Tags
Big Pharma, Book Review, Cracked: Why Psychiatry Is Doing More Harm Than Good, James Davies, Medicine, Psychiatry, Soapbox
Wool Pulled Justifiable Rage Disorder
Why has the prescription of antidepressant medicine roughly tripled in less than 20 years? Is it that we are indeed becoming sicker, that we are all becoming more and more stressed and psychologically unwell, is it merely that doctors and psychiatrists are much more skilled at diagnosing psychiatric conditions than they used to be, or is it that we are now medicalising (drugging) what is normal about the variety of day to day human experiences, which at times can be sorrowful, challenging or confusing?
This briiliantly clear, cogently argued, shocking and timely book by psychotherapist and anthropologist James Davies rendered me almost incoherent with rage, exposing as it did something which many of us have been aware of, but maybe have not had the tools or ability to follow to a conclusion. James Davies has those tools and abilities; he thoughtfully, knowledgeably, skilfully connects all the dots together, uncovering the horrendous duplicity, collusion and sheer unscientific snake oil peddling visited upon us by Big Pharma, in the field of mental health.
I can’t urge the reading of this book strongly enough. Anyone who cares about what it 
means to be a fully human being, and especially anyone involved in any way in the caring professions needs to be aware of what Davies lays clear about the mental health industry. For industry it surely is.
With a carefully constructed series of explanations, revelations and arguments Davies delivers telling knock out punches to the House of Trick Cards of current mainstream psychiatry. The major punches involve
1) The increasing categorisation of VIRTUALLY ANY EMOTIONAL STATE so that it falls within a category of disorder – thus opening the way to the development of chemical coshes. This categorisation – the ‘Bible’ used to denote syndromes, the DSM (currently DSM 5), is NOT the result of huge studies and research itself, yet it gets used as if it were the result of close scientific analyses. The result of the sort of sordid, limiting tickboxy thinking, turning us all into robots who can be managed out of our normal human pain is the crass thinking that says, for example, if after a bereavement, sleep appetite and general mood are affected for more than 2 weeks, anti-depressants may be helpfully prescribed. Crazy, insidious, crass. We have become so afraid of our suffering that the answer becomes ‘cosh it, flat line what it is to be in any way human’
2) Trials – various meta analysis studies have shown that antidepressants are BARELY more effective, in mild to moderate depression, to placebo. Drug companies have disquietingly low bars to climb over, in order to ‘prove’ their products effectiveness. Davies uncovers the secrecy, the UNPUBLISHED drug trials that go against the findings Big Pharma wants and the manipulation of results. More than this, how drug companies positively USE that most powerful of tools – PLACEBO ITSELF to manipulate their own results higher – for example, the colour, the name, the advertising of the pharmaceutical – many of the effects that might be assumed to be the result of the chemistry of the drug ‘better than placebo’ – are in fact DUE to the use of placebo!
3) There has been a change in thinking from the 60s and 70s, where psychiatric drugs were seen as altering mood (in the same way as any mind altering drug, including alcohol and street drugs alter moods) A shift occurred to thinking of psychiatric drugs as ‘curative’. This might not seem an important shift – however it goes along with the idea that much uncomfortable, difficult human emotion is now being seen as potentially aberrant and classifiable as a ‘disease’ – as in the DSM – shyness becomes ‘social phobia’.
Medical naming encourages thinking about human beings in all their complexity as broken, and needing mending – and opens the door to the over-prescription. In fact, as one astute expert (among the many) Davies consults, points out tersely, this thinking of these drugs as ‘cures’ is erroneous, as unlike most physiological disease there just is no hard evidence to support the biology of a lot of what is now being treated as ‘disease’ through these medications – which alter mood. They do not ‘cure’ shyness, (or, lets medicalise it as social phobia) any more than a glass of wine ‘cures’ shyness – both change ways of perceiving the world, that is all.
4) Who bites the hand that feeds? There is a huge cover-up, smoke and mirrors going on in the world of funding ‘research’ into psychiatric medicine whether in academic institutions, or with clinicians. And, gentle reader, there is even less transparency over this in the UK than there is in the States, where under the Obama administration, spearheaded by a particularly truth-and-justice campaigning Senator, Senator Grassley, some efforts to bring the Pharma hyena under the spotlight are beginning to bear fruit. But not here, where there is murk a plenty. Perhaps though, the fact that fully 56% of the panel member luminaries involved in writing the DSM-IV bible had 1 or more financial associations with the pharmaceutical industry, should begin to rip the wool from over our eyes. And, for those writing/creating the diagnostic categories, which would of course be primarily treated by pharmaceuticals, – 88% of DSM-IV panel members had drug company financial ties.from Big Pharma. And things don’t have appeared to have changed for the better in terms of ‘arms length’ involvement with the writing of the now current DSM-V.
I am not saying (nor is Davies) that all these senior clinicians and medical academicians are corrupt, merely that neutrality becomes hard to achieve when your income is dependent on a particular company who are hoping your findings will support the excellence of their product, and even to demonstrate a need for their product
I received this book as an ARC – of course, given what I have said in point 4, you may feel that my judgement is compromised. I would argue that a lowly amateur reviewer lucky enough to get offered bookie freebies through third parties does not in any way equate to some stars of the psychiatric industry who receive millions for the sterling work they do in supporting the claims of specific drugs and manufacturers. A look at some of my reviews on Amazon will show that if I think a particular book is poor I will indeed say so.
This one though gets my gold standard bookie trial award. Properly researched, properly cited, free from duplicitous cover-up. Unlike the industry is exposes.It deserves to be a best seller – indeed, needs to be so – its material is provocative, prescient, and vital to know.
I have one cavil – my ARC was a digital copy, from the publisher via NetGalley. Now I don’t know if this will be any different than the standard digitise prepared for sale, but the digitisation on my ARC was poor – a lot of the useful charts and graphs do not appear and footnotes get chopped and inexplicably appear in the middle of other pages. If I were buying this book, I would definitely choose hard, over digitised, copy.
Available now in the UK, paper and digital; not in the USA in paper until August but available as digital
Cracked: Why Psychiatry Is Doing More Harm Than Good UK
Cracked: Why Psychiatry Is Doing More Harm Than Good USA
Well, you know I agree with you on this one. It’s much cheaper to drug someone than to give them proper counselling and support, for instance. And I’m afraid it’s so much easier for (some) GPs to reach for the prescription pad than to take the time to listen.
I have perhaps more sympathy with the doctors, under impossible pressure, unable to allow adequate time. What Davies really uncovers is just how intensely Big Pharma controls things, so that it becomes perceived wisdom to diagnose disorders, and treat the being of someone as if it were a simple mechanical (or pharmaceutical) fix that is the best way to do this. Psychiatry has become more and more about pharmacology. Much research (and the injection of much needed funding for universities) comes from the pharmaceutical companies, and inevitably it becomes harder to deliver objective truths if these will be negative for the Pharma company. It’s ever more insidious control by capitalism. I knew that the famed large scale double blind randomised cross-over studies happened less often than we might all think they do, but the level of cover-up, burying of ‘negative’ results, and financial inducements for academicians and clinicians is quite staggering. The statistics about the composition of the committees who write the diagnostic manuals says it all really. The book is a really good piece of investigative journalism, as well as everything else
Hmm…perhaps I have less sympathy with GPs than you because I worked with them. As private contractors they can choose whether to hire more doctors to relieve the time pressure and give a better service…or pay themselves more money and complain about workload. Sadly, in my experience, they almost always choose the latter and use prescribing as a quick fix to enable them to cope with overwork that they are on the whole responsible for creating. They even, against all advice, routinely put anti-depressants on repeat prescriptions so that they don’t have to see the patient each time.
I agree about capitalism being at the root of it all, but doctors are as guilty as drug companies of wanting to make a quick buck and sacrificing the well-being of the patient to do so. As a result of the last GP contract they on average increased their income by 33% when the intention of the govt had been that most of the extra cash should go on improving care. A failure of the set-up of the NHS that clinicians were allowed to retain their contractor status – a failure that has been recognised by all governments and dealt with by none. A truly public service would prevent or at least control these kinds of links with Big Pharma, but allowing clinicians to be profit-making enterprises inevitably leads to a warping in favour of the money-holders – I’m afraid clinicians’ ethics aren’t much higher than anyone else’s.
I had a couple of doctors who were not like that at all, and were extraordinarily dedicated. It’s probably all going to come down to individuals and maybe more of us are weak-willed and self-interest serving than one would hope for – so the best that could happen would be structures that would make self-serving less easy.
Interestingly, Davies says the whole mental health system is so shot through now with Big Pharma’s stranglehold, that change is unlikely to come from within. Part of HIS agenda is to make all this info more widely known, to encourage challenges to come from patients en masse – plus of course trying to stir up those who are in a position to push for changes in transparency about funding, vested interests etc
As someone who suffers with depression, I have also suffered with fighting off wanting pills. For me, they are a last resort. Something to get you through, until you find therapy, hope, a way to move onward. These answers take time. Sometimes decades. There is no immediate fix. Being on pills, though, for the rest of your life is not an answer either. You have to see the larger picture. Sadly, most people who are depressed don’t want to think of the future, of all that will require to get back to feeling okay again. They have lost all hope.
Of course, this subject splits me down the middle, because I have had medication really help a best friend of mine. It saved her life. The real transition for her, will be getting off of them. Who can say how long that will be?
Great review and this is something I am definitely going to have to read.
Yes of course, A, there is no one size fits all – but that is very much the point, in that the Big Pharma approach is getting use as if there is that one size only.
Certainly there are times when medication IS the answer, but increasingly medicine has become synonymous with pharma. A lot of what Davies was saying I knew, and obviously agreed with – but he went into things incredibly deeply, and tied a lot of stuff together which had been a suspicion but not fact, for me. The BIG shock was just how closely tied medicine now is to ‘medication’. And even more so how unscientific it is! The DSM bible is not the result of ‘gold standard trials’
Yeah it is a shame no one talks to anyone about their problems anymore and just tries to numb them to feeling enough that it doesn’t bother them. It is also pretty telling as to how unscientific psychiatry can be that SSRI drugs like prozac and zoloft are used to treat almost all psychiatric disorders (depression- prozac, anxiety- prozac, bipolar-prozac, ADD- prozac) Pretty much anything except schizophrenia
There’s a lot of interesting material about diagnosis – for example studies which looked at children around the time they start school Children born in July and August perform less well academically and are more likely to be diagnosed with behavioural problems like ADD (and therefore medicalised) than those born September/October time. This has nothing whatsoever to do with astrology, and everything to do with the cut off points for starting school. So those summer babes will be almost a year younger than the autumnals. At 5, a year is huge in terms of childhood development. Those younger children are just..younger, so they WILL find paying attention etc more difficult than their older cohort. The difference between age and development obviously narrows and then disappears in adulthood – a 31 and a 32 year old do not vary, a 3 and a 4 year old inhabit vastly different worlds, but of course if the youngest children in a year have been identified as having behavioural difficulties, and in worst case scenario, started young on being medicalised………..
I was myself a summer babe, but fortunately way back when we were not obsessive about rigid SATS etc, and there was rather more innate sense about the differences in children across a school year, and the what is normal what is abnormal way of perceiving little human beings – reductio statistician absurdum! – seemed not to be the modus operandi it now is
And then of course there is that wider issue of DIET and artificial substances interfering with delicate chemistry of the body – ADD in part caused by artificial chemistry and then medicated by different artificial chemistry
Fantastic post. However, I wonder what each author’s own definition of truth is. Is it being true to your art? To the reader? To oneself? It can be taken many ways. Also, the one gripe I have with Hemingway’s list of books is that they are all men authors. That is my thing with it. He is sort of deleting a lot of great writers, women authors.
Did you mean this as a response to this post A or does it belong to someone else’s post (loath though I am to refuse any compliments going, i don’t think this is meant for me!)
Dear Lady Fancifull,
You don’t know me (well not personally) but I wrote Cracked. Thanks for the kind review! Much, much appreciated.
Warmly
James
Ah, thank you James. Your book is one I’ve been repeatedly banging on about and urging people to read. Funnily enough I was at a social event tonight where a parent was talking about ‘social phobia’ in their child – who to be honest, sounded like someone who tended towards introversion and was not particularly at ease in a crowd – just another way of being a human being, in my book, who (if he’s lucky) won’r ‘grow out of it’ but will find compatriots who are similarly inclined, and gravitate towards a life where it is acceptable not to be a party animal – and I was talking about the perfidious DSM V in relation to this