Are you opposed to all psychiatric medicines?
No at all. I am always quick to point out that I was helped tremendously by one simple antidepressant (Desyrel) years ago. However, the difference in my treatment and what I see happening with many patients suffering from various depressive or anxiety "disorders" today is that my psychiatrist exercised caution in his approach. He tried one medication at a time, and it was the second one that really clicked with me. Treatment today is more often characterized by a hurried-up, managed care approach. Doctors feel they don't have the time to try monopharmacy or one medicine at a time. They employ polypharmacy or multiple medicines, some just to offset side effects of others. Patients, sometimes at their own request, are switched from one medicine to another without due consideration for the half-life (the time needed for a medicine to be washed from system) or possible interaction of drugs. It becomes quite confusing for the patient and even for the physician as there are some 25 or more drugs now on the market for treating depression and anxiety. Add to those the antipsychotic drugs that are becoming more frequently prescribed for severe cases of depression and bipolar disorders and you have the potential for some downright lethal drug "cocktails." It's more of a problem than the general public knows.
So do you believe that depression is basically a biological problem or an emotional one?
It's both, but the explanation is not all that simple. One area certainly influences the other, but which comes first is debatable. And, you must not forget the spiritual dimension, which is an underlying factor as well. We're all multi-dimensional beings. Depression clearly can come from brain injuries and is often present along with other illness such as heart disease or cancer. Thyroid dysfunction, chronic pain, anemia and nutritional deficiencies are all possible culprits as well. Post-surgical depression is common. What is not really well-established, but is nonetheless generally accepted, is that depression is genetic in origin. It seems to me from all the literature that I have studied over the years and cases I have observed that there could possibly be a genetic link. It is also just as possible that what we presume to be genetic could in fact be environmentally induced. In other words, families can replicate patterns of behavior that can be damaging to emotional development. So what can appear genetic, in the absence of real proof, may really be a series of habitual behaviors that are continually reinforced. On the one hand, humans are tough and resilient; on the other, we are fragile and subject to emotional wounds that can run deep. Is alcoholism really an inherited "disease" or a learned way of coping with pain from generation to generation? Because we don't really have a definitive answer to this question, it is best to use a multi-faceted approach to treating depressive disorders. That includes medication where necessary, lifestyle changes such as exercise and diet adjustments and counseling, which ideally should be spiritually based because we're undeniably spiritual beings.
In your book, Outsmarting Depression, you speak highly of alternative medicine as effective treatment for depression and other mental illness. Why don't more people seek this kind of treatment if it is supposed to be safer than drugs?
We still are locked into the mindset that traditional doctors know it all and we are bombarded by media messages reinforcing that notion. Nevertheless, alternative care is becoming an increasingly popular option for many health problems, including mental illness, of which depression is by far the most common. Unfortunately, insurance coverage for alternative care is still lagging far behind where it should be. Study after study has shown how cost-effective alternative therapies nutritional or orthomolecular medicine, holistic chiropractic care, homeopathy, even acupuncture (to name the more obvious ones) can be in helping maintain balanced mental, emotional and physical health as compared with traditional care, which relies heavily on pharmaceuticals. As I've said, there is a place for pharmaceuticals, but they are over-prescribed, especially in mental health treatment, to the point where doctors are causing some syndromes and illnesses, such as tardive dyskinesia, tardive dementia, diabetes, hypertension and more. In other words, the cure is becoming worse than the illness in many cases. We should all be up in arms about these unsafe practices. People already know that pharmaceuticals are excessively expensive. It's beyond ridiculous. According to both the AARP and another consumer group, Families USA, prescription drugs in general grew at a rate more than three times that of inflation in the past year. Psychiatric drugs lead the way. Because of our love of drugs, the quick fix that isn't, insurance costs have skyrocketed leaving more and more people out of the treatment loop. Medicaid and Medicare become necessities for the chronically ill, many of whom are senior citizens, but doctors have to use the right insurance codes to get paid themselves, which means they have to be treating some concurrent physical problem.
What is meant by the term "mental health wars"?
It refers to the battle for the mind, basically. In other words, who owns the right to diagnose and treat so-called mental illness? Psychiatrists and psychologists have been at odds with each other for a long time. Even within psychology, which some say is behavioral science and some say is pseudoscience or philosophy, there are conflicting schools of thought. Who is more correct Freud, Adler, Skinner, Pavlov? Or are they all out in left field? Medical doctors, whether psychiatrists, general practitioners or neurologists, have their differences, too. What is measurable and what is not? When is mental illness a brain disease and whose purview is it if it is? There is really no reliable test, no marker, to determine neurotransmitter or chemical dysfunction in the brain. What kinds of medicines are most effective in treating mental disorders. Is talk therapy just as effective and safer? And what kind of therapy works best? Is it cognitive behavior, interpersonal or something else? Can a pastor or a layman counsel just as effectively as a psychologist? Who really understands human nature? Then there are the research scientists and the greedy pharmaceutical investors who know that psychiatric drugs are big business. Whose interests come first, the patient's or the corporation's? Throw all the alternative practitioners into the mix, and you have an overwhelmingly difficult array of choices for health care. Insurance must have its piece of the pie, of course, and it mucks up the system pretty well.
What, as you see it, is the biggest problem with the mental health system today?
There are many, as I've alluded to in the previous answer. But the one that concerns me the most is the over-reliance on drugs for treating depression and other mental "disorders." Because diagnosing and treating what we call mental illness is so subjective and because doctors today mostly subscribe to the brain model instead of the damaged emotions model, patients are given confusing, incomplete and sometimes harmful options for recovery. In fact, many doctors don't expect them to recover but to remain on "maintenance" treatment indefinitely. The drug companies have waged a successful campaign to convince both doctors and patients of that need. Despite the rosy picture painted in the pharmaceutical companies' advertising (my favorite is the little bouncing blob in the Zoloft commercial), antidepressants and other drugs prescribed for depression, anxiety and other disorders are not as effective across the board as they are made out to be. Clinical trial data is misleading. A drug may look promising in the lab, but in actual practice, the story can be quite different because people are unique and complex. What may work for one may actually exacerbate the problem for another. A surprising number of people actually feel worse when taking psychiatric medicines. Certainly, their senses are dulled in many cases and they are lacking the energy or motivation to get up and deal with their underlying problems.
There are no quick fixes to damaged emotions. Most serious or clinical depression has its real roots in childhood or adolescence, and there is plenty of research to support that. Those people with temporary "situational" depression, as from grief over the loss of a loved one or a job or because of divorce, probably respond better in the short run to medication. More serious or chronic depression, particularly that stemming from various kinds of earlier abuse, requires good counseling and lifestyle changes, along with some possible medication for a period of time. Now, even social phobias and routine depression, which is a necessary and periodic fact of anyone's life, result in multiple medicines being prescribed, some of which interact with each other in ways we don't even know. So to sum it up, the biggest overall problem is that doctors and the insurance companies that drive managed care tend to be too results-oriented and aggressive with medicines alone in treatment.
Is depression really on the rise, or does it just seem that way?
Most doctors and counselors I have talked to recently tell me they believe depression is becoming more prominent in today's culture and they are treating it in patients more frequently than ever before. While they cite various reasons for it, time and time again, I hear references to the fast-paced, stress-inducing lifestyle of today as a chief culprit. Some point to an epidemic of materialism and self-centerednessa dog-eat-dog environment of survival that pushes us to succeed at all costs, thereby setting us up for failure. That could account in part for the middle-class depression epidemic, and those are the folks who are more likely to seek help from a doctor or counselor and be counted among the statistics. They are the folks targeted by the pharmaceutical companies and their costly psychiatric drugs because they can most afford to get help. Many others who are locked into a lower income system where literal survival is putting the next meal on the table or shoes on their kids' feet are equally depressed, but unable to get much help in the medical or mental health system as they are underinsured or not insured at all. These people may not even realize they're depressed; they're just trying to make it to the next day. Our social services departments are understaffed and have inadequate budgets, so they simply can't handle the load. These folks are not likely to have much of a support system. Both groups of people are likely to turn to substance abuse for relief of their pain, and this creates an even greater problem. At the lowest end of the scale, of course, are the outcasts the homeless or incarcerated, many of whom are mentally ill. They make up a revolving door of critical need that taxes every state's budget.
Is there a solution to this problem or is it going to get worse?
I don't have a crystal ball, but I'd have to expect it to get a lot worse before it ever gets better. You certainly aren't going to change human nature. This is an election year, so politics has entered the picture as well, for better or worse. We're a nation at war, so money is scarce. Social programs have often proved to be failures in the past anyway. What are some possible solutions? As I look around, I see a great need for stop-gap program that ideally would be suited for churches or parachurch organizations. But there are two basic problems to overcome here. One is that church populations are declining as society grows more secularized and the other is the lack of understanding and incorrect attitudes toward the mentally ill within the church. Those churches that get it and have growing recovery programs staffed by laypeople, most of whom are recovered themselves and are supervised by licensed counselors, are having the greatest success within their communities in helping the emotionally wounded and addicted. They will still need to refer some of these people to doctors or counselors for some professional help, but the emotional and spiritual support they receive is the missing link in their recovery. I can look back and see how critical this kind of support was to my own recovery from depression years ago. That's why I help in my church's recovery program. Pastor David Seamands, who wrote a great book back in the 1980s called "Healing for Damaged Emotions," calls it "recycled grace." I like that. We all function better when we are connected as a community seeing to each other's needs. The world forces isolation and a false picture on us, and we must fight that.
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