Assigning Blame

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Health Care, Social Issues

Following up yesterday’s post on the “causes” of the Virginia Tech massacre — I was disappointed to see that Arianna Huffington wrote this:

Reports that Cho had been taking antidepressants once again turn the spotlight on the uneasy question of what role these powerful medications might have played in yet another campus massacre.

It’s the same bloody-morning-after question I’ve been asking since 1998, when we learned 15-year old Oregon school shooter Kip Kinkel, who opened fire in his school cafeteria, had been on Prozac. Nearly ten years — and numerous school-shooters-on-prescription-meds — later, we’re still waiting for answers….

… Eli Lilly, the maker of Prozac, has vehemently denied numerous claims that the drug causes violent or suicidal reactions. But the company’s own documents admit that “nervousness, anxiety, insomnia, inner restlessness (akathisia), suicidal thoughts, self mutilation, manic behavior” are among the “usual adverse effects” of the medication. And a clinical trial found that Prozac caused mania in 6 percent of the children studied.

Can there be any doubt that Cho was exhibiting many of these adverse effects during his reign of terror in Blacksburg? His rambling, multi-media diatribe seems like a textbook example of manic behavior. The question is, was his manic behavior purely the result of a sick mind or was drug-induced psychosis part of the toxic psychological mix?

We don’t know. But we do know that one school shooter after another was on prescription drugs. Kip Kinkel was taking Prozac. Columbine killer Eric Harris was taking Luvox. Red Lake Indian Reservation shooter Jeff Weise was taking Prozac. James Wilson, who shot 2 elementary school kids in Greenwood, South Carolina, was taking anti-depressants. Conyers, Georgia school shooter T.J. Solomon was on ritalin. Is this just a coincidence?

A “coincidence” that people with behavioral problems are prescribed drugs? Huffington seems to think that these were perfectly well-adjusted children until some pharmaceutical salesman got hold of them. I doubt that’s the case. It’s more likely that these kids were given drugs after they developed some behavioral pathologies, in hopes that the drugs would help. Apparently, they didn’t. It is unfortunately the case that Prozac doesn’t do squat for, say, attachment disorder or other personality disorders, which might well have been behind all of the atrocities Arianna cites. It is also unfortunately the case that the only treatment for some problems is long and intensive (and expensive) work with a therapist. It’s easier to hand out pills

We can only speculate what was going on with Seung-Hui Cho, but schizophrenia certainly would account for all of his actions and behaviors. It’s typical for schizophrenics to be perfectly bright and normal children until they hit late adolescence or early adulthood — college years, in other words — when the symptoms begin to manifest. In rare cases symptoms are not apparent until the late 20s or early 30s. John Nash (the subject of “A Beautiful Mind“) fell apart during his graduate school years. The “Unibomber,” Ted Kaczynski, also began to struggle with his symptoms while in graduate school. At the moment it’s thought that schizophrenia is caused by a combination of genetic and environmental causes; it appears some people are born with some brain miswiring that makes them susceptible to developing the disease.

Instead of incessantly looking for scapegoats like Prozac, what we need is a massive overhaul in the way our nation, society, and health system deals with psychiatric disease.

I agree with Joan Walsh that we humans tend to look for patterns or causes in order to reassure ourselves that episodes like the Virginia Tech massacre are not completely random. Well, in a sense, it wasn’t completely random; it happened because a young man with a serious psychiatric disorder wasn’t getting proper treatment and supervision. It just didn’t happen because of cultural rot or video games or even Bill Clinton. Walsh also wrote,

Several of the “lessons” people tried to draw were particularly heinous and bogus, of course. No matter what Michelle Malkin says, the answer to gun violence isn’t more guns. I already wrote about right-wing crackpots’ efforts to blame the victims for not fighting back, and I still can’t believe such cruelty didn’t get more coverage. Instead, on Sunday we got more noxious garbage on ABC’s “This Week,” as Newt Gingrich blamed liberalism for the massacre.

On one level, this wasn’t a surprise. In 1994 the then-House speaker blamed liberalism when Susan Smith murdered her two children in North Carolina, and said the only way to prevent such tragedies was to “vote Republican.” He blamed liberals, again, for the 1999 Columbine killings. What surprises me is not what Gingrich says, but the very fact that the serial adulterer from Georgia is still on Sunday news shows lecturing the nation on morality. Aren’t there enough interesting, respectable, credible Republican leaders to make the rounds?

And can you imagine if a major Democratic Party figure, who was once third in line for the White House and who might run for president again, was saying such idiotic and hateful things about Republicans? Can you imagine if, say, Al Gore blamed the Bush administration, or the conservative movement generally, for the Virginia Tech massacre? He would be howled into political exile by braying right-wingers, but it’s an acceptable part of mainstream discourse to blame liberalism for the nation’s most jarring tragedies. And mainstream media elites wonder why they’re losing their audience. (Tangent, or not: Was there a better symbol of the media elite’s growing irrelevance than the choice of Rich Little to entertain them — and mirror their obsolescence — at the White House Correspondents Association dinner Saturday night, after Stephen Colbert’s brave, bracing, hilarious performance last year?)

(Aside: I actually feel sorry for Rich Little. He’s an elderly fellow who was a big star in the 1970s. Now he probably feels publicly humiliated, and he’s going to be remembered as the old guy who bombed at the press dinner.)

Update: Cho’s commitment papers.

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29 Comments

29 Comments

  1. grannyeagle  •  Apr 24, 2007 @11:02 am

    I do not know what Cho’s psychiatric diagnosis was but if he was schizophrenic, he would most likely have been prescribed an anti-psychotic medication not an antidepressant. Also, in my experience, most schizophrenics are not violent although that can happen with the paranoid type. One of the warning signs when taking Prozac is the increased energy level. For example, a person may be very depressed and not want to live but not have the energy to take action, e.g. commit suicide. Prozac sometimes gives them just enough energy to do something.
    On the other hand, I cannot agree with the premise that these drugs alone cause people to be as violent as Cho & others were. There are a lot of variables. We, the public, most likely will never know the whole story.

  2. PurpleGirl  •  Apr 24, 2007 @11:12 am

    From all the different articles I’ve read, it must remembered that Cho’s extreme isolation began in childhood. Relatives remember him not wanting to touch or be touched as a child and he was non-communicative, he didn’t respond verbally. He was apparently diagnosed as autistic sometime after his family moved to the US. At least it is most probable that his disordered mind fell somewhere in the autistic spectrum. Unfortunately, we will never know the truth about his problems.

  3. PurpleGirl  •  Apr 24, 2007 @11:25 am

    One more thing, I do not intend to blame or imply that autism caused his actions. I only want to reiterate why he may have had such extreme social problems. Many systems failed him and have failed others, and, consequently, hurt society and resulted in those deaths.

  4. Gordon  •  Apr 24, 2007 @11:59 am

    While blame-o-mania is wildly rampant on the Right, there was a bit of blame-the-boomers over at the Agonist.

    What’s lacking is perspective. In the Middle Ages, world population was ~500 million, murder rates in Europe ~20 / 100K, and in London around 75 / 100K. That’s when it took a fair amount of physical strength and effort to kill people.

    Now world population is 6.5 billion (13X more), US murder rates are ~ 5 / 100K (1.4 where I live) and the miracles of modern technology have opened the field to almost anyone.

    But no, it’s just accepted fact that those fed Dr. Spock would inevitably produce people like Cho as flatulence. Ignoring the fact the Dr. Spock’s “permissiveness” was in relation to the radical behaviorism of BF Skinner…

    Sorry, getting a little off-topic. But it’s the same story: everything was dandy until those liberals / boomers / your-favorite-boogey-man-here came along. Anything’s better than actually trying to understand the guy. Only liberal wussies do that.

  5. maha  •  Apr 24, 2007 @12:25 pm

    But no, it’s just accepted fact that those fed Dr. Spock would inevitably produce people like Cho as flatulence. Ignoring the fact the Dr. Spock’s “permissiveness” was in relation to the radical behaviorism of BF Skinner…

    Spock didn’t even write that much about discipline. His book was mostly about how to sterilize baby formula and what do do about diaper rash. I think if all these people who are so certain Spock was “permissive” would actually read the bleeping book, any edition, they’d be amazed that what they think is in there … isn’t.

    My mom used to have a baby book she had purchased some time in the 1940s. I wish I still had the thing; it was hysterical. Stuff like Babies WILL be put on a FOUR HOUR FEEDING SCHEDULE WITHOUT FAIL or they WILL BE RUINED FOR LIFE. If you give in to their frantic cries of hunger and feed them after only THREE AND A HALF HOURS there will be DIRE CONSEQUENCES. (Of course the four-hour schedule thing only works with bottle babies; breast babies usually fall into a three-hour schedule, although newborns sometimes need to be fed more frequently.)

    There was also warning about not picking babies up and cuddling them when they cry or they will be spoiled, which I think is horrible. There is nothing more natural to our species than cuddling a fussy baby. It’s a baby’s first lesson in social interaction. I think if you don’t respond to them naturally they just act out more and more until they get your attention.

    Of course, potty training was supposed to be accomplished at some ridiculous early age before a baby could be expected to have bowel and bladder control. If all that was Skinner’s influence, then Skinner should burn in you-know-where. He caused a lot of suffering.

    Anyway, Spock came along and said outrageous things like it being OK to feed a baby when he or she was hungry. He also wrote that it was better not to push kids through developmental stages like walking or potty training before they were ready. That’s what got translated into “permissiveness.” Spock was actually pretty strict about some things, like being consistently firm about a regular bedtime.

    My favorite personal Spock story happened after my kids were in school. My son, in elementary school, was sick, so I hauled out Dr. Spock and looked up the symptoms, and correctly diagnosed chicken pox. Then a few days after he was better my daughter came home from middle school and complained of a headache. So I looked up “chicken pox” in the Spock book and, sure enough, it said “older children will come home from school and complain of a headache.” The spots showed up the next day. The man was a genius.

  6. moonbat  •  Apr 24, 2007 @12:57 pm

    I never knew that about Dr Spock, although I’m certain I am to some degree the product of his teachings. He really has gotten a bad rap, by merely being around for the baby boom, that era so despised by righties. Next time some ignorant rightie brings up Dr Spock, I’ll be prepared to confront the loudmouth with: Did you ever read him? and go from there. Thanks.

  7. maha  •  Apr 24, 2007 @1:26 pm

    moonbat — the biggest reason the Right went ballistic about Spock is that he became very outspoken against the Vietnam War. That’s when the rumors about his alleged “permissiveness” really got out of hand.

  8. joanr16  •  Apr 24, 2007 @1:26 pm

    While I imagine none of us really want to jump up and defend Big Pharma, still, crappy logic is crappy logic. The adverse effects that Huffington mentions simply would not lead a person to go on a shooting spree. That would require paranoid delusions and/or a state of complete emotional separation from other human beings (which, it’s been pointed out, seemed to affect Cho since early in life).

    maha’s examples of Ted Kaczynski and John Nash make this distinction clear. Kaczynski sat in his little cabin building intricate bombs, and then sent them out to maim or kill perfect strangers. That’s about as emotionally distant as you can get. Nash imagined a complex plot of spies and constant danger, with the fate of the world depending on his intellect. From what I’ve seen of Cho’s videos, he believed his whole world had slighted him, and he owed vengeance to everyone who came between him and a lonely martyr’s death. There’s a hell of a lot more going on there than Prozac could ever explain.

  9. Morris Berg  •  Apr 24, 2007 @2:02 pm

    Hold on . . . hold on . . . I love this site and agree with most of the views expressed, but there is much more to the SSRI-Violence-Suicide angle than you suggest. I was formerly a published neurochemist, and I have a very formidable knowledge of the research in this area.

    It is not disputed (as evidenced by the blackbox warnings) that DEPRESSED individuals (esp. children/teens) on these drugs commit suicide at a rate or 3-7x more than DEPRESSED individuals on placebo. Some individuals (not all) respond in a very violent manner on these substances . . . though it is usually self-inflicted rather than outwardly expressed as in rampage killings.

    Without going through all the various research, etc., I will merely note a couple things:

    (a) we still don’t know if he was even on SSRI’s but – as Huffington was saying – if so, then this should at least be investigated . . . that is so obvious as to be unremarkable;

    (b) There are a couple problems with the “it must’ve been the underlying condition . . . he was messed up anyway” argument: (1) it is convenient in its non-disprovability (i.e. what if these drugs really had this effect . . . you could ALWAYS argue that it was the underlying condition NOT the drugs . . . thus there is no null hypothesis); (2) the strange and sudden violent effects have been seen in HEALTHY VOLUNTEER STUDIES (so there is no underlying condition to blame it on . . . this is IMPORTANT).

    Look . . . no one is claiming 100% causation (he obvioulsy had problems), but this is something that should REALLY be investigated if he was indeed on these drugs. The argument is that these drugs cause – in some individuals – specific violent behavior (towards self and others) where there is no history of such behavior and that stops once the drugs are stopped. If this hypothesis is baloney, then it can easily be investigated and put to rest.

  10. maha  •  Apr 24, 2007 @2:31 pm

    Morris — certainly prescription drugs could make a problem worse, especially when the patient’s condition is misdiagnosed. This is true of non-psychiatric illness as well. I’m just saying it annoys the hell out of me when someone like Cho, who obviously had a long-standing and severe psychiatric disease, does something really horrible, and the first thing people say is “it must have been Prozac.”

    No, it must have been untreated (or wrongly treated) psychiatric disease.

    Certainly, a lot of people are getting prescriptions for SSRIs who shouldn’t be taking them, but people get prescriptions for antibiotics (and all kinds of other drugs) who shouldn’t be taking them, also. All prescription drugs have known nasty side-effects and risks or they wouldn’t be prescription drugs. Browse through the PDR sometime.

    In the case of psychiatric illness the chances of misdiagnosis or writing the wrong prescription are especially high, because psychiatric illness usually doesn’t have the more cut-and-dried symptoms that other illnesses have. I also believe strongly that a lot of psychiatric patients need more than just a prescription.

    As for your claims about suicide — in fact, recent research indicates that the risk of suicide in young people receiving antidepressant treatment is not statistically significant; the risk-benefit ratio is positive; in other words.

    After reaching the end of a meta-analysis of 27 different studies, an American research team has confirmed that “the benefits of treating young people with antidepressants exceed the risks”. And the risk of suicide in particular, which is considered not to be “statistically significant”.

    After warnings from European and French medicines agencies, doctors at the Columbus University in the United States confirm that there is an increased risk of “suicide and suicidal thoughts” among children and adolescents receiving antidepressant treatment. But, according to them, this is so slight that it does not present a challenge to the risk-benefit ratio of this medication.

    The recommendations of the French Health Products Safety Agency (the AFSSaPS) are perfectly clear on the subject. The Agency stresses in fact that “the first-line treatment of depression in children and adolescents (relies on) a psychotherapeutic approach. The prescription of antidepressants, where envisaged, should only be a second-line treatment in the event of a major depression (…). Where antidepressants are prescribed, there must be close monitoring of the patient, including for indications of suicidal behaviour, particularly at the start of the treatment”.

    I’ve never seen demonstration that there was any increased risk of suicide among depressed adults receiving medication compared to depressed adults who were not medicated. I do think people who are prescribed these drugs need to be monitored closely in the beginning, but again, that’s true of a lot of drugs.

    Update: Here’s another story about the study. This was just published today.

    According to a new study, conducted by the Center for Innovation in Pediatric Practice (CIPP) at Columbus Children’s Hospital and published in the April 18 issue of The Journal of the American Medical Association (JAMA), there is more information for parents about the risks and benefits of antidepressant treatment for children with depression and anxiety disorders.

    The Children’s Hospital study found the overall benefits of antidepressants in treating pediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders (ANX) in children 19-years-old and younger appear to out-weigh the risks of suicidal thoughts and attempts associated with these medications.

    “Although our findings regarding suicidal thoughts and attempts are in the same direction as the Food and Drug Administration (FDA) meta-analysis, we found a much lower overall risk and we added analyses of the potential benefit of these medications,” said lead author Jeff Bridge, PhD, CIPP principal investigator and assistant professor of pediatrics at The Ohio State University College of Medicine. “This is good news for parents because it gives them more information for discussions with their family’s physician about their child’s treatment options.”

    The study found that for every 100 children and adolescents younger than 19 years who were treated with antidepressants for MDD, OCD and ANX, about one child would have thoughts of suicide or attempt suicide beyond the risk associated with the condition itself. The FDA study, which included seven fewer trials, found that for every 100 patients, approximately two would be expected to have suicidal thoughts or attempt suicide beyond the anticipated risks due to short-term treatment with antidepressants.

    The “anticipated risk” part is the well-known effect of what happens when a deep depression begins to lift — a previously enervated patient becomes more active and able to carry out suicide fantasies. This also is true of depressed people who are not taking drugs. That’s why these people require close monitoring. As the patient becomes less depressed, this danger of suicide passes.

  11. Morris Berg  •  Apr 24, 2007 @3:15 pm

    Ah . . . but without getting in to the statistical details, I have to see a couple things before I could agree with the conclusion.

    First: I would like to see the funding/conflicts of the authors.

    Second: a meta-analysis that is based on methodologically flawed studies will exhibit the same deficiencies. An example of such manipulation that has been documented in quite a few SSRI studies is when a patient has a very negative reaction (hostility, suicidality, etc) and must discontinue treatment prior to the end of the study. These are NOT included in the treatment group of the study though arguably they should be. Sometimes they will simply “proclaim” actual suicides that occur on said drugs to be unrelated to the drugs. Or they will creatively code the adverse effects (lability v. suicidality).

    Furthermore: it is estimated that upwards of 50% of psych studies are ghostwritten by marketing firms, so once agin, I would need to see the data.

    I am a bit wonkish on the statistical data side of this, but I won’t bore anyone any further , but there are a lot of ways to methodologically “tweak” data (and these have been documented time and again in psych studies) to get the results you would like. Therefore, it is very important to independence/conflicts are very important. I couldn’t find the actual study so I won’t pass judgment.

    There are a lot of assumptions that are made (by professionals as well) that have no basis in science but are merely marketing. Remember “chemical imbalance”/”serotonin imbalance”? This has finally been laid to rest. The term itself not only overly-simplistic but this “imbalance” has never ever been shown in any sort of study. But it sure sounds plausible (much like hormonal imbalance/menopause and HRT) . . . and it sure sells these drugs, but it is still nothing but marketing.

    And the healthy volunteer studies are still the most damning: see Traci Johnson (http://findarticles.com/p/articles/mi_qn4159/is_20050619/ai_n14674527)

  12. Morris Berg  •  Apr 24, 2007 @3:35 pm

    I really would like to see who funded this study and the methodology involved before I will address it further.

    Regardless, I would merely recommend examining the data, methodology, and conflicts before accepting any concusions contained in a press release.

    Cheers,
    Moe

  13. maha  •  Apr 24, 2007 @4:04 pm

    The thing is, Morris, that it ought to raise alarm bells whenever a psychiatric illness or treatment is dealt with differently from other illnesses and treatments. Having taken a whole mess o’ different anti-depressants over the years I have a keen appreciation of what they can do as well as personal experience with what depression can do, and I firmly believe that there’s a lot of hysteria about anti-depressants, particularly the SSRIs, just because of peoples’ medieval attitudes toward psychiatric disease. I also believe strongly that the “black box” warnings were more about that hysteria than science.

    Again, all prescription medications carry some risk, and they can all do more harm than good if they are used inappropriately. That’s why they are prescription medication. I respect that. I think the SSRIs are often prescribed for people who would be better off without them, just like tranquilizers and amphetamines were way over-prescribed in the recent past. I’d be the first one to say that physicians perhaps should be more conservative about handing out SSRI prescriptions, especially to young people or people who haven’t had a proper psychiatric evaluation.

    But I have absolutely stopped listening to people who bounce off the walls and shriek about the evils of Prozac every time a kid with an obvious, long-standing personality or mental disorder does something violent. I think it’s at least as likely — more likely, actually — that the disorder caused the behavior and the drugs he was on just didn’t relieve the disorder.

  14. sisyphus  •  Apr 24, 2007 @4:20 pm

    A serious issue that remains is the forced treatment issue.
    Here in California Mr. Cho would have been taken to a State mental treatment facility at the first sign of instability(danger to self or other)
    Then Saint Ronald Reagan closed these facilities and we now find seriously mentally ill in prison or homeless.

  15. beckya57  •  Apr 24, 2007 @6:13 pm

    Bravo, Barbara, both for the post and your rebuttal of Mr. Berg’s arguments. The research simply doesn’t support an increased risk of suicide from antidepressants, and there’s no controlled research that I know of indicating that any psychiatric medications cause violent behavior (at least when properly used). There is a slight risk of increased suicidal ideation when people start taking antidepressants, which is why they need to be closely monitored. The same increase in ideation also shows up with “talk” therapy such as cognitive behavior therapy; it hasn’t been identified as a problem, however, I believe because patients seeing a therapist are being closely monitored, while the same wasn’t necessarily true for people getting medications. The FDA now requires close monitoring, particularly when the med is first started, and that’s appropriate. The fact that we see the same effect with CBT suggests that this is an effect of depression treatment in general, not of meds specifically, and may well be due to the fact that energy tends to improve well before mood does. I don’t like Big Pharma any more than anyone else, but there has definitely been a lot of hysteria in this area. I think it’s very understandable that grieving relatives of someone who’s suicided or committed an aggressive act would look for answers; also, at the risk of sounding unsympathetic, I think there is often a tendency to look for answers that exonerate oneself, eg the drug did it, not my parenting. However, those of us in the scientific community, and also in the media (eg Ms. Huffington), need to pay attention to the evidence, not emotions.

  16. Jean L'homme  •  Apr 24, 2007 @8:15 pm

    I too feel sorry for Rich Little. One knows how hard it is to recognized when ones time has passed. To be asked to perform for this (august) group was enough to convince him otherwise. Shame on the (not so august) grouop. I agree maybe the time has passed for them.

    Glad to hear there are some out there who read Dr. Spock. I fear too many people get their information from cliff notes.

    Since it’s apparent there is nothing new under the sun, and we aren’t any worse today than yesterday; let’s really look at things. At least today we are exposing all, maybe just most, of these negatives and recognizing the importance of doing something about them.

    Of course this is also why I am a moderate liberal democrat. The status quo does not take care of things. We must be our brother’s keeper.

  17. maha  •  Apr 24, 2007 @10:20 pm

    Glad to hear there are some out there who read Dr. Spock.

    It’s been a while. The old baby is 26 and the new baby is 22.

  18. aeolius  •  Apr 24, 2007 @10:52 pm

    Wow look at all the armchair diagnoses!
    I worked in a psychiatric hospital for 25 years and would not on the evidence presented diagnose him.

    [Wow, look at the twit who can’t read! We’ve all been careful to explain that anything we say is speculative! — maha]

    On of the major reasons is that I do not have cultural competency on Korean mental illness, nor the dynamics of Korean families.

    [You work in the cafeteria, then? “Korean mental illness” is likely to very similar to, oh, “human mental illness,” I suspect. — maha]

    [Remainder deleted because commenter annoyed me. — maha]

  19. Donna  •  Apr 24, 2007 @11:40 pm

    I can feel a lot of hooks reaching themselves into my own psyche and opinions with this post and the comments!!!! Disclosure: my first career was in the psychiatric field. [that was waaaay back before I finally got tired of the daily wading through theoretical bs and made a radical career change into the blessed common sense of carpentry].

    Morris Berg, I really, really, really appreciate what you attempted to communicate with your comments. I may get clobbered for my admittedly opinionated take on the mental health field and the use of drugs, but what the hey…..

    Effective therapists are the exception. I used to have a sign on the outside of my clinic door:
    “Q. What’s therapy?
    A. Therapy is when the therapist tries to get the client to do something that the therapist cannot do either.
    Q. What’s that?
    A. Share innermost feelings openly and honestly.”

    Instead of therapy that really addresses inside troubled depths, what passes as therapy is usually diagnosis from theory followed by some regular ‘talking’ with the patient from which the theorist reinforces his/her pet theory at the exclusion of actually exploring the inner and outer uniqueness of the human being in the office. Because people in trouble need to not feel so absolutely alone, the talking does make a difference short-term. But when I was in the field, I rarely saw any significant progress for deeply troubled individuals. So, guess what, the preference is to use drugs to control mood, affect, anxiety and any outward symptoms which are so distressing to everybody involved….including the therapists who otherwise might have to realize that all their own education and theories weren’t worth squat.

    Symptoms are a call for help and are also the quickest route to what roils inside. Drugs are a way to CONTROL symptoms, and drugs effectively create a wall between what roils inside and the conscious self. What roils inside does not go away because it is not felt….. what roils inside still lives and still has effects…..sort of like those underground mine fires that never burn out but send up smoke or burn from a new air-hole from time to time.

    We live in a amazingly superficial society which has produced a superficial fix of talk therapy/drugs designed to help us all adjust rather than plumb the depths of societal and personal angst. I see Cho as a symptom of that reality.

  20. erinyes  •  Apr 25, 2007 @5:20 am

    Y’all just don’t understand the problem. It all started with the “hippies” in the 60’s, at least that’s what a commentor stated in last week’s Orlando Sentinel opinion section. There was a similar comment in the FT. Meyers paper several months ago.
    Yep, it’s the fault of “hippies” and liberals! Please ignore the actors posing with guns and other weapons on those DVD and video covers at the neighborhood movie rental store. War is peace, ignorance is strength, and mass murder is entertainment.
    May you live long and prosper…….
    (oops, wrong Spock!)

  21. maha  •  Apr 25, 2007 @8:41 am

    Donna — I have my own problems with much psychological theory and the way therapy is done (or not), and much of what you say is true. However, based on my own experience and a lot of reading I have come to think that the PRIMARY cause of much — not all — but much psychiatric disease (like most psychosis and clinical depression) is physiological. So when you say

    Drugs are a way to CONTROL symptoms, and drugs effectively create a wall between what roils inside and the conscious self. What roils inside does not go away because it is not felt.

    I see it the other way around. I think it’s more often the case that there’s an underlying physical cause that predisposes a person to psychosis or depression. The crap one gets hit with in life shapes the way the disease manifests itself but isn’t the primary cause.

    Short-term depressions perhaps can be handled with therapy alone, but those of us with long-term, chronic depression need meds more than we need therapy, frankly. I tried doing without meds for years, and that was stupid. The fact of the matter is that something in my brain just doesn’t work correctly, and no amount of therapy or other self-improvement program (which I diligently worked at for YEARS) fixes it. Therapy helped me cope with the disease and increased my functionality somewhat, but that’s about it.

    In other words, in my case, it was therapy that masked the symptoms and medication that actually treated the disease.

    I’m not saying therapy was a waste; I think it did me a lot of good. It just didn’t get at the primary cause of my dysfunctions.

    There is nothing more important to de-stigmatizing psychiatric disease than getting people to understand it’s a bleeping disease, like diabetes or mumps, and not a character flaw or demonic possession.

    I’m not saying everything has a physiological basis; I understand no one’s found a physiological basis for personality disorders, and maybe there isn’t one. But we KNOW there’s something out of whack with brain wiring and chemistry in schizophrenia, clinical depression, and a lot of other common psychiatric diseases.

    I could be wrong, but I think one can get stuck plumbing “the depths of societal and personal angst.” There’s a point at which the patient has to fully acknowledge the angst, certainly, but the ultimate goal is to let it go, and I don’t think psychology has that part figured out yet. That’s one of the most important things I took away from Zen training, actually. I think now that the precise issues one wallows in are less important than the wallowing itself.

  22. Morris Berg  •  Apr 25, 2007 @11:43 am

    The last I will write on this:

    1) My views on the potential violent adverse effects of SSRI’s are based solely upon data I have seen (a) from independent sources; (b) from industry data that had been hidden going back 20 years and only allowed to see the light of day due to lawsuits . . . NOT from a barabric view of mental health issues . . . I studied neuropsych for more than 6 years for crissake and to lob that allegation is tantamount to Cheney criticizing Reid for not supporting our soldiers and marines. It is analytically vapid and intellectually dishonest.

    2) I hold the view that these substances may be effective for some people . . . I am not demonizing them or anyone with mental disorders.

    3) As I have repeatedly said, my argument (and I think Huffington’s tho’ I do not speak for her nor adopt her views in toto) is for more thorough investigation. An argument that proceeds by “the research simply doesn’t support . . . X” is not determinative of any point for a couple of reasons: (a) generally: absence of evidence is not evidence of absence; (b) specifically to this field and this issue: many of the studies in this field simply did not purport to examine or measure any such effects(violence/suicidality/aggression) . . . those that did were often miscoded or – if they discontinued treatment because of the negative effects – they were simply discarded. In psych more than any other field, there is little to no independent research on these matters and you trust industry-funded studies at your own peril.

    We have two potential (non-exclusive) causative factors common to these shootings (this is not in dispute): (1) underlying mental disorders that have led to some treatment/intervention; (2) antidepressents or other pharmacological intervention.

    The science simply does not establish if and/or to what degree either may play. I WANT THESE STUDIES DONE.

    My position is UNREMARKABLE, but every time I ever suggest the possibility, the reaction I receive is often an ungodly amalgamation of anecdote, accusation, and ambiguous assertions about “studies” (pardon the alliteration).

    I like this blog. Keep doin wut ya doin, maha . . . I think these types of discussions are the first step towards answering these questions.

  23. maha  •  Apr 25, 2007 @12:01 pm

    To aeolius, who lacked the character to provide a real email address:

    Next time, read a blog’s comment policy before you comment. Comments that begin with unjustified insults of me or my readers are subject to deletion and/or ridicule. Since your first sentence was both an insult and a lie, you have no right to claim you are being treated unfairly. I don’t have time to deal with ignorant snots who can’t be civil.

    Regarding what you say about psychiatric disease and culture — certainly, many psychiatric diseases manifest themselves differently in different cultural contexts, but that doesn’t mean that nations like Korea have unique psychiatric diseases. It means that culture can effect how a disease is understood or expressed.

    Now, get lost.

  24. maha  •  Apr 25, 2007 @12:13 pm

    Morris — I’m all for continuing research in how antidepressants work, but frankly all I’ve ever seen from the “let’s blame Prozac” side are “ungodly amalgamation of anecdote, accusation, and ambiguous assertions about ‘studies’ (pardon the alliteration).” I linked to two news stories about recent research. Where are your links? If there is data showing the extreme cause-effect that you allege, then link to it. Otherwise, chill.

  25. Morris Berg  •  Apr 25, 2007 @1:54 pm

    Ahh crap . . . I guess I lost the last post:

    Ugh . . . Ok here we go again.

    First: where did I say extreme cause-effect?

    Second: Remember how this works: the burden is on the drug-makers to prove them effective and SAFE not me to prove them to be unsafe. This is the same issue we saw with Vioxx. Mercjk had the data showing an incraesed cardiac risk and withheld it. If it were not for Dr. Graham (who had access to the data vis-a-vis his position at the FDA), how would anyone ever have overcome the conventional wisdom (that had been so well marketed) that these were “safe”?

    Ask and ye shall receive:

    The best overview of the existing science and relevant literature: Antidepressants and Violence: Problem: at the Interface of Medicine and La, by David Healy, Andrew Herxheimer, and David B. Menkes, PLOS, September 2006, Volume 3, Issue 9, 372. http://psychrights.org/Research/Digest/AntiDepressants/healyherxheimermenkesSSRIsandViolence.pdf

    GlaxoSmithKline’s Paxil/Seroxat has been the subject of five BBC Panorama investigative reports and a lawsuit charging fraud by New York State Attorney General. Check it out: http://news.bbc.co.uk/1/programmes/panorama/default.stm

    FUN FUN SCIENCE:

    Even more suicide attempts in clinical trials with paroxetine randomised against placebo, by Ivar Aursnes, Ingunn Fride Tvete, Jorund Gaasemyr, and Bent Natvig, BMC Psychiatry, 2006, 6:55. http://psychrights.org/Research/Digest/AntiDepressants/BMCPsychiatryEvenMorePaxilSuicides.pdf

    Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis, by Peter R. Breggin. International Journal of Risk & Safety in Medicine 16 (2003/2004) 31–49. http://psychrights.org/Research/Digest/AntiDepressants/breggin31-49.pdf

    The SSRI Trials in Children: Disturbing Implications for Academic Medicine, by Jonathan Leo, PhD, Ethical Human Psychology and Psychiatry, Volume 8, Number 1, Spring 2006. http://psychrights.org/Research/Digest/SSRIs/leoSSRIsandKids.pdf

    Efficacy of antidepressants in adults, by Joanna Moncrieff and Irving Kirsch, July 16, 2005, British Medical Journal, doi:10.1136/bmj.331.7509.155 2005;331;155-157 BMJ, concluding SSRIs have no clinically meaningful advantage over placebo, there is little evidence to support claims they are more effective in more severe conditions, they have not been convincingly shown to affect the long term outcome of depression or suicide rates and given the doubt about their benefits and concern about their risks, current recommendations for prescribing antidepressants should be reconsidered. http://psychrights.org/Research/Digest/SSRIs/BMJ7-16-05EfficacyofAntidepressantsinAdults.pdf

    FDA Public Health Advisory, Suicidality in Adults Being Treated with Antidepressant Medications, June 30, 2005. http://psychrights.org/Research/Digest/AntiDepressants/SSRI200507.htm

    November 11, 2004, letter from David Healy, MD, to the Medicines & Healthcare products Regulatory Agency regarding corruption in reporting the clinical trials for SSRIs (he calls them “manoeuvres”). http://psychrights.org/Research/Digest/AntiDepressants/11-5-2004DHealy2MHRA.htm

    Drug Safety Research, Special Report: Antidepressant Drugs and Suicidal/Aggressive Behaviors This drug safety report documents higher than expected numbers of suicidal and aggressive behaviors observed in some clinical trials of antidepressants in children also can be seen in spontaneous adverse event data, and add substantial additional evidence to the case. The data show that suicidal/aggressive behaviors are reported in both adults and children, but more than twice as often in children. Finally, while two drugs now carry warnings about this risk, similar risks were reported for the four drugs without warnings. Findings from these adverse event data should be interpreted in context with other scientific evidence, and with consideration of the limitations outlined below. http://psychrights.org/Research/Digest/AntiDepressants/sui_behav_antidep.pdf

    Collection of 1500+ news stories with the full media article available, mainly criminal in nature, that have appeared in the media or that were part of FDA testimony in either 1991, 2004 or 2006, in which antidepressants are mentioned. http://www.ssristories.com/index.php

    E-mail me if you would like more . . .

    Cheers,
    Moe

  26. Donna  •  Apr 25, 2007 @1:58 pm

    Maha, I totally agree with you about there being a physiological aspect of clinical depression and other psychological distresses [and I am not making some blanket statement against drugs being helpful or, in some cases, clearly more useful than other treatment modalities].
    To me, it is impossible to separate the physical self from the psychic/emotional/thinking self. The body is the reflection of and storage depot for all experience, whether the experience is a broken ankle [which subtly torques the rest of the body], a non-nurtured babyhood [which lays down a ‘life is hard’ orientation, with extrinsic muscles out-powering the intrinsic ones, for which the infant has no perspective and which the infant-later-grown-up just takes for granted as ‘how life is’], or a parent’s constant carping to ‘act right’ [which can mean rounded shoulders and belly distress as well as development of a thinking process which focuses on image instead of substance], or even a spiritual crisis.

    But speaking of the physiology vs history aspect: seems to be a chicken or egg conflict. The correct drug can alter body chemistry and alleviate clinical depression. That is good, indeed.
    Other ways that could correct the same ‘body chemistry’ are possible, but not pursued because of stopping far short in even probing deeply enough into the human condition in our culture. Waaay back when I was in that clinical work, I did some ground-breaking work which eventually resulted in my colleagues referring the toughest, most hopeless cases to me [whether schizophrenics, paranoids, welfare-receiving repeat-hospitalization ones, suicidal depressives….] . I am not going to go into all that in this blog, except to say that the body is an on-going alive self-corrective system and can use its own chemistry to block or open areas. Absolutely rare to change without drugs, yes. Impossible, no.

    Having said all that, I want to say that you are right-on that the ‘wallowing’ is often the arrival place in most help programs, becoming an end into itself [ugh]. I love how you have mastered this issues in your life. You are definitely not into wallowing.

  27. maha  •  Apr 25, 2007 @2:29 pm

    Moe — I honestly don’t understand arguments in which n = something. I used to be production editor for a bunch of sociology journals, and n was always equaling something, plus there were chi square and p values and I never could make heads or tails of it. So I’ll take your word for it that something was proved here. On the other hand, when someone says “SSRIs have no clinically meaningful advantage over placebo,” then I know something is screwy. SSRIs don’t work for everybody, but when they do work they do a job.

  28. Morris Berg  •  Apr 25, 2007 @2:42 pm

    The statement itself is not as bold as you might think (tho’ I agree that it is a bit bold). The key though is “over placebo.”

    You would be surprised at just how effective sugar pills are on our existing measures of depression.

    Here is a brief example/illustration of just how generally weak the efficacy of these drugs is:

    Only 2 studies showing statistically significant therapeutic effect (over placebo) must be submitted to the FDA to show “efficacy.” So if you ran 8 studies that showed NO improvement over placebo (but did not submit them) and 2 that showed marginal but statisticall significant improvement, you would have “shown them effective.”

    This is what happened with either Zoloft or Paxil . . . I can’t quite recall.

    The point though is that the placebo effect is very high on depression.

    Well that is what happened with

  29. maha  •  Apr 25, 2007 @3:00 pm

    You would be surprised at just how effective sugar pills are on our existing measures of depression.

    Morris, as a chronic depressive, as someone who has spent most of her whole damn wasted life fighting my stupid brain chemistry, and who only began taking medication relatively recently and am now sorry I didn’t begin it about a hundred years ago and saved myself a lot of grief, I cannot tell you how angry statements like that make me.

    You try living with my brain for a little while, and then see how you feel when some damn bleeping dweeb tells you that all depressed patients need is a placebo. The word “homicidal” does come to mind. I guess you’ll blame my meds for that.

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