By Robert Whitaker
August 13, 2022
Source: Mad in America
Photo / Image Source: Unsplash,
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Harm Done
In their responses to Moncrieff’s paper, many psychiatrists sounded a “no harm, no foul” argument. “Antidepressants work,” they stated, and thus the prescribing of antidepressants was a helpful practice, even if there was some confusion about the cause of depression and what the drugs did.
Here is how Massachusetts psychiatrist Daniel Carlat put it, in his interview on National Public Radio’s “On Point” program:
“Doctors don’t know exactly about how (antidepressants) work. Patients do want to know there is an explanation out there. And there are times when we do have to give them a shorthand explanation, even if it is not entirely accurate.”
In terms of harm done by the chemical imbalance lie, whether an antidepressant reduces the patient’s symptoms over some period of time is beside the point. The chemical imbalance story informs the patient that he or she suffers from a brain pathology, which requires treatment with a drug that treats that pathology. That is a diagnostic story that changes a patient’s sense of self and understanding of his or her own mind. Moreover, the treatment is designed to change how the individual emotionally responds to the world—this is an intervention of a most profound sort.
Indeed, the decision to take an antidepressant puts the patient on a different life course. It puts a person on a path of a medicated future, as opposed to the life the person had known before and the life that the person might have if he or she sought some other non-medical form of treatment. In that sense, the decision of whether to take an antidepressant acts as the proverbial fork in the road—two different lives stretch ahead.
That is the harm done when the chemical imbalance story was told to patients seeking help for depression: They made a profound decision about their future based on a lie.
The chemical imbalance story also did harm at a societal level. It remade our collective sense of self.
Before Prozac arrived on the market, a NIMH survey found that only 12% of American adults said they would take a pill to treat depression. This was a survey that told of a public that understood, at some level, that to experience periods of suffering was normal, that life had its ups and downs, and that often people could call on an inner resilience—and environmental support—to lead them out of the tunnel of darkness.
But then came the selling of psychiatry’s disease model, and in fairly quick order the public came to see human nature in a new light: our moods were directed by a molecule called serotonin, and if a person experienced depression, they had, in the words of Nancy Andreasen, a “broken brain.”
This is a conception that also stifles political efforts to create a society that better nurtures mental and emotional well-being. The chemical imbalance story placed the cause of depression within the brain of the individual, which fits a neoliberal agenda, but produces a blindness to social conditions that promote suffering and depression: poverty, lack of access to decent housing, poor childcare support, and so on.
As Moncrieff wrote, surveys have found that more than 85% of the public came to believe that depression is caused by low serotonin. That number tells of a conspiracy—by a guild, pharmaceutical companies, and academic psychiatrists—that profoundly betrayed our society. They told us a story that their own research had shown to be false, and they did so because it benefitted guild interests and the financial interests of pharmaceutical companies.
As for the members of the scientific councils, they were signing off on a story that kept them in good standing as industry “thought leaders” and further burnished their public reputations as leaders in the field.
From a legal standpoint, it doesn’t really matter whether “antidepressants work.” Lying to patients and to society is a form of medical battery, and any possible therapeutic benefit doesn’t excuse that deception. However, when that “antidepressants work” claim is examined, it can be seen that it is a continuation of the false marketing of these drugs.
How can such practices impact your health? Why? What is your experience?
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