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A Mad, Mad Nation:
Mental Illness and the Drugging of Rebellious Tendencies


Interview by Silja J. A. Talvi
10.29.01

We are, for all of our phenomenal accomplishments, a nation in psychic pain.

Mental illness looms everywhere, forming a debilitating and destructive backdrop to our fast-paced, materialistic American lives.

Depression, anxiety and Attention-Deficit Disorder (ADD)—and the medications to "treat" them—are so commonplace that they warrant their own prime-time commercials and full-page, glossy advertisements. The long list of mental disorders grows longer, year by year. Depression has grown tenfold since 1900. Half of Americans, we are told according to a 1999 U.S. Surgeon General's report, will experience a mental disorder at least once in a lifetime. More than 16% of Americans are believed to have anxiety disorders. At least five million Americans are on Ritalin or similar drugs.

And where there is suffering, it seems, there is profit to be made. With roughly one in four American adults now on psychiatric medications, the parent companies of the best-selling prescription drugs—Prozac™ (Eli Lilly), Zoloft™ (Pfizer), and Paxil™ (GlaxoSmithKline) among them—are raking in the rewards of both large-scale emotional anguish and aggressive pharmaceutical marketing campaigns.

In his new book, Commonsense Rebellion: Debunking Psychiatry, Confronting Society, author and clinical psychologist Bruce E. Levine tackles the prevalence of psychiatric disorders—and the tide of prescription drugs prescribed for those disorders—head-on.

Our societal emphasis on viewing mental disorders as diseases akin to diabetes or cancer is not only deeply flawed, Levine argues, but dangerously diversionary. He insists that the real issues underlying rising levels of mental suffering in our country have much more to do with omnipresent and deeply warped societal expectations than the psychiatric industry would care to admit. He frames such "illnesses" themselves as rebellion against what he calls an "increasingly impersonal and coercive institutional society."

Levine finds fundamental flaws in the ways that we treat those among us who grapple with mental suffering, pressuring them to return to "normal."

Indeed, he describes the normalcy to which we are all are expected to acclimate as a dulling void of disconnectedness and dehumanization: a place of alienation from work, of mass living, of suburban detachment and urban anonymity, of false and misleading "democracy" and of creativity-sapping commercialism. He is quick to point out that the many American men and women who feel they have been helped by mood-lifting pharmaceutical drugs are not wrong for seeking relief, but argues that those medications—used to treat any number of different disorders—are not what they seem.

Commonsense Rebellion reaches for solutions as much as it offers criticism, presenting, in the process, a glimmer of the world of possibilities both inside and outside the existing social framework. In this interview with LiP, Levine shares his perspectives on rehumanizing our society and weaning ourselves from harmful notions about mental disorders.

One of the primary themes in Commonsense Rebellion is your contention that our high national rates of mental illness in the US are, in fact, natural reactions to the rapid growth of what you term an "institutional society," and that this society has created so much discontent and disconnection that many of us are actually breaking down because of it. Tell me more about that.

[Drug companies have marketed] the idea of biochemical brain imbalances. But if you just [employ] simple common sense, you don't have to know anything about genetics or biochemistry…just take a look at 30 years ago: we have twice as many overweight children now compared with then; we have a tripling of suicide rates of teen boys compared to the 1960s and a quadrupling compared to the 1950s.  So, simply, there's something going on here that isn't just genetic or biochemical. There's something going on here with our society.

People need to understand that, yes, we're in the wealthiest society by far in the history of the world, but in order to achieve that wealth, efficiency, productivity and consumerism, we become one-dimensional. And we have sacrificed virtually all of the things that human beings need to stay alive.

[What happens] when you become industrialized, institutionalized…you lose any kind of self-criticism. That's what we've done. And there are dramatic effects that you can see.

You note throughout your book that no biochemical, neurological or genetic markers have been found for ADD, depression, schizophrenia, anxiety, alcoholism, gambling, or any other mental illnesses we can think of.

Does this mean that these mental illnesses simply don't exist? Or that we need to start thinking about them differently?

That is the core question. Here's the problem. [From] a purely scientific view, there has been no biochemical evidence that there are these imbalances.

When the right wing hears someone criticizing psychiatry, they get all excited. They want to hear that everybody's doing all right, and that this is much ado about nothing. I tell these guys, "Wrong, you got an estimated 750,000 people a year trying to kill themselves. You got over 2,000 a day. There is something going on out there."

The question is, what do we call it?

The problem in our society is that nobody gives a damn about anybody until they have an illness. Then they have to care about them.

Prior to 1980, there was no such thing as "Post Traumatic Stress Disorder". All these guys come back from Vietnam, abused and used and exploited by this country, and they're in bad shape. There's no doubt about the fact that they're having all these kinds of strange symptoms. They're having nightmares; they're isolating themselves.

At first, the right wing is going, "to heck with them, they're being sissies, there's nothing to worry about." Typical liberals are going, "No, these guys are really hurting here, we have to do something." But the only way we can do something for them is to declare them mentally ill and come up with this diagnosis of PTSD so we can treat them.

Let's forget about the fact of how the hell they got that way. Was it helpful, ultimately, to medicalize their condition that way? What does that do in the long term?

The problem is is that what ends up happening in a pharmaceutical-dominated industry is that as soon as you medicalize [a condition], it becomes something to drug. So, for example, in 1999, Zoloft was officially declared as treatment for PTSD.

And now, kids who are bored in school and then get diagnosed with ADD, they're going be put on Ritalin or other amphetamines.

So, what good have you done here by medicalizing? Certainly, [we've] made pharmaceutical companies incredibly wealthy.  Prozac in the year 2000 made over $2.5 billion dollars a year, which is more than Coors grosses.

I think what people have to understand is that there are huge incentives for these multibillion dollar, multinational pharmaceutical companies to have these conditions medicalized. Then, down the food chain, you have your psychiatrists, psychologists and social workers who certainly make a living out of [so-called "syndromes"] being medicalized. There are  huge incentives to see more and more human conditions and problems as illnesses.

In some sense, everybody wins, except for the fact that what ultimately happens here is not just that we have a lot of silly diagnoses. [The worst] problem is not even the fact that a lot of these drugs are highly dangerous and ineffective…or that pharmaceutical companies have utterly corrupted the industry. The major problem, for me, is that what we've done with this huge expansion of the business and medicalizing of all of our difficulties has diverted us from examining a society that has grown increasingly dehumanizing.

Doesn't medication actually play any kind of a useful purpose in, for instance, helping severely depressed people or suicidal people through self-destructive periods in their lives?

First of all, they don't do research on these anti-depressants, including the SSRIs like Prozac, Paxil, Zoloft, on suicidal people. For a lot of reasons, including ethical [ones]..So there's absolutely no scientific evidence that any of these things will help anybody from being less suicidal, and there's a lot of anecdotal evidence and a lot of lawsuits out there that have said that these things have pushed them over the top and [actually made people] more suicidal.

There's the case, in June, of the Wyoming jury that awarded $8 million in damages to the family of a man who killed his wife, daughter, and granddaughter before committing suicide. They determined that Paxil caused him to go over the edge.

Right. There's no evidence that any of these drugs are effective with suicidal people.

So, am I just saying that I want drug prohibition here? For me, again, another core issue of Commonsense Rebellion is that what I want to do is help people to get rid of hypocrisy about drugs in America. The marketing of the pharmaceutical companies is to get people to think that these things are medicine akin to insulin.

That's a great marketing move.

For me, if you understand what these medicines are, comparing them to insulin is comparing apples to oranges. If you want to compare apples to apples, compare these psychiatric drugs to illicit drugs

For example, let's start with Ritalin. The ADD drugs...are classified by the DEA as Schedule II psycho-stimulants. That means that they have highest potential for abuse and addiction, but also have some medical potential.

All of those drugs affect the neurotransmitters: dopamine, norepinephrine, serotonin, What other drug out there is a Schedule II psycho-stimulant that affects those same neurotransmitters?

Cocaine.

Exactly. The World Health Organization, 30 years ago compared cocaine to these kinds of drugs. None of these things that I'm talking about, really, should be shocking. People have written this stuff for a long time…you just don't hear about it.

I'm interested in what happened with Prozac being repackaged as Sarafem.™. I began noticing those commercials a while back and thinking: "Why have I never heard of this syndrome, premenstrual dysphoric disorder (PMDD) before?"

So, Sarafem is just repackaged Prozac, isn't it? How do they get away with inventing a syndrome for the sake of repackaging a drug?

The DSM IV (shorthand for the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders) has about 400 different diagnoses. PMDD is in the appendix, so it has not quite made the big 400. It's one of the "up and coming" stars. I'm sure it will be in the next one.

It's just straight-out marketing. They realized it was smarter, if they wanted to market to women, to go with pink and lavender colored pills, and Sarafem was a nice, feminine name, so they repackaged Prozac, which is fluoxitine chloride.

Do you have a sense as to how successful their marketing campaign has been? Are women out there deciding that they have PMDD and asking for Sarafem?

My sense anecdotally is that it's been a fantastically effective campaign. Women are going to the doctor and saying they're having these kinds of problems. Especially when they're going to see their doctor in their HMO, and have [about] 10 minutes with them, what I hear back from women is that they're told, "Well why don't you think about Sarafem?"

Explain the "rebellion" component of your book title.

What I believe is that a lot of what people call mental illness and disease now are kinds of rebellions against what's around them.

What people need to understand when they take a look at others doing self-destructive drinking or not paying attention in their classroom is that there's a kind of rebellion. That if you really pay attention to these people and get to know what they're all about, they're angry, resentful about something going on around them.

What a lot of people have done over the ages, and you see this both politically and psychologically, is [have] their rebellion without wisdom. Their rebellion becomes self-destructive.

A lot of what people do, without help, good parenting, good teaching, good counseling, is [rebel irrationally], without thought. And then they make life worse for themselves and everybody around them.

What I do, clinically—and what I argue for in the book—is try to understand and assume that there's a reason ... for why someone is angry, depressed [or] bitter.

What you are supposed to be doing as a counselor, teacher or parent, is [to] help folks move into a more constructive kind of rebellion…as opposed to what we do in our culture, our society, and certainly within the mental health business, which is to try to squash rebellion. And worse than that, not even identify it as such.

The ultimate invalidation is to look at some kid who is refusing to pay attention or behave well, and not respect that there's something by way of rebellion and resistance going on there, and then to medicalize it and then to drug it.

[It's] no accident that the greatest growth in diagnoses and in our population of people on drugs [have to do with] kids and teenagers. One of the reasons is that there's more and more pressure on kids to conform and comply.

The thing that most embarrasses me about my business is that I'm utterly convinced that all of this will be obvious to people down the road—especially kids who have gone through it—that there was a kind of rebellion going on and it was squashed by biochemical means.

But the thing is, it won't ultimately work. It won't. As we know, lots of these teen shooters have been on these psychiatric drugs. Things won't work the way they want them to work. These drugs are short-term, and they get folks to be a little bit more compliant in the short-term, but in the long-term—like all of the attempts to control people—you produce resentment and resistance and even more anger. And God knows what kind of horrific behavior is going to be happening more and more down the road.

You refer to yourself, in one of the chapters of the book, as a "dissident shrink," and you allude to similarly-minded patients' rights groups and dissident professional organizations that have sprung up around the country.

What, exactly, does it mean to be a dissident shrink? Is it an easy place for you to be in?

That's a great question. I would say, for me, emotionally, given how embarrassed I've been about what's happened to this field in the last decade especially, it's about one of the few terms I could use to describe myself that feels OK.

When I first heard about folks using that term about five years ago, my initial reaction was, "Calling yourself a dissident is kind of elevating yourself."

But then when I thought about it some more, what you're basically saying is that you're dissenting with the mainstream view, the vast majority of psychiatrists and now, more and more psychologists, who [believe that] if people are not adapting, they either need to be drugged or behaviorally manipulated.  There's absolutely no attention paid to the fact that there are some severe problems going on in society...

[The psychiatric profession doesn't] care about the fundamental dehumanizing parts of our industrialized order of things at all. And therefore, what they're [encouraging is something] like what Howard Zinn refers to in A People's History of the United States as "the coming revolt of the guards."

If [teachers and psychologists] only help people adapt to a kind of dehumanized social order, they're nothing more than guards.

That's why it's so important for [Zinn] to say, "Hey, if you guys out there are just doing that, and not helping people navigate through the system and at the same time saying there's something corrupt and dehumanizing about the way that people are living in this culture and society, you are part of the guard class here."

I'll be damned if I'm going to be in that class. That's why the idea of referring to myself as a dissident psychologist feels pretty damn good.

Talk to me about how our American way of work contributes, directly and indirectly, to the kinds of mental problems and disorders that we see in Americans today?

People...are hearing that we've become this wonderfully high-tech society and that there are all these wonderful jobs in computer technology and biotechnology. But the reality is that the four leading jobs through the year 2005, as projected by the US Department of Labor, are cashiers, janitors, retail sales clerks, and waiters/waitresses. Prison guards are way up there, too.

How is that happening? You've got the "Wal-Martization" of society...You've got a culture taking people out of mom-and-pop independent jobs. When a Wal-Mart comes to town, it's estimated that 100 mom and pop stores go under.

All of these folks now get to work as retail clerks and cashiers and that sort of thing. But what happens is that the quality of jobs in America are now devoid of a lot of things they had before when they weren't making much money.

A hundred years ago, you had many people busting their butts farming and working [who] didn't have that much money. But they had some degree of autonomy, some control over their lives. [There was] community among fellow farmers, and a feeling of usefulness. They could solve problems on a regular basis, and their life had meaning. They were always learning new things. There were all these wonderful human things going on.

Today, you hear from the International Center of Technologies that 80% of Americans find their jobs meaningless. A lot of these people are clients of mine who work, who have six-figure incomes. We're not just talking about clerks and waitresses. We're talking about folks at the highest levels of society who are basically doing something they have no respect for and they find utterly useless. You've got teachers out there spending half of their year teaching to these damn proficiency exams. You've got people working in managed care HMOs, and they know the whole thing is one big silly bureaucratic game. You've got people in all aspects of society working those kinds of jobs.

If you don't think that has much of an impact on mental health, then [you] don't know human beings.

I'm intrigued, in particular, by your chapter on "Mass Society." Mass living, as you point out, is a relatively recent event in human history. What, if anything, can we do to avoid the suffering and alienation that you're talking about in the context of our lives in a mass society?

The first thing that people have to do is to understand that when you're in these kinds of mass living environments, they do have all these negative impacts. So the first thing is not to pathologize your anxiety and depression and anger. The first thing to do is to understand that it's probably pretty legitimate. The second thing to do is to try to navigate these systems [so as] to have as little mass living as possible.

So, what the heck does that mean?

You can refuse to shop in Wal-Mart or shop there as little as possible. Not for moral or political reasons, but just for psychological reasons.

When you go into an owner-operated store that sells things that Wal-Mart does, maybe you'll pay a bit more...but what's going to happen there? There's a chance that you're going to make friends with that owner, and you'll feel good about keeping your money there in your community. That owner-operator will know what you do for a living, and he's maybe going to turn other customers onto what you're all about...There are all kinds of ways that good things can happen when you're in a kind of human-scale environment.

Many people make their living working for corporations and big companies. Is there truly a choice where this kind of thing is concerned?

Yes and no ... I think it is unrealistic to believe that you can totally extricate [yourself]. You can do a little, but mainly, what you're doing is finding people out there who are like you and thinking about things like that 

In the year 2001, life is all about keeping the light of what it means to be a human being alive. Keep the torch of it alive.

If your goal is not just to change society, but to have a more human life for yourself and your family and your friends—and you're thinking and acting locally, thinking interpersonally, and caring some about global [issues]—you're going to have a chance at a lot of successes.

You'll be able to pull off some satisfying things, You're going to be able to pull off a LiP Magazine, for example ... It just warms my heart to know about you guys and see what you're about. What you guys are is "commonsense rebellion."

For me, that's the only way that you're going to keep the torch of humanity alive. And at some point in time, with all of these kinds of examples out there, if more and more of society happens to go that way, that's great. But if you're focusing on changing things at the kind of grand political level of national elections and stuff, you're going to eventually become cynical, helpless and hopeless. That's my clinical psychological approach. I've seen it happen in too many people.

Do you have words of optimism and encouragement for people suffering with psychological pain? How might they go about finding this sort of path you're describing?

What I've found from my patients over the last 16 years is that the people who I see who are depressed and anxious are a lot of the most likable people I know. To me, it usually indicates that their soul is still intact. They're capable of feeling hurt, loss, pain—they haven't utterly anesthetized themselves like a lot of society. Take a look: one out of four people are on psychiatric drugs.

So, the first thing is, feel good about yourself that you're human enough to still feel hurt, anxiety and pain.

The second thing is, forgive yourself for probably doing a hell of a lot of stupid things with that—self-destructive things, unkind, selfish things to yourself and others.

The third thing is that once you understand that there are good reasons for why you're feeling the way you are, you want to move into finding a way to transform your life. That can be a real, satisfying, lifelong project.

Partially, what you start to understand is that you [need to] develop, in your life, a community of people who are like you, a community of people who really dig you. People who, when you see them and they see you, are really excited. 

[If] they're interested in who you are, and you're interested in who they are, then at that point in time, you're starting to create a more human life for yourself.

[ L i P ]

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Author: Silja J.A. Talvi is a Seattle-based journalist and LiP Contributing Editor who writes frequently on criminal justice and prison-related issues.
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