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The mental health movement has helped destroy Native people by being a tool for cultural genocide. Long before the “Mentally Ill Indian,” there was the “Crazy Indian,” the “Dumb Indian,” and the “Drunken Indian.”

How the US Mental Health System Makes Natives Sick and Suicidal

David Edward Walker
6/18/15

At a youth wellness conference at Yakama Nation I helped organize in 2001, an elder of the Kah-Milt-Pah honored us with her presence. For the first two days, she sat next to her daughter in the front row, one palm resting on a handmade cane, watching and listening as keynote speakers stepped up. I remember she became particularly focused when a youth invited to the stage to share his life challenges broke down mid-sentence.

At 4:30 p.m., near the end of the last day, she struggled to rise and then stood next to her chair. Members of the discussion panel fell silent while she was helped to the stage by her daughter. She then turned around to face the 700 or so mostly Native attendees and began speaking in her native dialect about the sacredness of children. A microphone was hurriedly brought over as her daughter stood beside her, carefully translating her words into English.

This translating was time-consuming, and as an organizer, I knew the event center closed at 5 p.m. Soon, a custodian approached me and whispered, “We need to shut down.”

We stood together for a moment listening to and watching her, dressed in her dark calico dress, a kerchief holding back her grey braids, leaning over her cane.

“Fine,” I said, “you tell her.”

He smiled and shook his head. She finished at about 7:30 p.m., and I don’t believe anyone left, not even that custodian.

Later on, I found out that she understood and spoke English well; she just chose not to speak it. Her insistence on using her native language told everyone present how she felt about the colonizing language of English, imposed in her lifetime by coercion and force. It may have become the common tongue of Indian Country, but she would not feel obliged to use it. Only her Native words could speak to the heart about “what has happened” to the children.

The intrusion of a new language upon a people can build bridges, tear them down, or serve an oppressive agenda. It can do all three at once. In the last 40 years, certain English words and phrases have become more acceptable to indigenous scholars, thought leaders, and elders for describing shared Native experiences. They include genocide, cultural destruction, colonization, forced assimilation, loss of language, boarding school, termination, historical trauma and more general terms, such as racism, poverty, life expectancy, and educational barriers. There are many more.

One might expect such words to be common within the mental health system in Indian Country. Yet the major funder and provider of Native mental health, the Indian Health Service (IHS), doesn’t seem to speak this language.

For example, the agency’s behavioral health manual mentions psychiatrist and psychiatric 23 times, therapy 18 times, pharmacotherapy, medication, drugs, and prescription 16 times, and the word treatment, a whopping 89 times. But it only uses the word violence once, and you won’t find a single mention of genocide, cultural destruction, colonization, historical trauma, etc.—nor even racism, poverty, life expectancy or educational barriers.

This federal agency doesn’t acknowledge the reality of oppression within the lives of Native people. Instead, it uses another powerful word, depression. For about a decade, IHS has set as one of its goals the detection of Native depression. This has been done by seeking to widen use of the Patient Health Questionnaire-9 (PHQ-9), which asks patients to describe to what degree they feel discouraged, downhearted, tired, low appetite, unable to sleep, slow-moving, easily distracted or as though life is no longer worth living.

The PHQ-9 was developed in the 1990s for drug behemoth Pfizer Corporation by prominent psychiatrist and contract researcher Robert Spitzer and several others. Although it owns the copyright, Pfizer offers the PHQ-9 for free use by primary health care providers. Why so generous? Perhaps because Pfizer is a top manufacturer of psychiatric medications, including its flagship antidepressant Zoloft® which earned the company as much as $2.9 billion annually before it went generic in 2006. Even with the discovery that the drug can increase the risk of birth defects, 41 million prescriptions for Zoloft® were filled in 2013.

The most recent U.S. Public Health Service practice guidelines, which IHS primary care providers are required to use, states that “depression is a medical illness,” and in a nod to Big Pharma suppliers like Pfizer, serotonin-correcting medications (SSRIs) like Zoloft® “are frequently recommended as first-line antidepressant treatment options.” (iStock)

The Pfizer PHQ-9’s lead developer, Dr. Spitzer, was the “task force leader” for the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM III-R) when I started graduate training as a clinical psychologist in 1986. The DSM III-R created 110 new psychiatric labels, a number that had climbed by another 100 more by the time I started working at an IHS clinic in 2000.

Around that time, Pfizer, like many other big pharmaceutical corporations, was pouring millions of dollars into lavish marketing seminars disguised as “continuing education” on the uses of psychiatric medication for physicians and nurses with no mental health training.

I recall being asked if I was going to one of these seminars, held at the fanciest restaurant in a city north of the Yakama Nation Reservation. Although a government employee is technically not allowed to accept gifts of more than $20, this lavish (and free) meal seemed a grey area. After all, it was “educational.” I didn’t happen to drink alcohol, so I wasn’t interested. After this event, several primary care colleagues began touting their new expertise in mental health, and I was regularly advised that psychiatric medications were (obviously) the new “treatment of choice.”

Since those days, affixing the depression label to Native experience has become big business. IHS depends a great deal upon this activity—follow-up “medication management” encounters allow the agency to pull considerable extra revenue from Medicaid. One part of the federal government supplements funding for the other. That’s one reason it might be in the best interest of IHS to diagnose and treat depression, rather than acknowledge the emotional and behavioral difficulties resulting from chronic, intergenerational oppression.

The most recent U.S. Public Health Service practice guidelines, which IHS primary care providers are required to use, states that “depression is a medical illness,” and in a nod to Big Pharma suppliers like Pfizer, serotonin-correcting medications (SSRIs) like Zoloft® “are frequently recommended as first-line antidepressant treatment options.” This means IHS considers Native patients with a positive PHQ-9 screen to be mentally ill with depression. And in just the last four years, the Indian Health Service has spent over $1.1 billion to treat Mentally Ill Indians. In quiet ways, IHS admits to being obsessed on this point. For instance, in its National Behavioral Health Strategic Plan 2011-2015, IHS states an objective to “recognize the heavy influence of biomedical models” (it’s not certain what happens after recognition), but in its very next objective, notes a desire to “assist the Indian Health System to make needed prescribed psychotropic medications available to persons served.”

There are many things wrong with this model. For instance, the biomedical theory IHS is still promoting is obsolete. After more than 50 years of research, there’s no valid Western science to back up this theory of depression (or any other psychiatric disorder besides dementia and intoxication). There’s no chemical imbalance to correct. Even psychiatrist Ronald Pies, editor-in-chief emeritus of Psychiatric Times, admitted “the ‘chemical imbalance’ notion was always a kind of urban legend.”

Unhinged Trouble With Psychiatry

Researchers, writers, and mental health professionals have sought to get word out about the deceptiveness of this false science for decades. In 2011, Marcia Angell, former editor of the New England Medical Journal, summarized the work of three such voices for the New York Review of Books. Angell reviewed The Emperor’s New Drugs by Harvard psychologist Irving Kirsch in which he concludes that there is no significant difference between the drugs and sugar pills for reducing depression. Angell also reviewed award-winning investigative journalist Robert Whitaker’s book, Anatomy of an Epidemic, in which he describes the pharmaceutical industry’s funding of “key opinion leaders” for promoting its medications and its profound influence on increasing the number of DSM “disorders” eligible for medicating. Dr. Angell closes with a review of Daniel Carlat’s Unhinged: The Trouble With Psychiatry. After Carlat thoroughly “follows the money” in pharmaceutical funding of psychiatry, he admits to nearly doubling his hourly income by seeing his patients for “psychopharmacology” instead of therapy.

The Emperors New Drugs

IHS continues to apply the PHQ-9 in its stated belief that “early identification of depression will contribute to reducing incidence” of suicide, violence, etc. while allowing “providers to plan interventions and treatment to improve the mental health and well being of American Indians and Alaska Natives.”

Antidepressants do not reduce suicide. Much money has been spent on studies trying to support such an idea that either fail or are easily exposed for poor science and shoddy designs that result in retractions and back-pedaling. A 2010 study of sales of antidepressants in Norway, Finland, Sweden and Denmark from 1975 to 2006 found no relationship between suicide rates and the great popularity of psychiatric drugs.

In an astonishing twist, researchers working with the World Health Organization (WHO) concluded that building more mental health services is a major factor in increasing the suicide rate. This finding may feel implausible, but it’s been repeated several times across large studies. WHO first studied suicide in relation to mental health systems in 100 countries in 2004, and then did so again in 2010, concluding that:

“[S]uicide rates… were increased in countries with mental health legislation, there was a significant positive correlation between suicide rates, and the percentage of the total health budget spent on mental health; and… suicide rates… were higher in countries with greater provision of mental health services, including the number of psychiatric beds, psychiatrists and psychiatric nurses, and the availability of training in mental health for primary care professionals.”

Global Suicide Rates World Health Organization

In fact, authors of the 2010 study stated rather specifically that the suicide rate climbed alongside the increased “availability of training in mental health for primary care professionals.” This describes the very strategy IHS has been using to try to reduce suicide.

Mental health folks didn’t care for such findings and wanted to try again. A 2013 follow-up study by Anto Rajkumar and colleagues using similar WHO data gathered from 191 countries found, “Countries with better psychiatric services experience higher suicide rates.” It might be beside the point to mention that research repeatedly demonstrates physicians commit suicide at twice the rate of other people. After all, they have more legal access to drugs.

Despite what’s known about their significant limitations and scientific groundlessness, antidepressants are still valued by some people for creating “emotional numbness,” according to psychiatric researcher David Healy. Research undertaken at the University of Washington in 2004 suggested people will quit using antidepressants because of feeling numb while others continue for the same reason.

The side effect of antidepressants, however, in decreasing sexual energy (libido) is much stronger than this numbing effect—sexual disinterest or difficulty becoming aroused or achieving orgasm occurs in as many as 60 percent of consumers. Such a side effect can in itself increase anxiety, depressed mood and hopelessness. In this way, IHS has become complicit in reducing sexual interest while having a potentially negative impact on intimate relationships within the communities it serves. The agency has been spreading lies about faulty brains with “chemical imbalances” for years now and recasting reactions to oppressive social conditions and life challenges as a pathological illness to be numbed or sedated.

Dr. David Healy is better known for his research showing that antidepressant medication increases suicide and violence in certain people. When I mentioned his early work to IHS primary care colleagues, I met great skepticism. But Healy’s work has withstood the test of time, including repeated scrutiny by major scientific authorities worldwide, even by a reluctant FDA that dragged its heels before mandating a “black box warning” about suicide and violence potential. Over the years, I’ve thought about Dr. Healy’s work when incidents of mass violence have occurred at Red Lake, Tule River and Marysville.

A formal report on IHS internal “Suicide Surveillance” data issued by Great Lakes Inter-Tribal Epidemiology Center states the suicide rate for all U.S. adults currently hovers at 10 for every 100,000 people, while for the Native patients IHS tracked, the rate was 17 per 100,000. This rate varied widely across the regions IHS serves—in California it was 5.5, while in Alaska, 38.5. It’s important to note that IHS has experienced chronic difficulties in getting its providers to comply with entering all the suicides they encounter in their practices for this project. Yet there are crucial lessons to learn from what has been tallied.

Suicides for all U.S. youth in the age range of 15 to 24 nearly tripled from 1958 to 1982, but since 1999, this rate has remained stable at between 10 and 11 per 100,000. The IHS Suicide Surveillance data reveals the rate for Native youth to be climbing . Over 52 percent of suicides described in the Great Lakes report were by young Native people aged 10 to 24. Between 2005 and 2010, the average suicide rate for Native 14 to 24 year olds greatly exceeded even the overall Native rate. According to the Center for Disease Control, the Native youth and young adult suicide rate hit an all-time high in 2014 at 31 per 100,000. That’s triple the U.S. youth rate.

According to the Center for Disease Control, the Native youth suicide rate hit an all-time high in 2014 at 31 per 100,000. That’s triple the U.S. youth rate. (National Suicide Prevention Strategic Plan)

It’s not surprising that alcohol was involved in 82 percent of reported suicide attempts. It’s a shocker, however, that medication overdose was the primary method people used. Fifty-nine percent of Native people attempting suicide favored overdosing on meds—well beyond use of firearms, hanging, intentional car wrecks, or other means.

Nearly one in four of these suicidal medication overdoses used psychiatric medications. The majority of these medications originated through the Indian Health Service itself and included amphetamine and stimulants, tricyclic and other antidepressants, sedatives, benzodiazepines, and barbiturates. The Suicide Surveillance report doesn’t specify what “other prescription medications” make up an additional 22 percent of medication overdoses and may have also originated at IHS.

Despite what IHS may say, there’s no evidence to suggest that psychiatric medication reduces either suicide or what it prefers to call depression. However, there’s solid evidence the agency’s expansion of its biomedical model and the drugs it promotes may be increasing the Native youth suicide rate—these drugs are being favored as a means of taking one’s life.

What’s truly remarkable is that this is not the first time the mental health movement in Indian Country has helped to destroy Native people. Today’s making of a Mentally Ill Indian to “treat” is just a variation on an old idea, a fitting example of George Santayana’s overused adage: “Those who cannot remember the past are condemned to repeat it.” The Native mental health system has been a tool of cultural genocide for over 175 years—seven generations. Long before there was this Mentally Ill Indian to treat, this movement was busy creating and perpetuating the Crazy Indian, the Dumb Indian, and the Drunken Indian.

We need to expose what has been made invisible and forgotten. We need to revisit the displaced and poverty-stricken ancestors subjected to Indian Lunacy Determinations and sent away from their homes and families. We need to learn more about the Hiawatha Asylum for Insane Indians, where people were kept shackled until the cuffs of their chains meshed with their skin.

We need to open the skeleton’s closet through which mental health first entered the boarding schools, determined stilted curricula for generations of children, and used its methods to sterilize those it deemed inferior. We must make peace with the fabled Firewater Myth, a false tale of heightened susceptibility to alcoholism and substances that even Native people sometimes tell themselves.

There are forgotten heroes to know, ancestors of those currently trapped by the Native mental health system—a Lakota diagnosed with “horse-stealing mania,” a Cherokee laying claim to the land of Sweden, and a Mohawk, the first Indian psychologist, stepping up to challenge the white man’s labeling of his community’s children as feebleminded.

English will necessarily be the shared language of inquiry, but let’s use it to be accurate about these seven generations of harm.

Because it’s oppression, plain and simple.

Portions of this story appeared in Dr. Walker’s blog postings at Mad In America. His award-winning Medicine Valley novels and some scholarly papers can be perused at www.tessasdance.com.

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ronpies's picture
ronpies
Submitted by ronpies on
Since my comment re: the so-called “chemical imbalance theory” is quoted (out of context) in Dr. Walker’s piece, I feel obliged to respond to some of the claims in his posting. I would like to be clear at the outset, however, that I am not an expert in Native American (American Indian) peoples; nor am I particularly familiar with—or a defender of—the Indian Health Service (IHS). Thus, I am not defending IHS’s mental health policies or practices. However, as a specialist in mood disorders and psychotropic medication, I do feel qualified to comment on some of Dr. Walker’s claims and concerns re: suicide, depression, and antidepressant medication. I do so in the context of sharing with Dr. Walker the sense of alarm and dismay over the tragically high suicide rates found in many Native populations in this country. In brief, I would note the following: • First, while I have indeed called the “chemical imbalance” explanation of mood disorders an “urban legend”—it was never a real theory propounded by well-informed psychiatrists—this in no way means that antidepressants are ineffective, harmful, or no better than “sugar pills.” The precise mechanism of action of antidepressants is not relevant to how effective they are, when the patient is properly diagnosed and carefully monitored. [for more on the so-called “chemical imbalance” notion, see: http://www.mentalhealthexcellence.org/nuances-narratives-chemical-imbalance-debate-psychiatry/ • There is good evidence that, when properly prescribed for major depression, antidepressants are more effective than the placebo condition (which, by the way, is more than a “sugar pill”; in most large studies, the placebo group is provided with 8-12 hours of supportive contact with professional staff). Even Kirsch’s data (which have been roundly criticized if not discredited) found that antidepressants were more effective than the placebo condition for severe major depression. In a re-analysis of the United States Food and Drug Administration database studies previously analyzed by Kirsch et al, Vöhringer and Ghaemi concluded that antidepressant benefit is seen not only in severe depression but also in moderate (though not mild) depression. [See: Vöhringer PA, Ghaemi SN. Solving the antidepressant efficacy question: effect sizes in major depressive disorder. Clin Ther. 2011 Dec;33(12):B49-61. Epub 2011 Dec 2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/ ] • Suicide is a diverse, multi-caused, existential decision that involves a complex interplay of numerous risk factors. For example, in one recent study of suicide and suicide attempts among White Mountain Apache youths (aged < 25 years), the most frequently cited attempt precipitants were family or intimate partner conflict [see Mullaney et al, Am J Public Health. 2009 October; 99(10): 1840–1848]. • The effect of antidepressants on completed suicide is not entirely clear. While there is no clear evidence that antidepressants significantly reduce suicide rates, neither is there convincing evidence that they increase suicide rates. (The FDA’s “black box” warning applied to a construct called “suicidality”, which included non-lethal gestures and suicidal ideation. The FDA’s analysis did not turn up higher rates of completed suicide in younger populations taking antidepressants). A recent comprehensive review by Dr. Nassir Ghaemi concluded that antidepressants probably have a “neutral” effect on suicide rates (The Psychiatry Letter, April 2015). That said, several epidemiological studies have found an association between antidepressant use and reduced suicide rates. For example, a recent 27-year observational study of antidepressants [Leon et al, J Clin Psychiatry, 2011;72:580-586] concluded that “…antidepressants were associated with a significant reduction in the risk of suicidal behavior”, which was defined as a reduction in actual suicide attempts or completed suicides, while taking ADs. Similarly, A study of suicide rates and antidepressant use in the U.S.(1996-98) concluded that "increases in prescriptions for SSRIs and other new-generation non-SSRIs are associated with lower suicide rates both between and within counties over time..." [Gibbons et al,Arch Gen Psychiatry. 2005 Feb;62(2):165-72]. • That said, many mood disorder specialists (including me) do become concerned when a patient with bipolar disorder--often misdiagnosed as having unipolar major depression--becomes agitated and irritable while taking an antidepressant. This may well increase that person's risk of acting out in a self-injurious manner, or becoming violent. This is owing to the inappropriate use of antidepressants, in individuals who are best treated with mood stabilizers and supportive psychosocial therapies. • The association Dr. Walker cites between mental health services and suicide rates (“...suicide rates were higher in countries with greater provision of mental health services...”) needs to be interpreted with caution. The “arrow of causality” may be such that in countries with higher suicide rates, efforts are initiated to provide mental health services. Surely a reduction in such services is no answer to rising suicide rates! • None of my points imply that a “biomedical model” is the best approach to treating depression within Native populations. Certainly, any psychiatrist would agree with Dr. Walker that “...compassion, lovingkindness, and a respectful, caring dialogue about life and its many problems can be very affirming and even lifesaving.” [http://www.madinamerica.com/2015/05/the-american-indian-youth-suicide-epidemic-mental-health-professionals-as-superheroes/]. But such a humanistic approach does not and should not rule out professional mental health services, including—in carefully selected cases—psychotherapy and/or antidepressant medication. Respectfully, Ronald Pies MD Professor of Psychiatry, Lecturer on Bioethics & Humanities SUNY Upstate Medical University; and Tufts U. School of Medicine

linjean's picture
linjean
Submitted by linjean on
Wado/thank you for this very important article. I was prescribed benzodiazepines for 6 years, as well as antidepressants off and on for about 20 years. Although I have been off these medications for 3 years and will never take them again, I continue to suffer from a severe protracted withdrawal syndrome and have extensive neurological damage. Most mental health care providers have no understanding of the historical and intergenerational trauma Natives experience, which is not surprising among those seen by urban Indians, and these doctors are willfully ignorant of the consequences of the medications they prescribe. They convince their patients that something is wrong with their bodies and minds - that they have a chemical imbalance, which is really just propaganda promoted by the pharmaceutical companies. And they do this to children! My experience has made me determined to go back to school for an MSW, and I've been concerned about how my stance against psychotropic medication prescriptions will be received among my colleagues and future employers. I am grateful for your most important words on this topic.

Anisahoni's picture
Anisahoni
Submitted by Anisahoni on
Thank you for your comment, Dr. Pies. I appreciate your acknowledgement of a lack of expertise about both Native people and the Indian Health Service. I feel there is a disconnect regarding the issues I raise about “suicide, depression, and antidepressant medication” and your statement that it doesn’t matter how antidepressants work so long as “the patient is properly diagnosed and carefully monitored.” To remind you of what I've written about, one theme asserted in my article pertains to the actual usefulness of the psychiatric concept of ‘depression’ in Indian Country and another has to do with use of a drug company screening tool by primary health care providers unschooled in psychiatry. I maintain that emotional and behavioral reactions related to chronic oppression should not be considered interchangeable with depression as defined by the American Psychiatric Association. Your colleagues at APA have already ignored more than 50 mental health professional associations that petitioned for an outside review of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM) prior to its release. I don't believe the DSM is going to include much on oppression, is it? I don’t believe the concept of depression in the DSM is ‘good enough’ for describing individual reactions to abject poverty, racism, unacknowledged genocide, and cultural destruction. If one acknowledges the upheaval experienced by oppressed people, wouldn’t it be better to discuss how well the sedation of ‘anti-oppressants’ is working? Ah, but that sounds like soma, and it’s a brave new world we live in thereby. Here is your quote in 2011 in “Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists.” But that isn’t quite true, is it? I’m referring to past stories in Psychiatric Times, apparently featured under your editorship, such as “Scientists Study Serotonin Markers for Suicide Prevention” which stated, “Brain serotonin levels as a predictor of suicide has been the subject of intense research scrutiny over the past several years” or the story “A Look at Women and Depression” which said, “Research data indicate that people suffering from depression have imbalances in the activity of the neurotransmitters in the brain. Two neurotransmitters implicated in depression are serotonin and norepinephrine.” Also, I contacted Dr. Irving Kirsch at Harvard University to follow up on your characterization that his data being ‘roundly criticized if not discredited.’ Dr. Kirsch asked that I pass along his exception to your remark, noting: “my work has not been discredited at all. It has always been and remains very controversial, but the data are sound, and it is still being widely cited. There have been numerous subsequent meta-analyses, some by my harshest critics and some of done by FDA reviewers, and everyone gets the same results. The difference between antidepressant drug and placebo is very small and clinically insignificant.” The ‘good evidence’ you assert regarding the effectiveness of antidepressants really needs to be assessed first in light of the ubiquitous influence of pharmaceutical manufacturers over the funding of such studies. You acknowledge yourself that you can offer no specifics showing antidepressants reduce suicide, while commiserating with the experience of suicidal loss pervading Indian Country. There’s a lot of money currently being spent on a false hope, you see, and it’s one your profession has helped to perpetuate. I do appreciate the question you raised in Psychiatric Times on April 14th, 2014: “Shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.“ My answer is absolutely yes, and the psychiatric profession is ethically culpable for not having done so. That doesn’t mean I agree with the metaphor of ‘mental illness’ derived from a society saturated with injustice, inequity, and moral decay or with contemporary psychiatry’s myopic preoccupation with quixotic and simplistic brain studies. As to some of the other issues you raise, I’ll draw your attention and that of readers to an essay by Joanna Moncrieff and David Cohen available at PLOS Medicine entitled “Do Antidepressants Cure or Create Abnormal Brain States?” and hope that David Healy might weigh in on your contention that antidepressants don’t increase suicide. In the meantime, I’ll point once again to the dominant method of suicide attempt in Indian Country: medication overdose.

Adam C. Hull
Adam C. Hull
Submitted by Adam C. Hull on
Siyo to all Native people. I have intimate knowledge of this topic due to first hand experience with the "White Sickness," as well as with the "White" Doctors. These soulless, blackhearted people, in their arrogance judge all Native People to be sick or inferior. Nothing has changed that fact since first contact. WE ARE HOLY PEOPLE, and thus they were NEVER fit to judge any aspect of our culture or lives. When we recognize this and reclaim our rightful place on this Earth, the healing will truly begin.

Rohan's picture
Rohan
Submitted by Rohan on
What a great article by David Walker. It's very interesting that Dr Pies 'felt obliged' to comment/contradict the author as he has done here in the comment section. Having read reams and reams of academic research on this subject, he has most definitely rubbished the chemical imbalance theory, but now says that it was never a theory to begin with, at least not one pushed by psychiatry. Alas, there is much contrary evidence to this, see the works of: David Healy, Robert Whitaker, Peter Gotzsche, etc etc. I was new to all before 2009 when my beautiful nephew was prescribed an antidepressant (Celexa) for a relationship break up. A few short weeks later he killed himself and his friend, totally out of the blue and having never had any previous history of suicide ideation or violent thinking. Indeed he was the nicest young man you could imagine. It's therefore a pity, having had first hand experience of these dangerous drugs, that Dr Pies would not put the comment section to better use and advise using caution when prescribing them. It's something that Dr David Healy does so well, but then he's an expert psychopharmacologist, Dr Pies is not. Incidentally, Professor Kirsch's work has never been discredited, quite the opposite in fact. Once again, thanks for a great and well researched article. Rohan

Bruce Levine PhD
Submitted by Bruce Levine PhD on
Thank you, Dr. Walker, for providing an excellent and accurate depiction of the negative impact of the U.S. mental health system, pseudo-scientific psychiatry, and antidepressant drugs which -- as a great deal of research shows -- harm more than help. In response to the lengthy comment by psychiatrist Ronald Pies, I am glad to see that Dr. Pies admits that he did in fact state, “First, while I have indeed called the ‘chemical imbalance’ explanation of mood disorders an 'urban legend'—it was never a real theory propounded by well-informed psychiatrists.” However, it would have been nice if Dr. Pies had also admitted that it is this pseudoscientific “urban legend” chemical-imbalance theory that has convinced millions of people to take these drugs and to give them to their children, and that “well-informed psychiatrists” (as Pies calls them) did NOT step forward to inform the general public that this theory was false; for example, organizations such as the National Alliance on Mental Illness (NAMI) perpetuated this false theory despite the fact that sitting on the board of NAMI was the president of the American Psychiatric Association and other so-called “well-informed psychiatrists.” Perpetrating this false chemical imbalance theory on Native Americans is insult to injury because this now admittedly false theory in effect blames their depression on some biochemical defect on their part rather than on historic oppression, unemployment, poverty, and other societal causes that have been shown, even by the U.S. government, to be associated with depression – see http://www.huffingtonpost.com/bruce-e-levine/the-poltitics-of-suicide-_b_6728694.html Next, what’s sad to see is Ronald Pies defense of the effectiveness of antidepressants in the face of overwhelming evidence that that these drugs do far more harm than good. For a sample of the MANY studies showing the ineffectiveness of antidepressant (even in studies by drug companies that are dice-loaded to make these drugs look more effective than they really are) and how antidepressant use makes it MORE likely depression will reoccur and be chronic instead of a one-time event, see http://www.madinamerica.com/mia-manual/antidepressantsdepression/ Regarding Dr. Pies’ attempt to discredit Dr. Kirsch’s research finding on the ineffectiveness of antidepressants, Dr. Pies states, “Even Kirsch’s data (which have been roundly criticized if not discredited) found that antidepressants were more effective than the placebo condition for severe major depression.” The truth is that while Dr. Kirsch has been roundly criticized by establishment psychiatrist such as Dr. Pies, Dr. Kirsch has NOT AT ALL been discredited but in fact vindicated as he is now on the faculty at Harvard and his research was presented on 60 Minutes – see http://www.cbsnews.com/news/treating-depression-is-there-a-placebo-effect/ And what Kirsch actually found about antidepressants and serious depression is the following: While there is no increased responsiveness to antidepressants among severely depressed patients, the placebo is slightly less powerful for this group. Specifically Kirsch said, “Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication. See http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045 Bruce E. Levine, Ph.D. Clinical Psychologist

Iam Idlenomore RedBrown
Iam Idlenomore ...
Submitted by Iam Idlenomore ... on
I always see these kind of articles skewed in a way that distracts from the actual issue of Mental/behavioral Health, I can understand the point of view from a Native mental health perspective, but all the way through the reading I felt like I was missing something, it's starts with a story of the Elder who stands up and talks, but doesn't really mention anything she says through her 2 hour speech. Then just goes on and on about terminology and diagnosis, and I guess what sounds like the lobby of Pfyzer on the whole system. But I sense a hint of deniability or something in that sense, like the article is saying that Mental health issues such as Depression are more manufactured than reality? In Canada, as our health care system is not controlled by big pharma & insurance companies, we have in place(In certain areas) and very limited access to, Aboriginal Mental health professionals, and a system in place that deals with Natives much differently than this article states. Aboriginal Health for and provided by Aboriginals... who know traditions of healing and teachings etc.. But much of the time, A native person will never be diagnosed until they end up in the Judicial system, by then it's usually far too late and since 2010, the Federal Government has been cutting resources for inmates with Mental and Behavioral issues, etc. Choosing the Pharmaceutical route instead... Keep them drugged and keep them in prison seems to be the way it's heading... Kind of what it sounds like IHS is doing as well. From what I understand about Aboriginal Psychology here in Canada, what is available is very limited, but the focus tends to be a more natural one, and more focused on getting oneself back in touch with Traditional ways of healing both the Spirit and the mind as a whole.. I'm guessing, but probably because of the historic reasons in place and the way the current system operates. We have come back from so much, and there is still a long way to go, I have been on and off medications, but nothing seemed to do anything the way it was supposed to, I chose the path of finding my own way and made it through, with learning yet to come. It really seems like the systems place are still trying to treat us like we're wild animals with no souls and no brains, which is wrong in all kinds of ways... and does a disservice to wild animals at the same time. The government and all its agencies and departments need to stop trying to destroy our humanity.

Lorenn Walker's picture
Lorenn Walker
Submitted by Lorenn Walker on
Thank you for this article Dr. Walker and everyone’s comments. Maybe some of you are interested in this regarding suicide prevention for Native youth (I'm not endorsing and didn't review carefully--just thought might be of interest): http://www.sprc.org/webform/adolescent-suicide-prevention-program-manual. My two added points to this discussion are, one that depression can be considered a normal human function instead of something that requires medication or other professional intervention (http://www.scientificamerican.com/article/depressions-evolutionary/). Instead of medicating depressing feelings, which are normal at times in life, more frank discussion of our feelings and thoughts needs to happen, and especially for youth. We need to understand more how emotions, cognition, behavior, and the environment affect human behavior. And we should openly talk about this with youth. We should not make negative thoughts taboo. I don’t think there a person alive in the Western world today who never once thought of suicide. I believe it has passed most of our minds at some point and we need to talk about it. Second we know labels and expectations, especially those of experts, affect behavior. Ellen Langer and Carol Dweck have done extensive research showing the value of the “psychology of possibility” and “growth mindsets” that positively influence our lives and learning. In the US, we clearly suffer from obvious social problems including negative biases that harm native people and other disenfranchised populations. How much goes into social science research compared to drug manufacturing, etc.? The National Science Foundation only started tracking the amount spent on social science research compared to other areas in 2009 http://www.thenewatlantis.com/publications/the-sources-and-uses-of-us-science-funding It’s a sad statement about the US when we see the bleak conditions many live in on reservations, and equally appalling is that most of the 2.3 million or so people we have imprisoned in the US were impoverished before their incarceration and that they represent disproportionate people of color. Astonishingly even Serbia allows the people it imprisons to vote while many in the US lose that right after being convicted of a felony. Social institutions like our criminal justice system and public housing — including the state of disrepair of many reservations — clearly contribute to depression. I lived in Serbia this summer for a month in an impoverished area. Even though I knew I was returning to my home (on beach in Hawai’i), I felt increased depression and pessimism the longer I was in Serbia. Thank you all again for this discussion. Lorenn Walker
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