Psych105

The authors of the meta-analysis also assert that “for patients with very severe depression, the benefit of medications over placebo is substantial”—which suggests that antidepressants do affect mood through brain chemistry. The mystery remains unsolved.

There is little evidence to support the assumption that supplementing antidepressant medication with talk therapy improves outcomes.

The first two editions of the D.S.M. (the first was published in 1952, the second in 1968) reflected the psychoanalytic theories of Freud and of the Swiss émigré Adolf Meyer, who emphasized the importance of patients’ life histories and everyday problems. But the third edition, published in 1980, began a process of scrubbing Freudianism out of the manual, and giving mental health a new language.

criticism surrounding the role of the pharmaceutical industry in research and testing. The industry funds much of the testing done for the F.D.A.

the anxiolytics were enmeshed in exactly the same scientific, financial, and ethical confusion as antidepressants today.

Meprobamate carved out an area of mental functioning and fired a chemical at it, a magic bullet, and the bullet made the condition disappear. What Miltown was saying, therefore, was that the Freudian theory that neuroses are caused by conflicts between psychic drives was no longer relevant. If you can cure your anxiety with a pill, there is no point spending six years on the couch. And yet, in the nineteen-fifties, references to Freud appeared alongside references to tranquillizers with no suggestion of a contradiction.

thalidomide, which was prescribed as a sedative, caused birth defects

Valium and Librium can be addictive.

This is one of the reasons that when the SSRIs, such as Prozac, came on the market they were promoted as antidepressants—even though they are commonly prescribed for anxiety. Anxiety drugs had acquired a bad name.

The critics who say that psychiatry is not really science are not anti-science themselves. On the contrary: they hold an exaggerated view of what science, certainly medical science, and especially the science of mental health, can be.

Progress in medical science is made by lurching around.

Is depression—insomnia, irritability, lack of energy, loss of libido, and so on—like a fever or like a disease?

Depression often remits spontaneously, perhaps in as many as fifty per cent of cases; but that doesn’t mean that there isn’t something wrong in the brain of depressed people.

In the case of mood disorders, it is difficult to find a test to distinguish mental illness from normal mood changes. The brains of people who are suffering from mild depression look the same on a scan as the brains of people whose football team has just lost the Super Bowl. They even look the same as the brains of people who have been asked to think sad thoughts.

There have been many medical treatments that worked even though, for a long time, we didn’t know why they worked—aspirin, for example.

“at some period in history the cause of every ‘legitimate’ disease was unknown, and they all were at one time ‘syndromes’ or ‘disorders’ characterized by common signs and symptoms.”

Mental disorders sit at the intersection of three distinct fields. They are biological conditions, since they correspond to changes in the body. They are also psychological conditions, since they are experienced cognitively and emotionally—they are part of our conscious life. And they have moral significance, since they involve us in matters such as personal agency and responsibility, social norms and values, and character, and these all vary as cultures vary.

argue that the increase in the number of people who are given a diagnosis of depression suggests that what has changed is not the number of people who are clinically depressed but the definition of depression, which has been defined in a way that includes normal sadness.

In 1949, Philip Ash, an American psychologist, published a study in which he had fifty-two mental patients examined by three psychiatrists, two of them, according to Ash, nationally known. All the psychiatrists reached the same diagnosis only twenty per cent of the time, and two were in agreement less than half the time