If one in five of us are Eloi, then who are the Morlocks?

Dr. Helen links a post by ShrinkWrapped about the disturbing trend highlighted in a Drudge headline that read:

'1 IN 5' AMERICANS MENTALLY ILL
Hey, if that's true, that must mean that this blog has a lot of mentally ill readers. I won't comment on the authors, but there are at least four of us right now, so according to statistical odds... well, you do the math.

Here's ShrinkWrapped's analysis:

When I looked at the story my first thought was: How many of these people were unhappy rather than ill? How many were feeling terribly stressed rather than Psychiatrically disturbed? Then I noticed where the report came from: the Substance Abuse and Mental Health Services Administration or SAMHSA. I have no idea who they are but have two questions:

1) How do they define "Mental Illness"? It has become a protean concept meaning everything and anything from unhappy to abusive of Alcohol to committed to violent Jihad. Loose definitions of Mental Illness serve to decrease personal responsibility and justify expanded government intervention in order to ensure treatment to all these ill people.

For some time now, I have been concerned that "substance abuse" is a foot in the door for medical statism (in the form of urine testing, government invasion of patient medical records, and resultant "intervention"), and that under Obamacare, it is poised to become a huge growth industry.

Reading ShrinkWrapped, it's hard not to see a connection between the expanded definition and money:

Why don't we reserve the concept of Mental Illness for those who suffer from a serious definable Mental Disturbance that brings the person far out of the (wide) limits of normal human variability? I know this would decrease the income of some Psychiatrists, Psychologists, Social Workers, and various Counselors, but to be human is to function less than optimally much of the time, worse during periods of high stress. Pathologizing human variability and behavior is a sign of, dare I say, Mental Illness.
Aside from the increased income and expanded power of the treatment community, what is the consequence of labeling all these people as mentally ill?

They will be given medication. Substances. Drugs, if you will. Most typically, the drugs they'll get will be in the SSRI (Selective Serotonin Uptake Inhibitor) category.

The main indication for SSRIs is clinical depression. SSRIs are frequently prescribed for anxiety disorders, such as social anxiety, panic disorders, obsessive-compulsive disorder (OCD), eating disorders, chronic pain and occasionally, for posttraumatic stress disorder (PTSD). Though not specifically indicated by the manufacturers, they are sometimes prescribed to treat irritable bowel syndrome (IBS), Lichen simplex chronicus and premature ejaculation.

All SSRIs are approved in the U.S. for use with psychiatric disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

How many people are on these drugs? I don't know, but the number seems pretty high:
The number of people being treated with antidepressants increased from 13 million in 1996 to 27 million in 2005, rising from 6 percent to 10 percent of the population. More than 164 million antidepressant prescriptions were given out in 2008, generating $9.8 billion for pharmaceutical companies.
I'd say that if 20% of the population is mentally ill, there's a pretty good market that's still untapped.

Interestingly, some doctors in England (long overdosed on socialized medicine) say that they feel "forced" to prescribe these drugs:

GPs know they are overprescribing antidepressant drugs such as Prozac and Seroxat, but believe the lack of other forms of help for those suffering from mild depression and stress leaves them no choice, a survey reveals today.

The survey shows that 80% of GPs believe they are writing too many prescriptions for the SSRIs (selective serotonin reuptake inhibitors), as the class of drugs made famous by Prozac is known.

The findings are alarming in the wake of a decision last week by US drug regulators to demand a warning that some people might become suicidal on them, and the decision last year by the British regulators to ban most of them from use in children for the same reason.

Sales of Prozac, Seroxat, Lustral, Effexor and other drugs of the class have boomed as mild to moderate depression, anxiety and stress have become acceptable diseases of the late 20th and 21st centuries, linked to fast lifestyles and taxing jobs.

They have mostly been handed out by GPs, rather than hospital consultants, often in response to crises like marriage breakdowns, job loss and bereavement. Last year 500,000 prescriptions were written for Seroxat alone.

Writing too many prescriptions, huh? Isn't that called "overprescribing"? Don't they send doctors to jail for that? Oh, sorry, I guess they only do that when the doctors are overprescribing drugs the DEA doesn't like.

Still, an article in Psychology Today used the term "overprescribing" in reference to SSRIs:

We often hear concern voiced about "undertreated populations," even though the same psychiatrists know that 5,000 Americans recently began a new course of Paxil every day. But how credible is such concern, and is it truly warranted or a convenient way of changing the subject about overdiagnosis? The International Review of Psychiatry reported in June 2005 that more than 67.5 million Americans--almost one-in-four of us--have taken a course of antidepressant medication. Which begs another question: When do we reach a number or percentage so sizeable that concern about undertreatment tips appropriately into unease about overmedication?

The data reported by the article make clear that the outcome we're facing as a country is extremely troubling. If 4-out-of-5 Americans are being put on antidepressants out of concern about undertreatment, then 70-80% of SSRI patients are risking mild-to-serious side effects for symptoms they have not produced, for an illness they do not have. That makes no sense at all; it doesn't begin to add up.

It makes sense if the goal is to get as many Americans as possible on these meds. 67 million Americans ain't hay. I'm no economist, but it could be there's a lot of money at stake.

Or am I being cynical to smell a profit motive? Could an entire industry really have arisen with a vested interest in labeling as many Americans as possible "mentally ill" just in order to make money?

Are these drugs making Americans happier people and better citizens? Assuming that is the goal, is that the way the drugs work? I don't know but reading about what these drugs do to people makes me a little uneasy. If this piece by a psychiatric technician is even half correct, I don't think I would want to be on the stuff. He tried the stuff, and said it made him like an Eloi:

An initial mild euphoria took hold in twenty minutes as I continued to smell the roses. I sensed the medication's smooth absorption via the gastro-intestinal tract and insidious entry into the CNS. I hadn't tainted the results with prior research to self-administration. Everything felt free and easy, not a care on earth. Yet I could still make notes and identify plants.

The Paxil high got heavier an hour into the trip, with the thought: Are you anxious? Depressed? Obsessive? Uneasy with people? Then Paxil's the drug for you. One problem: You may never quit.

The absolute worst feeling I got from the drug, that is perhaps what most users embrace, was becoming an Eloi. The sensation was distinct and lasted for two hours. The Eloi are one of the two post-human races in H. G. Wells' 1895 novel The Time Machine. In the year AD 802,701, humanity has evolved into two sub-species: the Eloi and the Morlocks. The Eloi are the attractive upper crust living on the surface of the earth, while the Morlocks live underground, working and tending machinery that provide food, clothing and infrastructure for the Eloi. The Morlocks continue to support the world's infrastructure and serve the Eloi who have undergone drastic physical and mental deterioration. Having solved all problems that required strength, intellect and virtue, they have slowly become miscellaneous dingbats. It is revealed that the Morlocks are tending to the toiless Eloi's needs as a farmer tends cattle -- because the Eloi comprise most of the Morlock diet.

The whole thing is well worth reading, and his conclusion is disturbing:
Paxil, and the stable of like SSRI (selective serotonin reuptake inhibitors) antidepressants, are hands down the most pathetic therapeutic craze I've witnessed since earning a Psych Tech Certificate two decades ago. By rendering a patient or citizen unwilling to make judgments and incapable of taking stands, there is no role for them other than in the vegetable garden of life.

It's the most amazing, most common prescription in the world. So many millions more could be dangerous if they get pointed in the wrong direction.

I don't take SSRIs, and I don't especially want to.

This touches on something I read recently about SSRIs in the context of Dr. Stephen Schneider, who was sentenced to prison for overprescribing opiates to patients.

M. Simon and I have posted repeatedly about a federal prosecutor's vindictive rampage against pain relief activist Siobhan Reynolds, apparently for publicly defending Dr. Stephen Schneider

Glenn Reynolds linked Jacob Sullum's latest Reason piece about the bizarre (IMO) attempt to censor Siobhan Reynolds. Unfortunately, the Supreme Court declined to hear the case:

Reynolds unsuccessfully challenged Treadway's fishing expedition on First Amendment grounds in U.S. District Court and the U.S. Court of Appeals for the 10th Circuit, and this week the Supreme Court declined to hear her appeal. Perhaps the Court was impressed by the 10th Circuit's reasoning. We can't judge for ourselves, because the appeals court's decision is sealed, like almost every other document related to Reynolds' case.

The extraordinary secrecy is far broader than necessary to protect the confidentiality of grand jury proceedings, extending even to a friend-of-the-court brief, based entirely on publicly available information, that was filed last December by the Institute for Justice and my employer, the Reason Foundation (which publishes Reason magazine). Furthermore, one of the main justifications for grand jury secrecy--that it protects innocent people who are investigated but never charged--does not apply in a case like this, where the target of the investigation wants transparency and the government is trying to hide what it's doing.

While I am always against government censorship, there is something about the censorship in this case that never passed my common sense smell test. Why the long, blacked out pages in the amicus brief that Reason filed?

NOTE: That last link is misleading; the blacked out pages I'm referring to are here, and are referred to in Reason's brief. (I linked the discussion of it in my previous post.)

Perhaps I have too much natural curiosity, but I read through it over and over, and it just makes no sense. Sure, they wanted to silence Reynolds, but there had to be more to it than her contention that the government was persecuting Dr. Schneider.

In a news report about the case, I found a fascinating comment which offered an explanation:

The secrecy of the case isn't directly based on the chronic pain law suit against Reynolds, but rather, the cause of the patient's chronic pain injuries in the first place. The government is attempting to cover up a prevalence of injuries caused by SSRI antidepressant (induced Serotonin Syndrome) and other psycho pharmaceutical medications (induced Neuroleptic Malignant Syndrome) that these medications have caused throughout the world over the last five decades. The state governments could be implicated for causing these injuries if it is revealed that patients are forced on these medications in juvenile detention centers, prisons, children in state care, and court mandated treatment. It would implicate the federal government as causing injuries to our military soldiers, federal prisoners, and enemy combatants. It would implicate hundreds of thousands of doctors, hospitals, psychiatrists, and nurse practitioners who have concealed these injuries. It is known as the "White Wall of Silence" when medication induced injuries are simply diagnosed as a newly contrived illness to prevent a patient from filing a medical malpractice lawsuit. If a thorough investigation would follow the money, it would implicate pharmacies, distribution centers, medical researchers, and pharmaceutical corporations who have hidden the adverse effects of these medications. It would implicate prosecuting attorneys, defending attorneys, and court justices who have refused to allow these induced injuries admissible in courts. It would implicate lobbyist, elected and appointed officials, and federal regulators who have received financial gain and created legislation to conceal these injuries or to prevent lawsuits. I wonder how many well know suspected medication induced suicides could be implicated as homicide when it is revealed that certain known combinations of medications can induce predictable suicidal tendencies. A recent report shows that the FDA has not tested medications for mitochondrial damage which a key element to these chronic pain injuries. It's a world crisis that would make our current economic crisis appear as minor setback. After all, what industry would gain the most from a world economic recession (depression)?
In a later comment, Siobhan Reynolds confirmed that the above was the reason for the secrecy:
everything the poster said above my post is also true...Big bad story behind this whole thing..that is why the government went for such a BIG LIE with all the deaths...
And why they want it so hush hush...
Shhhh.......
Siobhan Reynolds
Pain Relief Network
OK, now, I am a total outsider and I do not know whether the possible interactions between SSRIs and opiates might be the reason for the secrecy. But I am a blogger, and so I have to at least entertain the possibility.

What if it is?

What is Serotonin Syndrome? The term is mentioned in the Wiki SSRI writeup I mentioned earlier, but it doesn't get into specifics as to how it might be fueled by combinations. This article does:

Serotonin syndrome has been reported with a combination of an SSRI and pentazocine, morphine, tramadol and dextromethorphan (found in some cough mixtures). Case reports of serotonin syndrome have been described for tramadol and paroxetine (Egberts et al, 1997) and tramadol and sertraline (Mason & Blackburn, 1997).
Which means that if Dr. Scheider's patients were also on SSRIs, then SSRIs might have contributed to the deaths along with the opiate drugs.

If a combination of opiate type drugs with SSRIs can be deadly, and a patient is being prescribed both, then why would the authorities single out only one category of drugs? Is there an anti-opiate witch hunt? Clearly, some drugs are more favored than others. And if some drugs are more favored than others, might some overprescribing be more favored too?

It seems quite possible.

It might also explain why Dr. Schneider got 30 years in the joint while the SSRI community will get billions in tax dollars to treat millions and millions more of us Eloi.

UPDATE: I published this post just as I was running out the door, so I didn't catch the fact that one of the links did not go to the document I thought I was linking.

Corrected.

Commenter Charlie Martin notes that "One in Five suffer from a mental illness" doesn't imply that "one in five is depressed". I hope I didn't imply that it did.

At any rate, depression is only one of the conditions for which the SSRIs are prescribed.

posted by Eric on 11.20.10 at 11:13 AM










Comments

Depends. Do they consider depression mentally ill?

The day I turned 36 -- yes, this is important -- I'd had a URI for about two weeks, which would not let me sleep. I kept meaning to go to the doctor, but at the time we had only my car and my husband only got home after the doc in a box closed. The day of my bday ALL the submissions I had out -- about 60 short stories and one novel -- came back rejected.

My husband came home early, so we could go to dinner, but I looked so bad he took me to doc in a box. Who gave me antibiotics and then proceded to tell me I needed prozac, because I was clearly clinically depressed.

I told him no, while I was depressed I had good reasons, between lack of sleep and really bad disappointment. He told me I only THOUGHT so and I was really just chemically imballanced and prozac would make me all better. I told him unless they showed me a TEST result for this imballance, I was NOT taking prozac. He said they didn't have a test, but they could tell because when you gave someone prozac, they did much better.
When I called him a witch doctor (he was an MD, not a psychologist or psychiatrist, btw) he called my husband and tried to convince him to make me take the prozac. My husband called him a witch doctor and we left with the antibiotics.
I know this is tangentially related to the post, but whenever I read these statistics that's what I think of. Let me see, they won't let us medicate ourselves, but the medical profession considers even justifiable and, let's face it, sane depression a medicable "mental illness".

Oh, what a brave new world this is...

And M. Simon -- you can't be a little schizophrenic. The word for that is "author." (And it is not, so far, mwahahah a medical condition.)

Sarah   ·  November 20, 2010 11:55 AM

Gotta say, I'm pretty happy with my Prozac habit. Or rather, I'm not depressed, and I'm as big an asshole as I was before I started taking it.

Anonymous   ·  November 20, 2010 12:00 PM

There's a "not" missing in that comment.

Anonymous   ·  November 20, 2010 12:03 PM

As someone who actually does need the damn things, I suspect that a lot of the prescribing is done in lieu of what should happen - namely, a bit of sympathetic human contact, possibly extending to counseling. It's only if that fails that the next step up needs to be considered.

I actually do have actual clinical depression. If I wean off the antidepressants, within a week or two of getting past the "withdrawal syndrome" (Yes, they are addictive, and withdrawal is hellish - as I've discovered when I've forgotten to take the things), I'm non-functional and tip to suicidal very quickly.

I rather doubt a quarter of the population has this problem. Most have perfectly normal grief/upset/shock as a result of adverse circumstances, and will recover with a sympathetic ear and possibly counseling (As always, there's good and bad - I've found cognitive therapy to be very helpful, and I've had some very good psychologists who've helped me to track down old, festering issues).

Unfortunately neurological disorders are largely still witch-doctoring. The DSM-IV can be used to diagnose anything with anyone. Until brain function is understood it's going to be that way.

Kate   ·  November 20, 2010 12:22 PM

QOTD:

you can't be a little schizophrenic. The word for that is "author."

Eric:

You're making a logic error. "One in Five suffer from a mental illness" doesn't imply "one in five is depressed".

Charlie Martin   ·  November 20, 2010 12:56 PM

Charlie, I don't think I implied that. Nor would I; my objection is to the ever-larger numbers of people given SSRIs. I'm not saying 1 in 5 Americans are depressed; only questioning the wisdom of medicating 1 in 5 Americans with SSRIs.

Eric Scheie   ·  November 20, 2010 3:55 PM

Do I qualify? What are the benefits?

M. Simon   ·  November 20, 2010 6:50 PM

...there are at least four of us right now, so according to statistical odds... well, you do the math.

Is it a normal distribution?

M. Simon   ·  November 20, 2010 6:52 PM

Let us suppose they are telegraphing something. About 1 in 5 are genetically susceptible to chronic substance use. If that whole cohort is in trouble we must be in a very high stress era.

It may also substantiate my analysis from a while back that 15% to 25% of the population are regular drug users as opposed to the 5% of [strike]Jews[/strike] drug users actually reported.

M. Simon   ·  November 20, 2010 6:58 PM

I agree with Kate above, SSRIs are being used instead of other treatments, where use in conjunction with would help so much more.

We also tend to see SSRIs as miracle workers, and become surprised when they turn out to be lacking in some area. So we get adolescents and young adults on Prozac or Paxil, but not under observation because we think their suicidal tendencies have magically gone away.

I credit insurance companies in large part for this, for they don't want to pay for counseling and hospitalization. So you get suicidal people walking around ineffectively treated and doing themselves in.

The criminalization of mental illness is a subject for another day.

Alan Kellogg   ·  November 20, 2010 7:14 PM

Pot is one of the most benign anti-depressants known to man.

I'm sure that is part of this. In fact it is one reason Big Pharma supports "The Drug Free America" coalition. Pot wouldn't be free. But it would be tenths of a cent a dose vs dollars a dose. That kind of competition would cause a collapse in the anti-depressant market if 25% of anti-depressant users could benefit from pot. If it was significantly more than that? The drug makers would find themselves really depressed.

M. Simon   ·  November 20, 2010 9:08 PM

I was told by a well-informed mental health practitioner that in order for a patient's problem to qualify for a standard DSM mental illness diagnosis, it has to be treated by medication, or else the DSM diagnosis won't withstand scrutiny by the relevant bureaucracies and insurance companies. Hence the medication (usually by SSRIs).

If this is true, it sounds nightmarish.

Eric Scheie   ·  November 20, 2010 11:57 PM

I'm the one who mentioned depression, Charlie -- partly because that's the most common "medicated" issue. I mean, we're doing enough prozac for significant amounts of it to end up in the water.

I agree with M. Simon on the self-medicating, which can be at least as effective (though not always.) I don't do it, but that's because I self-medicate for any weird wobble in my canter by writing it out into novels. Heaven help us if I am ever unable to sell the novels.

M. Simon -- the benefits suck, but at least you're never alone. And your characters can give you enough of an argument to spare your loved ones. :)

Sarah   ·  November 22, 2010 10:41 AM

"Let us suppose they are telegraphing something."

Let us suppose we're not paranoids.

Rob Crawford   ·  November 23, 2010 10:50 AM

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