WHEN TREATMENTS POSE A THREAT

“The road to hell is paved with good intentions.” -Proverb 

It’s interesting that western cultures tend to stigmatize, pathologize, and medicate people who experience visual or auditory hallucinations, while other cultures around the world celebrate such experiences. In fact, the individuals who receive hallucinatory images are celebrated and trained by shamans and tribal elders to become spiritual leaders. Their experiences are viewed as gifts to be developed — not as symptoms to be eliminated. Almost all of the wise teachers and prophets of history—such as Jesus Christ, Buddha, and Mohammed — had their hallucinations deemed special by their society. Imagine how they would have been treated today in the United States. They probably would have been locked away and medicated into a zombie-like state. What changed? 

The history of psychiatry in the United States is a fairly dark one, with all sorts of things we would have done differently if we knew what we know now. Still worrisome, however, is the ever increasing tendency to pathologize anything and everything, which in turn leads to the increasing use of prescription drugs. From the first edition published in 1952 to the fifth one published in 2013, the number of diagnoses in the Diagnostic and Statistical 

Manual of Mental Disorders has risen from 106 disorders discussed in 130 pages to 298 disorders discussed in 992 pages.16 Even more concerning than the overpathologizing of this developmental process are the increasing financial ties between the medical and pharmaceutical industries. Between the release of DSM-IV to DSM-V, the percentage of manual developers with pharmaceutical affiliations increased from 57% to 72%.17 

I am not alone in this assessment, Dr. Allen Frances, Chairman of the Department of Psychiatry at Duke University and Chairman of the task force which produced the DSM-IV, has been very vocal about the expanding boundary of psychiatry and the over-treatment of the worried-well, with DSM-V and the direction the field is taking. He states: 

“New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs — often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. The American Psychological Association is not competent to do this.”18 

The United States is currently the most medicated society in the history of the world. I recently attended a conference in which the following data were presented for 2020: 60% of patients receive psychiatric medications only; 30% of patients receive a combination of medication and therapy; and only 10% of patients receive therapy only.19 Further‐ more, 1 in 4 women in the United States were on antidepressant medication in 2020. These numbers are terrifying and dangerous. First of all, nobody should be on medication without any conjoint behavioral or talk therapy. The idea that taking a pill will magically cure you is ridiculous. The numbers above should be completely flipped on their heads, with behavioral and talk therapy always being the first treatment recommended for mental health disorders, followed by therapy in conjunction with medication. Only in very rare cases should a patient take medication without talk therapy.