Dr. Marcia Angell On The 'Mental Illness Epidemic'

I can't wait for the next issue of The New York Review of Books. It's slated to carry the second half of a review written by Dr. Marcia Angell of Harvard Medical School, and I'm eager to see how it's going to come out.

Marcia is the former editor of the New England Journal of Medicine, and from her lofty position at the pinnacle of the medical establishment, she speaks out about the shortcomings of the American health care system and the dangers of financial conflicts of interest in medicine. A 2009 piece of hers in the New York Review of Books, titled "Drug Companies and Doctors: A Story of Corruption," brought vehement objections in print from Stanford and the American Psychiatric Association, which, in my opinion, she soundly trounced in her response.

Her current review looks at three books, two of which have already been mentioned on CommonHealth: Robert Whitaker's Anatomy of an Epidemic and Dr. Daniel Carlat's "Unhinged." I haven't read the third yet: Irving Kirsch's "The Emperor's New Drugs: Exploding The Antidepressant Myth," but it sounds like it suggests that antidepressants are largely ineffective, and any positive results they may produce likely stem mainly from the placebo effect.

It's worth reading the whole review, but here's a small excerpt:

The authors emphasize different aspects of the epidemic of mental illness. Kirsch is concerned with whether antidepressants work. Whitaker, who has written an angrier book, takes on the entire spectrum of mental illness and asks whether psychoactive drugs create worse problems than they solve. Carlat, who writes more in sorrow than in anger, looks mainly at how his profession has allied itself with, and is manipulated by, the pharmaceutical industry. But despite their differences, all three are in remarkable agreement on some important matters, and they have documented their views well.

First, they agree on the disturbing extent to which the companies that sell psychoactive drugs—through various forms of marketing, both legal and illegal, and what many people would describe as bribery—have come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated. This is a subject to which I’ll return.

Second, none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain.

And the teaser:

If psychoactive drugs are useless, as Kirsch believes about antidepressants, or worse than useless, as Whitaker believes, why are they so widely prescribed by psychiatrists and regarded by the public and the profession as something akin to wonder drugs? Why is the current against which Kirsch and Whitaker and, as we will see, Carlat are swimming so powerful? I discuss these questions in Part II of this review.

I'm staying tuned...