Reaction Paper #2
In a world where media rules and information is increasingly accessible to the masses,
the problem is no longer accessibility to information, but rather, accessibility to reliable and valid
information. Once information is distributed to the public, i.e. through a scientific journal or an
article, it is extremely difficult to change the public opinion even when compelling evidence
rides against the previous ideology. In Dumas-Mallet’s article, she touches on the consequences
of the misrepresentation of biological psychiatry in the media, and how harmful the mono-causal
ideology in media regarding mental illness truly is. The idea that mental illnesses such as
depression are caused only by a deficiency in serotonin is completely misleading and harmful to
the public. This ideology, however, greatly benefits the pharmaceutical industry as it appeals to
the public through medical advertisements, making the issue of mental illness seem like it can be
quickly and easily solved with a prescription. This is not reality for most people and is largely
why patients continue to be dragged through an exhausting trial-and-error series of different
medical prescriptions. This issue holds dear to my heart, as someone who has battled with
depression in the past and has been put through this process, I have experienced first-hand just
how harmful and deprecating this process can be. Many of these medications have side effects
that can worsen symptoms, and even create new issues that weren’t there to begin with.
Medications like Lexapro are so common for treating depression and anxiety and can be
prescribed easily by doctors without even addressing the full picture of what is going on in the
patient’s environment. Not to mention, much of the evidence supporting the efficacy of these
medications is based on a series of copious randomized trials done on incredibly small groups.
Ioannidis elaborates on this issue in his article, “Effectiveness of antidepressants: an
evidence myth constructed from a thousand randomized truths?” The title says it all. Much of the
empirical evidence we rely on to validate these drugs is exaggerated to the point of falsification.
Many of the negative trials are not even published which has completely misled the public to
believe these medications are far more effective than they really are. Reading this article was as
much shocking to me as it was not. It is not news that the pharmaceutical industry, Big Pharma if
you will, is more concerned about profiting off sick patients seeking medications than it is
treating and curing patients. There is no business for them if they do not have a constantly sick
population of people for them to treat. It seems that antidepressants have become a band-aid for
what Ioannidis describes as “the patient-physician interaction that has become so sparse in
modern society”. He also illustrates what I believe to be a valuable point in the Big Pharma
conversation, if it’s not this industry to exploit people for large profits by continuously feeding
patients ineffective drugs, then what industry will be left to take this seat? Whenever a society
looks at dismantling an institution or industry, it is imperative to consider the implications. In
this case, this could mean an even more harmful industry, such as the weapon industry as
Ioannidis suggests, takes over and does potentially even more harm.
It’s not just medications that are lacking strong empirical support, Gnaulti illustrates how
this issue has pervaded into psychotherapy and the over usage of cognitive behavioral therapy as
treatment largely as a result of the increasing lack of intellectual diversity in psychology
departments. CBT, known for it’s measurable and agenda-driven technique, is used by about
80% of practitioners in clinical psychology. While it is claimed to be an evidence based
treatment, Gnaulti says it is not free from being “evidence biased”. The efficacy of this treatment
can largely be attributed to the patient-therapist relationship rather than the actual CBT
techniques. Regardless, this is more common than any other technique. Similarly to
antidepressants, studies done on CBT were short term, randomized, and largely low quality. Both
issues can be somewhat attributed to the over usage of the medical model and the hyper-clinical
ways of thinking that are valued and accepted today in clinical and psychiatric settings. While
copious amounts of empirical research support that the effectiveness of these treatments is
largely based on the patient-therapist relationship, the trust built within that relationship, and
how genuine the patient feels the therapist is, journals are published and focus on the measurable
technique of CBT. That is what earns credibility in our society, and that is something that is
easily replicable even though its efficacy is up for debate. This issue sounds all too familiar to
me. Our society and the institutions that run it, are so fixated on being able to throw band-aids on
these issues. We would rather treat symptoms than go to the root of the illness. There is more
money in doing things this way regardless of how inefficient it may be. Instead of focusing on
the relationship match between the patient and the therapist, as we know that to be most relevant
in a successful treatment, we fixate on training our psychiatrists in the technique of CBT. Instead
of taking the time to build a relationship between the patient and the physician, physicians are
encouraged to throw largely ineffective medications at their patients and check back in six
months. These issues I have outlined are merely a few symptoms of our sick society. I am
hopeful that moving forward we have learned that attempts to throw band-aids on these issues
will continue to be fruitless. It is imperative that we do the opposite of what we have done in the
past and focus on treating the root of the illness, what I believe to be a combination of
corruption, greed, divisiveness, and the spread of harmful misinformation.
