Regarding Psychiatry

It's already been pointed out in many places that so-called anti-depressants aren't effective at treating depression after the first few weeks. One such place is this APA Journal article on the effectiveness of SSRIs and related atypicals compared to placeboes:

We are very heartened by the thoughtful responses to our article. Unlike some of the responses to a previous meta-analysis of antidepressant drug effects (Kirsch & Sapirstein, 1998), there is now unanimous agreement among commentators that the mean difference between response to antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published (see Thase, 2002) and were accessible only by gaining access to U.S. Food and Drug Administration (FDA) documents.

The small difference between the drug response and the placebo response has been a "dirty little secret" (Hollon, DeRubeis, Shelton, & Weiss, 2002), known to researchers who conduct clinical trials, FDA reviewers, and a small group of critics who analyzed the published data and reached conclusions similar to ours (e.g., Greenberg & Fisher, 1989). It was not known to the general public, depressed patients, or even their physicians. We are pleased that our effort facilitates dissemination of this information.

The issue of psychiatry's failures is a complex one. There are certainly many well-meaning people involved in psychiatry, and I would not be at all surprised to find there are some not-so-well-meaning people involved too--most likely in the upper positions of power.

I think at the heart of the issue is whether the use of chemicals is appropriate for dealing with emotional and social problems. (I should point out that as far as we can tell, we aren't dealing with medical diseases in the vast majority of psychiatric cases. Psychiatrists have moved away from using the term 'disease' and instead use 'disorder' due to this very lack of proof. If anyone wants me to expand on this particular subtopic, please ask.)

The question is: if psychiatry's approach is so wrong, how did it manage to become so significant and popular? Well, obviously, profit is a primary factor. But I think there's a key to understanding what went wrong. The key is the difference between the institution of medicine, a healing profession, and the judiciary and penitentiary institutions, which are centered around punishment and behavior control. As you might expect, to be treated as a criminal requires a high degree of evidence (or at least it should). We do things to criminals without their consent but only with a code of law in place and the right to a fair and reasonably immediate trial. On the other hand, doctors can treat people nonconsensually in the cases where the patient is unable to make a decision (e.g. too young to decide; unconscious from an accident; not in a sound state of mind; etc.). Doctors can only do this when using approved medical treatments and practices, and it is done for the benefit of the patient.

Okay, I'm rambling here, but the main point I'm approaching is that in medicine the focus is on doing what's best for the patient, but in the judicial/penitentiary institution the focus is primarily on doing what's best for everyone else (ie- society) at the expense of the person in question. What would happen if there was a medical profession which filled the function of the penitentiary system? What if it treated behaviors against which one can't reasonably make criminal laws, like being annoying in a classroom? Or being angsty or otherwise annoying?


I suppose this is the sort of thing one writes a thesis about rather than a post to k5. I've certainly skipped a lot when writing this, so please ask for clarifications, more evidence, further explanation, etc.