Book Review: "Cracked: Why Psychiatry is Doing More Harm than Good?"

Paradigm shift, that's what this angsty and de-constructionist book succeeds in inducing in me --- a big shift in my own personal perspective towards one of the most controversial of medical profession in our contemporary society --- psychiatry.

Throughout the reading process, which takes about three days, there was a constant running scene of George Carlin's comedy gold that keeps on reliving at the back of my mind. In one of his finest stand-ups, he discussed about the rampant usage of euphemistic language throughout the professional communities, "We have no more stupid people, everybody has a learning disorder. Or he's minimally exceptional. How would you like to be told that about your child? 'He's minimally exceptional.' 'Ohhh, thank God for that!'"

George Carlin: The grandmaster of black comedy,
playing with language since he was in a foetus.

And although George Carlin exaggerates a great deal for comedic purposes, there is an element of truth in it, as there is a subtle but malevolent mechanism that is involved here, namely that of our blatant medicalization of almost everything that is out of the norm and appears as an outlier, and this medicalization blurs the boundaries between normality and abnormality. This is crucial, as there is no clear cut distinction between them, and to purport a categorical distinctive criteria between the two is allegorical to drawing a fine line where there is no fine line.

This tendency to medicalize and categorize our so called mental illnesses reaches its peak when the psychiatric association -- the APA -- constructed the influential DSM (Diagnostic & Statistical Manual of Mental Disorders), and this manual is currently in the 5th edition. Many of the disorders listed in these manuals were considered to enter into this manual through, wait for it, voting?! And the criteria is often times constructed equally through voting, and often times single-handedly written by a SINGLE INDIVIDUAL! Now that, my dear friends, is hubristic. We know so little about the true nature of mental disorders (some may even consider them as non-existent, and are instead created cultural concepts), but we carry on believing in this faulty system precisely because there is no alternatives that are currently available.

Take for example one of the "mental disorders" that are currently listed in the latest version of the DSM (DSM-V):
Prolonged grief disorder: Diagnosed when there is a loss of a significant other which causes depressive symptoms and significant distress that result in impaired everyday functioning, after the death of the person for at least six months. (Indeed, the arbitrary criteria of six months is entirely questionable. Why can't it be five months, or one year, or two years? Why six months? There are no studies to support it, let alone be included in the "Bible" of psychiatry.)

Now, many will argue that this is valid because often times grief can cripple a person emotionally and psychologically. But the counterargument is this: A sense of distress is a very normal emotional response, and often times, the sense of loss can extend beyond years. To propose a biomedical model to explain it disrupts our very human experience, because instead of looking at this phenomenon humanistically, we are objectifying and reducing the issue into the problems in our brains (e.g. there is a lack of certain neurotransmitters, or parts of our brains are malfunctioning, which studies have often showed that there is no clear causal relations in the first place). Instead of medicalizing it, which makes the pharmaceutical companies gain a huge amount of profit, and passing out medicines that are no better than placebos, we should help these people through meaningful human connections, and helping them out when they need it. There are many implications to this disorder, as with many other controversial disorders, such as the "premenstrual dysphoric disorder" (PMDD), as these disorders are essentially a medicalization of a fairly human response, and to diagnose them in a clinical setting means to give out pharmaceutical medicines such as antidepressants that may bring about serious side effects.

There is another case that is written in the book that still give me the chills whenever I think about it. In the Western countries, there is a big pharmaceutical company named Eli Lily. What they did was they "created" a new medication for PMDD to "help" women who suffered under unstable emotional bouts two weeks before menstruation. The medicine is named "Sarafem", and they are pink pills, and the name is derived from the Hebrew word 'angel'. Now, the scary part is that the chemical ingredients of Sarafem is essentially the same with Prozac, an antidepressant, which has no part to do here because PMDD is not a depressive disorder! This is ingenious because they repackaged Prozac into a female wonder-drug, by using subliminal messages such as the pink packaging or the name itself that is imbued with stereotypic female overtones. And the worst part is, nobody knew about it!

Prozac's chemical molecules
Fluoxetine: an antidepressant of the SSRI class.

Sarafem's chemical molecules
Also...... Fluoxetine

French philosopher, Michel Foucalt, once famously (or infamously) said that madness has always existed, but madmen hasn't. Because madmen is a culturally evolved concept that is put in place in order for people with higher powers to confine them and restrict them so as not to destroy the entire structure of society into chaos. Whether that is true or not is still to be questioned. But what is true is that the psychiatric industry still has a long way to go, whether ethically or practically, as there are still many questionable flaws that are embedded in its very fabrics.

Michel Foucalt: fabulous, important,
and downright inscrutable and indecipherable.

Reading this book is like reading "Alice in Wonderland". It brings you to a place where things may appear bizarre and out-of-hand at first glance, but will soon take on a reality so startling, so unsettling, and so disturbing that it shatters your very beliefs, and lead us to question everything that we know about the psychiatric community ("To be ethical, or to profit, that is the question!") The book listed out so many other deceptions and faults of the psychiatric community, as well as the pharmaceutical industry, that it makes one shiver to think about how naive we once were to hail it as an advancing science, when it is actually moving nowhere in its inertia. It is a rabbit hole where crimes such as shadowy economic links between psychiatry and pharmacy, conjured research trial results, serious side effects of drugs, drugs that are no better than placebos, are kept silently at the vault of their secrets. But the vault is leaking.

It is a book that is rather dry and is honestly boring, and its implications are rather biased (the author is a psychotherapist, but in the book, nowhere is it to be found that psychotherapy is equally scrutinized with a critical lens, and the book neglected many other mental diseases, such as schizophrenia, or bipolar disorders). I am generally skeptical of skeptics (hah, the irony!), but this one got me sold. And although I do not enjoy it, not because it was dry (although there is an element of that), but because the truth listed inside is disturbing (as truths often are), it is an important and honest polemical work. And it not only deserves to be read widely, it demands to be.

Nothing better to end a long article than an Obama picture.

There are other books that offered a critical re-evaluation of psychiatry as a whole, that are written with a much more interesting (or "entertaining" if that is the word for it) prose, such as:
(1) Tom Burns: The Necessary Shadow
(2) Ben Goldacre: Bad Science
(3) Ben Goldacre: Bad Pharma
(4) Christine Montross: Falling into the Fire
(I absolutely recommend Ben Goldacre's two books as they are very very good, with enough anecdotes that makes the best black comedy material.)