychotics are now among  the most profitable drugs in the world, just behind statins and on a par with  diabetes medications.

Indeed, newer versions of the drugs, such as  Zyprexa and Seroquel, have become some of the most profitable drugs in history.

In the last ten years prescriptions for  antipsychotics for adults in the UK have increased by 67 per cent – last year  nearly 8 million prescriptions were written in England alone.

But only a minority of these prescriptions  will have been for  schizophrenia, suggests the evidence – antipsychotics  are no longer used only to treat severe mental disturbance, but have broken into  the mainstream.

This rapid expansion of their use may be good  news for the pharmaceutical companies, but often it’s far from being in the best  interests of patients and we should be worried about their increasing  use.

For while antipsychotics can be useful for  those who are severely psychotic, these are dangerous drugs.

The growing popularity of antipsychotics has  occurred partly because of the newly fashionable diagnosis of bipolar  disorder.

Bill OddieKerry Katona

What do they have in common? Bill Oddie and Kerry Katona  both suffer from the disorder

 

Once considered rare and seriously disabling,  bipolar disorder has been transformed – under pharmaceutical industry influence  – into a vaguer notion of ‘mood swings’ that can apply to almost  anyone.

As a result, if you now visit your GP with  depression or anxiety or if you have symptoms such as irritability, and  moodiness, there is a significant possibility you will be given a diagnosis of  bipolar disorder and prescription for an antipsychotic.

Worryingly, the drugs have also been  suggested as a preventative measure in young people who are not psychotic, but  might be ‘at risk’, and have been widely prescribed to elderly patients with  dementia.

And these drugs are harmful. I first became  aware of how harmful they can be when as a junior doctor 20 years ago I worked  in one of those vast asylums that was in the process of being closed  down.

Some of the old inmates were still shuffling  stiffly and aimlessly along the endless corridors. They looked heavily doped up  and it struck me that the drugs hadn’t returned patients to normality, as we  were told they did.

I got a strong feeling that as a doctor I was  not being told the whole story about antipsychotics.

The text books had almost nothing about the  experiences of the people who took them. I was determined to find out more about  their effect.

THE MYTH OF A  ‘CHEMICAL IMBALANCE’

When these drugs were discovered – more than  60 years ago – they were embraced by psychiatrists.

Unlike the straitjacket or electric shock  therapy, they were said to treat not just the symptoms of schizophrenia –  dulling the voices and the visions – but also to correct the underlying  disease.

Unwelcome side-effects: For many people, the dampening down of feelings that results from taking antipsychotics is intolerable 

Unwelcome side-effects: For many people, the dampening  down of feelings that results from taking antipsychotics is  intolerable

 

They did it, said leading researchers, by  reversing a ‘chemical imbalance’ in the brain (although the evidence never  really stacked up – a rival, and I believe far more plausible, theory said the  drugs worked by damping down brain activity, but this was rapidly  forgotten.)

As a result, the drugs came to be seen as a  cleverly targeted and sophisticated, and essentially benign, treatment. It was a  seductive claim, but it was a myth; one swallowed hook, line and sinker by the  medical profession at the time.

The claim is still being propagated today,  but it has been extended – now it’s said that large numbers of people may need  antipsychotics to rebalance the malfunctioning chemicals that cause bipolar  disorder.

The notion that they can restore some form of  biochemical harmony has allowed these unpleasant and risky substances to be  misleadingly portrayed as essentially harmless.

These are some of the things that patient  information leaflets should tell you, but don’t.

Antipsychotics are likely to make you feel  slow and groggy and they will sap your initiative, reduce your sex drive and  dampen your emotions.

The bitterest pills: Antipsychotics are likely to make you feel slow and groggy 

The bitterest pills: Antipsychotics are likely to make  you feel slow and groggy

 

When I looked at how patients described the  drugs’ effect, typically they used terms such as ‘sluggish’, ‘inhibited’,  ‘feeling nothing’, ‘feeling weird’, ‘spacey’, ’empty’.

(Not for nothing are antipsychotics also used  as animal tranquillisers in veterinary medicine.)

For people who are acutely psychotic, the  damping down of feelings may be welcomed, but for many they are intolerable.  This is one patient’s memorable description: ‘Beware. This medication is Satan  in a flipping pill.’

FEARS ABOUT BRAIN  SHRINKING

Then you need to know about the variety of  metabolic changes they can induce in your body; major weight gain, high  cholesterol and other harmful fats, along with raised glucose that can lead to  diabetes and heart disease (the drugs have been linked with 1,800 deaths from  stroke and heart disease a year in people with dementia).

Despite these now well-recognised effects,  two years ago the British Medical Journal reported that out of 300,000  psychiatric patients on antipsychotics, fewer than half were getting a metabolic  check.

Antipsychotics can also shrink the brain.  This had long been suspected but it was difficult to prove because schizophrenia  is believed to have the same effect.

However, earlier this month a long-running  brain scanning study, reported in the American Journal of Psychiatry, concluded  that ‘the higher the antipsychotic medication, the greater the loss of both grey  and white brain tissue’.

‘This is one  patient’s memorable description: Beware. This  medication is Satan in a flipping pill.”‘

 

Long-term treatment can also cause an  irreversible form of brain damage called tardive dyskinesia which results in  embarrassing involuntary movements and may be associated with some mental  decline.

This was clearly recognised in the early days  of the drug, but as the idea that antipsychotics could treat disease became more  widely accepted, psychiatrists increasingly dismissed or downplayed these  involuntary movements, saying they were an effect of the disease and that anyway  they were infrequent and unimportant.

But these disturbing side-effects – jerky  uncontrolled movements, particularly around the face, mouth and tongue – do  occur, and I regularly see patients who suffer from them.

Some will claim that the benefits of the  drugs outweigh such risks, and point to ‘good’ evidence that antipsychotics are  an effective treatment for bipolar disorder.

However, the trials testing the effectiveness  of antipsychotics on bipolar disorder have been done on patients suffering from  manic depression.

What we now call bipolar is a greatly  expanded version of this rare condition, which is characterised by a manic  period lasting weeks (but possibly months), when the patient becomes  hyperactive, elated, disinhibited; they don’t sleep, barely eat and act quite  out of their normal character.

This is often followed by a crash and a  period of deep depression.

TOO EASY TO END UP  ON THESE DRUGS

 

The symptoms that can get you a diagnosis of  bipolar disorder today are quite different from those of classic manic  depression.

It’s all so vague you can now be diagnosed as  bipolar simply as a result of going through changes of mood caused by the ups  and downs of daily life.

But a diagnosis of bipolar disorder can lead  to lifelong prescriptions for heavyweight drugs that should be reserved for  serious psychiatric conditions. And yet almost all the drug trials testing  antipsychotics have been conducted on people suffering from classic manic  depression.

This means they tell you nothing about what  the drugs will do for people with milder emotional problems.

Brain damage: Long-term treatments can cause tardive dyskinesia, which results in embarrassing involuntary movements and may be associated with mental decline 

Brain damage: Long-term treatments can cause tardive  dyskinesia, which results in embarrassing involuntary movements and may be  associated with mental decline

 

Another serious problem with the trials done  to test the effectiveness of antipsychotics in general is that the patients who  go in the placebo group – those given a ‘dummy’ pill to compare against the  patients having the real treatment – will virtually all have been on drug  treatment prior to the study, often for years, since they have serious long-term  conditions such as schizophrenia and manic depression.

They then have to come off their treatments  to be part of the drug trial, usually quite abruptly.

But coming off antipsychotics, like many  other mind-altering drugs, is known to have all sorts of very unpleasant effects  – agitation, insomnia, anxiety, restlessness and irritability.

In other words, the group getting the drug is  being compared with a group who are in a state of cold turkey.

These flaws mean you can’t be certain the  trial results are reliable, even for the classic version of manic depression.  Given the brain damage, diabetes and heart disease associated with these drugs,  not to mention the sexual impairment, weight gain, mental clouding and emotional  suppression, trends towards this unfounded and increasingly unrestrained  prescribing represent a serious threat to public health.

Other senior psychiatrists share my  reservations about the value of expanding the definition of bipolar disorder so  widely.

The editor of the Canadian Journal of  Psychiatry has described it as ‘bipolar imperialism’, while journalist Robert  Whitaker sums up the recent history of antipsychotics like this: ‘Behind the  public façade of medical achievement is a story of science marred by greed,  death and the deliberate deception of the American public.’

I think it is going to be seen to be just the  latest in a series of scandals that have engulfed these drugs in recent  years.

THERE ARE  ALTERNATIVES

'Bipolar imperialism': Several senior psychiatrists share Dr Moncrieff's reservations about the value of expanding the definition of bipolar disorder 

‘Bipolar imperialism’: Several senior psychiatrists  share Dr Moncrieff’s reservations about the value of expanding the definition of  bipolar disorder

 

So what are the alternatives for people who  might be offered antipsychotics for emotional problems? What will work is going  to be different for each person.

It depends on why they are feeling the way  they are and what is going on in their lives that has led to this.

Therapy might be the best thing, some sorts  of short-term medication might be appropriate but most importantly, you have to  look at the circumstances. Antipsychotics have not been properly tested on  people troubled by milder emotional issues.

They can be helpful in reducing the symptoms  of an acute attack of schizophrenia or classic mania,  but the benefits of  long-term treatment are less certain, even in these serious  conditions.

Going on any drug for a psychological  disorder is a serious step. Patients need to be very clear about what is  involved. What is the benefit, what are the risks? There’s a long history of  failing to warn people about all the effects of antipsychotics.

If an antipsychotic drug is suggested for  you, make sure you ask your doctor some hard questions before starting a  prescription. Such as: How is this drug meant to work? How will it make me feel?  Will you be monitoring me for any metabolic changes? How much weight is it safe  to put on?

Your doctor probably won’t have the answer to  all of these questions because the research hasn’t been done. And that is the  problem.

There just hasn’t been enough attention paid  to the toxic effects of these drugs and how they impact on people’s everyday  lives.

But what we do know indicates they are often  unpleasant and can be dangerous. You may decide you are better off without  them.

Dr Moncrieff is Senior Lecturer in  Psychiatry at University College London. Her book, The Bitterest Pills: the  Troubling Story of Antipsychotic Drugs, is published by Palgrave Macmillan  £19.99.

Read more: http://www.dailymail.co.uk/health/article-2430129/Bipolar-Why-ARE-people-More-celebrities-say-theyve-got-.html#ixzz2fxnEIfaQ Follow us: @MailOnline on Twitter | DailyMail on Facebook

Fusion Center Study Finds 79% of Recent Mass Shootings Attributable to History of Mental Illness

August 21, 2013 in Featured

A chart from a Central Florida Intelligence Exchange (CFIX) study released in July shows cases of mass shootings believed to be attributable to mental illness.

Public Intelligence

Analysis conducted by the Central Florida Intelligence Exchange (CFIX) has found that 79% of mass shootings since 2011 have been perpetrated by individuals with “demonstrated signs of continuous behavioral health issues and mental illness.”  In a July case study titled “Acts of Violence Attributed by Behavioral and Mental Health Issues“, CFIX analyzed 14 mass shooting incidents that occurred between 2011 and 2013 and found that only three of the shooters had no history of mental illness.

The study, which focuses primarily on “violence perpetrated against healthcare providers and emergency responders” particularly “by patients with behavioral and mental health issues”, also discusses the correlation between mental health issues and mass shootings.  According to the CFIX analysts, across the country “the numbers of mass shootings involving perpetrators with behavioral health issues have noticeably increased” with 79% of mass shooting occurrences between January 2011 to May 2013 involving perpetrators that exhibited “continuous behavioral health issues” and “mental illness”.  In the same period, the only mass shootings found to have been committed by individuals with no previous history of mental health issues were the Sikh temple shooting in Oak Creek, Wisconsin, which is described as a hate crime, and the “work-related” shooting spree perpetrated by Christopher Dorner in early 2013.  Another incident in New York which involved a man named Kurt Myers killing several people at a car wash and barber shop in March 2013 has no known motive, though speculation centered on the shooter’s money problems.

The analysis provided by CFIX is useful for understanding the connection between mental health issues and senseless acts of large-scale violence, though the analysts’ conflation of mental disorders and mental illness leads to some conclusions that may not be warranted.  For example, Adam Lanza, the perpetrator of the mass killing at Sandy Hook Elementary School in Newtown, Connecticut, had been reportedly diagnosed with mental disorders including Asperger syndrome that are fairly common and do not constitute mental illness.  These issues are further complicated by the fact that many perpetrators of mass shootings suffer from mental illness throughout their lives, though are never formally diagnosed.  Due to the fact that many perpetrators of mass shootings commit suicide or are killed by police during the incident, this diagnosis often never occurs leaving only vague statements from friends and family members about the perpetrator’s history of unusual behavior.

A list of the perpetrators of mass shootings that were found by CFIX to be linked to “mental illness” is included below with a brief synopsis of the shooters’ actions and history of mental health issues.

Mass Shootings Attributed to History of Mental Illness

  • Jared Loughner; January 8, 2011; 6 killed, 13 injured – Loughner went to an event with U.S. Representative Gabrielle Giffords in a Safeway parking lot in Tucson, Arizona and killed six people, including a U.S. District Court Judge John Roll and a 9-year-old girl.  Loughner was later diagnosed with paranoid schizophrenia and was initially ruled incompetent to stand trial.
  • Eduardo Sencion; September 6, 2011; 4 killed, 7 injured – Sencion killed 4 and injured 7 in and around an IHOP restaurant in Carson City, Nevada using a Norinco Mak 90 semiautomatic rifle illegally converted to fully-automatic mode.  Sencion was diagnosed with paranoid schizophrenia at age 18.
  • Scott Evans Dekraai; October 12, 2011; 8 killed, 1 injured – Dekraai went into Salon Meritage hair salon where his ex-wife worked in Seal Beach, California and opened fire with several handguns killing 8 in the salon and injuring 1 in the parking lot.  Dekraai had been diagnosed with posttraumatic stress disorder in September 2008.
  • Jeong Soo Paek; February 21, 2012; 4 killed – Paek walked into a spa owned by his sisters’ families, killing his sisters and their husbands with a .45-caliber handgun before killing himself.  Paek had a history of mental health issues according to court filings and had been described as suicidal in the years leading up to the attack.
  • One L. Goh; April 2, 2012; 7 killed, 3 injured – Goh, a former student at Oikos University, a Korean Christian college in Oakland, California, stood up in a nursing classroom while class was in session, ordered classmates to line up against the wall, and opened fire with a .45-caliber semi-automatic handgun killing 7.  Goh was later diagnosed with paranoid schizophrenia by court-appointed psychiatrists.
  • Ian Lee Stawicki; May 30, 2012; 5 killed, 1 injured – Stawicki walked into Café Racer in the University District of Seattle, Washington and opened fire with two .45-caliber handguns, killing four patrons and wounding the café’s chef.  Stawicki’s father later said his son suffered from mental health issues throughout his life and may have been manic depressive.
  • James Eagan Holmes; July 20, 2012; 12 killed, 58 injured – Holmes used a Smith & Wesson M&P15 semi-automatic rifle, Remington tactical shotgun and two Glock 22 handguns to kill 12 and wound 58 during a midnight premiere screening of The Dark Night Rises at the Century 16 multiplex in Aurora, Colorado.  Holmes was seeing a psychiatrist at the University of Colorado prior to the shooting who later reported that he had made “homicidal statements” and said he a was a threat to others.  Holmes reportedly asked other students at the University of Colorado about dysphoric mania, a mental disorder characterized by simultaneous symptoms of mania and depression.
  • Andrew Engeldinger; September 27, 2012; 5 killed, 3 injured – Engeldinger opened fire with a Glock 19 9mm pistol killing 6 and injuring 2 at his workplace Accent Signage Systems in Minneapolis, Minnesota after being fired.  According to his parents, Engeldinger had a history of undiagnosed mental illness.
  • Adam Lanza; December 14, 2012; 27 killed, 2 wounded – Lanza killed his mother, then took several firearms in his mother’s car to Sandy Hook Elementary School where he killed twenty children and six employees of the school with a semi-automatic Bushmaster XM15-E2S rifle.  Lanza had behavioral problems throughout childhood and was said by family members to have a personality disorder.  Lanza was reportedly diagnosed with sensory processing disorder as a child and family friends claimed that he had been diagnosed with Asperger syndrome.
  • William Spengler; December 24, 2012; 3 killed, 2 wounded – Spengler killed his sister, then intentionally set their house on fire, firing an illegally-acquired Bushmaster semi-automatic rifle at firefighters responding to the scene, killing two and injuring two more.  Spengler was convicted of manslaughter in 1980 after murdering his grandmother with a hammer and had spent years in a correctional mental health facility.
  • John Zawahri; June 7, 2013; 5 killed, 4 wounded – Zawahri killed his father and brother after setting their house on fire, then hijacked a passing car, forcing the driver to drive him to Santa Monica College where he killed 3 more people and wounded 4.  While attending high school, Zawahri had communicated to a classmate his desire to hurt other students and was later admitted to UCLA’s Neuropsychiatric Institute for a brief period of time.

 

 

http://publicintelligence.net/mass-shootings-mental-illness/

1-in-5 U.S.children have a mental disorder to the extent that the child has difficulty functioning

Psychiatrists: 1-in-5 U.S.children have a  mental disorder

Published: Aug. 27, 2013 at 12:21 AM

DALLAS, Aug. 27 (UPI) –DALLAS, Aug. 27 (UPI) — Twenty percent of U.S.  children experience a mental disorder to the extent that the child has  difficulty functioning, two psychiatrists say.

Dr. Adam Brenner and Dr. Preston Wiles at the University of Texas  Southwestern Medical Center in Dallas says some early warning signs of mental  illness include:

— Loss of interest in previously enjoyed activities such as spending less  time with friends, quitting sports or other extracurricular activities.

— Decline in functioning such as failing at school or no longer keeping up  with regular chores at home.

— Suspiciousness or strong nervous feelings such as spending excessive time  alone in their room, or acting as though they are “being watched.”

— Changes in sleep, appetite or personal hygiene such as staying up all  night, requiring frequent reminders to bathe or change clothing.

— Problems with concentration, memory or speech such as talking in a  disorganized or unusual way, talking too fast, or jumping between unrelated  topics.

“It is often difficult for young people who are suffering from mental illness  to be aware of changes in their thinking, feelings or behavior,” Brenner said in  a statement. “It may be a family member, friend or teacher who first notices the  signs of the illness.”

What should someone do who notices these signs in my child or teen? Brenner  says a gentle talk with the child or adolescent about your concerns may be a  good first step.

“They may already have noticed something but have been too ashamed or  frightened to discuss it,” Brenner says. “Consulting your primary care doctor or  school counselor may also be beneficial when deciding how you can best help your  child. Most importantly, if there is any concern that a person is a danger to  themselves or others, either by voicing ideas of suicide or talking about  shooting or harming others, call 911 or take the person to the nearest emergency  room for assistance.”

© 2013 United Press International, Inc.  All Rights Reserved.
Read more:  http://www.upi.com/Health_News/2013/08/27/Psychiatrists-1-in-5-USchildren-have-a-mental-disorder/UPI-63761377577303/print#ixzz2dFKvlnJA

Are antidepressants overused? : 75% of those who write these definitions have links to drug companies.

Contact: Emma Dickinson edickinson@bmjgroup.com 44-020-738-36529 BMJ-British Medical Journal

Head to head: Are antidepressants overprescribed?

Antidepressant prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions. Does this reflect overmedicalisation or appropriate treatment? Two experts debate the issue on bmj.com today.

Glasgow GP, Dr Des Spence, thinks that “we use antidepressants too easily, for too long, and that they are effective for few people (if at all)”

He acknowledges that depression is an important illness, but argues that the current definition of clinical depression (two weeks of low mood – even after bereavement) “is too loose and is causing widespread medicalisation.” He also points out that 75% of those who write these definitions have links to drug companies.

National Institute for Health and Clinical Excellence (NICE) guidelines do not support the use of antidepressant medication in mild depression, nor necessarily as first line treatment of moderate depression. Instead, they promote talking therapies.

“But even if we accept that antidepressants are effective, a Cochrane review suggests that only one in seven people actually benefits. Thus millions of people are enduring at least six months of ineffective treatment,” he writes.

He is unconvinced by research showing that depression is undertreated and that antidepressants are being used appropriately, saying “the only explanation is that we are prescribing more antidepressants to ever more people.”     He also questions the view that depression is a mere chemical imbalance and concludes: “Improving society’s wellbeing is not in the gift of medicine nor mere medication, and overprescribing of antidepressants serves as a distraction from a wider debate about why we are so unhappy as a society. We are doing harm.”

But Ian Reid, Professor of Psychiatry at the University of Aberdeen, says the claim that antidepressants are overprescribed “needs careful consideration.”

He argues that the rise in prescriptions is due to small but appropriate increases in the duration of treatment, rather than more patients being treated, and that increased use of antidepressants in other conditions “has compounded misunderstanding.”

He refutes the idea that GPs are handing out antidepressants “like sweeties” and points to a survey showing “cautious and conservative prescribing” among GPs in Grampian. He also points to “methodological flaws and selective reporting” of data showing that antidepressants are no better than placebo except in severe depression. Instead, he says, practice is supported by evidence.

Finally, he dismisses reports that limited availability of psychological therapy leads to inappropriate antidepressant prescription, saying there is no consistent relation between the availability of psychological therapies and antidepressant use.

“Antidepressants are but one element available in the treatment of depression, not a panacea,” he writes. “Like ‘talking treatments’ (with which antidepressants are entirely compatible), they can have harmful side effects, and they certainly don’t help everyone with the disorder. But they are not overprescribed. Careless reportage has demonised them in the public eye, adding to the stigmatisation of mental illness, and erecting unnecessary barriers to effective care.”

Link between creativity and mental illness confirmed

Simon Kyaga

[PRESS RELEASE 16 October 2012]

People in creative professions are treated more often for mental illness than the general population, there being a particularly salient connection between writing and schizophrenia. This according to researchers at Karolinska Institutet, whose large-scale Swedish registry study is the most comprehensive ever in its field.

Last year, the team showed that artists and scientists were more common amongst families where  bipolar disorder and schizophrenia is present, compared to the population at large. They subsequently expanded their study to many more psychiatric diagnoses – such as schizoaffective disorder, depression, anxiety syndrome, alcohol abuse, drug abuse, autism, ADHD, anorexia nervosa and suicide – and to include people in outpatient care rather than exclusively hospital patients.

 

The present study tracked almost 1.2 million patients and their relatives, identified down to second-cousin level. Since all were matched with healthy controls, the study incorporated much of the Swedish population from the most recent decades. All data was anonymized and cannot be linked to any individuals.

 

The results confirmed those of their previous study: certain mental illness – bipolar disorder – is more prevalent in the entire group of people with artistic or scientific professions, such as dancers, researchers, photographers and authors. Authors specifically also were more common among most of the other psychiatric diseases (including schizophrenia, depression, anxiety syndrome and substance abuse) and were almost 50 per cent more likely to commit suicide than the general population.

 

The researchers also observed that creative professions were more common in the relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to some extent, autism. According to Simon Kyaga, consultant in psychiatry and doctoral student at the Department of Medical Epidemiology and Biostatistics, the results give cause to reconsider approaches to mental illness.

 

“If one takes the view that certain phenomena associated with the patients illness are beneficial, it opens the way for a new approach to treatment,” he says. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavour to treat the patient by removing everything regarded as morbid.”

 

The study was financed with grants from the Swedish Research Council, the Swedish Psychiatry Foundation, the Bror Gadelius Foundation, the Stockholm Centre for Psychiatric Research and the Swedish Council for Working Life and Social Research

http://ki.se/ki/jsp/polopoly.jsp?l=en&d=130&a=151722&newsdep=130

 

Harvard psychologist Jerome Kagan, offers a scathing critique of the mental-health establishment and pharmaceutical companies, accusing them of incorrectly classifying millions as mentally ill out of self-interest and greed.

SPIEGEL Interview with Jerome Kagan 2 AUG 2012

Harvard psychologist Jerome Kagan is one of the world’s leading experts in child development. In a SPIEGEL interview, he offers a scathing critique of the mental-health establishment and pharmaceutical companies, accusing them of incorrectly classifying millions as mentally ill out of self-interest and greed.

Jerome Kagan can look back on a brilliant career as a researcher in psychology. Still, when he contemplates his field today, he is overcome with melancholy and unease. He compares it with a wonderful antique wooden chest: Once, as a student, he had taken it upon himself to restore the chest with his colleagues.

He took one of its drawers home himself and spent his entire professional life whittling, shaping and sanding it. Finally, he wanted to return the drawer to the chest, only to realize that the piece of furniture had rotted in the meantime.

If anyone has the professional expertise and moral authority to compare psychology to a rotten piece of furniture, it is Kagan. A ranking of the 100 most eminent psychologists of the 20th century published by a group of US academics in 2002 put Kagan in 22nd place, even above Carl Jung (23rd), the founder of analytical psychology, and Ivan Pavlov (24th), who discovered the reflex bearing his name.

Kagan has been studying developmental psychology at Harvard University for his entire professional career. He has spent decades observing how babies and small children grow, measuring them, testing their reactions and, later, once they’ve learned to speak, questioning them over and over again. For him, the major questions are: How does personality emerge? What traits are we born with, and which ones develop over time? What determines whether someone will be happy or mentally ill over the course of his or her life?

In his research, Kagan has determined that how we are shaped in our early childhood is not as irreversible as has long been assumed. He says that even children who suffer from massive privations in the first months of life can develop normally as long as they are later raised in a more favorable environment. Likewise, he has studied how people become human in a certain programmatic way in the second year of life: Their vocabulary suddenly grows in leaps and bounds, and they develop a sense of empathy, a moral sensibility and an awareness of the self.

But Kagan’s most significant contribution to developmental research has come through his examination of innate temperaments. As early as four months old, he has found, some 20 percent of all babies already have skittish reactions to new situations, objects and individuals. He calls these babies “high reactives” and says they tend to develop into anxious children and adults. Forty percent of babies, or what he calls the “low reactives,” behave in the opposite manner: They are relaxed, easy to care for and curious. In later life, they are also not so easily ruffled.

Kagan could have reacted to his finding in a “low-reactive” way by kicking back and letting subsequent generations of researchers marvel at his findings. Instead, he has attacked his own profession in his recently published book “Psychology’s Ghost: The Crisis in the Profession and the Way Back.” In it, he warns that this crisis has had disastrous consequences for millions of people who have been incorrectly diagnosed as suffering from mental illness.


SPIEGEL: Professor Kagan, you’ve been studying the development of children for more than 50 years. During this period, has their mental health gotten better or worse?

Kagan: Let’s say it has changed. Particularly in poorer families, among immigrants and minorities, mental health issues have increased. Objectively speaking, adolescents in these groups have more opportunities today than they did 50 years ago, but they are still anxious and frustrated because inequality in society has increased. The number of diagnosed cases of attention-deficit disorders and depression has increased among the poor…

SPIEGEL: … you could also say skyrocketed. In the 1960s, mental disorders were virtually unknown among children. Today, official sources claim that one child in eight in the United States is mentally ill.

Kagan: That’s true, but it is primarily due to fuzzy diagnostic practices. Let’s go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). That’s why the numbers have soared.

SPIEGEL: Experts speak of 5.4 million American children who display the symptoms typical of ADHD. Are you saying that this mental disorder is just an invention?

Kagan: That’s correct; it is an invention. Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.

SPIEGEL: So the alleged health crisis among children is actually nothing but a bugaboo?

Kagan: We could get philosophical and ask ourselves: “What does mental illness mean?” If you do interviews with children and adolescents aged 12 to 19, then 40 percent can be categorized as anxious or depressed. But if you take a closer look and ask how many of them are seriously impaired by this, the number shrinks to 8 percent. Describing every child who is depressed or anxious as being mentally ill is ridiculous. Adolescents are anxious, that’s normal. They don’t know what college to go to. Their boyfriend or girlfriend just stood them up. Being sad or anxious is just as much a part of life as anger or sexual frustration.

SPIEGEL: What does it mean if millions of American children are wrongly being declared mentally ill?

Kagan: Well, most of all, it means more money for the pharmaceutical industry and more money for psychiatrists and people doing research.

SPIEGEL: And what does it mean for the children concerned?

Kagan: For them, it is a sign that something is wrong with them — and that can be debilitating. I’m not the only psychologist to say this. But we’re up against an enormously powerful alliance: pharmaceutical companies that are making billions, and a profession that is self-interested.

SPIEGEL: You once wrote that you yourself often suffered from inner restlessness as a child. If you were born again in the present era, would you belong to the 13 percent of all children who are said to be mentally ill?

Kagan: Probably. When I was five, I started stuttering. But my mother said: “There’s nothing wrong with you. Your mind is working faster than your tongue.” And I thought: “Gee, that’s great, I’m only stuttering because I’m so smart.”

SPIEGEL: In addition to ADHD, a second epidemic is rampant among children: depression. In 1987, one in 400 American adolescents was treated with anti-depressants; by 2002, it was already one on 40. Starting at what age is it possible to speak of depression in children?

Kagan: That’s not an easy question to answer. In adults, depression either implies a serious loss, a sense of guilt or a feeling that you are unable to achieve a goal that you really wanted to reach. Infants are obviously not yet capable of these emotions. But, after the age of three or four, a child can develop something like a feeling of guilt, and if it loses its mother at that age, it will be sad for a while. So, from then on, mild depression can occur. But the feeling of not being able to achieve a vital goal in life and seeing no alternative only starts becoming important from puberty on. And that is also the age at which the incidence of depression increases dramatically.

SPIEGEL: The fact is that younger children are also increasingly being treated with antidepressants.

Kagan: Yes, simply because the pills are available.

SPIEGEL: So would you completely abolish the diagnosis of depression among children?

Kagan: No, I wouldn’t go as far as that. But if a mother sees a doctor with her young daughter and says the girl used to be much more cheerful, the doctor should first of all find out what the problem is. He should see the girl on her own, perhaps carry out a few tests before prescribing drugs (and) certainly order an EEG. From studies, we know that people with greater activity in the right frontal lobe respond poorly to antidepressants.

Part 2: ‘Psychiatrists Should Ask What the Causes Are’

SPIEGEL: Should one just wait to see whether depression will go away by itself?

Kagan: That depends on the circumstances. Take my own case: About 35 years ago, I was working on a book summarizing a major research project. I wanted to say something truly important, but I wasn’t being very successful. So I went into a textbook-type depression. I was unable to sleep, and I met all the other clinical criteria, too. But I knew what the cause was, so I didn’t see a psychiatrist. And what do you know? Six months later, the depression had gone.

SPIEGEL: In a case like that, does it even make sense to speak of mental illness?

Kagan: Psychiatrists would say I was mentally ill. But what had happened? I had set myself a standard that was too high and failed to meet that standard. So I did what most people would do in this situation: I went into a depression for a while. Most depressions like that blow over. But there are also people with a genetic vulnerability to depression in whom the symptoms do not pass by themselves. These people are chronically depressed; they are mentally ill. So it is important to look not just at the symptoms, but also at the causes. Psychiatry is the only medical profession in which the illnesses are only based on symptoms …

SPIEGEL: … and it seems to discover more and more new disorders in the process. Bipolar disorders, for example, virtually never used to occur among children. Today, almost a million Americans under the age of 19 are said to suffer from it.

Kagan: We seem to have passed the cusp of that wave. A group of doctors at Massachusetts General Hospital just started calling kids who had temper tantrums bipolar. They shouldn’t have done that. But the drug companies loved it because drugs against bipolar disorders are expensive. That’s how the trend was started. It’s a little like in the 15th century, when people started thinking someone could be possessed by the devil or hexed by a witch.

SPIEGEL: Are you comparing modern psychiatry to fighting witches’ hexes in the Middle Ages?

Kagan: Doctors are making mistakes all the time — despite their best intentions. They are not evil; they are fallible. Take Egas Moniz, who cut the frontal lobes of schizophrenics because he thought that would cure them …

SPIEGEL: … and received a Nobel Prize for it in 1949.

Kagan: Yes, indeed. Within a few years, thousands of schizophrenics had their frontal lobes cut — until it turned out that it was a terrible mistake. If you think of all the people who had their frontal lobes cut, being called bipolar is comparatively harmless.

SPIEGEL: It’s not entirely harmless either, though. After all, children with this diagnosis are being subjected to a systematic change in their brain chemistry through psychoactive substances.

Kagan: I share your unhappiness. But that is the history of humanity: Those in authority believe they’re doing the right thing, and they harm those who have no power.

SPIEGEL: That sounds very cynical. Are there any alternatives to giving psychoactive drugs to children with behavioral abnormalities?

Kagan: Certainly. Tutoring, for example. Who’s being diagnosed with ADHD? Children who aren’t doing well in school. It never happens to children who are doing well in school. So what about tutoring instead of pills?

SPIEGEL: Listening to you, one might get the impression that mental illnesses are simply an invention of the pharmaceutical industry.

Kagan: No, that would be a crazy assertion. Of course there are people who suffer from schizophrenia, who hear their great-grandfather’s voice, for example, or who believe the Russians are shooting laser beams into their eyes. These are mentally ill people who need help. A person who buys two cars in a single day and the next day is unable to get out of bed has a bipolar disorder. And someone who cannot eat a bite in a restaurant because strangers could be watching them has a social phobia. There are people who, either for prenatal or inherited reasons, have serious vulnerabilities in their central nervous system that predispose them to schizophrenia, bipolar disease, social anxiety or obsessive-compulsive disorders. We should distinguish these people from all the others who are anxious or depressed because of poverty, rejection, loss or failure. The symptoms may look similar, but the causes are completely different.

SPIEGEL: But how are you going to distinguish between them in a concrete case?

Kagan: Psychiatrists should begin to make diagnoses the way other doctors do: They should ask what the causes are.

SPIEGEL: The problems you describe are not new. Why do you believe psychiatry is in a crisis at this specific time?

Kagan: It’s a matter of the degree. Epidemiological studies are saying that one person in four is mentally ill. The Centers for Disease Control and Prevention in Atlanta recently announced that one in 88 American children has autism. That’s absurd. It means that psychiatrists are calling any child who is socially awkward autistic. If you claim that anyone who can’t walk a mile in 10 minutes has a serious locomotor disability, then you will trigger an epidemic of serious locomotor disabilities among older people. It may sound funny, but that’s exactly what’s going on in psychiatry today.

SPIEGEL: Do you sometimes feel ashamed of belonging to a profession that you think wrongly declares large parts of society to be mentally ill?

Kagan: I feel sad, not ashamed … but maybe a little ashamed, too.

SPIEGEL: Over 60 years ago, when you decided to become a psychologist, you wanted “to improve social conditions so that fewer people might experience the shame of school failure … and the psychic pain of depression,” as you once put it. How far did you get?

Kagan: Not very far, unfortunately, because I had the wrong idea. I thought family circumstances were crucial to being successful in life. I thought that, if we could help parents do a better job, we could solve all these problems. That’s why I chose to be a child psychologist. I didn’t recognize the bigger forces: culture, social standing, but also neurobiology. I really thought that everything was decided in the family, and that biology was irrelevant.

SPIEGEL: Over time, you’ve come to realize that the bond between a mother and her child is not so important after all.

Kagan: That’s right, though one must remember that the mother’s role was not emphasized until quite recently. Sixteenth-century commentators even wrote that mothers were not suited to looking after children: too emotional, overprotective. But when the bourgeoisie increased in the 19th century, women didn’t have to go out and work anymore. They had a lot of time on their hands. So society gave them an assignment and said: “You are now the sculptress of this child.” At the same time, middle-class children didn’t have to contribute to their family the way peasants’ children did. They were not needed and therefore ran the risk of feeling worthless. But when a child doesn’t feel needed, it needs another sign. So love suddenly became important. And who gives love? Women. Eventually, John Bowlby came along and romanticized maternal attachment.

SPIEGEL: Bowlby, the British psychiatrist, was one of the fathers of attachment theory. Do you consider his hypotheses to be wrong?

Kagan: People wanted simple answers, and they longed for a gentler conception of humanity, especially after the horrors of World War II. This fit the idea that only children who are able to trust their mothers from birth are able to lead a happy life.

SPIEGEL: Anxieties over whether raising children in day care centers could harm them persist to this day.

Kagan: Unfortunately, even though we already disproved this in the 1970s. Nixon was president at the time, and Congress was toying with the idea of national day care centers. Along with two colleagues, I got a big grant to study the effect of day care on a group of infants. The children in the control group were looked after at home by their mothers. At the end of 30 months, we found that there was no difference between the two groups. Nonetheless, to this day, 40 years later, people are still claiming that day care centers are bad for children. In 2012.

SPIEGEL: Professor Kagan, we thank you for this conversation.

Interview conducted by Johann Grolle and Samiha Shafy

In the Age of Anxiety, are we all mentally ill?

NEW YORK (Reuters) – When Cynthia Craig was diagnosed with postpartum depression eight years ago, she told her family doctor she felt anxious about motherhood. She wondered whether she had made a catastrophic mistake by quitting her job, whether she could cope with the long, lonely hours stay-at-home mothers face – and even whether she should have had children.

              “Anxiety is something I have always had, especially during times of change,” said Craig, 40, who lives in Scotland, Ontario. “But I was never worried about the level of anxiety, and it never prevented me from leaving the house, driving, socializing or even speaking in front of people.”

              Her doctor referred her to an anxiety clinic, where a nurse asked Craig dozens of yes-or-no questions – are you afraid of snakes? do you hear voices? do you vomit from anxiety? – and made a diagnosis. “She said, ‘Let’s call it Generalized Anxiety Disorder with a touch of social phobia,'” Craig said.

              That didn’t feel right to her, but the clinic’s psychiatrist agreed with the nurse and said Craig’s concerns about motherhood constituted an anxiety disorder, a form of mental illness, and prescribed Pfizer’s Effexor and then GlaxoSmithKline’s Paxil. Craig says the drugs exacerbated the very anxiety that she doubted required medication.

              Craig’s case is one of millions that constitute an extraordinary trend in mental illness: an increase in the prevalence of reported anxiety disorders of more than 1,200 percent since 1980.

              In that year, 2 percent to 4 percent of Americans suffered from an anxiety disorder, according to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders, used by psychiatrists and others worldwide to diagnose mental illness.

              In 1994, a study asking a random sample of thousands of Americans about their mental health reported that 15 percent had ever suffered from anxiety disorders. A 2009 study of people interviewed about their anxiety repeatedly for years raised that estimate to 49.5 percent – which would be 117 million U.S. adults.

              Some psychiatrists say the increase in the prevalence of anxiety from about 4 percent to 50 percent is the result of psychiatrists and others “getting better at diagnosing anxiety,” as Dr. Carolyn Robinowitz, a past president of the APA who is in private practice in Washington, D.C., put it. “People who criticize that are showing their bias,” she said. “When we get better at diagnosing hypertension, we don’t say that’s terrible.”

Critics, including other leading psychiatrists, disagree. They say the apparent explosion in anxiety shows there is something seriously and dangerously wrong with the DSM. Its next edition, due in May, would lower the threshold for identifying anxiety.

The criticism rests on three arguments. First, the DSM fails to recognize that anxiety is normal and even beneficial in many situations, so it conflates a properly functioning brain system with a pathology. Second, the DSM’s description of anxiety is more about enforcing social norms than medicine.

Finally, they say, anxiety is adaptive. Its brain circuitry was honed by evolution for a purpose. Only when that mechanism misfires should a person be diagnosed as mentally ill.

“No human emotion is more basic than anxiety,” said sociologist Allan Horwitz of Rutgers University. “Many forms of it simply should not be categorized as disorders, because they’re the result of the way people evolved thousands of years ago, rather than something going wrong.”

IDENTIFYING THE TRULY ILL

Horwitz and other critics recognize that when the brain’s anxiety system misfires it can prevent people from functioning, as when someone is unable to leave home, interact with friends and family or walk past even a leashed dog. But the anxiety system is working properly when it makes someone afraid of heights or wild dogs or threatening strangers.

“Anxiety or panic symptoms that have been severe, persistent and cause clinically significant distress or impairment need to be diagnosed promptly,” said Dr. Allen Frances, a psychiatrist who led the previous DSM revision and questions some of the new criteria. “Very effective treatments are available.”

“We don’t oppose people getting treatment,” said Horwitz, co-author of the new book “All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders.” “But people are much too willing to think they have a disorder that requires treatment.”

Many psychiatrists don’t see it that way. Under changes for the DSM-5 proposed by experts convened by the APA, symptoms such as excessive worry, restlessness, feeling on edge, avoiding activities that cause anxiety, and being overly concerned about health or finances or family would have to be present for only three months rather than six to justify a diagnosis of Generalized Anxiety Disorder (GAD). And people would have to display one physical symptom, not the current three.

“Because its threshold for GAD is set so ridiculously low, DSM-5 will mislabel as mentally ill many people who are experiencing no more than the normal and expected worries of everyday life,” said Frances.

Dr. Donna Rockwell, a clinical psychologist who has organized opposition to aspects of the DSM-5 process, warned that “unless come to their senses, GAD will be identical to the existential worries all of us face as part of being human.” That will bring “a bonanza to the drug companies,” she added, opening the floodgates to “more inappropriate, expensive and potentially harmful drug use.”

Drugmakers reported $661 million in U.S. sales of anti-anxiety drugs last year, according to IMS Health. Most psychiatrists see that as evidence people suffering from mental illness are getting help. On Thursday the Pharmaceutical Research and Manufacturers of America issued a report touting the many drugs being developed for mental illnesses, including 26 for anxiety.

“When anxiety symptoms impair a person’s functioning, what’s so bad about helping them get back to a normal state and using medication if appropriate?” asked Robinowitz.

The message that what used to be considered part of the human condition is pathological is getting through, at least to some people.

              James Heaney, 44, told his family physician in 2000 that he often felt shy or mildly depressed in social situations – “like I saw on the TV commercial” telling viewers to “ask your doctor” about social anxiety. “There was no in-depth evaluation of my symptoms,” said Heaney, then a network administrator for a school district near Rochester, New York. After a 10-minute interview, he had a diagnosis of “mild social anxiety” and a prescription for Paxil. “For such a powerful drug,” he said, “it was remarkably easy to get.”

              EVOLUTIONARY RESPONSE

Research over the past decade shows that feeling anxious is how the brain’s emotion centers send signals to its thinking centers that something is amiss.

For instance, it is normal to be anxious over a sick child, a loved one’s illness, unemployment or other setbacks in life, said New York University sociologist Jerome Wakefield, co-author of “All We Have to Fear.”

“The feeling of anxiety tells you something poses a threat, which can motivate you to stay vigilant” – about, say, a change in a sick child’s symptoms, he said.

              In the Paleolithic era, when our prehistoric ancestors lived in small clans, how people were viewed by strangers and kin could determine survival. So when people fret over going to a party, giving a speech or otherwise subject themselves to judgment, it reflects an adaptive response to the millennia-old need to be attuned to other people’s disapproval, researchers say. Anxiety about public speaking accounts for about half the diagnoses of social anxiety disorder.

              “There is great evolutionary and survival value in anxiety, which makes it difficult to identify as an illness or pathology,” said psychologist Frank Farley of Temple University.

Anxiety was working properly among survivors of Hurricane Katrina, Wakefield and Horwitz contend. Years after the devastating 2005 storm, schools, housing, policing and other aspects of life in New Orleans had still not returned to normal. Using DSM criteria, a 2007 study concluded that half the surviving residents were “mentally ill” because they experienced anxiety about those lingering effects.

              “If you survived Katrina, anxiety is not a sign of mental illness; it’s the brain working as it should,” said Wakefield. Such emotions can spur survivors to agitate for rebuilding neighborhoods, he said.

              Another concern is that by labeling normal human variation – being more anxious, fearful or worried than the average person – a mental illness, psychiatry is venturing into social control.

“To suggest that anyone who’s afraid to speak in front of hundreds of strangers has a mental illness creates social pressure to change,” said Wakefield. “And that pushes psychiatry away from medicine and into enforcing social values.”

BAD REACTIONS

In retrospect, Marla Royce (who asked that her real name not be used) thinks her brain’s anxiety system was working as evolution intended. A successful Texas novelist, she was upset about the death of her father in 2004. Her anxiety was compounded when her publisher did not promote her new book, leading Royce to worry that her writing career was over.

“It was just garden-variety situational anxiety,” she says now about the agitation and disorientation she felt.

Royce said she went along “trustingly and blithely” when a family physician diagnosed her with GAD. “He said the pharma sales rep had just left some samples, so he gave me Lexapro,” to which a psychiatrist added Paxil, Xanax and Klonopin.

              She became dependent on the drugs, taking ever-higher doses. Her psychiatrist told her that “was proof my anxiety disorder was out of control and that I would have to be medicated for life.” She suffered “steadily declining mental and physical health” until she stopped the meds five years ago and shared her story with the online support group PaxilProgress.

              James Heaney’s shyness turned to numbness on Paxil. “It made me insular and nonresponsive to my friends and family,” he said. “My mood became very variable,” and co-workers told him they felt uncomfortable asking him for computer help as they once did “because they weren’t sure which James they would get.”

              He weaned himself off psychiatric drugs in 2011. The social anxiety he still occasionally feels “is a relatively easy problem to deal with,” he said.

              For Cynthia Craig, the drugs she was prescribed triggered “excruciating anxiety symptoms like I had never experienced in my entire life.”

              “I told my doctor I don’t want to be on anything,” she said. “My anxiety is predictable and something I can handle.”

              (Reporting by Sharon Begley; Editing by Michele Gershberg and Douglas Royalty)