Postpartum Depression History, Attention Focused On Postpartum Depression
Q: In the 19th century, a woman who experienced
depression or discontent was likely to be diagnosed as "neurotic"
and subjected to treatment ranging from vibrators (to induce
orgasm) to clitoridectomy (to ensure that she never had another
one again), with various talk, drug and institutional therapies
in between. In the 1950s, a neurotic woman might find herself
undergoing electroshock therapy, or, if she was lucky, she might
be offered the sedation of Valium. Today, the depressed housewife
is likely to find herself on one of the new antidepressants such
as Prozac, Zoloft, Paxil or Wellbutrin.
A:Andrea Yates, a reportedly depressed housewife, had, in the years before she killed her five children, been treated with various drugs, including Wellbutrin, Effexir and Haldol. According to her husband, Yates suffered from postpartum depression. According to Bruce E. Levine, Ph.D., author of "Commonsense Rebellion: Debunking Psychiatry, Confronting Society -- An A to Z Guide to Rehumanizing Our Lives," the combination of medicines that Yates reportedly took, particularly if she was taking them at the same time, may well have been a prescription for a tragic psychotic break. We often think of the history of psychiatry as a story of progress, an evolution from barbaric and invasive treatments to more sophisticated, humane care based on sound scientific principles. And while it certainly seems like progress to move from attacking depression with scalpels and electrodes to treating it as a chemical imbalance with medication, in high-profile cases like those of Andrea Yates and Columbine High School's Eric Harris, who was also being treated with antidepressants, critics like Levine have serious questions about the efficacy and safety of these medications. Levine, a practicing psychologist for more than 15 years, believes it would be rash and reductive to lay the blame for Yates' and Harris' homicidal impulses at the feet of American pharmaceutical companies. But if we are going to treat depression -- and postpartum psychosis, anorexia, oppositional defiant disorder, premenstrual syndrome and dozens of other illnesses -- with tools from the chemistry set, says Levine, it is fair to ask whether we know what we are doing at all. Why are we now prescribing stimulants for women who, three decades ago, would have been put on sedatives? Is this a sign of progress, the result of better diagnostic tools and more effective treatments? Or is it a sign of social engineering to accommodate the changing expectations of women in society? Are the cutting-edge psychiatric treatments of today any less arbitrary than those of 30 or even 100 years ago? And if we don't know exactly how a medication works, is it possible that, in rare cases, we might inadvertently give a patient a medication that triggers a psychotic reaction? "The history of psychiatry is one of nearly unmitigated failure," says Levine, who also is a member of the International Center for the Study of Psychiatry and Psychology, an organization that educates the public on the dangers of psychotropic drugs, electroshock and psychosurgery, as well as argues against the idea that mental disorders can be traced to biochemical and genetic causes. The theory that depression and other disorders are caused by "chemical imbalances" in the body that can be remedied by psychotropic medication is, according to Levine, "just that: a theory." Not only does he believe that psychotropic medication is, at best, ineffective; he also claims that the rush to solve social problems by medicating individuals is blinding us to the ways in which people are rebelling against an "institutional society" that doesn't meet human needs. Speaking by telephone from his home in Ohio, Levine addressed the ways in which pharmaceutical companies romance Americans, the effects of the mental health industry on women and children, and the possible role of psychotropic medication in the Andrea Yates case. (Several days after Salon's interview with Levine, Families USA, a healthcare consumers group based in Washington, published data showing that last year, leading pharmaceutical companies spent more than twice as much money on advertising, marketing and administration as they did on research into new medicines.) You have written: "One of the greatest marketing feats of the past 20 years is use of pharmaceutical companies' dollars to convince the mass media that psychiatrists who prescribe these companies' drugs are basing their treatment on anything resembling science." What do you mean by this? Thirty years ago people used to laugh at psychiatry. Since then, the science has not advanced, but the marketing on the part of pharmaceutical companies has. Just like any other corporation, these companies bring out new models and new brands; when people start to notice problems with one product, they bring out another one which may not be any better than the last one, but its problems are less well known. These are multibillion-dollar companies that have made sure that professional organizations and consumer groups hear the same line over and over again. Even lots of doctors don't have the time to do much more than read press releases. But today, even mainstream psychiatry textbooks will tell you that many of these drugs have no benefit beyond the placebo effect, especially for children. Meanwhile, estimates are as low as half a million to as high as 2 million children are being put on these drugs, which may have no greater benefit than a sugar pill. All these new antidepressants -- Prozac, Paxil, Zoloft -- are SSRIs [selective serotonin reuptake inhibitors]; they all increase the level of the neurotransmitter serotonin in the brain. The theory is that this increase fixes depression.