So, today's discussion will be about drugs and docs, the former first. In doing so I think it is important to take at least a brief look at the history of the Food and Drug Administration (FDA), the government agency charged with the regulation of drugs. The FDA has its roots in the Pure Food and Drug Act of 1906. This act was signed by one of Progressivisms headliners Theodore Roosevelt. But, there is another figure who should be included in the discussion of the 1906 Act. His name is Upton Sinclair, and he was an avowed Socialist. The webpage for the FDA mentions Mr. Sinclair in its history.
Upton Sinclair wrote a book called The Jungle , his purpose in doing so was to convince the American public of the injustice of the Capitalist system. The book details some of the rather disgusting conditions of a meat packing plant. Instead of turning to Socialism the American public was simply grossed out. Sinclair famously stated "I aimed for America's heart and hit them in the stomach." Indeed. Sinclair was a very active Socialist in fact running for political office in California on the Socialist ticket with little success. He had a little more success running on the End Poverty in California (EPIC) ticket. His goal was the same for both tickets. He said about his EPIC run "The American people will take Socialism but they won't take the label. I certainly proved it in the case of EPIC. . .I think we simply have to recognize the fact that our enemies have succeeded in spreading the Big Lie. there is no use attacking if by a front attack. It is better to outflank them." Typical leftist m.o. is to change the name but not the goal.
I still have more studying to do before I form a complete opinion on the FDA, but just looking at the origins, and the leftists who influenced it certainly gives me pause and is a little off putting to say the least.
Much of the information in this section comes from an eye opening book by Robert Whitaker titled Anatomy of an Epidemic
Drugs for mental health issues were first introduced in the mid 20th century. It was at this time that the Psychological fields were floundering a bit in trying to determine which direction and theoretical orientation to commit to. The model that won out was a medical one. A medical model means diagnosing and than treatment. Treatment in medicine of course includes well medicine.
Some important historical milestones include the 1938 Food and Drug Cosmetics Act, Whitaker explains on pp. 55-56 "The law required drug firms to prove to the Food and Drug Administration that their products were safe (they still did not have to prove that their drugs were helpful), and in its wake, the FDA began decreeing that certain medicines could be purchased only with a doctor's prescription," Also in 1946Congress passed the National Mental Health Act which meant that the government could sponsor research in the mental health field, providing grants. The National Institute of Mental Health (NIMH) was established three years later to oversee the reform. Yipee! The left specializes in regulation, and the mental health field gets to participate in that big time.
In accordance with the medical model for mental health in 1952 the Diagnostic Statistical Manuel (DSM) for mental disorders was published. The DSM and the subsequent revisions became the staple for diagnosing in the mental health arena. I must say my hardbound copy of the current DSM IV-TR has been a joy and is quite a useful doorstop among other things. It certainly is interesting to consider the various diagnoses that have been added and removed from the DSM. But, for now it is important to note that it originates from the medical model and is relied on for much of mental health treatment.
Alright so we see some of the groundwork that had been laid out, let's take a look at some of the drugs. In 1954 the FDA gave its stamp of approval for a drug called Thorazine. It was initially billed as a tranquilizer but through a metamorphosis which included government and media became a disease fighting pill rather than just a tonic. Shortly after Thorazine's introduction a new "happy" pill called Miltown was also introduced with promises of Nirvana (the propaganda for this pill included a Salvador Dali exhibition for which he was paid quite well). Ch. 4 in Whitaker's book gives these details and more about these 2 drugs. Miltown became a predecessor for more modern drugs such as Prozac. Thorazine was given all sorts of credit for success in decreasing the amount and time of hospitalizations for individuals diagnosed with schizophrenia. But, Whitaker on pp. 92-94 uses hard facts to refute that notion. Here are some highlights. Prior to the introduction of Thorazine people admitted for a first schizophrenic episode in the 40's and 50's 75% were recovered enough in the first three years to return to the community, the majority within the 1st year. Returning to the community meant back to family and even work. California records from 1956 after Thorazine's introduction found that 85% who were not prescribed medication were discharged within 18 months. Those treated with the drug had a lower (74%) rate of discharge. So, why does Thorazine get credit as some breakthrough drug for schizophrenia patients being discharged from hospitals at an increased rate?
Well, credit was given to Thorazine when in reality it lay elsewhere. As Whitaker explains on p. 93, "The 1965 Medicare and Medicaid legislation provided federal subsidies for nursing home care, but no such subsidy for care in state mental hospitals, and so the states, seeking to save money naturally began shipping their chronic patients to nursing homes. That was when the census in state mental hospitals began to noticeably drop rather than in 1955, where Thorazine was introduced."
Well, blow me over with a feather, a government program caused a decrease in the appropriate care a certain population would receive? Whitaker goes into great detail on a number of diagnosis and their preferred medications. I highly recommend reading his book. Of particular note are the absolute explosions of the diagnosis of ADHD and Bipolar disorder. This is a disturbing pattern that has long been an irritant for me. While I believe that there can be some benefits from medications, I have felt strongly for some time that we are overdiagnosing and overmedicating. Whitaker's take down of Prozac is particularly well done.
Whitaker presents some other significant facts that I wish to highlight here. Social Security and Disability payments from the government are programs from the ideological left. From p. 250 Major Depression is the leading cause of disability in the US for people 15-40 year olds. With Bipolar Disorder 85% used to recover from this previously uncommon illness now only about 1/3 function well. In 1955 46,000 people were hospitalized with Anxiety and Manic Depressive (Bipolar) illness, today 40 million people have one of these diagnosis. More than 1.5 million people are on SSI or SSDI and that number is increasing at a rate of 250 children and 850 adults daily. I suppose it is possible that we are just struggling that much as a society, but it certainly begs for more explanation than that.
I'm just presenting facts here, and as I've stated before coming to any real conclusions will require much more study. A friend recently directed me to a book titled Manufacture of Madness by Thomas Szasz. But, I have to say that what I've found so far is in a word disconcerting. Given that psychology has been used in the past to justify the eugenic process of weeding out undesirables can you blame me for wondering if it continues to be used so now? As my boss Dr. Thurber pointed out to me "why put them in camps or sterilize them when you can just imprison them in their own homes."
Now one more note about the medical model. Doctors became the experts. I want to re-iterate here that I know some fine people who are psychiatrists and I do not wish to disparage them in any way. But, I do wish to point out that the model and orientation of psychiatry is driven by medication and by psychiatrists being the overseers of it.
One expert psychiatrist I want to highlight is Dr. Benjamin Spock. In doing so I'd like to state that I do not necessarily disagree with all of his assertions. But, he is one of the most famous psychiatrists in recent history. He became a go to expert on parenting. But, Dr. Spock also was quite politically active. He was a part of a movement called the New Left. Sounds inspiring no? It was a coalition of several leftists organizations. Dr. Spock advocated strongly for the passage of medicare. He was a vocal opponent of the Vietnam War. In 1972 Dr. Spock was the presidential candidate of the People's Party. Dr. Spock's platform called for free medical care, legalizing abortion and marijuana and guaranteed minimum income for families. I say as a sidenote that I find it a little shocking that a man known as a huge advocate for children was also a huge advocate for abortion. Again I don't disagree with all of Dr. Spock's techniques on parenting, but it is an uncomfortable reality that politically he was so far to the left. To refer back to part 1, why would taking over Psychiatry be a Communist goal? Well, I don't yet know the full answer to that, but to note that one of Psychiatry's biggest names was on the Communist side of things certainly says something.
The concluding post on the subject will be my personal perspective in working in the mental health field.