“Cracked: Why Psychiatry is Doing More Harm Than Good” by James Davies (Book Review)

My involvement with the community outreach at my local church enables me to deal with people who suffer from depression and other psychological ailments so I have a strong personal interest in the field and have learned a lot from this book. But I am rather dubious when reading scientific literature whose line of reasoning I cannot follow on an academic level but after reading the book I am convinced that there’s a lot of very important insider information that needs to reach the wider public and consciousness. The author is a psychiatrist and social anthropologist who graduated from Oxford University and started working with the NHS (National Health Service) in the UK since 2004. He therefore has worked clinically, both privately and publicly, with many patients sufferings from major depression and psychotic experiences.

Apparently, up until the 1950s psychiatrists didn’t have a shared manual or dictionary in which all the disorders were clearly defined and list each of the disorder’s core symptoms. DSM or Diagnostic and Statistical Manual of Mental Disorders was therefore created and first published in 1952 with a modest 130 pages. Over the years it has been revised and new mental disorders were created and added. Today it boasts a total of 886 pages with a whole list of new mental illnesses such as ADHD or Attention Deficit Hyperactivity Disorder, depression, bipolar, etc. that were identified and standardised by DSM. For instance, if you visit a GP (General Practitioner) because you’re feeling down you’ll be asked to describe your symptoms and the diagnosis will be based on the DSM. For example, if you mention that you’re sad, teary, and experiencing interrupted sleep, then you are more likely to be diagnosed with one of the depressive disorders. And the GP will then prescribe some kind of anti-depressant. This has become the standard practice of psychiatry since DSM was created.

Dr Davies explains that the successive expansion of the DSM and ICD (International Classification of Disease) encourages practitioners to wrongly medicalise more and more emotional troubles as mental disorders that warrant only pharmaceutical treatments. The book explores in depth how psychiatry has reclassified more and more of our natural human behaviours and feelings as psychiatric disorders requiring treatments. A great example of how psychiatry has gone bonkers, Dr Davies states the fact that “bereavement or ordinary grief was considered a mental disorder” but it was removed from the final draft version of DSM-5 due to the mounting pressure put on the DSM committee to mend its ways. Another example, a new disorder called ADHD actually helped trigger the unnecessary medicalisation of a vaulting number of school children misdiagnosed with the condition. At least 5.29 percent of global child population is now thought to suffer from ADHD and there’s an increasing rate of other childhood psychiatric disorders that it’s estimated 14-15% of children worldwide now suffer from a diagnosable mental disorder in any given year. As a result we have an unprecedented medicated youths. But as disturbing as these figures may be, it pales in comparison to the adult population. There’s other new mental disorder like “depression” that have become a trend in today’s society with a huge number of adults taking anti-depressants thereby exposing more and more people to potentially dangerous psychiatric medication. Another example, in 2011 alone 254 million prescription of anti-depressants were dispensed to the American public, and a higher figure was reported in the UK. IMS, a provider of healthcare data, has shown that the global antidepressant market increased from $19.9 in 2009 to $20.4 billion in 2011, and the global antipsychotic market from $23.2 billion in 2009 to $28.4 billion in 2011, an expansion of over $8 billion in just two years. These drugs, the author argues, have not only failed to produce any concrete results toward improving or curing the patients, but in some extreme cases they have led to impairment and death.

The author mentions the issue of “Chemical Imbalance Theory” – a psychiatric myth that people across the globe including myself have been led to believe that our emotional troubles are rooted in biochemical imbalances or genetic disposition. He quotes the APA (“American Psychiatric Association”, that conceded a few years ago through escalating pressure) that “there are no discernible pathological lesions or genetic abnormalities in mental disorders.” In other words, he basically debunks the ‘Chemical Imbalance Theory’ and remarks that no biological markers have been identified for thousands of behavioural disorders that now prevail. Dr Davies asserts that solid scientific research now shows clearly that the so-called “happy pills” or anti-depressants don’t actually work, at least not in the way people think. It also reveals the strange ways in which anti-depressant can profoundly change a person. Not in curing them but in altering someone’s personality in a profound, unsettling and unpredictable ways.

Dr Davies also examines with much care and detail psychiatry’s extensive financial links with the pharmaceutical industry; how most consultants and academic drug researchers receive funds, consultancy fees and honoraria from the industry. I was especially blown away by the staggering amount of professionals – GP/General Practitioners, researchers, consultants, government agencies and even the media – that accept money from the pharmaceutical industry at the expense of the patients’ lives. Psychiatry, as the book shows, is in a state of near irreversible corruption.

One of the chapters that’s quite new and enthralling to me deals with psychiatric imperialism. It recounts stories of how the Western pharmaceutical company, Glaxo Smith Klein (GSK), had launched a massive marketing campaigns to capture Eastern markets such as Japan. Prior to this campaign, anti-depressants weren’t considered a viable treatment for the Japanese population, and there wasn’t a recognised medical category in Japan for what is termed in US or Europe as “mild or moderate depression.” The Japanese category that came closest to depression is “utsybyo” which is a chronic illness as severe as schizophrenia. GSK had been successful in their marketing strategy by presenting the “disease” – depression – and its “cure” – anti-depressant – that eventually converted the Japanese population to a more Anglo-American way of understanding and treating emotional discontent. Within a few years, “depression” had become a massive word in the Japanese household and the sales of GSK’s anti-depressant pill Seroxat had soared from $108 million in 2001 to nearly $300 million in 2003. The process of medicalisation that were purposely manufactured in Japan were also applied in Argentina and many other foreign markets throughout Asia, South America and Eastern Europe by other Western pharmaceutical companies. To claim, according to the author, that the pharmaceutical industry were behind many new and spreading worldwide mental health epidemics is not to deny the reality of psychological distress. Emotional suffering is universal but we also know that it’s susceptible to being culturally shaped and patterned by the meaning we ascribe to it. So if a company like GSK can convince enough local Japanese people that their way of understanding and treating distress needs a radical makeover, then the rewards can be staggering if locals took the bait.

The book also explains the wider cultural obsession with emotional anaesthetics – pills, alcohol, retail therapy, escapist activities and all the other modern trend of anti-depressant pursuits – as the principal consumables for managing emotional stress. Rightly so, because we live in a society of instant gratification and the demand for instant result has seeped into every corner of modern life. When people are feeling low or unhappy they expect their experience as “depression” and no longer were they suffering from normal human reactions to difficult life’s situations. And they’d right away take some “happy pills” (anti-depressants) rather than face their suffering and work productively to getting over the depression. Modern society dictates that “we should be happy all the time” and psychiatry together with the pharmaceutical industry took advantage of this craze in trying to medicate people out of their low mood or distress. The modern trend of anti-depressants for coping with significant loss of a loved-one or a job; ADHD medication for the temperamental children; Prozac for women’s PMS and a host of other issues are reason enough to listen to what Dr Davies has to say and question our current practices.

Towards the end of the book Dr Davies has quoted Dr Thomas Szasz (one of the most influential critical psychiatrists of the 20th century and author of the now classic “The Myth of Mental Illness”) on what his philosophy was. Dr Szasz says: “My understanding of emotional suffering, and I hope I won’t be misunderstood, is no different from the traditional understanding of the Jews, Christians or Muslims of emotional suffering. Suffering is life. God didn’t put us on this earth, assuming that he did, to be happy. Life, as I put it humorously, is not a picnic. It makes no difference if you’re a king or a pope or a tyrant.”  He added, “Our age has replaced a religious point of view with a pseudo-scientific point of view. Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering anymore. Instead we have brain disorders, but the brain has nothing to do with it, except that it is an organ necessary for thinking.” The author then summarises what Dr Szasz has said: “So by reducing everything to the physical, we have distorted our understanding of the meaning and potential purpose of emotional discontent. We have turned it into a malady from which we need to be cured.”

Dr Davies gives a final warning at the end of his book for those who are currently taking anti-depressant or any psychotic drugs: “While most psychiatric drugs have harmful side effects, they also can have powerful withdrawal effects. Therefore, any sudden withdrawal is always dangerous. It is therefore crucial that anyone deciding to withdraw from any kind of psychiatric medication do so under the supervision of an experienced physician who is, of course, well-informed and thus able to respect fully any patient’s desire to explore non-medication alternatives.” His arguments are based on what his clinical experience taught him; that it is oftentimes better to face one’s suffering and work through it productively than have to recourse to painkillers or any other anaesthetic drugs.

Overall, the book is imminently readable (for a lay person like myself), riveting, engaging and astonishingly provocative. Dr Davies has certainly exposed in this book the nefarious secrets of modern psychiatry and pharmaceutical industry. The enormous research he did is well-documented and it gives him a strong credibility. Certainly a must read for anyone with strong personal interests in the field or anyone with a family or a friend (or themselves) on anti-depressant medication.

Lastly, think twice before you casually accept a GP or any professional diagnosis along with a powerful, mind-altering prescription drug, and be wary not to become the human scapegoat of the modern pharmaceutical industry. If you are working or find yourself working in the psychiatry, health care, pharmaceutical industry, media or any government agency that deals with the anti-depressant or psychotic drugs, be careful not to become greedy and avoid like a plague anything that would lead you to the devil’s bargain. For what doth it profit a man if he gain the whole world and yet lose his own soul?