Friday, July 01, 2005

Myth, History and Mental Illness

I'm sure that we've all herad about Tom Cruise's brilliant remarks stipulating that "there is no such thing as a chemical imbalance" and that Brooke Shields should have "exercised and taken vitamins" in order to deal with her post-partum depression. Brooke Sheilds was obviously none too happy about Cruise's anti-psychiatry rant.

But before I dismiss Cruise's commentary out of hand, I have to ask, does he have a point?

Let's take it point by point.

Tom said: "Matt, you have to understand this. Here we are today, where I talk out against drugs and psychiatric abuses of electric shocking people, okay, against their will, of drugging children with them not knowing the effects of these drugs. Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug? Do you understand that?"

ECT has always been controversial and yes, people are forced, against their will to have ECT. Of course, ECT has been used for centuries. In the past, physicians used electric eels to shock patients, theorizing that this therapy would reverse severe mental illnesses like schizophrenia. In the 1950s and 1960s, ECT was vogue and patients often underwent 100s of shock sessions to induce changes in the brain. However, oftentimes too much electricity was used too frequently and the result was severe memory loss and brain damage. After One Flew Over the Cuckoo's Nest came out, ECT was all but abandoned. However, more experimentation in the 1990s led to the development of better ECT, which has proven itself the safest and most effective treatment for severe depression or mania today. According to several different mental health organizations, ECT has a success rate of around 80%, while anti-depressants sit at around 50-60%.

Next, Tom claims that we drug children against their will. That's also potentially true, but as many parents know, the medical treatment of children is a parent's responsibility. Whether or not children know the potential side effects of cough syrup, anti-febral agents or antibiotics really isn't relevant. Moreover, parents are informed of the side effects of medication that were uncovered during their FDA trials. That information is readily available and if it isn't or if side effects were not uncovered, the fault lies with pharmaceutical companies and the FDA, not with the practice of psychiatry.

Addera,, and Ritalin. Well, I've taken both in the past so I can speak to what they are. They are amphetamines, derivatives of what most people would think of as speed. They act in a contradictory way, slowing down afflicted individuals while normal folks will get hyper. They gave me a headache. Regardless, Tom's claim that they are used as street drugs and therefore, are bad, is stupid. Everything and anything could be used as a street drug. I mean, it's almost like saying, do you know what super glue is? Do you know that it's used a street drug? Well, so what? I'm not going to stop using super glue because some idiots sniff it to get high. People abuse substances.

Next Cruise quote: "All it does is mask the problem, Matt. And if you understand the history of it, it masks the problem. That's what it does. That's all it does. You're not getting to the reason why. There is no such thing as a chemical imbalance."

First point, do drugs mask the problem? In some instances, I'd have to say yes. We all know people who actively make horrible decisions and become unhappy as a result. Instead of working on their decision-making processes, they hope that taking a little pill everyday will make everything better. Those people abuse psychiatry when therapy would help them change their lives in a more meaningful way.

That being said, it would be and is an absolute mistake to assume that just because such people exist, that all mentally ill people fall into that category. Perhaps one of the most frustrating experiences a person can have is feeling anxious, scared or paranoid and running into a well-meaning loved one asking, "why are you anxious?" Well, if I knew why I was anxious, I would take active steps to prevent anxiety in the future! Sometimes, there is no psycho-spiritual reason for unhappiness or hallucinations or whatever. They just happen.

I would be fascinated to see how Mr. Cruise would explain the well-documented changes visible in a bipolar or schizophrenic brain. Tell me, Mr. Cruise, would exercise or vitamins decrease the size of a bipolar patient's enlarged basal ganglia? Or perhaps you would like to tell the obsessive compulsive person who has plucked one side of the scalp completely bald that taking more vitamin C would cure her?

Tom's next quote: "But what happens, the antidepressant, all it does is mask the problem. There's ways, [with] vitamins and through exercise and various things... I'm not saying that that isn't real. That's not what I'm saying. That's an alteration of what I'm saying. I'm saying that drugs aren't the answer, these drugs are very dangerous. They're mind-altering, antipsychotic drugs. And there are ways of doing it without that so that we don't end up in a brave new world. The thing that I'm saying about Brooke is that there's misinformation, okay. And she doesn't understand the history of psychiatry. She doesn't understand in the same way that you don't understand it, Matt."

I have to say that I agree with Tom. Drugs are not always the answer and they most certainly can be dangerous. When friends ask me if they think that they should start taking a drug, I always tell them to try EVERYTHING else before they start. Taking anti-depressants or any other type of psycho-active drug is a serious decision. Of course, by the time a patient makes it to a psychiatrist, chances are they need some serious help. That's another thing I tell my friends. Never NEVER take psychiatric drugs from a general practitioner. NEVER. They aren't qualified. I don't care if they did a rotation in psychiatry. Nope. This is the only life you have and you deserve a specialist. Rant over.

Psychiatric drugs are absolutely dangerous, much moreso than Tylenol or other over-the-counter drugs. They can easily kill you, but there's a cost/benefit analysis that needs to go on here. Would you rather take a drug that has side effects, or would you rather kill yourself or risk hurting yourself or others?

"They're mind-altering, antipsychotic drugs." Well, no. These drugs are mind-altering in that they change the chemical interactions in your brain. However, they're not mind-altering like LSD, which dramatically changes perception. And they're not "antipsychotic," either. Antipsychotics are a very specific type of psychiatric drug and Tom's conflation of antipsychotics with antidepressants clearly calls into question the validity of anything he's trying to say. Psychosis and depression can go hand and hand, but dare I say they don't commonly cuddle with one another. Psychosis is an altered perception of reality to the extent that real and unreal are not as black and white as they should be. Seeing things, hearing things, and smelling things that aren't there is quite a bit different than being sad. Very different. Believing that you can fly, that you're invincible, that aliens are communicating with you is different from feeling weepy. Slicing your skin open with a knife to let the bugs out is different from insomnia. Failing to recognize that destroys his credibility.

The history of psychiatry? Now that's a topic. Psychiatry runs back centuries, millenia really. Hippocrates mentions characteristics of mentally ill people. Bipolar disorder was being studied as early as the 1500s. Psychiatric medications really only bubbled up in the 1950s. Previous to that, psychiatrists typically followed one of the European philosophers, Jung or Freud or Erikson to try to help people. There was a branch of psychiatry that believed that in order for women to recover from their hysteria, orgasms were necessary and as such, vibrators were originally marketed as a medical tool. Yep, people had some odd ideas. But fact of the matter is that people were suffering and medicine has responded to that. Early Cesarean sections were butchery just as early ECT was butchery. Now these procedures help people. I'm curious to know what particular history Mr. Cruise is referring to. There's so much; it's a very rich field. From Robert Stoller's gender identity clinic to the develpment and administration of thorizine, there's a lot there.

Tom's next quote: "You don't even know what Ritalin is. If you start talking about chemical imbalance, you have to evaluate and read the research papers on how they came up with these theories, Matt, okay? That's what I've done. Then you go and you say where's the medical test? Where's the blood test that says how much Ritalin you're supposed to get?"

Well, the National Institute on Drug Abuse seems to disagree with Tom on the value of Ritalin and the nature of the chemical imbalance that causes them. In terms of blood tests, that's an interesting point and one that I have made myself. While I'd like to see physicians invent some kind of definitive test, I think it's dramatically stupid to say, "well, there's no test for that so it doesn't exist." Clearly, AIDS existed in the 1970s before there were tests for it. Where's the blood test that can tell you you have a cold? Moreover, the amount of medication each person needs is highly specific. One 120lb person might take 10mg of ritalin and another might need 30mg. It's a severity issue. And if a blood test could tell me how severe my cold was, I'd be hella impressed.

And Tom's final idea? "Matt, but here's the point. What is the ideal scene for life? Okay. The ideal scene is someone not having to take antipsychotic drugs."

Well, who couldn't agree with that? It would be excellent if there was no disease and if I could snap my fingers and not be bipolar. But we don't live in a fantasy world where taking a walk will cure hallucinations and popping a multivitamin and eating kiwi will make a manic person come back down to earth. I don't think there's one ill person who wouldn't agree that being well and not having to take drugs would be much, much better than being sick. But what kind of point is that? It would be ideal if I could fly too! Let's live in the real world.

Is Tom Cruise being insensitive? Absolutely. He clearly still believes that psychiatry is how it was 60 years ago.

There are nuggets of truth in what Cruise is saying, legitimate criticisms that might be useful if expressed with some degree of intelligence. It's a shame that Cruise is the one saying this stuff. An intelligent advocate of mental health reform could actually sit there and say that the FDA should have more stringent testing on medicinal trials, that states should actively chart the effectiveness of ECT and other controversial procedures, etc. Cruise, on the other hand, is useless. Worse than useless, actually; as the American Psychiatric Association said, "It is irresponsible for Mr. Cruise to use his movie publicity tour to promote his own ideological views and deter people with mental illness from getting the care they need."

I'm saddened by this media frenzy because a great opportunity to talk about the benefits and detriments of psychiatric care has been missed. Psychiatry is a mixed bag and someone with the visibility of Tom Cruise could really educate himself and talk about it. Instead of saying divisive and unhelpful things, he could have facilitated a national conversation about something other than his curious relationship with Katie Holmes.