Yesterday ABC interviewed Joe Pantoliano about "Mad Pride," a movement whose members think of mental illnesses as gifts and, in some cases, reject traditional treatment. In this, they have something in common with today's antidepressant critics.
In his appearance (the teaser for which appears above), Pantoliano mentions that he takes antidepressants, and argues for the less controversial causes of mental health parity and frank discussion of mental illness. He's founded a nonprofit organization "based on accepting, encouraging people to admit to their disease — to seek treatment and become even greater members of society." But some members of the Mad Pride movement prefer to forgo treatment — at least, the conventional psychiatric variety.
ABC's Ia Robinson and Astrid Rodrigues talked to musician Madigan Shive, who was diagnosed with bipolar disorder but now prefers not to label her condition. Though she has delusions and "extreme state[s] of consciousness," Shive doesn't take medication or go to psychotherapy. Instead, she relies on her own "mad map" of triggers and coping strategies, and a network of friends who will take her to a hotel room, instead of a hospital, when her symptoms become severe. She says, "Please don't change this thing in me that creates this music and keeps me alive. ... I need my madness."
Shive says she knows people who take psychiatric medication "and use it smashingly well and I support all that." Similarly, David Oaks, leader of Mad Pride group MindFreedom International, says his organization isn't against drugs, but only against forced drugging of people who would rather manage their illness in other ways. One of MindFreedom International's FAQ pages says, "one of the main human rights violations in the mental health system today, is the way the psychiatric drug approach dominates, squeezing out alternatives and spreading dis-information."
Writer and psychiatry lecturer Charles Barber might agree, though he comes at the problem from a different direction. In a Salon article, Barber advances the recently popular argument that the rise in antidepressant use in America can be blamed on pharmaceutical marketing. Of TV ads for antidepressants, he says,
Often it is hard to tell exactly what condition the drugs are treating. The taglines of the drugs are often vague - for drugs for depression, the slogans might speak broadly but inspirationally about change and hope and getting back to one's true self. (Now that I think of it, these meta-messages are not unlike those of the Obama campaign.) The drugs thus appear to be defined less as mediators of specific medical conditions than as ways to enhance one's lifestyle and quality of life. And this is good for business: It turns out that the market base of people who are interested in enhancing their lifestyle is far greater than of those who suffer from major depression and other serious and debilitating mental illnesses.
Barber doesn't really address the problems with the health insurance industry that cause many people to take medication when more expensive therapy — or a combination of meds and therapy — might be more effective. Instead, he's more interested in branding those who take antidepressants as greedy consumers intent on "enhancing their lifestyle." And is he implying that the Obama campaign, too, was trying to sell us something we don't need?
It's become popular to argue that lots of people are on antidepressants for frivolous reasons, for what Barber calls "the blues, or financial, career or relationship problems, all of those things that we used to regard as life problems, and not medical or diagnosable ones." Most people who make this argument blame the pharmaceutical industry, but some, like Barber, seem to reserve a bit of blame for patients as well. It's undeniable that more people are taking antidepressants than ever before, and it's certainly possible that some could benefit more from other treatments. But who are these vaunted pill-poppers who don't "really need" their Prozac? Whose problems are too minor for drugs, better suited instead to finger-wagging and a course in biting the bullet? Would Barber be willing to point the finger at someone who's lost a job, a marriage, a child, and say, this form of relief should not be available to you?
A more compassionate approach would be to examine psychiatric drugs from a patient's point of view. Are they being pushed on patients who don't want them? Do antidepressants lessen patients' self-reported feelings of sorrow over what Barber calls "life problems"? Are there other treatments or practices that might help them more? In many cases, the answer to this last question is yes, and when that's the case, insurance should cover these more effective practices. But we're not going to get the answers to any of these questions if we infantilize patients, assuming they're all reaching for something they saw on TV as an easy way out of their troubles.
There are plenty of problems with the Mad Pride movement — for one thing, untreated mental illness can make people hurt themselves or others. Robinson and Rodrigues mention John Hinckley and Virginia Tech shooter Seung-Hui Cho as people whose violence may have stemmed from insanity. Oaks says, "The vast majority of people with psychiatric diagnoses [...] — we're law-abiding, we're peaceful," and this is no doubt true, but he doesn't offer a solution for people who are so violent or suicidal that they can't make decisions about their own treatment. At least, though, Oaks and his fellow Mad Pride activists argue for more autonomy for those who are suffering. In arguing against the pressures of pharmaceutical companies, Barber is actually exercising his own kind of pressure.
At the end of his piece, Barber changes direction, acknowledging, "I can claim confidently that there is, right now, a high-water mark of worry and suffering on numerous fronts - economic, of course, but also social, with our ever-increasing isolation and Internet-driven loss of human connection and the ongoing trauma of wars and crises that just don't seem to end." In some ways, he recognizes, this is a difficult time to be alive. Perhaps it's not so shocking that many people turn to medication for relief — and that others find more relief in refusing such medication. And while both approaches have drawbacks, perhaps we should be a little slower to judge them.
'Mad Pride' Activists Say They're Unique, Not Sick [ABC]
Are We Really So Miserable? [Salon]
MindFreedom International [Official Site]
Teaser - Joey Pants on ABC Primetime - Tuesday, Aug. 25 at 10pm [YouTube]