Scientific Psychiatry, Part I
David Gersten, M.D. Reprinted from The Life Connection Oct 2007
Several years ago there was an item in the media that caught my attention. Actor Tom Cruise had gone to visit actress Brooke Shields to formally apologize to her, after he openly criticized her for using Paxil, which she believes helped her recover from postpartum depression after the birth of her daughter in 2003. Cruise, a Scientologist, had previously insulted Shields and told her that such medication was never necessary.
Since 2004, Cruise has spoken openly about Scientology and its rejection of psychiatric drugs. On one occasion Cruise referred to psychiatry as a “Nazi science” in an interview in Entertainment Weekly.
Cruise’s beliefs come straight out of Scientology and the writings of L. Ron Hubbard, founder of Scientology, who believed that psychiatrists denied human spirituality. To some extent, Hubbard, in my opinion, is correct in his view that psychiatry (and psychology) has largely ignored man’s spiritual nature. Hubbard also proclaimed that psychiatry was “an evil enterprise, a form of terrorism, and the cause of crime.” According to Hubbard, “The psychiatrist kidnaps, tortures and murders without any police interference or action by western security forces.” Hubbard also claimed that the human mind was governed by biochemical reactions. I have to agree with him about that, but Hubbard saw that as a very bad thing, as if acknowledging the biochemical side of human beings was a denial of our spiritual side.
Tom Cruise’s attacks on the use of antidepressants, and all physical compounds, whose purpose is to foster better brain function, arise directly out of the rather warped mind of L. Ron Hubbard. While Cruise’s popularity in America has dramatically plunged over the past two years, I am concerned about fans of his who might take his opinions to heart, people who might greatly benefit from some medication.
History of Psych Meds
Let me step back in time to give you a brief history of psychiatric medication. Sigmund Freud, a neurologist, was one of the founders of modern psychiatry. He experimented with a number of compounds to assess their benefit for the mind. Not a great researcher in this area, cocaine was one of the favorite “medications” Freud was testing on himself.
On a more serious note, the discovery of Thorazine was a huge turning point for psychiatry and for millions of psychotic people. Like many discoveries, Thorazine was an accident. It was being developed as an antihistamine, but through a series of serendipitous events, scientists discovered that it helped schizophrenic patients. Within a few years, psychotic patients in long-term mental hospitals were being treated with Thorazine. The results were dramatic. Most schizophrenics, who had spent years locked in rather dismal facilities, suffering with voices and delusions, benefited tremendously from Thorazine. The benefits were so great that plans were made to begin emptying out the state mental hospitals. The overall plan was to build a county mental health system (CMH) throughout the country. Psychotic patients were discharged from the state hospitals with the idea that they could live on their own or in less structured, open facilities, and would go to CMH for medication and group therapy.
It was a wonderful idea that largely failed. It wasn’t that the medication stopped working. The failure was that huge numbers of schizophrenic people stopped going to CMH and stopped taking their medication. They lapsed back into a disorganized, confused schizophrenic state . . . and many of those people now form the foundation of the homeless people of America .
Another breakthrough in psychopharmacology, the first antidepressant, amitryptiline (Elavil), was also made by astute scientists, who were not looking for antidepressant medication. Amitryptiline had been invented and was being tested as a new antipsychotic medication. Numerous schizophrenic patients received amitryptiline. The study had good news and bad news. The bad news was that this new medication did not help schizophrenics with their psychosis. However, one researcher observed that some of these patients were less depressed. And the rest is history. Amitryptiline was tested as an antidepressant and it had significant benefit for people who were clinically depressed.
Generations of medications have come and gone since thorazine and amitryptiline. In the sixties, there was a backlash against psychiatry, and the anti-psychiatry movement was born. At the same time, psychiatry was struggling to find its identity. Was it more of an art or a science? That debate continues.
As a psychiatrist, I have often felt caught in a very strange place. I have treated thousands of people with serious mental illness, have worked with hundreds of people who attempted suicide, and have seen the light side and the dark side of psychiatry. I’m a pragmatist. First, I’m interested in what works. Secondly, I’m interested in why a particular approach works. During my psychiatric residency, which ended in 1978, I was taught that enormous research had proven that, in the treatment of depression, a combination of medication and psychotherapy was the most effective approach. Research continues to support that conclusion, but in many cases, I will use natural treatments, such as amino acid therapy, rather than a medication, and to the shock of nearly every new patient, I insist on psychotherapy as part of their treatment. The exact nature of my psychotherapy approach is not the point of this article, but I have not found that talk therapy is very useful after a couple of visits.
Driven by changes in insurance, the birth of managed care, rising overhead, and the desire to be perceived as “real doctors” by the rest of Medicine, many psychiatrists stopped honing their skills as counselors. Most people who see psychiatrists now expect a 15-minute medication evaluation. Huge numbers of psychiatrists are referring their patients to psychologists and the like for their “counseling needs.” For me, it is impossible to look at an individual as a “medication issue.”
My personal quandary is that I believe that, in general, psychiatry ignores spirituality and nutrition, over-diagnoses mental illness, over prescribes psychiatric medication, and has largely been ignoring psychotherapy. On the positive side, psychiatrists and psychiatric medications have alleviated enormous suffering.
Mental health is not different from holistic health. It is always best to treat the whole person. Medicine, in general, began to fragment patient care with the advent of specialties. Most of you know, that if you have a primary care physician, he or she will treat just so much, and will then make a referral to a specialist. As often as not, you get lost in a large bureaucracy in which the many doctors treating you may not all be communicating with each other. Even the specialists have sub-specialties, leading to further fragmentation in treating the whole person.
I have worked in every kind of psychiatric facility that exists, including: office outpatient, psychiatric hospital, medical patients in the hospital with psychiatric problems, board-and-care facilities, long-term lockup facilities in San Diego , long-term residential treatment facilities for children and adolescents, and long-term state psychiatric hospitals. When you have seen mental patients, by the tens of thousands, in so many facilities, you have seen a piece of society that very few people can comprehend. I’ve seen and treated every kind of mental suffering in huge numbers, worked with suicide and homicide, multiple personalities, alcoholism, and everything under the sun.
I would like to take Tom Cruise for a visit in a psychiatric hospital. I’d especially like just to sit with Tom in one of the long-term locked wards of the state mental hospitals. The patients there are the ones for whom nothing worked . . . not counseling, not medication, not all the work of social services. It is the end of the line. I’d like for Tom and me to sit down with a depressed schizophrenic patient and talk. I would ask Tom to use the methods he has learned from Scientology to “cure that patient.” The problem is that Tom would probably be so terrified to sit in a large room filled with people with chronic psychosis that this scenario would never take place, and if it did, Cruise would probably be requiring psychiatric medication in a short period of time to handle anxiety. It’s not that these people are dangerous. Mental patients are no more dangerous than the average person. It’s just that, if you have not spent years working with the mentally ill, it is a scary experience because you just don’t have a clue how to really connect, and how to be helpful. It’s understandable. That’s why psychiatrists have 8 years of training after college, and clinical psychologists spend 5 to 7 years getting their doctorate.
I’m a bit peeved that a celebrity, who has no training, who has not spent one hour in a psychiatric hospital, is making comments that are likely to cause at least a few people to stop taking a lifesaving medication. There’s a real possibility that there will be some suicides caused by Tom Cruise’s ignorant and biased remarks, the possibility that someone who really would benefit from treatment with an antidepressant medication won’t take it, because he believes Tom, and he’ll kill himself.
Psychiatry, like the rest of medicine, is an art and a science. Healing is the merging of the art and the science. In terms of psychiatry, there is not much science that generally goes into the consideration of what medication or other treatment you might need. Psychiatry is about brain, mood, thought, and behavior. That’s what we treat.
While there are countless factors that affect mental health that most psychiatrists don’t deal with (such as: mercury toxicity, Candida, parasites, food allergies, electromagnetic fields, spiritual disconnection, and lack of purpose), this article will focus on brain chemistry and neurotransmitters.
…Part II to follow soon.