Fork in the Road

There is a theory that the real cause of the collapse of Rome was purely chemical: the Romans manufactured their utensils from lead, the lead slowly leaked into their food through repeated use, and from there the lead entered the bloodstream and finally the brain, which thus deteriorated over time. Most historians don’t put much stock in this, correctly seeing it as one-dimensional and purely material in nature, and dismissive of the social and economic factors (along with Rome’s “imperial overstretch”) that clearly did the ancient empire in. But one wonders if there may be some truth to the theory, even if only a small one. Maybe it was a factor in the overall drama, part of the synergistic forces that led to the empire’s decline. It’s an interesting thought.

I was thinking about this in the context of mounting evidence that in a mechanical-material way, Americans may also be destroying their brains. It now turns out that constant cell phone use may be a cause of tumors in the brain, although the evidence is not definitive at this point. More definitive is the neurological fallout from the use of screens—TV, Internet, e-books, text messaging—along with the phenomenon of multitasking that typically accompanies this. Here the pile-up of data is quite large, collected in articles that have appeared over the last decade in journals such as Harper’s, Atlantic Monthly, the New Yorker, and the New Atlantis, and discussed at length in Nicholas Carr’s book The Shallows. (In particular see studies by Walter Kirn, Christine Rosen, and Maryanne Wolf of Tufts University.) Persistent staring into screens, it turns out, changes the brain, and not in positive directions. Constant screen use seems to have an effect similar to constant marijuana use. It should thus not be too much of a surprise that concomitant with the so-called information revolution has been a dumbing down of the American population, although obviously there are other factors involved (the commodification of education, e.g.). But unlike the Roman fork, which is highly debatable, this material factor is quite certain.

Equally interesting (or horrific, in my view) is what appears to have happened to the American brain as a result of the shift in psychiatry from therapy to drugs. Three comprehensive and very well documented studies have just appeared, arguing that the model of mental illness being caused by brain chemistry is full of holes: The Emperor’s New Drugs, by Irving Kirsch (psychologist at the University of Hull in England); Anatomy of an Epidemic, by Robert Whitaker (author of a 2001 study of the history of the treatment of mental illness); and Unhinged, by Daniel Carlat (a Boston psychiatrist). All three of these men are highly respected in their fields, and their conclusions, along with a discussion of the bible of psychiatry, the DSM (Diagnostic and Statistical Manual of Mental Disorders, about to go into its fifth edition), are presented in two recent articles by Marcia Angell in the New York Review of Books. The overall picture is quite grim.

First, the stats: between 1987 and 2007, the number of those so disabled by mental disorders that they qualified for Supplemental Security Income or Social Security Disability Insurance increased 2.5 times, so that 1 out of 76 Americans now falls into this category (what an amazing statistic). For children, the increase is 35 times during the same time period, and mental illness is now the leading cause of disability among this population. A survey of American adults conducted by the National Institute of Mental Health, 2001-3, found that 46% of them met the criteria of the American Psychiatric Association for being mentally ill at some point in their lives. Ten percent of Americans over the age of six now take antidepressants, and I read elsewhere that in terms of the global market (i.e. in dollars, in sales), American consumption of these drugs amounts to 2/3 of the entire world’s—this for a country that has less than 5% of the planetary population. Even so, as Ethan Watters documents in Crazy Like Us: The Globalization of the American Psyche, “the virus is us: As we introduce Americanized ways of treating mental illnesses, we are in fact spreading the diseases.”

As Ms. Angell points out, much of this spread (at home and abroad) has been economically driven, because once you say that mental illness is the result of an imbalance in brain chemistry, then the obvious “solution” is a pill that will rebalance the brain; and Eli Lilly, Pfizer and the rest are right there to market Prozac, Zoloft, Risperdal, and etc., and make fortunes from the lot. These companies, she writes, “through various forms of marketing, both legal and illegal, and what many people would describe as bribery—have come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated.” But the brain chemistry argument, as all three of her authors point out, involves a great leap in logic. It was found that psychoactive drugs affect neurotransmitter levels in the brain, and from this it was concluded that “the cause of mental illness is an abnormality in the brain’s concentration of these chemicals that is specifically countered by the use of the appropriate drug.” As Daniel Carlat notes, by the same logic one could argue that the cause of all pain is a deficiency of opiates, or that headaches are caused by having too little aspirin in one’s system. The logic, in short, is upside down; and as far as the empirical evidence goes—there is none. Decades of research have demonstrated that neurotransmitter function is normal in people with mental illness before treatment. (One has to wonder about the whole cholesterol industry as well. I read one study that indicated that half of Americans who have heart attacks also have low cholesterol. But that’s another story.)

This type of research tends not to make it into the public eye, however, because negative results on drug efficiency “often languish unseen within the FDA….This practice greatly biases the medical literature, medical education, and treatment decisions.” Positive studies by drug companies get extensively publicized; negative ones get suppressed. And there is a lot of evidence to show that it is the drugs that cause the mental illness. Schizophrenia and depression used to be episodic, interspersed with long periods of normalcy. Now, they are chronic and lifelong. The results of long-term use of psychoactive drugs, says Steve Hyman (a former director of the NIMH and former provost of Harvard), are “substantial and long-lasting alterations in neural function.” The brain begins to function in a different way, in other words, even after only a few weeks of drug use. Complex chain reactions ensue, ones that require additional drugs to combat the side effects of the original drugs. One researcher, Nancy Andreasen, has published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain—atrophy of the prefrontal cortex. (This did make it into the public domain, specifically the New York Times, 15 September 2008.)

Angell’s discussion of the DSM is equally chilling. It turns out that a lot of the decisions regarding what to include as a mental illness have been arbitrary, even whimsical. George Vaillant, a professor of psychiatry at Harvard Medical School, wrote in 1984 that the book represented “a bold series of choices based on guess, taste, prejudice, and hope.” In fact, there are no citations of scientific studies in the DSM to support its decisions--! The actual “science” of the book is thus dubious. Coming back to the economic factor, it turns out that drug companies lavish huge attention and largesse on psychiatrists—gifts, free samples, meals, plane tickets to conferences, and jobs as consultants and speakers. Of the 170contributors to the current version of the book, the DSM-IV-TR, 95 of them have financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia. What these folks do is expand diagnostic boundaries or create new diagnoses, new “illnesses,” which meshes pretty well with the financial goals of the companies who employ them. David Kupfer, the head of the task force currently working on the fifth edition of the DSM, was (prior to his appointment in this capacity) a consultant for Eli Lilly, Forest Pharmaceuticals, Solvay/Wyeth Pharmaceuticals, Johnson & Johnson, and Servier and Lundbeck. What a shock, that the already large list of mental disorders will be even larger in the new edition. So much for “science.”

Apparently, then, we have our own leaden forks, to the extent that lead may have attacked the Roman nervous system. It’s the result of a number of factors, including the American worship of technology, the search for simple (and individualistic) answers, and a lust for profits that is so huge that Lilly and all the rest couldn’t care less as to whether they are harming the American public. Nor is it very likely that any of the literature on cell phone cancer, neurological damage from screen usage, iatrogenic mental illness (i.e. illness that is doctor-generated, or Big Pharma-generated), will make any difference at all. For the fork in the road occurred decades ago, in psychiatry as well as telecommunications, and a reversal of any of this seems virtually impossible at this point. And as the American brain goes, so goes the empire. I can't help wondering if any of this will make it into the history books, on our decline and fall.