BEST years of their lives, or society-induced teenage trauma? In the second decade of this century, mainstream media gave much attention to a ‘mental health crisis’ in young people. Children and adolescents were a huge growth area for psychology, psychiatry and the pharmaceutical industry. This campaign was interrupted by Covid-19, when concern for the impact of lockdown, social distancing and school closure was overridden by the priority of pandemic control.
Until the turn of the millennium, youth had been a vast untapped potential for Big Pharma. A child starting on antidepressants is a customer for life.
My research at King’s College London showed that the ‘mental health crisis’ was mostly contrived: despite the constant barrage of fearful messages in the mass media, there was no sharp rise in psychiatric admissions or suicides. This was an application of the problem-reaction-solution strategy: people are persuaded of a pressing problem (mental health crisis), provoking a reaction (clamour for something to be done) leading to a solution (expanded surveillance and treatment).
This strategy was blatant with Covid-19. Experimental mRNA vaccines were pumped into arms, with only a steadfast minority refusing the injections which proved neither safe nor effective. The entire industry of vaccination is based on deception. The official story is that deadly diseases of the past, such as poliomyelitis, were eradicated by vaccines. The truth is that the contagious killers which ravaged industrialised society had faded by the mid-twentieth century thanks to sanitation and smaller broods of healthier kids. Mortality plummeted.
The same dubious causality was used in psychiatry. In the 1950s the resident population of mental institutions reached its peak. Although asylums had been renamed hospitals earlier in the century, there was no effective treatment for insanity, and conditions in antiquated and overcrowded wards were shameful. In the 1930s an onslaught of physical interventions (insulin coma therapy, shock treatment and frontal lobotomy) failed to fulfil the promise of heroic medicine.
In the mid-1950s antipsychotic drugs were discovered and for the first time the delusional and behavioural symptoms of schizophrenia could be effectively controlled.
Chlorpromazine (brand name Largactil) had profound impact: wards were calmer, rehabilitation units were created and rows of beds were removed as patients were discharged. The drug revolution led to legislative reform: in England and Wales, the Mental Health Act 1959 required review of all certified patients, and within five years, fewer than a quarter were detained. The signs were so promising that the minister for health Enoch Powell declared in 1961 that the mental hospitals would become obsolete, replaced by care in the community.
Yet the major tranquillisers of chlorpromazine, haloperidol and thioridazine, while transformational, were not the only impetus for the decline in the mental hospital population. It began to fall in 1954, before the brown syrup appeared. As with the vaccination myth, the ‘wonder drugs’ of psychiatry went down in history as a sudden turning point, overlooking the social conditions for change after the Second World War. The anti-psychotic drugs caused problems of their own in debilitating side-effects.
In the 1960s mental health was declared a new frontier for medicine. The message was that mental illness was no different from physical health problems, and deserved the same level of resources. The pharmaceutical industry was keen to destigmatise mental health and change attitudes so that people perceived nervous disorders as common and curable. The drug companies worked with the psychiatric profession to revise and expand the classification of diseases, defining illnesses on the basis of emerging treatment, rather than the other way round.
With the growth of therapy in the US, the drug companies focused on middle-class neuroses and in 1961 Merck distributed 50,000 copies of a book Recognizing the Depressed Patient. As the early classes of antidepressant drugs had toxic effects, doctors prescribed anxiolytics such as Valium, which was doled out in great quantity for neurotic disorders (one of the first was thalidomide, but that’s another story). Valium was notorious for addiction.
In 1987 a new antidepressant entered the market. Prozac was an instant success, heralding the era of mass antidepressant therapy. With direct consumer advertising in the USA, Prozac was described by psychiatrist Peter Kramer as ‘a feminist drug – liberating and empowering’. Kramer hosted a popular health programme on National Public Radio, funded by Eli Lilly, featuring numerous ‘key opinion leaders’ promoting antidepressants as a panacea for life’s ills.
In my experience as a psychiatric nurse, these drugs did not deserve the promise given to patients. I cringe on remembering colleagues spouting the line that the tablets will ‘kick in after about ten days’. Gradually I discovered that treatment was not really evidence-based, but an enterprise controlled by the pharmaceutical industry. I worked for a health informatics company, dealing in pharmacovigilance. It found drug company researchers buying data from a licensed primary care database to show that reported adverse effects of new products such as statins were caused not by the pills but by the disease. Seroxat, an antidepressant, was thus excused blame for suicides: it was their depressive symptoms rather than the drug.
Although naïve at the time, I found the Andrew Wakefield controversy troubling. Much effort went into allaying public concerns about the MMR jab, introduction of which Wakefield and 16 fellow researchers had found correlated with autism and inflammatory bowel disease. If Wakefield was wrong in his assertions, surely science would correct his error with refuting evidence? But he was made a pariah, and booted out by the General Medical Council. A charismatic figure, Wakefield was a danger to Big Pharma because he threatened the lucrative vaccine business.
Years later, I wrote a critical appraisal of antidepressants, drugs now taken by about one in eight adults in the UK and an increasing proportion of teenagers. I submitted a carefully researched review to the only journal likely to consider it. The new British Journal of Mental Health Nursing was edited by Professor Peter Nolan, an Irishman who had worked as a personal aide to the Libyan leader Gaddafi after the revolution. Peter was a true radical, a rarity these days. He agreed with my concern about Big Pharma, but had been forced to take drug company advertising. My article was published but with a lengthy retort by another mental health scholar, who poured scorn on my objective analysis.
What is to be done? The problem-reaction-solution structure of mental health care must be dismantled. Instead of increasingly relying on technology which feeds corporate profits on a false curative premise, care must return to human endeavour.
If they are really antidepressants, why are people taking them for months, years or decades?