As a practicing child psychiatrist, I agree with some of B.K. Eakman’s points regarding psychotropic medications (Cultural Revolutions, May) but not with the main thrust of her argument.
Before the mid-1950’s, there were no effective treatments for mental illness. None. Psychotherapy was, of course, in full flower, and psychoanalytical theorists (Freud and his followers) ruled the field. Unfortunately, their practices were largely oriented to the “worried well.” The state hospitals were crammed full of the severely psychotically ill who suffered terribly. When the first antipsychotic drug, chlorpromazine, and first antidepressant, imipramine, appeared, the results were so startling that thousands of patients were able to be discharged from mental hospitals.
These early drugs work well to this day, but they (like all drugs) have side effects. Thus science (and, yes, that includes pharmaceutical corporations) has strived to find drugs that might work better with fewer, or less bothersome, side effects. The Prozac generation of antidepressants came along in the late 80’s. The big improvement over the older drugs is the relative lack of danger in case of overdose. They also cause fewer “nuisance” side effects, such as weight gain. Whether they can cause what we shrinks call “behavioral disinhibition” is a matter of debate. I’ve never had a patient who was taking these drugs kill someone, but I have, occasionally, seen an increase of temper or aggressive behavior. Generally, you can spot this, change the dosage or the drug, and all is well.
The argument that, because the Harrises and Klebolds of the world all seem to be on meds, meds must be bad holds no logic. I use and will continue to use psychotropic drugs in my practice so long as I believe that they help people and that the risk of harm is low. That ratio of good versus bad has to be strongly weighted in favor of the positive.
I read a lot of conservative publications and, in general, detect an undertone of hostility toward psychiatry. This may reflect more on the type of people in the specialty than what we psychiatrists actually do. I would estimate that 25 percent of my colleagues are homosexual; only five percent, Christian; and the vast majority, left-liberal in political view. This undoubtedly has some impact on the way in which they practice psychiatry.
Unfortunately, mental illness is very real and needs treatment. Within the realm of medicine, psychiatry is a low-prestige, relatively low-income specialty, and, politics aside, there are a lot of honest, hard-working physicians trying to help their patients with whatever will work best.
—Mitch Parsons, M.D.
Mrs. Eakman Replies:
If Dr. Parsons finds “an undertone of hostility” towards psychology and psychiatry among conservatives, and if he notes that many of his colleagues tend to be politically liberal and sexually confused, this is not surprising. The politically left-leaning, in my experience, tend to prefer a quick fix to the arduous, long-term challenge of dealing with life experiences, which requires a certain strength of character.
Where psychology and psychiatry—and, indeed, all of the behavioral sciences—began to go wrong was when guilt and conscience began to be condemned. In the 1940’s, the argument was that guilt and conscience forced people to take responsibility for feelings and events beyond their control. This view was promoted heavily after World War II by Drs. Broch Chisholm, Ewen Cameron, and John Rawlings Reese, among others. Then these ideas made their way into women’s magazines. Women of the immediate postwar era were vulnerable to this logic and ready to accept it. “Do you want to be a Hitler, a Mussolini?” psychologists challenged. Nobody did. So this effort to eradicate or at least soften guilt, sin, shame, and conscience during the 50’s and 60’s started to overturn 2,000 years of Judeo-Christian thought.
Suddenly, we were looking at guilt and conscience not as civilizing influences that reign in the baser instincts but as neuroses and psychosis. Of course, troubled people would prefer to let a pill cure their troubles or at least help them to deal with their problems rather than take on the incredibly difficult task of applying religious principles.
To save his own life, a person with homosexual tendencies should learn not to practice his behaviors at all. Ever. That is easy to say, of course, but not easy to do. The person who is hypercritical and without patience, whose gut reaction is to cut down anyone who gets in his way or annoys him, should learn to stop his tongue, to say nothing, to think something else every time, period. Again, easy to say, not easy to do. But that is what Christianity demands. The Sermon on the Mount sets out this principle repeatedly. Better to lose one of your limbs, Jesus said, than to cast your soul into hell.
Any psychologist will admit that, once the behaviors mentioned above become habits, they will quickly become ritual obsessions, wreck your life, destroy any enjoyment that you may otherwise have—and you cannot fix that with a pill, with electroshock, or with psychotherapy.
I never claimed that all people who take psychiatric drugs go berserk. I wrote that angry persons who take antidepressants often lose impulse control. Does that mean murder? No. But it may mean throwing the pan of oatmeal boiling over on the stove right through the window, or smashing the computer keyboard because you hit a wrong key. Many adults who are prescribed antidepressants for migraine headaches and other problems have had such reactions and are too embarrassed by these behaviors to tell their doctors. Some simply stop taking the pills, citing the excuse that “I just didn’t feel good.” But what about kids, who lack impulse control anyway? They aren’t going to make the connection between out-of-character behavior and normal teenage impulses.
I find it troubling that Dr. Parsons should applaud the fact that so many mentally ill people have been discharged from hospitals now that psychiatric medications have allowed them to “function” in society. Is that why we have thousands of rapists, murderers, pedophiles, and folks with criminal records as long as your arm running amok?
We are dealing with a problem of perspective. Side effects such as weight gain do not compare, in any way, with such side effects as loss of impulse control, and pills and psychotherapy cannot take the place of character, integrity, and conscience.