In the 80’s no-budget horror-comedy, Dr. Jekyll and Mr. Hyde… Together again!, Dr. Jekyll announces that surgery is costly, painful, and really icky. His solution? Drugs. Lots and lots of drugs. All the other doctors in the room cheer.
Today, Jekyll’s run away with the store. The number of Americans on antidepressants has doubled in the decade between 2007 and 2017, from 13.3 million to 27 million today. A mindblowing 1 in 10 people in the United States, including kids, are on antidepressant medications. Most mental illnesses now, including depression, are treated as chemical imbalances, with an emphasis on pharmaceutical rather than psychological treatment. The pharmaceutical industry also happened to boom, creating more billionaires than pills in an XL bottle of xanax. But that’s totally unrelated. Really! Just ask this totally trustworthy rat-looking pharmaceutical exec. He’ll tell it to you straight.
I don’t believe that Americans have become twice as likely to be chemically imbalanced. I don’t believe that the number of mentally ill has doubled. I do believe that a mix of lifestyle changes and overdiagnosis has caused a massive uptick, that isn’t necessarily good for patients, or the world. Looking at history, we see that some of the greatest crisis leaders succeeded not in spite of, but in part because of mental illness.
By the end of this post I’d like to have you convinced that most people labeled mentally ill are not really mentally ill, and are in fact suffering from conventional drugs and treatment. This is partially due to mass over-diagnosis, but also our perception of mental illness as something fixable through pharmaceuticals. I argue that mental illness is not just something to overcome, but often times a strength, and in that cases can today be treated without drugs.
TLDR: Fuck Dr. Jekyll.
The recommendations in this blog may be useful in understanding depression and other mental illness, but should not be taken in place of medication, standard therapy, or doctor recommendation.
Pay no attention to the salesman behind the curtain! (Imaginary Illness)
Our drug is proven to improve mood! It’s the humane solution! And it comes with twenty-five free life-threatening side-effects! Order now for your choice of bowel failure.
In 2005 the Pharmaceutical industry spent 32 million on DTC antidepressant ads. Today it spends 122 million. This massive marketing campaign was kicked off by GlaxoSmithKline, a British company eager to de-stigmatize depression and help as many sick men and women as possible. Basically, a bunch of wholesome goobers.
GlaxoSmithKline proceeded to promote the hell out of antidepressants, DTC’s, and consequently, established depression as something normal, something entirely chemical and detached from circumstance. The depressed, the manic, and the mentally ill all had a chemical imbalance according to Glaxo and other companies, and shouldn’t have to rely on wishy-washy talking cures or head shrinking to fix a chemical issue. Stigma gone! Problem solved, right? Well, not quite.
While they had the best intentions, trying to de-stigmatize mental illness and making profit for a company eager to help patients, these companies unwittingly began a vicious cycle ending in millions of Americans being diagnosed with phony illnesses and drugs.
See, the trouble was that psychiatrists began to doubt themselves. They’d look at other medical professionals, with their fancy scalpels drugs and chemicals, and they wanted in. So the psychiatrists started to doubt themselves. Were they really doctors? What if uncle Gerald was right? Maybe they just forget the whole therapy thing and go back to dental school? More doubt crept in. The psychiatrists began to feel that just talking to a mentally ill patient was an impotent treatment, and started to prescribe more and more drugs to fix the problem. The drugs didn’t necessarily fix the patient, but it did quiet them, a short-term result that made doctors look good and the pharmaceutical companies very happy. And so began a race to the bottom, with more and more psychiatrists diagnosing more aggressively, trying to catch up with other more sophisticated and scientific psychiatrists by handing out pills like candy. And before they knew it, one out of ten Americans was gobbling up addictive, mentally draining DTC antidepressants.
Nobody had bad intentions. There was no mustache-twirling supervillain conspiring to over diagnose. There’s no one to blame -- It just happened. The market can be funny like that.
It’s impossible that people have become twice as depressed in just 10 years. It is very possible, however, that our standards for mental illness have changed. While catching more sick people under the umbrella term of “Mentally ill,” may sound good on the surface, it draws the patient into a web of drugs and treatments that often leave them worse than where they started.
A 2010 US study found that there was no significant increase in suicide attempt for patients on antidepressants. But there was no decrease either. It changed almost nothing measurable, other than the patient's self-reported mood. That isn’t to say nobody needs drugs. There are definitely many cases where drugs are absolutely necessary. Just not nearly as many as there are now.
I’d argue that most would be better off with traditional psychotherapy, or just working through their troubles by just talking to clinical psychologists without drugs. Which is why I’d like to tell you about
A Kind of Cure (Managing mental illness without intensive medication)
This sharp increase is too great to just be overdiagnosis. Some has to do with lifestyle. I’d argue that while overdiagnosis is responsible for the majority of this trend, a more sedentary, indoors, depressive lifestyle is responsible for the rest.
People in wealthier, developed nations have a lifestyle hinged on lots of sitting, less connection, and low level stress. I argue the uptick in mental illness is a lot to do with this change in how we live. Consider the following:
-Risk of developing major depression has increased tenfold since World War II. Peoples who have seen war tend to be less depressed than those who have not.
-People in less developed countries have lower risk of depression, Manic Depression, and other mental illnesses than in industrialized countries
-Depression is higher in cities than in rural areas
-Within the United States, the Old Amish communities are among the happiest in the country.
More and more of us are sedentary today. It’s unavoidable, a means to earn a living. And we eat artificial food, use mobile phones rather than face-to-face communication, and are constantly bombarded by low-level stressors like cars and subways. Those are all more or less unavoidable as well. Isolation, one of the greatest
But the answer isn’t just more pharmaceuticals. It’s often lifestyle changes. Psychiatrists would prescribe more lifting, long walks on the beach, or clinical therapy, rather than clinical drugs. Before intensive chemical treatment for mental illness was common, it was managed. History is littered with great figures who managed. These guys and gals weren’t ill. They were
Crazy like a Fantastic Mr. Fox (Mental Illness as a Strength)
Winston Churchill was a fantastically charismatic leader, incredible writer, and responsible for the best squad roasts of 1940. He was also a life-long manic depressive. His father died in an asylum. Churchill would often refer to periods of terrible depression as his "black dog." During these fits manic-depression, Churchill exhibited little energy, few interests, and would always see the worst in everyone, according to friends and family. On the other side of the spectrum, when his "black dog" backed down, Churchill exhibited abnormally high levels of energy and restlessness, often beginning to work at 8 am and ending work at around 2 am.
The rest of Parliament didn’t have the time of day for wacky Churchill’s gloom and sudden boom during peacetime. They said “When Winston was born lots of fairies swooped down on his cradle with gifts–imagination, eloquence, industry, ability–and then came a fairy who said 'No one person has a right to so many gifts,' picked him up and gave him such a shake and twist that with all these gifts he was denied judgment and wisdom.”
But while the rest sought to see the good German, to appease, only Churchill could see that the Nazis wouldn’t settle for anything but a horrible war.
But they didn't get peace. They got war. Chamberlain was out. Suddenly, Churchill’s mental illness was useful. Churchill took the reigns, his manic-depression contributing in part to the victory.
During bouts of mania, Churchill's chipper attitude and seemingly endless energy, despite a terrible blitz, inspired everyone around him. It was exactly what people needed. And when depressed, his mind wandered to the dark depths that nobody else would go, allowing him to better predict German movements.
While his Manic-depression could be difficult, it was both a curse and a blessing, making it considerably more manageable.
Steve Jobs was obsessive. General Grant was a manic depressive. MLK struggled with depression his whole life. So did Ghandi. So did Hemingway. And Van Gogh. And Beethoven. There are so, so many more examples of mental illness acting as a strength throughout history, especially during crisis.
For all of them, mental illness was difficult for them to manage. It was tough. But it also contributed to their success, and who they were as people. The illness was tied up in their identities as a strength rather than a weakness. It was something manageable. I wonder if they would have accomplished the same if they had accepted their peculiarities as some terribly nasty disease. I doubt they’d have been as happy. I believe that, like these examples, many Americans have mental illnesses manageable without pills that could act as a strength in many cases.
I’m not the first guy to point this link between mental illness and achievement out, or poke at holes in the pharmaceutical industry. Dozens of fantastic essays and best-sellers have dissected these trends out before. And they’re all sharp as hell. Check them, and my other sources, below:
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1. Schneeweiss S, Patrick AR, Solomon DH, Mehta J, Dormuth C, Miller M, et al (2010). Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults: A Propensity Score-Adjusted Analysis of 9 Years’ Data. Achieves of General Psychiatry 67(5): 497-506.
2. Ghaemi, S. (2012). A first-rate madness. New York: Penguin Books.
3. Psychology Today. (2018). Are Mental Health Issues On the Rise?. [online] Available at: https://www.psychologytoday.com/us/blog/our-changing-culture/201510/are-mental-health-issues-the-rise [Accessed 23 Jun. 2018].