While the impact of materialism in popular culture is undeniable, many continue to be unaware of its impact in other arenas. A materialist approach is one concerned only with that which can be measured, touched, and quantified. As such, medicine is at the materialist forefront. With a recent surge in "evidence based medicine", the medical students and residents of the current age are being indoctrinated with a materialist worldview. Rather than striking a balance, the roles of the gut feeling, intuition, and a "sixth sense" are being usurped in favor of percentages, ratios, and other forms of "hard data".
This is becoming increasingly apparent in mental health. Principles that have been applied to the body at large are now being applied to the brain. And while receptors and receptor sites do, in fact, exist in the brain and though neurotransmitters are able to be studied, quantified, and observed, the brain is quite different from the rest of the body. It cannot be isolated and studied in the same fashion as cells and proteins. It exists in, receives input from, and interacts with a complex world. It has faculties of memory, emotion, desire, and so on. It exists in a socio-cultural religious context that cannot and should not be divorced from its other functions.
However, in today's medical and mental health professions much of the hype surrounds which receptors and neurotransmitters are associated with which experience: depression, anger, inattentiveness, guilt, love, spirituality, etc. And while this is not bad, in and of itself, it is taught in a manner that divorces it from the surrounding world. That somehow serotonin is the issue in the depressed patient and not the consumer-producer environment which has prolonged the work day, increased debt, and broken up the family. As if depression is some sort of fault of nature rather than a consequence of our society.
A Quick Story:
As part of my internal medicine residency I had my own population of clinic patients. When I would see them, I would then have to describe their story and phyical exam findings to an attending physician. One day in the clinic, I saw a patient of mine who had already been to her psychiatrist two days prior. When I asked her how she was doing she broke down in tears. She cried and cried and cried. I held her hand, offered her tissues and simply waited. I let her continue to cry until she was able to tell me what was bothering her. She went on to describe her problems at home, with a pending divorce, her son on IV heroin, working two jobs, the recent death of a sibling, and a sense that she was on a downward spiral, with no direction, no guidance, and no one to listen to her.
Now, while most visits with my patients take 15 to 25 minutes, this one took about an hour and a half before I emerged to discuss the patient with my attending. After I described our conversation, the patient's lack of suicidal thoughts, and her medication regimen, my attending asked me how much I was going to increase her SSRI dose (a class of antidepressants). I replied that I already gave her the treatment. I listened to her. I helped her walk through some of her problems by simply talking about her plan of action. I said that I offered some spiritual advice regarding the problems that she could impact and the ones that she could not. I explained that we made a checklist, a to-do list of sorts. And I explained that I was going to leave her medication dose right where it was, that I felt as though my one and a half hour encounter had made a big difference.
As I looked my attending in the eyes, I saw the fire..."You feel that you made an impact?! This isn't about feeling. This is about data. And the data shows that SSRIs relieve depressive symptoms! Increase her SSRI dose." A long, heated debate ensued. And needless to say, being the lowest on the totem pole, my words meant nothing. We increased her SSRI dose.
My point in relating this story is to illustrate the degree in which the medical profession is becoming mechanized, cook book-like, and predictable. Evidence based medicine, while admirable in many respects, is being taken to an extreme. Numbers and percentages applied to populations are being applied in an uncompromising fashion to individuals. Patients' depressive symptoms are being portrayed as resulting only from neurotransmitter function or dysfunction, with little, if any, acknowledgement of the patient's social situation, worldview, etc.
My Questions about Anti-Depressants:
So, I realize that the majority of the pharmaceutical company sponsored trials on SSRIs demonstrate an improvement in depressive symptoms when given to patients who have been diagnosed with depression. But why are symptoms the endpoint? What about suicide? If SSRIs have any impact on depression, why not look at the trends in suicides? Has there been a decrease in the rates of suicide since the advent of SSRIs? Well, clearly, the numbers of suicides have increased with time. There is no demonstrable shift in the slope of the curve with the advent of SSRIs in 1978. There is a steady upward trend, noted on this graph from the American Association of Suicidology. Now, it is true that this increase may be a reflection of the increase in population over the same period of time. However, the rates of suicides and suicide attempts have not been altered either.
The rates of suicide among the elderly had been on the decline since the 1930s, well before the advent of SSRIs. In addition, the age group 15-24 demonstrated a plateau prior to the use of SSRIs, which has remained constant. Neither the nationwide rates nor the rates of suicide within the 15-24 age group have decreased with SSRI therapy.
Even if we look at symptom control as a good measure of the impact of SSRIs on depression, we must ask ourselves if symptom control is even a good thing in the first place. One of the symptoms we physicians are trained to ask about is guilt. But, what's wrong with guilt? Guilt is a normal response to having perceived yourself to have done something wrong or inappropriate. This normal feeling of guilt is what causes a child to cry when they have disobeyed their parents. Guilt and remorse are the feelings which drive people to make ammends for mistakes they have made, people they have offended, etc. Why would we think that suppressing guilt would be a good thing?
Furthermore, isn't it possible that depression, itself, may be a symptom or a symptom complex? When a child has a fever, the fever is not the problem. The problem is the cause of the fever. Seeking the source of the fever is what the physician should do, not simply prescribe an antipyretic. Well, could it be that depressive symptoms are pointing to something else? That maybe something else is awry? If this is a possibility, we need to do some serious searching. Perhaps the answer is not even internal. Perhaps the precipitants of depressive symptoms lie in society, in the family, in the messages of television, in the workplace, and certainly in how our brain receives, processes, interprets, and reacts to them.
The Sarafem Deception:
The logo for Sarafem has two sides and this is quite appropriate in that two tones, two faces, double crosses, and the like all allude to deception. Sarafem is the pharmaceutical industry's latest scam. Originally marketed as an SSRI under the name Prozac, fluoxetine hydrochloride has returned to the drug market, this time different in name only. This time the target audience is different. Even the ailments aimed at are different.
Prozac, loaded with patient skepticism and a target for numerous conspiracy theories, has come off of patent. In anticipation of this, Lilly Pharmaceuticals launched the product again, under the name Sarafem, this time with different indications. The target audience is menstruating women with a newly described condition called Premenstrual Dysphoric Disorder (PMDD). Here is a quote from the Sarafem website (as of 9/7/01):
Irritability, sadness, sudden mood changes, tension, bloating. If you suffer from many of these symptoms month after month and they clearly interfere with your daily activities and relationships you could have PMDD. PMDD, Premenstrual Dysphoric Disorder, is a distinct medical condition that is characterized by intense mood and physical symptoms right before your period.
Sarafem can help. Doctors can treat PMDD with Sarafem the first and only prescription medication for PMDD.
"...the first and only prescription medication for PMDD," is a very deceptive statement and in fact, a downright lie. If PMDD even really exists, or if it should be classified as a "disorder", fluoxetine hydrochloride can be used to treat it, whether it is under the name Prozac, Sarafem, or the newly available generic. Now that Prozac is off patent, it can be produced by generic drug manufacturers and offered to patients at a substantially lower cost.
PMS and PMDD clearly refer to symptoms that men and women have known about for centuries. Why, now, in the late 20th and early 21st centuries, are these common symptoms being classified as disorders? Could there be a biological mechanism requiring these phenomena? Could there be another explanation? In Islam and Judaism, sexual intercourse is not permitted at the time of menstruation. Wouldn't it make sense that Allah Subhannahu wa Ta'aala would equip us with a phenomenon that makes our observance of His Law easy? In addition, sexual intercourse is painful for many women during menstruation. Furthermore, some pathogens are more easily transmitted during intercourse that occurs at the time of menstruation than during times of no menstruation. Medical texts are clear that this is the case with HIV transmission.
Also, we must remember that this society is obsessed with efficiency. The consumer-producer process has little room, if any, for the female biological processes, be they menstruation, pregnancy, or breast feeding. Anything that disrupts efficient production in the Dajjalic Order must be a disorder or a disease. So Sarafem's introduction into the market coincides not only with the loss of Prozac's patent, but also with an acceleration in our worship of progress, efficiency, production, and consumption.
The Quest to Eliminate Psychic Pain:
Just as the advent of opiates, NSAIDs, and acetaminophen have altered the world of physical pain, there are many in the the scientific, New Age, and materialist communities that are seeking to eliminate psychic pain. I do not object to this quest, but I do find the methods problematic.
Again, it goes back to the materialists' approach. That things of concern ought to be able to be touched, observed, quantified, and calculated. They ought to be predictable. (It should be noted that there is no problem with quantifying and calculating, or measuring and observing. The problem lies in their extremes.) The materialist approach relies entirely on that which can be measured. This means that the prophetic tradition has no place in the materialists' world. Heaven and Hell cannot be seen, nor can Allah, nor the angels. They are, thus, rejected.
Now, while the quest for the elimination of psychic pain is admirable, to do so without seeking it through Allah's guidance is to set oneself up for misguidance and destruction. In a text called the Hedonist Imperative, the elements of this straying are all too apparent. This document describes the quest for "dopaminergic overdrive" via medications as "the only cure for the world's horrors and everyday discontents that is biologically realistic." This is to totally deny the trials and punishments issued by Allah, as well as to deny the cure for such "discontents" as obedience to Him, Alone.
The Hedonistic Imperative has a section entitled "the Molecular Biology of Paradise" and describes serotonin as "the civilizing neurotransmitter." Any reference to a paradise created on earth (or in our heads) must set off alarm bells in the believers' minds, as this is the call of the AntiChrist...establishing a heaven on earth.
Social Mental Illness?:
The creation of disorders (as opposed to the recognition of disorders by scientific inquiry), has recently expanded to include the mental health of relationships. And, most people would probably say that dysfunctional relationships are a problem, especially in our society. But would any of us really think that this is the realm of the psychiatrist? Would we truly assume a biochemical brain-to-brain interaction on a societal level? I suppose that such a thing is possible, but are we now going to throw psychoactive drugs into the mix?!
In an article entitled Doctors Consider Diagnosis for "Ill" Relationships by Shankar Vedantam in the September 1, 2002 Washington Post, it was reported that the American Psychiatric Association (APA) may add a new classification of disorders to the DSM. This group of disorders would be called "Relational Disorders", supposedly (and at least initially) targeting family relationships.
Apparently they anticipated opinions such as mine...
Some worry that the new category of disorders would fuel fears that psychiatrists are inventing disorders as a backdoor way to fix social problems.
And thankfully, some physicians spoke out against the category, citing fears that it would be expanded to include employees, governmental expressions of dissent, etc.
When talk of the new category was begun by [Michael] First at a recent meeting of the APA in Philadelphia, the psychiatrist said that troubled family relationships were his only targets for treatment. But other doctors warned that the category could be quickly expanded. What about troubled relationships between managers and employees, or even troubled relationships between individuals and the state? One psychiatrist at another session dubbed terrorism an example not of individual pathology, but of "social pathology."
Darwinism quickly expanded to include Social Darwinism which was used by the likes of Hitler to justify his atrocities against the Jews; and the Europeans to justify their treatment of Africans both on the continent and during the Middle Passage. What's to say that this new category does not get used for expansion of psychopharmacological weapons programs? What will it mean for the treatment of those incarcerated in America's ever growing prisons?
I do not object, entirely, to the use of antidepressants. I object to data based on assumptions being taught as fact. I object to studies of populations being applied to individuals. I object to the brain being analyzed in isolation. And I object to medicine's general lack of a look-at-the-big-picture approach, especially in the absence of questioning its own intentions. And I certainly object to drug company sponsored studies.
I entered medicine with purely altruistic ideals, and while I remain an idealist, I have come to understand that the industry of medicine has become a beast. That it is even an industry, alone, is problematic. Worse, it is currently in a state of disrepair and decay despite the outward appearance of flashy gadgets, cutting edge technology, and improving diagnostic tools. It is being eroded by materialism - in its participants, in its systems, and in its science.
This corruption reflects a society-wide, indeed worldwide, trend toward a Dajjalic System, a New World Order - a system divorced from prophetic tradition - where materialism, secular humanism, and the self are the laws of the land.
Allah knows best.