One of the essays addresses the question directly:
...In the book, Barber argues that Americans are being vastly overmedicated for often relatively minor mental health concerns. This over-reliance on quick-fix medication is numbing our nation and dulling our awareness of real and pressing social issues and of non-psychopharmacological therapies and treatments.
Barber is hardly alone these days in this line of reasoning. The notion that American children and adults are being over-diagnosed and overmedicated for exaggerated or even fictitious mental disorders has now become one of the defining tropes of our era.
This storyline persists
despite the fact that government research has repeatedly
shown that most adults and children with mental health issues don’t
get the specialized help that they need...
...contrary to received wisdom, the United States is not a world leader when it comes to the use of psychiatric medications. (The U.S. is “’in the middle’ relative to other countries, and is not an outlier,” a study from M.I.T’s. Sloan School of Management, cited by Kramer, showed last year.)...
...contrary to received wisdom, the United States is not a world leader when it comes to the use of psychiatric medications. (The U.S. is “’in the middle’ relative to other countries, and is not an outlier,” a study from M.I.T’s. Sloan School of Management, cited by Kramer, showed last year.)...
Her next essay examines the questions of how and why we developed a national myth, that people -- particularly children -- are overmedicated.
The Med Scare
Judith Warner
February 21, 2008
At the end of my last column, I wondered about the purpose served by the narrative of the disastrously overmedicated American. I’ve been pondering this question as it relates to children for the better part of the past four years.
Recently, in search of an answer, I was re-reading “Huck’s Raft: A History of American Childhood,” by the Columbia University historian Steven Mintz. In the book, Mintz identifies a “pattern of recurrent moral panics over children’s well-being” that has emerged at varying points in our history, and dissects how these episodes mask other diffuse worries Americans have been either unable or unwilling to directly articulate.
“Children have long served as a lightning rod for America’s anxieties about society as a whole,” Mintz writes...
...I couldn’t agree more. And I believe it’s these fears, this worry, this adversarial attitude and this bad conscience that keep the narrative of the overdiagnosed and overmedicated child alive...
Judith Warner
February 21, 2008
At the end of my last column, I wondered about the purpose served by the narrative of the disastrously overmedicated American. I’ve been pondering this question as it relates to children for the better part of the past four years.
Recently, in search of an answer, I was re-reading “Huck’s Raft: A History of American Childhood,” by the Columbia University historian Steven Mintz. In the book, Mintz identifies a “pattern of recurrent moral panics over children’s well-being” that has emerged at varying points in our history, and dissects how these episodes mask other diffuse worries Americans have been either unable or unwilling to directly articulate.
“Children have long served as a lightning rod for America’s anxieties about society as a whole,” Mintz writes...
...I couldn’t agree more. And I believe it’s these fears, this worry, this adversarial attitude and this bad conscience that keep the narrative of the overdiagnosed and overmedicated child alive...
Ms. Warner makes some very good points. I won't elaborate on her arguments here, because she does a perfectly good job of presenting her case.
What I would add is a subtle point that, it seems, is overlooked in discussions on this topic. This is something that frequently causes confusion when it comes to interpreting information about medication (all medications, not just those used in psychiatry.)
The information we have comes from studies. Mostly, those studies are done on populations. But populations do not come in for treatment; individuals do. Doctors generally do not treat populations; they treat individuals. Populations do not ask their doctors about medication; individuals ask those questions.
But when individuals ask those questions, the answers they get do not pertain to the individual. Rather, the answers pertain to the average in a population of individuals who have been the subjects of research.
So, when we ask if "people" are overmedicated, what we learn is that there is no evidence that the percentage of the population receiving medication is not suspicious. The absolute numbers are large, and they are increasing. To some, the absolute numbers are alarming. But the absolute numbers do not tell us anything interesting.
Granted, there are people who do look at the proportions, and still find them alarming. It is hard to know what to make of that.
I have some speculations. For one, it may seem contrary to one's experience, to hear that 10 to 15% of the population has a problem with serious depression. If true, that would mean that during your typical trip to Wal-Mart, you would see several people with depression. But the last time you went, you did not see any. Therefore the statistics must be wrong. Something like that.
Another thing is this: most people experience their brain as a pretty reliable organ. It does not seem to make sense that so many people would have problems with it. But consider this: the human brain is the most complex organ in the body. Indeed, it is the most complex entity in the known Universe. Is is any wonder that a high proportion of people have problems with it?
Anyway, back to the point. Studies show that the population is not overmedicated. Does that not contradict some people's experiences, seeing themselves or their loved ones taking multiple medications, high doses of medications, suffering ill effects from all those pills? Ah. That is a different question. That is a problem experienced by individuals. If you merely look at what percentage of the population is taking some medication, you will not find out how many people are taking too much medication.
Plus, there is another issue. Some people will be overmedicated temporarily, when they are started at a dose that is too high for them, or the dose is increased too rapidly, or when incompatible medications are mixed. But, that should not go on for long. Sometimes it does, granted, but the temporary situations sometimes are a necessary part of an ongoing process. Or they are not necessary, but are identified and corrected.
The main point is this: just because studies show that the population as a whole is not overmedicated, that does not mean that there are not individuals who are. How common is it? I don't know. My suspicion is that it is all too common. Some instances are transitory, or unavoidable, but it still is a problem.
Comments
I find it particularly alarming that children are prescribed some of these drugs. How much is truly known about how various psychiatric drugs affect the development of the brain? If a fifteen-year-old is put on a regimen of SSRI inhibitors, how will it affect him down the road? If he's on them long enough, will he experience any adverse effects when he's thirty-five or forty? For that reason, I think that physicians should be extremely sparing in prescribing psychiatric medication to children.
I suspect that there is a good deal of over-medication when it comes to drugs like anti-depressants. If a patient goes in to his primary care physician and indicates that he's been going through a bad stretch emotionally, he will likely be offered a prescription for Prozac, or some analog. I had an experience like that myself. Several years ago, I went in for an annual check-up. My physician asked me how things were going. I said that they were going okay, but that I hated my job. She immediately asked me if I wanted a prescription for Prozac. I had the good sense to say no. Her response was, don't you want to feel upbeat about things? From talking to friends, that's not an uncommon experience. I suspect that drug-company reps push some of these drugs to primary care physicians as feel-good medications.
Posted by: ChuckO | February 28, 2008 2:11 PM
Thanks for pointing out what always gets lost in these "Pills: Threat or Menace?" types of stories. A lot of people who need effective antidepressant medication don't get it, for a variety of reasons, one of which is the prevailing notion that we are "medicalizing" life's normal emotions, such as shyness and sadness. This is pretty much nonsense, and really only restates the obvious: Antidepressant and anti-anxiety meds are meant for the people who really need them, not for "cosmetic" psychology, and a medicine that works for one person may not be effective for another.
Posted by: Dirkh | March 1, 2008 12:02 PM
One point that often seems to be overlooked is that if a patient finds these medications to be ineffective, or that the side effects outweigh any benefits, the medication is usually discontinued. Concerns of overmedication seem to presume that patients will continue taking, and physicians will continue prescribing, medications which are either ineffective or have adverse effects.
With the antidepressant percentages, one possibility is not that there is overprescription, but rather that PCPs are often prescribing them for depression/dysthymia that is comorbid to another untreated condition (ADHD is a good example) or else misdiagnosing depression in patients who present with superficially similar symptoms (bipolar disorder, for instance). Adding these cases to the prevalence rate of unipolar depression, and maybe adding in a few cases of dysthymia and anxiety, and the figures probably make sense without having to imagine any massive levels of "overprescription."
Posted by: Hyperion | March 2, 2008 1:25 PM
In response to ChuckO's comment:
I find your story a little difficult to believe. I thought MDs had to screen people before prescribing them an anti-depressant. My physician asked me a list of questions when I told him I was feeling unhappy. Only then did he prescribe anything. I suppose different doctors could do things differently, but I doubt that most physicians would prescribe an anti-depressant without checking to make sure the patient needs it.
Posted by: Esther | March 4, 2008 7:03 PM
Two points -- people with mental problems have to be pretty darn sick before they are obviously ill to a casual observer. The fellow walking down the street arguing with the fairies (and losing) is only the most evident of 50 or 100 others struggling with mental disabilities. I've had three friends die of depression, who were still working and coping with their lives right up till the day they committed suicide.
Second -- Being misdiagnosed is a problem, but being undiagnosed and untreated is probably worse. If you're misdiagnosed, at least someone knows there's a problem and is watching.
Posted by: Noni Mausa | March 24, 2008 6:35 PM