Tuesday, June 28, 2005

Hurray for the Washington Post: The Clash of Culture and Biological Psychiatry

Yes, another post from me tonight. My colleague alerted me to a three part series in the Washington Post on the difficulties of reconciling cultural and race differences with the determination of psychiatrists to pursue genetics and neurochemistry as a means to understanding the basis of mental illness.

First let me give all you loyal readers the links to each article. The author is Shankar Vedantam, who I have been a fan of for a long time because of his pieces on drug companies and mental illnesss. I remember a few years ago that he reported that clinical trials on Prozac (something that is well-documented now) revealed that Prozac was no more effective than a placebo AND that older antidepressants actually did a better job. If you want the whole scholary history on that, you should read David Healy's book Let Them Eat Prozac, which has a companion website. By the way--yes, another digression--I am writing a review of that book right now, which I promise to post for you readers as well.

Now, the links for the articles:
(1) Patient's Diversity is Often Discounted 6/26/05
(2)Social Network's Healing Power Is Borne Out in Poorer Nations 6/27/05
(3)Racial Disparities Found in Pinpointing Mental Illness 6/28/05

I interrupted my careful reading of these pieces to report them to you. But, to give you a preview of some of the important insights in this series, let me mention a few details.

First of all, Vendantam points out how NO Native Americans were involved in clinical trials for drugs, and yet are quite regularly written prescriptions. My guess is that it is far more "cost efficient" to write prescriptions for pills than to treat the myriad mental health problems among Native American populations.

Secondly, I was not at all surprised to discover that American-born Mexican have mental health trends that are more similar to "Americans" than Mexicans. The immigrants begin to repeat typical American patterns of mental dysfunction: depression, alcoholism, etc.

Thirdly, White women are three times more likely to commit suicide than African-American women or Mexican-American women. The reasoning here, which seems sound to me, is that white women simply don't have the same social supports.

Now, for a juicy quotation from the piece that resonates nicely with my own recent writing (perhaps should be incorporated in my book):

Unlike anti-psychiatry groups that wish to do away altogether with drugs and doctors, advocates for cultural competence argue only against one-size-fits-all thinking. Genetic vulnerabilities and brain chemistry are undoubtedly important, said Lewis-Fernandez, but his patient was badly served because doctors assumed all her problems could be reduced to brain chemistry.

"Sure, after a certain amount of suffering for a certain amount of time, your brain reacts," he said. "The idea of mainstream psychiatry is that the pill will correct the chemical imbalance in the brain. Yes, but the imbalance keeps happening because of the situation she is in, and the pill can't correct the situation."

Sound familiar? What I particularly like about this first article is that Vendantam reports what the "mainstream psychiatrists" think about what Psychiatry should be like, which makes it plain what a bad place we are for addressing mental health issues across racial, religious, sexual, ethnic, and cultural diversity:

Mainstream psychiatrists say such examples are interesting but insist that the field stay focused on biology and brain chemistry. That is the only way to integrate psychiatry with the rest of medicine and to produce objectively verifiable treatments, said Regier, of the American Psychiatric Association.

So, the need to legitimize "Psychiatry" is more pressing than understanding what cultural forces--good or bad--are impacting how those who are "different" experience and understand their mental illnesses. What a loss!

Oh--for "I"--you should check this series out for its discussion of the unscientific nature of the DSM. And, let me close with my favorite quotation from the piece:

"When science becomes a religion, it becomes scientism," he [Renato Alarcon, a Psychiatrist at the Mayo Clinic] said. "There are fundamentalists among the scientists."