Protesting Against Drug Companies Is One Thing

Peter Gotzsche, professor of psychiatry in Copenhagen, is a noted critic of psychiatric drugs and the psycho-pharm establishment.

So far, no problem. Many others are too. The prescribing of psychoactive drugs has gotten totally out of control. Psychiatry has passed from being the lowest-prescribing medical specialty to the highest.

Gotzsche also blows the whistle on how companies manipulate clinical trials, submerges doctors in a fog of propaganda, and generally keeps up the bottom line by damaging public health.

Hey, no problem. All this is true. But there's one thing: Let's not throw the baby out with the bathwater.

Current prescribing practices and industry PR strategies are the bathwater. They all help to create a kind of psychological dependency on drugs. It is as though insulin were being currently prescribed for the common cold or for sore elbows.

But insulin has a real place in the treatment of diabetes, and psychopharmaceuticals have a real place in the treatment of psychiatric diseases.

And it is this reality that is in danger of being lost sight of in media celebrations of Gotzsche and his views. (I attach one such celebration that ran in the main Madrid newspaper (Sunday, September 25, 2016). But you can find a lot of such stories: alarmist, disproportionate, and leaving readers with a vague feeling of unease that, in psychiatric drugs, some kind of scam is going down.

It's not.

Penicillin and the other antibiotics transformed the practice of medicine, making it possible to cure—absolutely cure—infections that previously would have resulted in amputations or death. Penicillin and antibiotics were wonder drugs.

The psychopharmaceuticals that reached the market in the decades following 1950 were wonder drugs as well. Chlorpromazine was the first of the antipsychotics: It tamped down the delusions, hallucinations, and agitation of people with major psychotic illnesses enough that they could be discharged from mental hospitals and have more or less normal lives. Never before in history had anything like this happened in psychiatry.

Lithium, introduced in 1949, stabilized patients with mania and hypomania, who previously might have agitated, and agitated, and agitated, within the asylum, until they ran out of energy and died of exhaustion.

The antidepressants that reached the market in 1957 opened a new era for patients with serious depression. Electroconvulsive therapy had been available since 1938, but many were fearful of it. The new antidepressants gave people with deep depression their lives back. For those who have never had serious depression, it is difficult to comprehend what this means. But one observer said that the only illness more awful than psychotic depression is rabies.

The new psychoactive drugs truly opened a new chapter in the history of civilization. Previously disabling diseases of the mind could now be managed, relieved, their sufferers permitted to lead again relatively normal lives, as opposed to vegetating on the hidden wards of a mental hospital, smearing their excrement and tearing their clothes into shreds.

The new drugs, on the whole, have been a blessing, and it is unnerving to see the whole psychopharmacological enterprise now trashed in an indiscriminate manner, the baby, as I said, thrown out with the bathwater.

Granted, people should be suspicious: Do I really need this Prozac-cousin? Maybe exercise therapy or psychotherapy would achieve remission of my symptoms more reliably or safely? These are totally valid questions, but your physician may well not ask them—his or her waiting room filled, and the prescription pad sitting there ready, inviting the gift of time.

But there are really serious psychiatric illnesses too. And exercise therapy and psychotherapy have placebo status in confronting melancholic depression or psychotic ideation ("Grandpa thinks grandma has been unfaithful and wants to kill her").

It worries me that the anti-psychiatric hype surrounding Gotzsche will turn heads and that Gotzsche, however laudable most of his efforts, will lead a children's crusade off the cliffs and into the gulch of madness.