Johann Hari is Wrong About the Treatment of Mental Illness
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I really didn’t want to talk about this, but the BBC has forced my hand by posting an inane video promoting the claims of Johann Hari and his newest book, in which he argues that antidepressants are essentially useless and that we should ditch our pills in favor of global societal change.
I didn’t want to talk about it for several personal reasons — for a start, I’ve met Hari and I always liked him, even (begrudgingly) after his plagiarism scandal broke. For years I thought he was a smart and thoughtful writer who covered important topics from a humanist angle. Then some people discovered that he had been stealing quotes his interview subjects said elsewhere and reporting them as though they had been spoken to Hari in his interview. He did it so often that he was fired from his job, lost his Orwell Prize, and basically became persona non grata in the English intellectual scene for several years.
I was kind of still rooting for him, though, I guess because I just thought he was a nice person who made a stupid mistake and that he could come back with a better set of ethical standards. Unfortunately, I was stupid and wrong.
The other reason I didn’t really want to talk about this topic is because I’m very biased in favor of antidepressants. I’ve been on an anti-anxiety/anti-depressant called escitalopram for several years now, and it literally changed my life. A doctor suggested it when I was in the midst of “elevatorgate,” when I was being just continually harassed all day every day, online and in person. I was really skeptical about going on a daily medication — I asked him if I could just have some xanax or something to deal with the occasional freak-out, but he insisted we try it. So we did, and what I found was that yes, it made me feel better about the unending harassment, but also it changed things that I didn’t even realize were wrong. For instance, I used to have nights where I would lay in bed quietly freaking out for hours over the fact that we are all going to die one day. After the medication, that stopped. I had assumed that it was just the human condition and not an actual problem that can be solved, but with the medication I would still have thoughts like that but I wouldn’t obsess over it for hours. My brain could move on and think of other more pleasant topics.
My brain was clearly broken, but I couldn’t realize it until it was fixed, because, well, my brain was broken. The chemistry was wrong. Yes, outside circumstances like elevatorgate made it much, much worse, but even when things were going great I had depression and anxiety, and my doctor realized that. Along with prescribing the drug, he strongly recommended I quit my job.
Now Johann Hari is back and he has written a book about how we don’t need psychiatric drugs like mine. He even slid into my DMs to ask me to promote his book. I didn’t respond because I had already heard friends whispering about what a complete mess the book is. I was hoping that Hari would just fade away again but his relentless publicizing has led to celebrities retweeting him into my feed, and now the BBC World Service making a little viral video just for him.
So, here we are. Hari’s claims can be broken down into two categories: things he is right about but the world already knew it, and things he is wrong about. For an example of the former, he says that antidepressants often don’t work. Yep, that’s a fact. Scientists aren’t even completely sure how they work, and the drug that changed my life might not do anything for you. Literally everyone in medicine knows this, which is why finding the right drug for you can often involve some pretty painful trial and error.
Then there are the things Hari just gets wrong. He says that doctors treat depressed patients with only one “menu item”: drugs. It’s not true, at all. Any decent doctor will tell you that there are ways to ease depression and anxiety that don’t involve drugs. In my personal example, my doctor told me to quit my job, but also to make sure I was exercising every day and not drinking too much. My current psychiatrist recommended I get a dog, which I did, and he has improved my life drastically, as I’ve discussed in another video. Sure, these are just my anecdotes, but they reflect reality. The NHS, the CDC, the Mayo Clinic — all major medical organizations recommend lifestyle changes to help in depression and anxiety, before or in addition to medication. This isn’t some grand secret that Hari has uncovered. Yet he has the audacity to say things like “if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.” Nope. There are absolutely no circumstances under which grieving for one minute would lead to a diagnosis of depression and a prescription for anti-depressants. No circumstance.
So Hari is wrong, and he’s dangerously wrong. When pressed, he may say he doesn’t want people to throw away their medication, but in practice that is what is going to happen when you pretend to be a scientist and you tell people that their doctors are against them and their medications are useless. He’s going to get people killed, and outlets like the BBC are helping him do it.
I’m actually OK with death as being essential for renewal, regeneration and evolution.
I mean things are bad enough today with the whole place being dominated by people whose formative years were half a century ago.
How bad would it be (think patriarchy) if we were run by people from Victorian times, or medieval times, or 10,000 years ago?
If you take this to the extreme, the world would consist of patriarchal microbes!
Accordingly I have big reservations about the idea of extending human life beyond a certain point. At least, FFS we need to learn to live sustainably first.
Thank you, Rebecca. – Bob Curtis, MD
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