Why was a child prescribed drugs that the Food and Drug Administration had not approved either for ADHD nor for long-term use in bipolar disorder, nor for babies of Rebecca’s age?
The story is emblematic of what American doctor, Marcia Angell (1939) has been denouncing for years. A doctor specialized in internal medicine and recognized authority in the health field, Angell has called for medical and pharmaceutical reform in the United States. She is the first (and so far the only) woman director of The New England Journal of Medicine and professor of social medicine at Harvard. The author of numerous publications, including The Truth About the Drug Companies: How They Deceive Us and What to Do About It (2004), Angell has for some years now carried on a battle against the excessive power of pharmaceutical companies and their capacity to fatally influence psychiatric practice.
Marcia Angell has often written interesting articles for The New York Review of Books, such as “Drug Companies & Doctors: A Story of Corruption” (2009). In 2010, she wrote “FDA: This Agency Can Be Dangerous,” in which she acknowledged that the FDA has “a very important mission” but denounced in no uncertain terms how the part of the agency responsible for regulating drug prescriptions, the Center for Drug Evaluation and Research, “has become the servant of the industry it regulates.”
Now, in two installments, The New York Review of Books, has published a dossier in which Angell denounces the degeneration of American psychiatry in treating mental illness (“Why Is There An Epidemic of Mental Illness?” June 23-July 13; “The Crazy State of Psychiatry”, July 14-August 17). Mental illness, according to current data, has become an authentic epidemic in the United States: in 1987 one in 184 Americans presented a disability connected to mental disturbance, in 2007 it has become one in 77. Amongst children the increase is even greater.
American psychiatry has changed since the 1950s: in the certainty that mental illness is reducible to chemical reasons, it has ceased to listen to patients’ stories and is only concerned with eliminating the symptoms presented through the use of drugs. The pharmaceutical industry, having become aware of this conversion of psychiatrists, quickly conquered the territory – a particularly appetizing one, since in psychiatry, compared to other branches of medicine, objective elements to categorize mental illness do not exist, and therefore the confines of diagnosis can be expanded at will, or created anew. We have arrived at a point, according to Angell, where it is the pharmaceutical companies that determine what constitutes a mental disorder (and how it should be treated). The advantages are immediate for the doctors: today, a psychiatrist is able to visit three patients in an hour, for a total of 180 dollars, whereas with traditional therapy the same doctor would only be able to visit one patient and earn less than 100 dollars.
Initially, the diagnosis of ADHD manifested in hyperactivity, lack of attention and impulsivity in school-age children, but in the middle of the 1990s, the idea that many children afflicted with this syndrome in reality suffered from bipolar disorder since infancy, became popular. There followed an explosion of diagnoses of infant bipolar disorder. But maybe it is not so difficult to find a two-year-old who isn’t sometimes irritable? Or a child in fifth-grade who is not sometimes distracted? The dramatic data is that the diagnosis has little objectivity: it depends on the child, on his family, on the pressure exerted on the parents by the psychiatrist. An aggravating factor is that in this time of economic crisis, to have a child classified with mental illness means being able to benefit from SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance). According to the economist David Autor, “this has become the new welfare.”
Psychiatrists, therefore, must change direction. They must cease believing that drugs represent the only way to cure disorders and mental illness. And it is urgent to reconsider treatment for children: out of bad faith or distraction, one looks for the cause in the brain of the little one, while very often the real problem is “only” that the child lives in a family which is extremely poor or needy. “Above all,” Angell concludes, “ we must always remind ourselves of the simple medical imperative: primum non nocere.”