There are psychiatrists in our universities who think half the population is mentally ill. There are leading research psychiatrists who believe that anti-psychotic drugs are fine for two-year-olds. Others find the fact that many varieties of expensive, side-effects-ridden anti-depressants seem to be placebos rather than medicine a matter of indifference.
Still others think that receiving hundreds of thousands of dollars every year from drug companies in no way undermines the integrity of their research on those companies' drugs. Nor do they see anything wrong with putting their names on books and articles ghostwritten by those companies.
Most of us outside the psychotropic community know it by its inescapable radio, tv, and print ads nudging us all toward an appraisal of ourselves as clinically depressed. Everywhere we turn, gentle voices whisper that we are not compos mentis. We know little or nothing of studies showing the inefficacy of anti-depressants, the corruption of psychiatric research and practice by the pharmaceutical industry, and the degradation of disease diagnosis into what people now call psychosprawl.
We've learned to be terribly eco-minded about other forms of ugly and destructive sprawl - urban sprawl in particular, with its uncontrolled, debilitating, resources-gobbling development ever outward. Yet we haven't yet been able to apply smart growth to the precincts of our own minds. Bizarrely, we've been kinder to the cityscape than to our own inscape, to the intimate reaches of our own identities. Into our complex and dynamic brain terrain we've allowed an astounding array of dangerous chemicals.
Some people have done this because they are truly suicidal with despair. Many others have done it because when you live in a You're Clinical echo chamber you begin to believe it. Surely many of the people addicted to prescription pain pills actually believe themselves to be in pain. In a similar way, many of the Americans who have spent years on one and then another and then three other drugs for depression believe themselves to be clinically depressed. And indeed after tampering with their brain chemistry in so serious a way over so many years, they may be right that they have some form of mental disease.
The following possibility seems not to have occurred to them: They experienced long ago a serious sadness that might have passed in time all by itself, or might have benefited from talk therapy, or exercise, or, to be sure, might have lifted with a short pill regime. That sadness, though, has sprawled, transmogrified, and now hardened, into a debilitating lifelong drug dependency.
Other, related possibilities also seem not to have occurred to them. For instance: Having put their five-year-old son on powerful drugs for some fashionable diagnosis (ADD, bipolar disorder), they created a young adult every bit as pill-dependent for life as they are themselves.
Why aren't we learning? Why do we lack the simple vigilance that would arm us against over-diagnosis, over-dosing, within the privacy of our own heads?
Part of it is certainly our carpet-bombing by You're Clinical advertisements and industry-sponsored research results. Part of it is that when you mainstream a behavior - Vycodin-chugging, Prozac-gulping - you make it not only acceptable but sought-after. ("When my neighbor's sad, her doctor gives her Prozac!") Part of it, I think, is the very human tendency to think of ourselves, our thoughts and feelings and personal histories, as special, intense, uniquely sensitive. Why do we so love those memoirs that Joyce Carol Oates calls pathographies ? These are not mere biographies, but narratives with an unrelenting focus on everyone's hopeless and disastrous mental frailty. We eat this genre up, can't get enough of it. We seem to feel that dysphoria is charismatic.
What I'm trying to describe here is the perfect psycho-storm: A combination of cynical mental health researchers, hapless physicians under pressure from patients demanding pills, and a pharmaceutical industry as far from dysphoric as it is possible to be.