A word about stories

This blog combines two interests of mine that are unrelated—except that they both involve analyses of story-telling. I don’t pretend that they belong together. I am putting them side by side, post by post, on an irregular basis, simply to see what happens.

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Review of Anatomy Of An Epidemic: This is your brain on psychiatric drugs

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

by Robert Whitaker

Crown, 404 pp., $26.00

About three-quarters of the way through Robert Whitaker’s expose of the psychiatric drug industry, Anatomy Of An Epidemic, I found myself beginning to worry. Whitaker’s claim is that contrary to what we have been told, psychiatric medications actually cause far more mental illness than they cure. Chapter by chapter, he had built a damning case at which to nod and wince—but now I was neck-deep in the chapter on antidepressants, and I was no longer nodding but reading with concern.

For several years back in my 30s, I had sought desperately for an antidepressant that would “cure” me of my longstanding depression and associated shyness; that would, as psychiatrist and author Peter Kramer infamously wrote in his own book, Listening To Prozac, make me “better than well.” I had tried and flunked not just Prozac, but a half-dozen other antidepressants, often combined with other psychoactive drugs that psychiatrists believed might “potentiate” the antidepressant effect: lithium, synthetic thyroid, speed (Dexedrine), an anti-narcolepsy drug (Provigil), bromocriptine, naltrexone, Depakote, amantadine. None of these drugs or drug combinations ever succeeded in doing much more than ruin my sleep, and I had long ago given up the quest for a magic bullet in favor of the quieter avenues of talk therapy. Yet now I found myself wondering: in those few years of drug experimentation, had I inadvertently made myself more rather than less vulnerable to future bouts of depression? Had I in fact damaged my brain, as the studies cited in the chapter I was now reading implied was a very real possibility?

I’ll most likely never know. And in fact, I’m not all that worried. The greatest danger of brain damage, the book asserts, is for persons who are “maintained” by their doctors not just intermittently, but continuously for many years on antidepressants or other psychiatric medications. The conventional wisdom is that maintenance in this manner helps prevent relapse back into depression—or back into schizophrenia, if one is taking antipsychotics; or back into anxiety, if one is taking an “antianxiety” medication such as Xanax. After reading Anatomy Of An Epidemic, I am thankful that I am not being maintained in this manner. I do not have to worry if the antidepressant I am taking every day is accelerating cell death in the hippocampus, an area of the brain important for mood and memory; or if the antipsychotic I am taking is causing my frontal lobes to shrink, eventually giving me what amounts to a drug-induced lobotomy; or if my antianxiety medication is destroying brain receptors in such a way as to possibly make my anxiety symptoms permanent.

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Plot twist in the story about antidepressants?

It occurs to me that we can think of the massive use of antidepressants and similar drugs in this country as involving a kind of story: depression is caused by such-and-such, the drugs will cure it by such-and-such an action, and everything is groovy. So say the drug companies in their TV ads; so hope the GPs and psychiatrists who prescribe the drugs to their patients with crossed fingers. And so hope the patients. I have close friends who, when the subject of this or that mental illness comes up, can be counted on to repeat the mantra of the drug companies: “It’s an imbalance in brain chemistry.”

Yet perhaps the story may change. Several books have recently been written that call the mantra into question; and negative information continues to come forth. Especially diligent in unearthing scary facts is journalist Robert Whitaker, author of one of these recent books, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. His latest blog post at Psychology Today summarizes several studies claiming that antidepressants may do worse than simply not work—they may actually worsen depression, via a phenomenon called “tardive dysphoria.” Whitaker isn’t shy about speculating about dire scenarios:

But now here we are 40 years later, with perhaps ten percent of American adults taking an antidepressant, and researchers are writing about “oppositional tolerance,” and drug-induced “tardive dysphoria.” That is surely a health outcomes story that needs to investigated, and if we want to put this into an even sharper moral context, we need only consider this: Many teenagers are now being prescribed an antidepressant, and when they take the drug, their brains will develop “oppositional tolerance” to it. What percentage of these youth will end up with drug-induced tardive dysphoria, and thus suffer a lifetime of chronic depression?

Many people are already leery of the antidepressants they feel they must take. If word spreads of studies like these, I can imagine all hell breaking loose. But what narrative will patients choose to replace the current one? And where will they turn if not to drugs?


Good article on Marsha Linehan, creator of Dialectical Behavior Therapy

Marsha Linehan's wrist, showing scarsLinehan is of the giants of modern talk therapy; in creating Dialectical Behavior Therapy, she went well beyond conventional CBT by including mindfulness and acceptance components, thereby more effectively reaching many people in deep distress about who they feel themselves to be. This article in the New York Times is a particularly nice celebration of her life work:

Expert on Mental Illness Reveals Her Own Fight

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Update and related post: Should “wounded healers” confess to their wounds?


Psychiatric medications as super-placebos

This isn’t directly related to my interest in the psychological aspects of language as behavior, but it does bear on the question of why humans suffer psychologically in the first place, and on how such suffering should best be treated: a review in The New York Review of Books of three books on what seems to be the con game of psychiatric medication.

The review is titled The Epidemic of Mental Illness: Why? and the books involved are The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch, Basic Books, 226 pp., $15.99 (paper); Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker, Crown, 404 pp., $26.00; and Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis, by Daniel Carlat, Free Press, 256 pp., $25.00.

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A note about language as behavior

My interest in language as behavior (rather than as we normally think of it, as something that simply describes the world) began quite abruptly back in early 2005. That was when I discovered a relatively new kind of talk therapy, Acceptance and Commitment Therapy, or ACT.

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My favorite ellipsis

Last night in the essays class I teach at NYU’s School of Continuing and Professional Studies, the subject of ellipses came up. In a story, an ellipsis consists of leaving something out. The “something” can be anything from a few words to entire events. Unless we are reading quite technically, we usually only notice an ellipsis when it goes wrong—when the gap seems awkward or omits information we’re looking for. But when an ellipsis goes right, especially at the level of a sentence or a phrase, it can produce prose that is wonderfully economical and far more enjoyable than if the writer had told all.

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Samuel R. Delaney on doubt in writing

Reading the excerpt below makes me think of how difficult yet rewarding it must be to peel and eat a durian, that strange fruit found only in southeast Asia, and guarded by not only a foul odor but a thick husk of thorns. The excerpt comes from an essay by the science fiction writer, literary critic, and teacher Samuel R. Delaney; the title is “Of Doubts and Dreams” and it can be found in a thorny volume by Delaney titled About Writing.

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Repealing the Law of Attraction

I picked a friend up from the bus stop the other day to drive them up to the art colony run by my girlfriend. This friend asked how I was doing, and being in a self-deprecating but decent mood I said something I hoped was witty: “Oh, smelly, grouchy, and broke, but I’m okay.”

My friend’s ears pricked up at the sound of the word “broke.” Being a singer-songwriter, she too is a struggling artist—like so many of us up here in Woodstock—and thus no stranger to the dilemma of how to make money from what you love without necessarily being at the top of your field. Her own solution of late has been to enthusiastically believe in the so-called Law of Attraction. So when she heard “broke,” she instantly concluded that (a) I probably was broke, but more importantly (b) I was thinking the kind of negative thoughts that would keep me broke forever.

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