Comfortably Numb: How Psychiatry is Medicating a Nation, by Charles Barber, is worth reading, if only for the H.L. Mencken quotation in the prologue: “There is always a well-known solution to every human problem–neat, plausible, and wrong.“
Barber begins with statistics and commentary about the rise of drugs to treat depression during the 1990s, focusing on the creation of SSRIs such as Prozac. Before the 1990s, drug treatment was hush-hush and reserved for those who had “serious and persistent mental illness.” However, with the invention of Prozac, mental health became cocktail party conversation. ?This brought back some memories for me. ?In the early 1990s I was a pastor for youth ministry at a large suburban church. ?I remember the day I discovered that every single one of my adult advisers was on an anti-depressant. Every one. ?Male and female. Eight of them. ?I remember one woman saying, “Prozac is better than sex.” ?(She said the same thing about Mars bars, which made me feel really sorry for her husband.) ?Funny thing, I would easily have qualified for drug therapy, since I was absolutely miserable during those years. ?However, I was receiving treatment from a spiritual director who never prescribed pills.
Back to the book. ?The material about neurobiology is very accessible, and I appreciated Barber’s big-picture approach. The account of how the DSM (Diagnostic Statistical Manual) has been changed over the years was fascinating. ?That sets the stage for understanding the main reason why drug therapy has won out over talk therapy in the last two decades: profit. ?Treating the “worried well” (after convincing them of their need for treatment) has created a vast pool of people who will be on pills for years and years.
Barber speaks highly of two recent (1990s) developments in therapy which are not given enough due: CBT and DBT. He touches lightly on the connection of these therapies to the tenets of Buddhism, and I would like to read more about this.
Cognitive Behavioral Therapy (CBT) was developed by Aaron Beck, and asks the fundamental question: What were you thinking just then? ?Instead of a patient becoming mired in rehashing the past, the therapist encourages the patient to look at the belief that triggered automatic thoughts and subsequent low mood.
Dialectical Behavioral Therapy (DBT), developed by Marsha Linehan, purposefully integrates the components of centering prayer and Buddhist meditation, and stresses “acceptance.”
Barber also discusses the American tendency toward isolation as a key factor in creating depression. ?In my opinion, this truth cannot be overstated. ?The more we pursue happiness as our individual entitlement, the more we are doomed to unhappiness. ?What I wonder about: how could the church fit into this picture in a healthy way? ?We are all about community — about finding meaning within a larger framework. ?Shouldn’t the church be on the forefront of meeting people’s mental health needs? ?Yet, for most of our congregations, the closest we come is to provide space for an AA group (which is a good thing, but not nearly enough).
According to Barber, the bottom line is this: attention to diet, exercise, fish oil supplements, intentional involvement in community, and appropriate short-term therapy at key moments are the components that will keep depression at bay for “the worried well.” ?He supports the use of drug treatment for those who do have serious and persistent mental illness.
As I read, I kept wondering: given the fact that much of the malaise in the American spirit is a spiritual crisis, why has the Presbyterian denomination been shrinking? ?Obviously, our churches are not meeting people’s deeply felt needs. ?I want to have hope that this can change.