One of the fiercest debates in the mental-health field is whether medication is necessary to treat depression and anxiety. Some experts say the conditions have a biological cause and
that pharmaceuticals can correct a chemical imbalance in the brain. Other people claim that mood disorders can be conquered with talk therapy (or exercise and vitamins, if you believe Tom Cruise) and that those who pop pills for all that ails
them are simply looking for a quick fix. Two new books argue that nondrug approaches are where it’s at.
David D. Burns’s
When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life (Morgan Road Books)
promotes cognitive-behavioural therapy, which proponents say helps people learn how to change negative thoughts. The Stanford, California, psychiatrist is best known for
Feeling Good: The New Mood Therapy (first published in 1980), which
focuses on depression and has sold more than four million copies. Burns claims that Feeling Good is the book most often recommended to patients by American and Canadian mental-health professionals. He’s hoping that “CBT bibliotherapy” will be
equally effective in helping those who suffer from anxiety.
He certainly has a wide potential audience. According to the Public Health Agency of Canada, anxiety affects 12 percent of the population. Another eight percent of adults
will experience a “major depression” at some point in their lives. Symptoms of anxiety include feeling nervous, worried, frightened, or tense; sweating, trembling, or having difficulty breathing; and pain or tightness in the chest or upset
stomach. Among the signs of depression are hopelessness, worthlessness, and a loss of pleasure or satisfaction in everyday life.
Distinguishing between anxiety and depression isn’t easy, because the two often go together. Anxiety,
Burns writes, results from the perception of danger, while depression occurs from the sense that a tragedy has already happened. If you’ve been feeling anxious, especially for an extended period, you’re also likely to be depressed, and vice
versa.
Burns doesn’t buy the claim that depression or anxiety results from a chemical imbalance in the brain. “This theory is fueled more by drug company marketing than by solid scientific proof,” he writes. “Billions of dollars of
annual profits from the sale of antidepressant and anti-anxiety medications are at stake.…They [drug companies] also subsidize a large proportion of the budget of the American Psychiatric Association and underwrite an enormous amount of
research and education at medical schools.”
Burns acknowledges that in some cases, medications can be helpful, even lifesaving. Nevertheless, he says many people who swear that a drug pulled them out of an emotional pit are in fact
experiencing a placebo effect. “Numerous research studies have shown that if you give an inert placebo to people who are suffering from depression, at least 30% to 40% of them will recover.…It was the patients’ expectations, not the pills,
that caused them to get better.…Hope is the most potent anti depressant in existence.”
Regardless of what the best treatment really is—antidepressants, cognitive-behavioural therapy, or a combination of the two—people who need help
for anxiety or depression face a big problem: long waiting lists. In B.C., family doctors typically tell patients they can expect to wait six months to see a psychiatrist. The waiting period to get into the Anxiety Disorders Clinic operated
by Vancouver Coastal Health and UBC varies from case to case but ranges from about four months to a year, according to UBC’s public-affairs department. For people in emotional distress, such delays only make things worse. That’s where Burns’s
book comes in.
When Panic Attacks: is a practical, user- friendly guide to a complex health issue. It’s written in plain language, so readers won’t be overwhelmed by scientific jargon, and Burns provides a clear description of the
cognitive “distortions” that characterize anxiety. Among them are all-or-nothing thinking (when people look at things in absolute, black-and-white categories), mind-reading (assuming that others are extremely judgmental and critical), and
emotional reasoning (“I feel like a loser, so I must be one”). Identifying cognitive distortions is one step in the “daily mood log” that Burns suggests readers fill out regularly. Based on the premise that when you change the way you think, you
change the way you feel, the log helps people see that their negative perceptions aren’t based in reality. But Burns doesn’t stop there. Negative thoughts surface when people are upset, he explains, while self-defeating beliefs are always
present. The book helps readers pinpoint personal values and attitudes—fear of rejection, conflict phobia, and feelings of inferiority, for instance—that lead to psychological vulnerabilities. The log
and other “worksheets” in the book point readers to specific cognitive techniques—40 of them—that they can use to defeat their fears and worries. Everybody is different, and what works on one person won’t necessarily help another. But
according to Burns, cognitive therapy does, in fact, work.
An anti-antidepressant view is one Gordon Warme holds in
Daggers of the Mind: Psychiatry and the Myth of Mental Disease (House of Anansi Press). The Toronto doctor,
who specializes in psychiatry and psychoanalysis, gives a refreshingly honest critique of his profession in his memoir. (Daggers is definitely not a self-help book.)
“We have wonderful drugs for the treatment of depression, say the
colleagues who think their patients are somatically abnormal, an idea that excites them so much they haven’t noticed that the incidence of depression exploded as soon as it was thought there was a drug treatment available,” Warme writes.
“I’m pretty sure that, more often than not, these excellent outcomes of treatment are yet another placebo effect.”
Not surprisingly, given his specialty, Warme advocates long-term psychotherapy for people experiencing psychological
pain. He claims that major personal change can only come about as a result of unremitting pressure—pressure to think and think again.
Love, sex, loneliness, and success are what inspire people or make them mad, he maintains, and
eventually “reality breaks through.” Throughout
Daggers of the Mind:, Warme refers to everyone from Carl Jung and Deepak Chopra to Anna Karenina and King Lear. Then there is Buddha, whom Warme quotes and who could have had the book’s last
word: “Pain is inevitable, but suffering is optional.” |
