I came across a very interesting two-part review on several books about mental illness and psychiatry in the New York Review of Books today.

The first part is here:  http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/. The reason that the reviews came to my attention is because the reviewer, Marcia Angell, is garnering a fair amount of backlash from the psychiatric community. It may be that she hit a little too close for their comfort.

Angell’s round-up includes three authors who cover a variety of important and thought-provoking issues and problems within the realm of mental illness treatment in their books, and who share similar views on the direction that treatment has taken. (I’ve read the Whitaker book, and found it fascinating).

Since the advent of the psychoactive drug revolution – starting with Thorazine in the 1950s, but really ramping up with Prozac in the 1980s – the people of America are being diagnosed will mental illnesses and treated with medications at a staggering rate. About 10 percent of Americans over age six now take antidepressants, and the new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US, according to Angell.

While the review highlights many linkages throughout each of the books in the evolution of mental illness treatment in this country, the bottom line is this: psychiatrists are prescribing drugs instead of employing talk therapy (or other therapies) because they get more money that way, both from insurance companies, and from the pharmaceutical companies with whom they’ve developed some ridiculously close, and to me, patently unethical relationships.

The psychiatric community, of course, is screaming mad. Some of the letters to the editors were published last week: http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/.

Nothing is black and white, both sides have strong points, and, as is often the case with discussions about clinical study findings, different stakeholders will place emphasis on different findings, so it’s hard to know which outcome to believe. If we can just pull our focus away from the finger pointing in this argument for a moment, however, there is another basic point that needs to be considered, and it is found in the last paragraph of the second part of Angell’s review: “Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better.”

I am not saying that we shouldn’t utilize medication. What I am saying is that we shouldn’t stop there, and be content with that modality of treatment. We must acknowledge that there are huge risks with these drugs. There is research that points to evidence of cognitive impairment after years of taking anti-psychotic and bi-polar medication. Some of the risk is in the unknown. These medications are new enough that we haven’t seen all of the long-term effects play out.

There are also some heavy side effects. My mom has been taking Zyprexa (Olanzapine) for just over two years now. Within six months of starting the drug, she had significant tremors in her hands and legs, and they’ve never gone away. She isn’t able to stand still anymore, and constantly shifts her weight from one foot to the other, like a small child that has to go to the bathroom. In fact, she now says that she “needs to pee” about every fifteen minutes, and I’m wondering if that is due to the anti-psychotic medication, too.

Have her primary symptoms of paranoia and delusions improved? Most definitely. Would other therapies work as well on these symptoms? I don’t know. But her case, and those of many others whom I’ve read about in my research, leads me to believe that we are doing ourselves a very great disservice by relying so heavily on drugs, to the detriment of the development or continued use of other treatment options.

As we’re hearing from Angell and others, the system doesn’t support other options. Prescription coverage is standard with most medical insurance plans, long-term outpatient mental health services are not. Not only are psychiatrists and doctors defaulting to medication instead of talk therapies, it is also less costly for the patient. As we know, though, you get what you pay for. For a country like America, that prides itself on its ability to innovate, it is shameful to settle for such a one-dimensional approach when it comes to the well-being of its citizenry. I echo Angell. We need to do better.