Anti Depressants?...

Carrol Cox cbcox at
Tue Aug 29 08:59:05 PDT 2000

About 35 years ago a customer (white) in a filling station somewhere in the south (my memory has grown faint on this) called an attendant (black) "Boy." The boy went home, got a .22 rifle, came back and shot the customer in the head. While few would approve of this as a daily practice, it was probably desirable that there be at least a sprinkling of such episodes to begin to make the point clear that certain careless modes of behavior could be hazardous. Statements re the need for depressed patients to get active may someday (if they haven't already) lead to similar episodes. In my posts yesterday I attempted the e-mail equivalent of a bullet in the head. Most victims of mental illness are not even in a position to "admit" they are ill, let alone respond with obscene arrogance (or is it arrogant obscenity?) to clods that think popular wisdom entitles them to patronize the ill. Since at the time I was diagnosed with depression I was in a position where (for various reasons) I had nothing to lose or nothing to gain (on tenure with no hope of promotion) I decided very early that I had more or less of an obligation to express as loudly and clearly as possible attitudes which others might have but dared not express. Anyone who has ever told a depressed person that (s)he should just "get more active" ought to be aware that rather more radical responses than being called "a malignant idiot" are not improbable. I can assure you that your chosen victim has heard that advice many times and is fucking sick of it, since she may well have been already kicking herself for her repeated failure to force herself into more activity.

That said, I grant that as an argument "malignant idiot" belongs more or less to the same rhetorical category as (say) "stalinist," and does not explain anything but is merely replaces explanation with merely labelling the facts needing to be explained.

Maria Gilmore wrote:

> While I will grant that my ears were burning for a while after Carrol
> cyber-boxed 'em for me, and I beat a hasty retreat
> ...I have hung in, albeit in lurker mode. I learn a ton from reading this
> list, and I find it entertaining too. <G>
> To Carrol, I must finally say, I honestly didn't mean to be obnoxious or
> attack anybody at all. As I remember, I made a rather naive suggestion
> that people patronize as a political statement or something
> foolish like that.

Interesting; I don't remember that post. :-) But along the same lines, Joanna wrote late yesterday, "I have made no comments on mental illness." O.K. I will accept that you had no intention of doing so, but your posts did allow that impression to be made. Your "Perhaps" statement in the first post I responded to can come across as saying mental patients are just imagining that they are ill. Hence my insistence that however fragmented our knowledge of mental illness and of anti-depressants may be, we are not totally ignorant -- and, moreover, "we" have fairly good knowledge of the limits of our knowledge, "we," that is, really do know that depression is a real illness, not treated easily, and anti-depressants do really work for many, are not, that is, merely placebos that help a few lazy people.

> I'm better informed now.
> And while I can do without some of his invective, I think Carrol (and Doug)
> are right to call Reese on comments that were at best innocently
> insensitive and based on ignorance. "People who stay active don't get
> depressed."

In fact, Reese's statement was a little worse: " I know that persons who remain active don't seem to get depressed. As Doug says, I wonder what planet Reese is living on. That is, what he *knows* here is in direct contradiction with what psychiatry does, already, *really know* about depression: that it is the *cause* not the result of inactivity. Last Tuesday I gave a ride to a new member of DMDSG -- and part of her story was being attacked by longtime friends with an accusation very similar to the accusation Reese makes here. She had been employed in a fairly good job for two decades after graduating from high school. She had been active in her church. She had not suffered any weight problems. Then depression struck. She lost her job. She withdrew from church activities. And as a sort of final blow, her two long-time friends dropped away from her because, they claimed, she didn't have an illness, she just didn't love Jesus enough. That of course is *exactly* the same brand of horsehit that Reese is spreading in the quoted sentence. (Note: This time I'm not calling *you* horseshit, Reese -- but it is an objective fact that your *opinion* here is horseshit. You've gotten plenty of information now on its wrongness, from me and from others. If you persist in this horseshit opinion. ???)

> With all due respect, horse hockey. There are tons of case
> histories of people who were living very active lives when their mood
> disorder manifested itself. Carrol's sensitive to how those who suffer
> mental illness are treated in this culture, understandably. I wish he
> wouldn't be so harsh when he fights back, but more than that I wish there
> were more people like him, who will call someone on their thoughtless
> ignorance about these illnesses in no uncertain terms.

Thank you. And I hope this post constitutes a sufficient backing off from the mere invective.

> He's right about antidepressants, too. And concerning doctors re Joanna's
> comments...I don't know about Europe, but the vast majority of head med
> prescriptions written here in the US are by general practitioners,
> internists, primary docs...*not* psychiatric specialists.

Yes. But there is this to be said even for the GPs. Psychiatrists charge such fucking high fees, the results are (admittedly) so unpredictable (the SSRIs are only sort of wonderful), and insurance companies pay only half as much as for "real" illnesses, that both patient and GP have some justification for the GP to continue to provide the treatment. And incidentally, one of the reasons Prozac was such a success, according to a psychiatrist who spoke to the DMDSG a couple years ago, was that the smallest dosage of it was often sufficient -- while in the case of earlier ADs GPs had tended not to prescribe a large enough dosage. The size of the Prozac pill forced them to come closer at least to prescribing an adequate dosage.

> THAT'S where the
> psychoactive pill flood is coming from. A general rule might be, beware
> of your family doc bearing Prozac to help you cope with the pain of life's
> losses.

There are of course very bad psychiatrists. I know a few. (And of course, the tendency to damn *all* psychiatrists as "pill pushers" makes it more difficult to identify the bad ones.) There are also many GPs who do a fairly good job of prescribing ADs.

The whole field of the treatment of mental illness is fucked up. A man called me the other day on a question on which sadly I could give no help but only sympathy. His son (age 27), who suffered from bipolar, was in jail on a felony charge; an assistant DA had admitted over the phone that the charge could have been a misdemeanor but the felony count was easier to prove. The son had no lawyer because on his original arrest he was in the "high" stage of bipolar and had claimed to have plenty of money to hire his own attorney and refused a public defender. Now the only way he could get a public defender was to hire a lawyer to argue his need for one. But he couldn't afford an attorney and was clearly incapable of being his own attorney. Moreover, bipolar (in some stages) makes it utterly impossible not to be insolent. (No -- that isn't my excuse; I suffer from unipolar.) He may well end up with quite a prison sentence. And sufferers from *any* mental illness do very poorly in prison, let alone those one of whose symptoms is extravagant overconfidence and insolence.

But then maybe it's all his fault for not spending enough time taking karate lessons.


More information about the lbo-talk mailing list