From the British Medical Journal The Lancet comes a review of two books, The Myth of the Chemical Cure, by Joanne Moncrieff and Side Effects by Alison Bass. It’s an important review. I’ve mentioned both these books and authors on this blog before.
This is a widely respected medical journal that is allowing for sharp criticism of psychiatric drugs and psychiatry. If you are not subscribed to the Lancet it’s very easy to do so and it’s free. Here is an excerpt:
The spinning chair. Bloodletting (copious). Removal of possibly infected viscera. Extraction of teeth. Electric shock. Forcible restraint, for days or weeks. Wrapping in cold blankets. Brain damage. Repeated coma. Back-breaking convulsions. Slicing through the brain with an ice pick. Sterilisation. Female genital mutilation.
Since the Enlightenment, all the above have been used to treat the “mad”. Even the most grotesque treatments have often been introduced as humane alternatives to existing options. In the 1950s, the chemical lobotomy, or “hibernation therapy” was introduced. Patients were given a drug that rendered them immobile and semiconscious for days, on the assumption that they would emerge improved. The drug was called a “neuroleptic”, or brain restrainer. Its name? Chlorpromazine. Since marketed as an antipsychotic, it is used, at lower doses, today. So too are a host of related drugs. Many doctors, and some patients, swear by them (other patients swear at them).
Antipsychotics are, at times, cruel drugs. Some cause shaking, salivation, restlessness, infertility, stiffness, agitation, and frail bones; others cause obesity, somnolence, and increase the risk of heart attack, diabetes, and stroke. Antidepressants also have side-effects, although theirs are typically less dramatic: sickness, sexual dysfunction, a feeling of being numbed, or losing one’s personality, and acutely increased risk of suicide. But side-effects, when they occur, seem justified, since mental illness is extremely unpleasant; and evidence indicates that the drugs work.
What if they didn’t? In The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment, psychiatrist Joanna Moncrieff has amassed copious evidence that perhaps the drugs don’t work. What have we missed, all these years? Selective and misleading outcome measures; inadequate follow-up; selective attention to evidence; publication bias; and our ability to define questions whose answers are predictable, but partial. Robert Whitaker’s Mad in America (2001) provided a breathtaking overview; Moncrieff, by contrast, examines many studies in detail. The Myth of the Chemical Cure is not always easy reading, but I do not think that serious psychiatrists can afford to ignore Moncrieff’s book. It is a mine of information; a provocation to think creatively and compassionately about patients; and a momento mori, the equivalent of a mediaeval scholar’s skull staring back from his desk: our works are mortal, and our paradigms always limited. (read the rest) — emphasis mine