COMFORTABLY NUMB

A sharply critical look at the way antidepressants are marketed and prescribed in the United States.

While the mentally ill aren’t receiving the treatment they need, Americans with ordinary life problems are being overmedicated, writes Barber (Psychiatry/Yale School of Medicine; Songs from the Black Chair: A Memoir of Mental Interiors, 2005). Though not a psychiatrist, he has a decade of professional experience working with mentally ill homeless people. He severely criticizes the pharmaceutical industry but places much of the blame on the medical profession, charging that at a time when the understanding of psychiatric drugs remains crude, doctors are too willing to prescribe the pills that patients request after seeing them advertised on television. The author divides the book into two parts. The first provides a capsule history of psychiatry in the United States and examines the shortcomings of the currently ascendant biological, or neuropsychiatric, approach. Barber attacks with shocking statistics (in 2006, 227 million antidepressant prescriptions were dispensed to Americans, up by 30 million from the 2002 levels) and punchy prose: “Psychiatry [is] jettisoning the impoverished mentally ill for the cash-carrying worried well.” He reserves particular mockery for the American Psychiatric Association’s diagnostic manual, citing its recent introduction of Motivational Deficiency Disorder as a nonsensical medicalization of laziness. Part Two advocates the use of an alternative, cognitive-behavioral therapy. The author spells out details of two related treatment approaches: the Stages of Change model, which recognizes that change is a dynamic process in which relapse is a realistic part of a continuum; and Motivational Interviewing, in which the therapist uses a technique of empathetic listening that centers on the client’s ambivalence about change.

Barber articulately and persuasively counsels that it’s time to abandon the quick-fix, pop-a-pill approach.