The Politics of Mental Illness
What media attacks on the Surgeon General’s report didn’t tell you
By Maia Szalavitz
December 28, 1999
When the Surgeon General issued a report saying that 50 percent of Americans
will suffer a mental illness at some point in their lives, the reaction of the
media and many pundits reflected the moral judgment and prejudice which still
surrounds the issue and which the report itself was trying to fight. Ignoring
the hundreds of pages of research in the report, pundits preferred to focus on
the idea that psychiatrists are "defining mental illness down" to help their
friends in the pharmaceutical industry.
Psychiatrist Sally Satel, writing in The New York Times on Dec. 15, complained
that the report would lead more people with "minor" mental illnesses to seek
help and that this would compromise efforts to force the seriously ill into
care.
Letters from other psychiatrists printed over the following few days strongly
attacked Satel. Bipolar disease expert and sufferer Dr. Kay Redfield Jamison
asked on Dec. 17 whether Satel would write an editorial supporting physicians in
ignoring patients with "mild" cases of diabetes, heart disease or cancer?
And there's the nub of the issue: While no one would find it at all remarkable
if the Surgeon General said that one in five people would suffer heart disease
or cancer at some point during the year, when the issue is the mind and brain,
Americans seem to expect lifelong, perfect health.
This makes little sense when you consider that the brain is the most complex
organ in the body (in fact, it is the most complex object in the known
universe). Why should it be any less prone to difficulty than the colon, stomach
or heart? Why should we expect to suffer numerous physical illnesses in the
course of a normal life, but never mental problems? And why shouldn't we treat
the distress caused by them?
Prejudice against believing in mental illness runs through media coverage of
psychiatric drugs and their increasing role in medicine. From George Will on the
right to Alexander Cockburn on the left, there have been numerous attacks on the
use of Ritalin for ADD and Prozac and its sisters for depression. Typical
headlines include "Drugging Unruly Kids Lazy Parents' Cop Out" (USA Today
12/17/99), "Ease up on Ritalin and Let Boys be Boys,"(The Houston Chronicle,
headlining Will's column, December 7, 1999) or "Would Tom Sawyer Have been
Prescribed Ritalin?" (The San Francisco Chronicle, 3/18/99).
The columns and articles represent a notion that because these drugs are being
prescribed more than before, they are being over-prescribed. "Spirited" active
children are being made into zombies, they charge. Non-depressives are rushing
to take Prozac to improve their personalities, while parents are pushing naughty
kids onto Ritalin rather than trying discipline.
The problem is, there is little data to back this notion, other than an increase
in prescribing - which could just as easily reflect greater awareness that there
is help for widely prevalent conditions. In response to Will's claims about ADD
in The Washington Post, the President of the American Academy for Child
Psychiatry, wrote that epidemiological studies find that 3-10% of school age
children have some form of ADD. About 3% are currently in treatment, well within
the range of appropriate prescribing and far less than the figure (of unknown
origin) cited by Will of 10-12% of boys being on Ritalin.
With depression, epidemiological studies find that most people actually don't
seek treatment. When depressives finally agree to try drugs, it is often after a
long and fruitless attempt to "snap out of it" on their own or with talk
therapy. This is especially true of Ritalin. The stigma placed on those who
"drug their kids" is so great (as those headlines clearly indicate) that even
parents of children with the most severe and obvious disorders try everything
from diets to behavior modification before even agreeing to a brief test of
medication. Hence, the need for the Surgeon General's report.
But why is the notion that "people with mental illnesses short of schizophrenia
are malingerers" still such a part of the assumptions many journalists make when
covering stories such as the Surgeon General's report?
For one, it fits ideological agendas of both the left and the right. On the
right, syndicated columnist George Will can use the issue to point to the need
for more parental responsibility and discipline, and less feminist interference
with "boys being boys." On the left, Alexander Cockburn can show that
pharmaceutical companies and their capitalist cronies make big bucks by pushing
these drugs on kids and destroying their individuality.
And there is another player with a big investment in fighting the treatment of
the mentally ill - the Church of Scientology, which believes that all of
psychiatry is mind control.
But if there were a rash of over-prescribing drugs like Prozac and Ritalin,
surely some enterprising journalist could come up with anecdotes about parents
who put their kids on Ritalin at the first sign of "acting out," or
non-depressives who used Prozac to boost their chances of success at dating or
at work?
Read the stories, or search for such cases, and you come up dry.
The few anecdotes that do surface, however, almost always come from
organizations affiliated with the Church of Scientology or from experts who,
while not affiliated with the Church itself, take its position that all
psychiatric medication is poison, and serve as expert witnesses when the Church
sues drug companies.Yet when the national media picks up local stories based on
Scientology-introduced information, the role of the Church tends to be ignored.
A perfect example is the recent decision of a Colorado School Board to pass a
resolution to discourage teachers from suggesting medication for children with
behavior problems. In the wake of Columbine, the Scientology-affiliated
Citizen's Committee for Human Rights (CCHR )sent a brochure to a school board
member describing the correlation between Prozac and other psychiatric drug use
and violence. Since one Columbine shooter was known to have been on the
antidepressant Luvox, the board member thought the issue worthy of
consideration.
Although courts have never found in favor of those claiming that these drugs
cause violence, it is easy to see how the media could continue to give weight to
the idea. If several of the school shooters were taking antidepressants, perhaps
this is what set them off? But distinguishing correlation from causation has
never been a strong point in the media.
The Colorado Board decided to hold a hearing on the subject. They invited a
representative from CCHR and Dr. Peter Breggin, an anti-psychiatric medication
psychiatrist who has written books such as "Your drug may be your problem" and
"Talking back to Ritalin." No parents testified that their kids had been forced
by teachers to take drugs—in fact, there was no testimony from experts (by far
the majority of psychiatrists) or anyone else on the other side, according to
The Denver Post. The paper's editorial on Nov. 14 opposed the resolution saying
that board members, "might as well spend their time trying to outlaw seat
belts - which dramatically reduce deaths and injuries suffered in traffic
accidents but cannot totally eliminate them."
When the story of the Denver board resolution hit the national and even
international press, the role of Scientology-affiliates in setting off and
shaping the debate was not mentioned.
Meanwhile, a major study of Ritalin for ADD was published in the Archives of
General Psychiatry. It found the drug superior to behavioral treatments alone
and to standard treatments used in various communities and schools. Adding
behavioral therapy to Ritalin didn't improve its efficacy: The only children
helped by this approach were those who had additional problems beyond ADD.
It didn't provoke any editorials.
Maia Szalavitz is a contributing editor to NewsWatch
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