Customer Reviews

Comfortably Numb: How Psychiatry Is Medicating a Nation

5 star:		(9)
4 star:		(4)
3 star:		(2)
2 star:		(0)
1 star:		(1)

 

 

I am not trying to take away from the importance of the book's subject, quality of author's prose, or the general conclusions that Mr. Barber makes about American society members' happy embrace of the magic pill as an istant solution to almost any problem life throws at them. However, I disagree with the author's liberal use of a key statistic - that "66 percent of the global antidepressant market was accounted for by the United States" - a phrase singled out and repeated on the cover jacket, and reviews, and thus removed even further from clarifying context. Given Mr. Barber's apparent knowledge of the subject matter, I believe he should have made clear that the quoted percentage is based on dollar sales, not patients or even prescriptions. As US prices for prescription medication are much higher than in the rest of the world, and IMS Health data (used as a source for the quoted percentage) most likely covers a handful of other major markets, besides US, the cited percentage creates the desired (?) sensational effect. For some readers, familiar with the pharmaceutical industry, this instance of biasing inaccuracy may undermine credibility of author's use of other numbers and facts to support his conclusions. It is a worthy read, nonetheless, as long as the reader is prepared to think critically and make up own mind.

This book helped me a great deal. So that you can "consider the source" when reading my thoughts, I am not a healthcare professional, but I have spent over 1000 hours on a suicide hotline, and am active in Operation Snowball--an anti-drug, anti-alcohol program for teens. It is in those volunteer capacities that I relish this work.

I think the author, Charlie Barber, along with a great many others I have read in recent years, points to some very basic issues we have to face in the coming years. John Cacioppo, author of "loneliness," (another book I loved) feels we face an epidemic of loneliness. And while drugs can be effective as we battle the onslaught, I am concerned that we too often run for the bottle of pills.

I loved the way Charlie details the issues in the first half of the book, and then leaves the reader with practical and useful strategies for moving forward. I don't pretend to have the training or experience to employ the therapies he describes, but knowing about them sensitizes me to alternative avenues for the callers I face and teens who struggle to make sense of the oft-tragic lives they have been handed.

I apologize if what I am about to say seems hopelessly naive, but it is the world I navigate. Often the most effective "medication" for the people in my life is a word of hope, a non-judgmental ear or simply a hug.

Here, Barber has basically expanded his Winter 2008 Wilson Quarterly article entitled "The Brain: A mindless Obsession," into a full-length book. In the article he gives an excellent summary of the history and present status of the nation's mental heath system, including a history of the various therapies. Both are excellent, but the article is, arguably the more focused and robust. In it Barber takes us across the rather long and sordid history of the study and practice of mental illness: From the medieval practices and forms of treatments that led to electro-shocks and lobotomies (euphemistically referred to as psycho-surgey), to talk therapy, corporate dispensing of antipsychotic drugs, to the present field of brain-imagery.

The book focuses on one of the more important issues: How mental health is managed through drug and insurance company manipulation and thus it is about how mental illness has been "Corporatized," making the drug and insurance companies filthy rich and U.S. the most mentally ill of all nations - that is, if one is to judge national mental health by the number of doses of antipsychotic drugs dispensed per capita.

Now, the mentally ill are literally "turned out" from mental institutions onto the streets according to convenience of the insurance schedules and financial bottom lines. And then patients are administered drugs according to the drug company schedules and their financial bottom lines. Both have become multi-billion dollar industries as a result. It gives a whole new meaning to drug trafficking.

The problem with all of this is not just the built in cynicism of having a profit-driven health system run amok, mostly by the insurance and drug companies, but also the fact that scientists still do not seem to have a clue as to why antipsychotic drugs work?

Even the brightest light in a very dim field, the area of neuro-imagery, has a huge down side too: There is no one-to-one correspondence between brain mechanics and brain content, or thoughts.

The upshot of the book is that we don't know nearly as much about mental illness as we pretend to, and this lack of knowledge, when coupled with corporate greed, becomes a lethal combination that is likely to bring unintended surprises in the future.

Five stars for the article, four of the book.

From reading the passionate reviews pro and con on this site it's obvious that Barber's argument hits a lot of people where they live. The debate over the efficacy of psychiatric drugs, particularly the now ubiquitous SSRIs, is ferocious. Barber's conclusions are informed by years of experience with mentally ill clients in shelters in new york city, as well as a long, careful interrogation of the many thorny questions raised by this topic.

Anybody who has had the pleasure of dealing with the mental health care system, whether seeking help for themselves or for a loved one, has stories of the inadequacy, inhumanity, and lack of resources and imagination the system embodies. a lot of our collective perception of psychiatry is a residual image from hollywood, from the mid-20th century freudian ideas that found their way onto the screen. a lot of people think that all psychiatrists are wise, kindly psychoanalysts. A lot of people think that psychopharmacology is an exact science, that we understand the unbelievably subtle, complex chemistry of the brain and how these medications work (or don't).

Like David Healy, Barber doesn't say that all psychomeds are bad; used properly they save and transform lives. but drugs are no more the single answer to the painful riddles of mental illness than recycling is the single solution to climate change. Comfortably Numb lays out how oversold, overprescribed antidepressants have transformed our culture, but that's only one of the ideas in this rich book. Barber argues persuasively for the urgent need to transform our approach, to rouse ourselves from our numbness, to bring imagination and ingenuity and humanity to our treatment of mental illness.

There is much in this beautifully written book to commend it, especially the cautionary message of how risky and ill informed the rampant overmedication of emotional ills is in America -- and why it might be occurring. The discussion of alternative psychotherapies is inspiring and informed. Critics, including Peter Kramer, author of Listening to Prozac, who claim Charles Barber is exaggerating the true scope of the increase by using the dollar value of prescriptions that includes price increases as opposed to simple pill numbers seem to be missing the forest for the trees. Just ask your acquaintances. There is hardly a family in America that hasn't been touched by psychopharmacology. Almost every other person is on or has been on antidepressants or even stronger medications. There really is something wrong with this picture, as Barber astutely argues, given our lack of knowledge about how these drugs work, what their long term effects are, and the conflicts of interest that permeate drug research.

Given all this marvelous insight it's a disappointment that Barber doesn't take his analysis to its logical conclusion and realize treatments for serious mental illnesses are as flawed as those for minor ones. Barber gets very tangled up trying to distinguish between "true" mental illness and what he thinks are lesser disturbances. This is because he understands how ill informed treatment paradigms are for what he calls "little d" depression but somehow thinks all these same medications are just fine for "big D" Depression because he has observed them "work". Barber gets a lot of credit for speaking from firsthand experience with seriously disturbed individuals but in those whom he has seen return to functioning it is not clear he has attributed the cause to the right place. Every mental disturbance, whether it's serious or not, cannot be segregated from the story that precedes it. To do so is to be dismissive and arrogant; it marginalizes that person's suffering. Whatever one's genetic predisposition or ability to tolerate stress is, ultimately every mental illness is situational in one way or another. The only road to true healing is by dealing with that situation. This turns out to be even more important for serious mental illness -- mania and psychosis -- than it is for psychosocial ills. Medication alone can never "cure" mania and psychosis and may only exacerbate it over time.

Barber recently appeared on Fresh Air (NPR) and admitted to the astonishment of many, given his views, that he takes Prozac. Perhaps this is why he gets tangled up and doesn't really have an entirely consistent point of view on these medications. Maybe he hasn't been able to withdraw. He must believe he has a "true" mental illness yet he indicated in the interview that the way he took control of his OCD [Obsessive Compulsive Disorder] was through behavioral and lifestyle steps (i.e. the situation), not medication. Mental illness is on a continuum from minor to major; it is presumptuous to assume that there is some magic point on this continuum where suddenly it's all right to use possibly toxic and addictive medications even if they do provide a benefit due to their stimulant or sedative effect. While there are surely situations in which a psychotropic medication may be life saving over the short term, using them long term and dismissing the importance of situational issues is probably always dangerous, not just sometimes, as Barber implies.

This is a very well written piece on the implications of our rapidly expanding use of drugs in psychiatry. It is fair and balanced... even restrained... in its discussions of the role of big pharma in the marketing of psychiatric drugs. The sections on cognitive behavioral therapy and motivational interviewing as alternatives to heavy use of drugs should be required reading for all mental health professionals. My only criticism: I would have liked to have seen more policy discussion. All in all, a very good addition to an important discussion.

I practically devoured this book. I think Charles Barber makes some excellent well thought out points. I feel he was also very unbiased. He makes it very clear that he is not against medication, and that it is helpful in many cases. I think by far his best statement is "before antidepressants arrived, depression was considered a rare disease, affecting about 1 percent of the population (as opposed to 10 to 15 percent today)."

As with every book you have to take the facts and make your own opinion, but there are some things that cannot be denied. I think there is a huge distinction between depression and Depression and I have heard too many stories from people I know that doctors are overly eager to prescribe medications.

I also do not feel that Barber has made therapy the cure-all. He states these statistics just as obviously as he does with the medication. Barber has a very realistic understanding of mental illness due to his background and his research. I think he says it very well when he claims that pharmeceuticals create the image that a pill will solve your problems when in reality it takes a lot of hard work.

I just had the pleasure of doing a talk show with the author and surprisingly we seemed to agree about many of the problems in psychiatry. While this book seems to rant about the over use of medications, the underlying message is for the mental health system to find the appropriate place for medication within the context of a comprehensive treatment regimen. This would include therapy, life style modification, diet, exercise and medication. I wrote my book to give the perspective of a psychiatrist who has been critical of all treatment options. There has been abuse and misapplication in the use of therapy and medications. Many also need to avoid hypocrisy in criticizing use of medications when they abuse caffeine, alcohol, marijuana,and non FDA regulated "natural" remedies
This book is a clinical compliment to comfortably numb offering a clinician's solutions to common mental health problems. Psychiatry in Techno Colors: A Psychiatrist's Memoir of Lessons Learned About Diagnosis and Treatment of Anxiety and Depression.

Barber gives a lucid account of how over the past fifty years our culture has embraced a pharmaceutical solution to what ails us. It's obvious he did his homework and knows what he's talking about from a researcher's standpoint. At the same time he poses a very convincing, hip perspective that resonates deeply with anyone who is willing to take a good, hard look at the evolution that has occurred resulting in the widespread acceptance of the medicating of our society. A great read.

I read it. It's a superb book. I'll make a few comments and let you go. I was on withdrawal from these medications for a long time. I now take no pills. But please don't go to Peter Breggin. He's not a good egg. As this author states, medication is necessary for schizophrenia and major depression. It may also be necessary for some cases of manic-depression. I am not a doctor. This guy knows his stuff! Thank you.