I asked before yesterday to Charles Barber to translate his interview is on its portal on its website:
Charles Barber was educated at Harvard and Columbia and worked for 10 years in New York with people with mental illness and homelessness. The book "Comfortably Numb: How Psychiatry is Medicating IS Nation" was published in 2008 and the work of Barber has been the subject of articles in The Washington Post, The New York Times, The Nation, and Scientific American Mind. He taught at Wesleyan University and is a leader of "The Connection", an innovative social services agency and teaches psychiatry at the Yale University School of Medicine. I've already mentioned his remarkable book that I bought from the bookstore at Harvard last September. Its independence, professionalism linked to his experience in the field and especially its social perspective makes him a trusted voice and original. It is part of Anglo-Saxon favorites like Kay Jamison, Peter Kramer and David Healy.
point of view with regard to diagnoses, treatments and drugs is quite different even if all adopt a very humanist (not always the case in France!): Jamison, as BP I, adopts a perspective traditional and goes a long way in accepting the disease. Kramer is a philosopher and knew the right questions, Barber and Healy (psychiatrist who is not) represent a minority view in the U.S. and critics but pose troubling questions about both the diagnosis and treatment information. They can not be suspected of being under the influence and they have the merit of open debate. I give you the link to see a review of his book by Dr. Peter Kramer ("Listening to Prozac") in "Slate". The latter shares some views with Barber, especially on the role of the pharmaceutical industry but disagreed on the increase in diagnoses and the fact that Americans are the biggest consumers of drugs used in global psychiatry.
"> http://www.slate.com/id/2184073/
Similarly, Judith Barber joined Kramer and Kramer criticizes harshly enough on the U.S. as" Prozac Nation ", she thinks Like Kramer that people who take drugs have good reason to do so.
http://warner.blogs.nytimes.com/2008/02/14/overselling-overmedication/
I also offers another item Kramer in "Slate" on a lawsuit from the Attorney General (Attorney) Eliot Spitzer against the GlaxoSmithKline for allegedly manipulated or suppressed research data for its drug Paxil appears as safe and effective for depression in children and adolescents, whereas this was not the case. He criticizes the conclusion of his article that the research laboratories control and manipulate the information so often venal. "For their sake" and according to Kramer, "this may be madness"
Psychiatrists, Children and Drug Industry's Role By GARDINER HARRIS , BENEDICT CAREY and JANET ROBERTS
Published: May 10, 2007
The intersection of money and medicine has Become One of The Most contentious issues in psychiatry ..
http://www.nytimes.com/2007/05/10/health/10psyche.html?partner=permalink&exprod=permalink
My free translation of the interview presentation of the book you Barber can read in English on its web page:
Question: Americans account for two-thirds of the market for anti-depressants and other psychiatric drugs. What drives Americans to be "comfortably numb"?
Response Charles Barber: Americans have always loved the quick repairs, and crush the enemy with technology-it is a foreign country or a medical problem. And we love it more than ever, probably nurtured by our attention to smaller and smaller, and our desire that everything should happen at the speed of a click of a mouse. Another factor that led the Americans to take drugs is the increasing isolation of people, simultaneously accompanied by an obligation of success and accomplishment, to find happiness. The upshot is that Americans rush to consultation, in particular for antidepressants, the most prescribed drug in number. We believe that we will find we will remove our distress.
Question; During the last decade, the public began to see mental illness as something common and easily treatable with drugs: celebrities declaring their problems, ordinary people talking about their pills. You think that attitudes towards people really affected by mental illness have changed?
Answer: No. Real sick-schizophrenics and bipolar patients, for example-are also stigmatized as before. It may now be acceptable and even cool to talk about antidepressants at a party, and it certainly cool for an actress to talk about her depression on the Oprah Show (as it is controlled and has a new movie in sight) but let's see what would happen if you were talking about the voices you hear or visions? People will flee as quickly as they can. And with rates Psychatrie drugs consumed by the masses, the number of people with severe mental disorders are adequately treated remains very low.
Question: Recently, there has been a considerable increase cases of depression, bipolar disorder and other psychiatric cases. Do you think these diseases are best diagnosed or over-diagnosed?
Answer: As always with this kind of thing is a bit of both. Certainly in the past, the great-uncle who was just considered strange or isolated really suffered from schizophrenia and no one knew or wanted to know. But things have gone very far in the opposite direction. Now problems of everyday healthcare and are treated with medication. Psychiatry has increased the number of diagnoses so significantly over the past 30 years can be diagnosed as "disorder acclimation or the brother and sister" or "phase problem of life." Have difficulty getting used to a new situation or have family problems may be painful or disturbing, but they are definitely not medical problems. Major studies estimate that a quarter of Americans suffer from a psychiatric problem each year, and most will be mentally ill at some point. I reject this approach. Serious mental disorders are a serious condition that affects a rather small proportion of the population.
Question: You describe the difference between depression and depression, the last part of human life and the first major illness with specific symptoms. Why do you think these are bad people who take drugs?
Answer: It is common for less severe cases are treated and on medication. Major depression is a disorder that is life threatening and has nothing to do with "feel the spleen" or having "difficulties with the winter." Confusing the two-serious mental disorder versus everyday problems-has prompted more than any one-on medical treatment for people who failed to meet not really the criteria for psychiatric illness. Moreover, even for serious cases, drugs are not the only approach. The cognitive-behavioral therapy has also shown itself even more effective than drugs for mild and moderate depression, without side effects and with lower relapse rates. Diet and exercise can also make a big difference, even for major depression. With our zeal for drugs, we neglect these approaches are very effective but not as simple as taking a pill.
Question: You note that "each generation of American chooses either a new drug, or it creates one ... The drug war will never win because Americans do not want to win. "How the war against drugs is Different or similar to the dependence of Americans on the respect of anti-depressants?
Answer: The difference between drugs and medicines (same word in English: drug) may be much smaller than what one might imagine. pharmacological profile of the Ritalin for example is very similar to that of cocaine. We also tend to blame others for our drug problems - the Colombians for cocaine, for example-rather than us trying to look inside to know why we are depressed and anxious and so attracted to drugs.
Question: You note that the profits of the 10 largest pharmaceutical companies in 2002 being more important than all the profit gains of 490 500 companies. What is the role of trade in the area of mental health-for example, doctors paid by the laboratories for writing articles in medical journals?
Answer: The mental health industry involves a lot of money. Many psychiatric drugs are the winners of the best sales the world. Antidepressants were the most profitable products in the world in the 90s. Of course the mix of all that money with the medicine can have disastrous results. Studies show that drug trials, carried out by people who have a conflict of interest in the drug evaluated were 5 times more likely to have positive results.
Question: The role of drugs and children is a sensitive issue. What are the risks to children and families who see only the positive effects of the pills?
Answer: Drug Treatments for Children are of particular concern. Giving medications to children involves changing their minds as they grow in directions that nobody understands. The rates of these treatments for children have skyrocketed in recent years, along with the controversial use of psychiatric diagnoses for children. As with adults, I think there is a small percentage of children who are really sick right diagnosis and need medication. Medication for ADHD may be broadly effective, but the increased use of psychotropic powerful and mood stabilizers, and the fact of combining them, is disturbing and largely inappropriate.
Question: Psychiatry in the United States has evolved into a phase that you call the "Corporate Psychiatry", where the emphasis is on profits and salaries paid only for medicines. Who should be blamed for this focus on drugs as an end in itself, the only solution? Mutuals, laboratory or physicians themselves?
Answer: While the labs were very manipulative in their practice of marketing, finally I blame the doctors. Insurance and laboratories are what the industry is supposed to do in the U.S.: profit. Attacking these industries for that is like criticizing a leopard attacks a deer. Unlike doctors, "Big Pharma" and mutuals have not taken the oath of Hippocrates.
Question: Are you suggesting alternative approaches, stage of change, motivational interviewing, commitments with peer requires a paradigm shift: "the cure may exist in the context of the disease." You also say that we must listen carefully to those who are sick about what works for them. Can you make a synthesis of these approaches and the need to change our way of seeing the disease and treatment?
Response: Lessons from the "movement cure"-made by those who have suffered from severe mental illness and felt better-are very different messages and marketing from laboratories that say how to treat diseases.
Former patients say only get better not to remove all the symptoms but to learn how to have a rich life, even with the presence of symptoms fortunately reduced returns. The former patients also say that the social context is crucial to get better: the strength of their relations and supporters make a big difference, as if to find something or someone, give a reason for wanting to go better. They also say they improve when they take charge of their healing rather than being passive in taking a pill or by simply following what the doctor said.
Motivational interviewing (MI) and the Stages of Change are procedures and ways of seeing the disease who have two decades since Prozac was introduced, but nobody knows this because there is no money or marketing associated with these methods. They involve, in one sentence, listening to patients instead of listening to Prozac. The Stages of Change model of change that are cyclical rather than linear (We must go through several cycles to obtain a different behavior). and MI, first developed for people who are experiencing substance abuse, is a way to meet clients "where they are" and then help them find their domestic reasons to get better. The MI approach is exactly opposite the old way of involving the confrontation of patients, but it is highly strategic and specific techniques are used to find items that the person can use for its own change. Research shows that the MI is effective in changing patient behaviors on many unhealthy behaviors in including depression and anxiety. /. END
Also I invite you to these very interesting articles in The New York Times on conflicts of interest evoked by Barber (including two great professors of medicine who have lied about their fees from pharmaceutical laboratories agreed by Sen. U.S. Congress, Charles Grassley during an investigation): Researchers Fail to Reveal Full Drug Pay and Top Psychiatrist Did not Report Drug Makers' Pay.
Another very informative article on children in psychiatric treatment (Tough Choices for Tough Children's author Judith Warner).
http://www.nytimes.com/2008/10/04/health/policy/04drug.html?partner=permalink&exprod=permalink
http://www.nytimes.com/2008/06/08/us / 08conflict.html? partner = permalink & exprod = permalink
http://warner.blogs.nytimes.com/2008/11/20/tough-choices-for-tough-children/
And here: a Socialist MEP Catherine Lemorton, rapporteur of the parliamentary commission on the drug told the lobbying of some laboratories with members of the National Assembly: back the words "member of Lobbying face" on the search engine Dailymotion.com.
To conclude, the real ethical issues facing medicine today, especially on clear scientific information and iatrogenic effects of certain drugs based on dose and duration of treatment.
It is clear that in general we can not do without drugs, but since France is one of the largest consumer in the world, we can just ask the question whether it is unnecessary to abuse by some physicians but also patients who want a "quick-fix" when they are not really in a hurry.
all about final diagnosis, especially in the field depression and bipolar disorder, where those who should care does not always do so and those who could use methods of cognitive therapies abstaining.
As always, the truth lies between these two fronts, "any drug" or "everything except drugs." What will I win or lose with one or the other and above all that tells me my reason and my conscience.
Personally, I think drugs are useful and necessary when the patient is in real psychological and social distress, depression (not depression), depression stirred (not angry) or hypomanic or manic phase (not hyperthymic). As we say in our book ("Cyclothymia, For worse and for better"): "As long as there is no break no need to repair" (p.191). The question then remains: what to do after the storm, when we continue the voyage in calm weather? Keep the life jacket on him or at hand. Here is the whole issue. But this is only my opinion. It is true that 400 mg of lithium per day is worth two bottles of wine and that drug use and health of body and mind of the patient should be the priority. Then
and complex .... Is that to feel depressed or "sick" means that the east really? The subjectivity of the patient is sufficient. I think not, because as David Healy, requires objective criteria such as hospitalization or be absent from work for more than a month. And yet, there would be objections to make.
We must return to the quantification of cyclothymia as proposed by Peter Kahn in 1909.
Nothing is simple with cyclothymia and psychiatry today.
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