Levine's critique is good as far as it goes, but he seems to overlook some of the pressures within psychiatry to move so dramatically to a biological model. Surely the fact that they lost exclusive control over the therapy field as other disciplines such as psychology, social work, counseling and nursing developed license-eligible clinical training programs is a piece of it. Plus psychiatrists have been on the low end incomes for physicians. Other physicians have often viewed them as not "real" doctors. Likely these pressures laid the groundwork that Big Pharma has been so able to build on.

And sadly, we psychologists are not innocents in all of this either. In our haste to make ourselves "scientists" we have become captive to outcomes studies, neuroscience and the like just as much as psychiatrists have been -- there's just not as much money in it for us as for them.

Phillip, This is great stuff - though you're right about him not pounding the atypicals.

The SSRIs have been out there since Prozac in the 1980's, and even though there are ongoing battles like the age on the warning label, the real battles are sitting in the atypical camp. The FDA has allowed all but Zyprexa to officially give them to younger (adolescents) children. There is no medguide. There has been no criminal trial against Eli Lilly. This is not to say that there haven't been victories. Releasing the internal documents, for example, was a big one. But great damage continues to be done, incuding massive off label use with young children, continued diabetes, and catastrophes from polypharmacy.

"In 2000, sociologist Robert Putnam reported: 'Low levels of social support directly predict depression.' Several studies show that people who have close friends, friendly neighbors, and supportive coworkers are less likely to experience symptoms of depression.

you don't freaking say. thank you for the eloquent summary.

Hey Philip, I don't know if you've already gone into this somewhere in your archives, but I would love to see some of the evidence against the serotonin hypothesis. I've always heard it touted as a "fact" and that taking it is like taking insulin.

I guess since they use the same diagnostic criteria, i.e. the DSM, I've always thought of psychologists and psychiatrists as about equally troublesome. Back when I got my masters in counselor education one of the profs jokingly pointed out that psychologists know that psychiatrists are fools and counselors know that psychiatrists and psychologists are fools. I'd agree with that over generalization and add that all three realize that social workers, the ones with the least training and often the most power (to have DFCS take children away from families, etc) are the scariest.

But then I don't work as a counselor anymore. Still I'm proud that as far as I know counselors never tried to get prescribing authority and charge less and sometimes will just listen.

My memory is that around the time Prozac was making it's debut, lots of studies were being touted about how talk therapy didn't really work but instead went on for years leaving some to question the motives of the therapist. And the social sciences do have their inferiority complex.

I was speaking recently with a psychiatric patient, who asked me what I did for a job.The person made sure to beg me never to become a psychiatrist, to please be a counselor, because "the drugs are what make me sick". The first being Paxil. It was an interesting conversation to hear from a psych patient, not wanting medications inside a psych ward.[just try that].

With the recent literature showing antidepressant benefits of behavioral activation/exercise, more conviction is added to my slowly grown realization that mental health clinicians are now usually tasked with enabling people to live in a society that poorly fits our enduring atavistic qualities that once allowed us to survive most of our time spent on this planet. Our wiring hasn’t changed. Our society has.

The population graph (Link below) represents only a small portion of our estimated 200,000 years on this planet as homo sapiens. We are wired for then, but trying to adapt that wiring to now.

http://en.wikipedia.org/wiki/Image:Population_curve.svg

We have very short memories and incredible capacities to “normalize” any set of circumstances, no matter how anomalous. We think of such things as these to be fully normal: air conditioning, 40 hour work weeks, grocery stores, televisions, mirrors, paper, computers, roads, sewage systems, clocks, houses, plumbing, plastic, stereotyped suburbia, franchises, shopping malls, transportation …

** We are wired as social animals, dependent upon stable relationships over time to exist at all.
** We are wired to be active, restlessly searching over the next hill for food or shelter and moving with the seasonal changes of food sources.
** We are wired to be vigilant (a.k.a., anxious), so that we are not eaten.
** We are wired with possibly lethal anger that we might protect ourselves or our group from harm.
** We are wired to be predatory, that we might eat.
** We are wired to rise and rest with the passage of the sun.
** We are wired to persistently make offspring and nurture them, else we perish.
** We are wired for the speed of nature … slow much of the time, with bursts of frenzy to survive.
** We are wired to make it through times when food is scarce.

We generally didn’t live beyond our third or fourth decade. There was probably no opportunity for “angst.” Our purpose was clear. Survive.

Instead, increasingly, we live fragmented, geographically hypermobile lives, not maintaining any community connections within a human population now radically denser than we’ve ever known. We sit in air conditioned insular enclaves watching TV. Exercise is an onerous, paid activity. Food is very easily obtained, even by the economically “poor.” We fill our ever lengthening lives with repetitive employment duties. We are prone to becoming bored, fat, lonely, lazy, bereft of purpose, overworked, chemically addicted, and puzzled about our reason for living in the first place.

So, as a psychiatrist I am usually tasked with relieving the angst of this evolutionary mismatch … with medication, unless faced with a true, major neuropsychiatric illness, e.g. schizophrenia. It feels at times as if I am a sort of social opiate.

“Here, let me ease the pain of your existence with this medicine in lieu of changing how you live in or perceive this anomalous time in our existence called ‘modern society.’”

I thought the advantage in seeing a psychologist is that this person has no authority over you. I've done so in the past but, really, it seemed like I was paying $80 an hour to have a friend. I also don't like to be agreed with all the time.

Intuitively, it seems pretty obvious that someone surrounded by a support network is less likely to become depressed. Sometimes, though, when you are depressed it's hard to reach out. Also, in my experience, most coworkers are kind of repelled by depression.

I enjoyed reading all your comments and agree with your points about atypical and how non-psychiatrist mental health professionals are also problematic.

In my Huffington Post blogs, I try to make only a couple of points at a time. Many of the Huffington Post readers have been propagandized that “criticizing psychiatry officialdom is the same as belittling mental suffering” and so I have, in my last couple of blogs, tried to point out the ridiculousness of that smear.

I am equally critical of psychologists with respect to diagnosis, assessment, psychotherapy, etc. in both Commonsense Rebellion and my recent book, Surviving America’s Depression Epidemic. Here, as in some of my pieces for Z Magazine (several are available on brucelevine.net), I often make the point that --with some outstanding exceptions-- I’ve found most mental health professionals to be compliant, gutless, and grossly deficient in the area of speaking truth to power--Bruce

I think $80 an hour is way too much to charge just for being someone's friend (even if it is in Canadian dollars). I would charge much less.

Kent, I'd pay you twice that and I think our dollar is still over par. :)

David, I really liked your post until this clanger: "...true, major neuropsychiatric illness, e.g. schizophrenia." Huh? Last I heard, schizophrenia remained a clinical impression, just like all the other mental illnesses.

While I recognize the good intentions of the writers, they commit our modern mistake of approaching issues and problems from the Adversarial System point of view, as the "Legal" approach to most problems permeates society. We need a return to common sense to understand the complex issues of human suffering, and how medicine/psychiatry has evolved to try to help these sufferings. "Psychiatry" is not a monolithic giant, with one way of thinking, trying to engulf humanity. As I explain in my book, The Return of Common Sense, there are hundredths of different school of thoughts, which advocates from the extreme believes of, "For every twisted thought there is a twisted molecule", to "psychosis is in the eye of the beholder, and a way for society to classify misfits". There are thousands with believes between these extremes. If Experts cannot agree, how can the public and other healthcare practitioners make sense of such a complex problems? I propose a solution, the return of common sense. The book will explain in general terms what upright, ethical, scientist on no pharmaceutical payroll, have been endorsing since the 1950's, Especially Robbins and Guze in the US, Martin Roth in England. With common sense you will be able to cut thru the hype, special interest groups, religious or political agenda's, and find a common ground for all this diverse organizations working thru a system to help people who are suffering from these devastating problems of hallucinations, clinical depression, alcoholism/drugs, and not push their individual point of view, a specific approach like Legal, or religious or political believes, forgetting the suffering person. The scientific method has provided treatment for devastating diseases than in the past were blame on poverty, morality, sin and aliens. Some of the famous one's; seizures, the Black Death plague, Tuberculosis, Pellagra, Scurvy, all taking hundredths of years before science was able to figure causes and treatments. Before the discoveries, people were ostracized, stigmatize and put to death because it was their "choices and behaviors" that cause this problems and the spreading to others. Common Sense will tell you that are no different today, in hundredth of years we will have the answers for Schizophrenia, Bipolar and drug dependency. In the mean time, as healthcare providers we try using the scientific method, religious leaders use their faith , social workers try reducing the social factors, and yes, pharmaceutical companies with their scientist can help develop medication to ameliorate suffering, even tough we do not know the causes. That at one point or another one of the representatives of these sectors have abused their privileges granted by us to help us, does not make the whole sector "the Evil Empire". For more explanations and discourse on these themes please read my book or visit my Website, www.commonsense-mentalhealth.com. I address in simple, common sense terms why Psychiatry, its disorders and medications cause so much confusion. Thanks, CS Felix
(Felix R. Toro, M.D.)

I'm a psych outpatient as well as an undergrad student majoring in psych in Singapore, studying as a student of an Australian university.

As a psych patient, I was given the drugs immediately as I opted for therapy with my psychologist. It didn't work very well as I was very depressed so after a year plus of therapy, she suggested that I 'go in' and see a doctor (as an outpatient). Of course there are the usual trial and error but my psychiatrist is rather receptive to feedback (and I'm a very intelligent patient) and she takes into account my age and my ability to afford meds.

I see my doc in a general hospital, and the meds are sold by the pharmacy of the hospital. And my drugs, being standard drugs are also generic ones. But the one thing I want to highlight is that it helped me to function and become more receptive to therapy because it helped control my bipolar condition.

I was obstinate abt meds at 1st and did not take it and the consequences were not pleasant for I always make a fool of myself, even in public. Though at 19, I can perhaps be excused for 'prancing around' when I'm manic, I can't imagine doing it when I'm 30.

There's a need to recognise that for certain illnesses, even for mental disorder that there is a place for drug therapy. And it's really a combination of two that works, not just one without the other.

I've been on atypical antipsychotics before but it was too much for me so I stopped after a few days. But it works very well for my uncle who have bipolar.

By the way, I'm on only valproate daily and tranquilizers as and when needed.