Yale University’s Charles Barber has just published a book called Comfortably Numb: How Psychiatry is Medicating a Nation, about the over-prescription and misprescription of antidepressants. Intern Callie Enlow, who found the book "thoughtful and surprisingly entertaining,’’ recently talked to Barber about the societal and marketing forces that made Prozac and its siblings the drug industry’s biggest cash cow.
PLAYBOY: Who did you write this book for?
BARBER: I think the natural audience is the people that have taken the drugs and have had a wide range of experiences on the drugs. I’ve also been contacted by a large number of their family members.
PLAYBOY: Some people don’t know the difference between a psychiatrist and a psychologist, not to mention a social worker and a counselor. Might that make it hard for people to seek appropriate treatment?
BARBER: That’s part of what I’m saying in the book. Therapists haven’t done a great job in marketing themselves. Most people who are drawn to the healing arts are not drawn to marketing themselves, and of course there’s not a product to push, like a pill.
BARBER: In the early 90s, there was this sort of gee-whiz quality about anti-depressants. The previous generation of anti-depressants had much more side-effects and could be lethal in overdose. Prozac has much less side-effects and is basically non-lethal. We’ve been very quick to embrace this way of treating these illnesses and the rates of anti-depressant prescriptions continue to rise. The stigma of taking a pill has been largely eradicated. We’re drawn to quick fixes.
PLAYBOY: Yet there’s been some question lately about the effectiveness of antidepressants. Do you expect a backlash?
BARBER: There’s a dialogue and an interest in alternatives, but the change will come from society, not the medical establishment. The book points to structural issues and those forces are just as strong if not stronger. The number of drug representatives have doubled and there’s still an emphasis on marketing. Most anti-depressants are prescribed by family doctors. Most of those practitioners wouldn’t know how to refer a patient to a cognitive therapist.
PLAYBOY: Right. Your book particularly advocates Cognitive Behavior Therapy, a talk therapy technique that could be more effective than antidepressants in treating depression. If most people get their anti-depressants from their family doctor, how will patients find out about this treatment?
BARBER: Cognitive Therapy is becoming better known, its’ profile is slowly rising. Dr. Aaron Beck (founder of Cognitive Behavioral Therapy) won the Lasker Medical Prize, in the science world it’s like America’s Nobel Prize. But I don’t think that Cognitive Behavior Therapy has permeated the public’s imagination. Psychoanalysis dealt with fun and sexy things like Oedipal stuff and sexual issues and analyzing dreams. Cognitive Behavior Therapy has a boring name and is a hard thing to simplify. In the book I talk about Cognitive Behavior Therapy being carpentry; there’s a technical, analytical aspect to it which is part of its effectiveness, but it’s not so much fun.
PLAYBOY: In your book you talk about depression and Depression. What is the distinction?
BARBER: A lot of it is designed on the ability of people to function, like if you’re still able to function in your relationships and vocation. There are very specific criteria for diagnosing Depression. We ask if the patient has had any ability to feel pleasure over the past two weeks. You have to be in a really rough spot not to feel any pleasure in the past two weeks. It’s pure pain, no relief. I’ve worked with enough really ill people and seen how their diagnoses have gotten generalized. There’s no better example than Depression, which is absolutely over-diagnosed. The serious conditions are relatively rare. At a linguistic level, it’s not helpful to have such a bland term.
PLAYBOY: Is that why you wrote the book?
BARBER: I was very influenced by the novelist William Styron’s memoir Darkness Visible, and by Styron in general. The other huge influence was Walker Percy, whose novel The Thanatos Syndrome came out a year before Prozac. It’s sort of a sci-fi spoof. There is a government/industrial conspiracy of putting “heavy sodium” in the water to better society. The protagonist, a psychiatrist named Dr. Thomas More, finds all his patients are kind of numbed out and he uncovers this conspiracy. It’s funny, over the past few years there have been studies of the water in various cities and streams. One found the drinking water in Philadelphia had 50-odd prescription drugs in it, trace amounts, but we don’t know how they interact. Many of those were antidepressants. I was interested in: how did we get here? What does it all mean?
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