Comfortably Numb: How Psychiatry Is Medicating a Nation

Therapeutic responses to mental illness have cycled through periods of enthusiasm, skepticism, and then abandonment after some new healing fad arrives. The selective serotonin reuptake inhibitors (SSRIs) are the latest response to undergo this cycle. After a rapturous reception upon their introduction in the late 1980s, which persisted until the emergence of uncertainty during the early years of the 21st century, we are now witnessing a rising chorus of cynicism and disbelief about these drugs. Charles Barber's Comfortably Numb joins the increasingly long list of books that are written for a general audience and question the widespread use of SSRIs.

Barber is a lecturer in psychiatry at Yale Medical School. He previously wrote a memoir about his own struggles with mental illness, and has worked in shelters for the seriously mentally ill. In Comfortably Numb, he ably documents the passion for and overprescription of SSRIs – well beyond their salutary uses for genuine mental illnesses. In addition, he goes beyond past critiques to persuasively show how they created not simply a new therapeutic drug but an entirely new culture surrounding mental illness. The brand names of various SSRIs and the many specific conditions they treat are now an integral aspect of Hollywood films, daytime talk shows, TV dramas, and personal self-identities.

Although Barber's claim that the craze for SSRIs is uniquely American is incorrect (it is also pervasive in Western Europe), he does present a convincing portrayal of these drugs and the culture surrounding them. Moreover, his assertion that doctors and universities (he also could have added mental health advocates and government bureaucrats) are even more to blame than pharmaceutical companies for the rise and ubiquity of SSRI use is on the mark. As Barber asserts, the manifest goal of drug companies is to promote the use of their products as widely as possible; clinicians, scientists, and regulators should feel obliged to take a more critical stance toward the SSRIs, but they have not.

The first part of Barber's book deals with his deep acquaintance both with the destructive and useful impacts of psychotropic drugs among persons with serious mental illness and in the culture at large. He contributes much knowledge about the emergence of a new drug culture surrounding the SSRIs. Unfortunately, the last half of the book, in which Barber attempts to explain the rise of the SSRI culture, is rambling and disjointed. Barber relies on an incoherent mish-mash of factors to tell his story, including the closing of the American Frontier (in 1893!); the rise of federal entitlement programs which, he asserts, led to feelings of entitlement to happiness; and even the poor quality of television programs.

Barber spends a considerable portion of the book promoting the wonders of cognitive behavioral treatment and other therapies such as dialectical behavioral therapy, motivational interviewing, and stages-of-change models (as well as Zen and fish oil), unwittingly reproducing the same uncritical stance that he accused the advocates of the SSRIs of adopting earlier in the book. Although he accurately notes, in regard to mediation trials, that “Indeed, the greatest single determinant of an outcome of a published study appears to be whether or not a drug company has sponsored the study” (p. 41), exactly the same can be said of the therapeutic allegiances of cognitive therapists and the research that they publish. His depiction of psychiatrist Aaron Beck, the founder of this approach, resembles the worshipful portrayals of Freud by his acolytes a half-century ago.

Worse, Barber's discussion of psychotherapy almost precisely echoes the reductionist view of the way that the brain influences human behavior – a view that he effectively countered when he examined the arguments of biological psychiatry. Barber bizarrely claims that psychiatrist Eric Kandel's Nobel prize-winning work on brain changes among sea snails “proves” that psychotherapy changes the brain in ways analogous to those of psychotropic drugs.

He quotes with a straight face a psychologist's statement that a patient's change in psychotherapy was due to the fact that “He was making new axons on dendrites. The size of his neurons could have been changing. Certainly new synaptic connections were being forced, causing a reworking and rewiring of the brain based on positive experience.” (p. 210)

Barber would have skewered such neurobabble had it regarded change brought about by a drug. The author is, unfortunately, part of the brain-enchanted culture that only seems to see negative consequences when medication is involved.

It is unfortunate that Barber did not elaborate on the important issue, which the first part of his book suggests, about which types of patients can benefit from which types of treatments under which types of conditions. Instead, his credulity about therapies that do not involve medication is as great as his skepticism about drug treatments. Perhaps the mental health professionals will one day break out of their repeating cycles of fervor and disenchantment with various therapies, but Comfortably Numb suggests that this time is not yet near.