The psychiatry field has come under a lot of fire lately for all those financial ties that big-time psychiatrists have with drug makers. Case in point: Noted Harvard psychiatrist Joseph Biederman stands accused by Sen. Charles Grassley of Iowa of failing to report more than $1.6 million in payments he received from pharmaceutical firms like Johnson & Johnson and Eli Lilly. This week, Biederman agreed to stop working on drug company-sponsored clinical trials until the allegations are fully investigated by Massachusetts General Hospital, where he works.
There are concerns, too, that psychiatrists in the real world of city hospital psych wards and small private practices spend far too much time writing prescriptions and far too little time listening to patients to help them work through issues that may be the root of their illnesses. Norah Vincent explores this controversy through firsthand personal experience: She becomes a patient herself, documenting what she saw in her new book, Voluntary Madness: My Year Lost and Found in the Loony Bin.
Vincent, the bestselling author of Self-Made Man, in which she wrote about disguising herself as a man, decided to have herself voluntarily committed to three different institutions. (She declined to provide their real names to protect the privacy of doctors and patients she met there.) She first faked her way into a big city public hospital by pretending to have a recurrence of her previous depression. She then intentionally caused a relapse of her depression by going off her antidepressant, which led to her being admitted to a small private hospital. Finally, she tried a recovery facility replete with yoga classes, gym, and facials.
Setting aside the ethical problems of faking mental illness (Vincent told her insurance company and offered to pay for the treatment) and the recklessness of causing your own depression relapse, the book is replete with insights into how varying treatment is for mental illness. Vincent spoke with U.S. News about her experiences. Edited excerpts:
What possessed you to check yourself into a psychiatric ward in the name of a good memoir?
I had two motivations. First, I had a horrible experience the first time I was in a mental institution years earlier, and I wanted to revisit it in a healthy state of mind to observe certain distressing things that were actually making a lot of patients worse. The second reason is that the people who are there seem like a group of ready-made characters perfect for a good story. I'm talking about the doctors and nurses as well as the patients.
What sorts of "treatments" (you put this word in quotation marks in your book) were the most offensive to you?
The push to overmedicate in the public city hospital [which in the book is given the pseudonym Meriwether] was probably the worst. Even though I said I didn't want to take medication and wanted to rely on psychotherapy, my doctor pushed me so hard to take a mood stabilizer that I was afraid to refuse it. She could have kept me committed longer than the 10 days I'd intended if she thought I was hostile to treatment. (I only pretended to take the pills.)
The other horrible thing I experienced in the city hospital was the complete lack of freedom: We didn't get fresh air, didn't have any way to exercise beyond pacing the halls, which many of us did, and weren't even allowed to give each other hugs of comfort. I also, though, understand that this is the reality of city hospitals. They can't reject anyone, so [they] often deal with violent people who are a threat to others and themselves. Sedation is sometimes the only option for them.
Did you see a big difference between the city hospital and the private facilities?
Very much so. St. Luke's [a pseudonym] offered much more one-on-one psychotherapy and group counseling than Meriwether, and they took a more flexible approach to medication. I was allowed a two-hour pass every day to go to a local gym since there were no exercise facilities in the hospital. The private treatment center, Mobius [also a pseudonym], was the most progressive, offering us refrigerators filled with nutritious snacks, yoga sessions, a gym, and a spa to get massages and facials (which cost extra) in addition to therapy sessions and plenty of fresh air and sunshine.
What's shocking, though, is that both St. Luke's and Meriwether charged $14,000 for a two-week stay, while Mobius charges $6,000. You can get a suite at the Ritz Carlton in Manhattan, room service, and a private nurse for the same cost as the shared room at Meriwether.
What made you decide—against medical advice—to stop taking your Prozac?
I'm always trying to wean myself off because I have bad side effects like tooth grinding, severe constipation, and a form of mania where I'm driven to spend to excess. But I also wanted to really experience the treatment as a patient, though there were times when I lost my journalist perspective in the height of the depression. Still, I never quite lost the part of me that was there for the analysis. It was interesting observing patients and thinking how crazy they were and then realizing that perhaps I was, too.
What's the single most important piece of advice you'd give to those in similar situations?
First of all, don't be afraid to question your doctor; he or she may not have your best interest at heart when it comes to determining what sort of medication you need. If you're willing to do the hard work—getting out to exercise or socialize with friend—you may not need to rely on as much medication and all the side effects that go along with it, like weight gain or high blood sugar levels. Also, realize that whatever you do will be a constant effort that you'll always have to work on. That all-elusive cure is probably never achievable, but you can overcome the horrible sense of isolation if you're willing.
Editor's note: Ceasing medical therapy for depression without consulting a doctor is not recommended. While lifestyle approaches like exercise are important for maintaining mental health, medical evidence suggests that the dose of medication that gets you well keeps you well.