Sunday, August 18, 2013

And Cracked it is - Review

Cracked. That’s the only possible way I can describe this book. Oh it made me angry. Livid. And I could only dream about ever being able to write as good and fitting a review as Andrew Solomon did in his essay “Smug about Suffering”, which I really recommend – beg, beseech, implore –  you to google and absorb. But I’ve got enough fury in me to add my own nickel of doom. I can only offer a few points because I could happily turn this into a dissertation, but I shall spare you.

The good bit, short and sweet: Yes, it was very readable, and as far as I can see, it has had great reviews (though I cannot possibly fathom why). And I am the first to agree that there might be occasions when people get overmedicated unnecessarily, and that it is a golden goose for the pharmacy industry. But something being profitable doesn’t necessarily equal sinister intentions.
The bad bits (and I hope you’ve got a few minutes, because there are lots): This has got to be one of the most one-sided, self-aggrandising, misinformed and irresponsibly polemic books recently written on the subject.

Another reviewer pointed out that a book written against the use of psychopharmaca and advocating an increased use of psychotherapy comes, I guess, at no big surprise from a psychotherapist. Talk about the sweet irony of applying Davies’ conspiracy theory of the pharmacy industry back onto himself. It works both ways, Mr Davies.

The one thing I agree with Davies on is that medication on its own often only masks the problem, and does not cure it – but no one has ever claimed it does. Though funny enough, that’s exactly the absurd accusation Davies hurls at psychiatry at various points in the book. Psychiatry is still in its baby shoes, the brain and mental illnesses largely not understood, but that does not mean we shouldn’t use the little knowledge we have to help ease mental suffering.

Demonising and attempting to discredit something which has saved the lives of so many of us in favour of something most of us only have limited to no access to is downright sinister.
Fact is, the therapy a lot of us need, CBT or whatever other kind Davies (rightly) makes his case for, we cannot access at all, because most of us cannot pay the outrageous fees in the private sector, or we have to join huge queues on waiting lists that often last a year or longer – and some of us haven’t got the strength to wait that long. The six free NHS sessions we are entitled to are done by counsellors, not trained psychotherapists, and due to government cuts, there are less and less mental health centres around, with staff in there hopelessly overwhelmed and under-trained.

The practical truth of the matter is, most of us have to do with pills. I should know. I’ve been on medication for nearly a decade, and several attempts to come off them failed. (Not because there was a problem with addiction, as Davies is quick to claim - it was simply that my old condition resurfaced and regained the upper hand.) Maybe if Davies is willing to come off his smug high horse and open a NHS mental health facility that provides care to those of us who cannot afford the insane fees he probably charges, he can talk again. But he probably won’t, and that makes him just another cafe activist.

In Davies’ view, psychiatry has become so reliant on and biased towards drugs that it perpetuates a treatment model in which therapy has been moved onto the back burner and people instead are stuffed with pills as a cop-out solution. Part of me wants to agree with that, but then he fires off the most outrageous claims and solutions. He quotes psychiatrist Duncan Double’s suggestion that “the only thing that is going to change things is if people literally stop going”. What does that mean? People stop taking meds out of protest?? The grassroots movement Davies dreams of would result in mass deaths, most likely by suicide. Baby and bathwater springs to mind.

Davies makes it appear that all antidepressants have terrible side effects and work not much better than a respective placebo. That is pretty much saying that mental illnesses treated with medication can just be “thought” away at random, again implying the old stigmatising thought that we need to “just get over ourselves”. Which is a terrible thought coming from a psychotherapist, and a Social Darwinist one to boot.

There might be truth in these side effects and not knowing whether meds will work. Well, sadly, in case of mental illness, you don’t get to choose the perfect option – because it doesn’t exist. Fighting mental illness is often choosing the lesser of the evils, weighing the drawbacks and benefits of both medications and the actual illness. For me, a few weeks of nausea and dizziness was but a small price to pay if it meant ending the agonies of permanent terror and black clouds of despair, numbness and emptiness. Finding the right medication, and the right dose, is often a matter of experimenting. I had side effects, but they went away once I got used to the meds. I have tried meds that didn’t work for me, and switched to others that do. Mind, I accept that some aren’t as lucky as I. But the pros and cons of medication is not something you can apply as a blanket statement over the whole of psychiatry. It’s down to working with individuals.

Then there is Davies' outrageous claim about psychoactive drugs altering personalities. If you want to read the other side, read Kramer’s Listening to Prozac. And then let’s delve into personality theory and what constitutes that concept. Frankly, in my view it’s b****t. Most people I know who are on psychoactive drugs feel like they’re back to their old selves, they’ve got their life back, their own persona managed to get the upper hand over the vines of mental illness that choked it. Including yours truly.
Only once did I have a friend who told me she didn’t like the change in me. “I was not who I was before”, she complained (though she had only ever known me as depressed), making the assumption that that ill person was me, thus equating my illness with my personality. The thought that a friend of mine wished me to suffer so she didn’t have to deal with a (positive!) change in me was too much – and needless to say, I have safely removed that so-called friend from my life.

At times Davies goes as far as dismissing the agony some people suffer as nonexistent in terms of illness or dysfunction, arguing that life contains suffering and it is important to deal with it, claiming medication stops us from doing just that. This goosestepping kind of cruelty makes me sick. Yes, there is suffering, and yes, we need to deal with it. But there is the type of suffering everyone experiences due to circumstances, and then there is the pointless pain in mental illness, which does not need an external cause, or takes a minimal external cause and blows it out of proportion.

Another of Davies’ crazy arguments is that religion used to act as a tool to cope with life, and its increasing disappearance is partly responsible for the increase in mental illness. Well, I used to live and work in a religious community – and I have seen just as many cases of people suffering from mental illness in that sector as I have in the secular one. The only difference was that often their anxieties and despair took on a religious flavour, if not got exacerbated by it. Take OCD and depression and add to that the literal fear of hell and damnation, plus perhaps a delightful community that blames your mental illness on your lack of faith and perhaps on demon possession, and you’re in for a fun ride. I was just lucky enough to have a pastor who could see the difference between spiritual and mental health problems and advised me to seek medical help.

But it’s not just Davies’ ridiculous arguments that drive me up the wall. It’s also how he deals with his opposition. A fine (and much infuriating) example of how he tries to discredit them is seen in his interview with Professor Sue Bailey, president of the Royal College of Psychiatry, who talks sense, compassion and common sense, who sees it as her first duty to help suffering patients and not engage in the one-sided intellectual masturbation Davies seems to be so fond of. He describes her as some sort of ball-breaking harpy, as “impatient” and “irritable”, while he depicts himself as “gently pointing things out”, a humbly “mumbling”, “ear-rubbing” nervous grassroots fella taking deep breaths to not be run over by her. Oh poor martyr. He claims to struggle to understand what she is saying, when anyone with two brain cells to rub together can make sense of  “we should focus on the reality of what we can do as doctors, rather than having erudite discussions about the various situations of what DSM should have done.” Davies doesn’t seem to comprehend that this type of Michael Moore-ish writing only serves to discredit himself.

I could go on and on, but I shall stop here. Suffice to say, yes there are people for whom psychoactive drugs have done more harm than good. They have come off them and chose not to go there again. But that’s fine. Each person is different, and each person needs to make their own choice about it. But dismissing the entire thing is dangerous, cruel and downright murderous – to quote Andrew Solomon’s critique of this book, “Davies’s book will likely influence at least a few people away from treatment that could save them. Some of these people may commit suicide and others will live in dire pain. His arrogant, ill-informed attempt to discredit psychiatry leaves him with blood on his hands.”

If you want a really well-rounded, good book to read on depression, anxiety and mental health in general, read Solomon’s “NoondayDemon”. Now that man knows what he is talking about!

Meanwhile, Davies should give up his profession and try his hand at something he is really good at – the fearmongering, mass-duping, misinforming mutant of pseudo-journalism they serve at The Daily Mail.


Anonymous said...

Hi Patty, great critique of this book. Sounds like the man is a total knobhead.
O.C. Jeff :-)

b grosjean said...

for another perspective directly from the field in Los Angeles,
check my essay

"Rethinking Psychiatry from locked in to locked out"