Some Comments on Psychiatry, Re: Marianne Williamson

Marianne Williamson has been getting some attention for her rather obscene claims about healthcare. But I think there’s an important discussion to be had here; inability to pay isn’t the only thing harming people in the current system. I present the following four facts:

1. Most psychiatric disorders don’t have well-understood mechanisms. For most conditions, there are several competing hypotheses, some or all of which may be true or varying degrees of close to true.

2. Most psychiatric medications’ functions are also not super well-understood. They range from “Well, we know this drug does this in the brain, and that seems to help for one or more of these six possible reasons, and probably some reasons we don’t have a framework to understand yet,” to “It works sometimes, we don’t know why.”

3. Generally, psychiatric medications have low success rates and often some bad side effect profiles. Rates in the 10-20% chance of working range are common. It’s pretty much expected that a given patient of, say, depression will just have to try several.

4. We’ve seen pretty clearly from the opiod epidemic that a lot of medical doctors and pharmacists are fine with killing people if it means selling more drugs. There are incentives in place to prescribe as much as possible, and precribe certain drugs over others for non-medical reasons.

I’m not saying that nobody should take psychiatric medicine or that everyone just needs to think more positively. Of course not, that’s absurd. I am saying that political and economic factors make it very plausible that a lot of people are suffering needlessly because of unethical but profittable prescription practices. In fact, that’s definitely the case: again, see the opiod crisis. That it extends to antidepressants, antipsychotics, and benzodiazepines isn’t a big stretch. How little is understood about the underlying mechanisms doesn’t help.

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