At least 10 percent of all Americans over six-years-old are currently on antidepressants. That's more than 35 million people, double the number from 15 years ago. Meanwhile, anti-psychotics have eclipsed cholesterol treatments as the country's fastest selling and most profitable drugs, even though half the prescriptions treat disorders for which they haven't been proven effective. At least 5 million children and adolescents use them, in part because more kids are being diagnosed with bipolar disorder.
So, are a growing number of people experiencing psychological troubles? Have we just become better at recognizing them? Or is some other dynamic at work?
One possibility is that the criteria for what constitutes a mental illness or disability may have expanded to the point that a vast number appear to have clinical problems. But there's an even more insidious development: the drugs being used to treat many of the new diagnoses could cause long-term effects that persist after the original trouble has been resolved. That's the case made by Robert Whitaker in his new book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.”
Speaking of long-term impacts on the brain, we're also heading toward a world where humans are directly linked with computers that profoundly influence their perceptions and ideas. Despite many potential benefits, there is danger here as well. Rather than simply augmenting our memories by providing neutral information, the brain-computer connection may lead people into separate realities based on their assumptions and politics.
Brain-altering drugs and digital “indoctrination” – a potent combination. Together, they pose a potential threat not only to the stability of many individuals but of society itself. Seduced by the promise that our brains can be managed and enhanced without serious side-effects, we may be creating a future where psychological dysfunction becomes a post-modern plague and powerful forces use cyberspace to reshape “reality” in their private interest.
Do prescription drugs create new mental problems? And if so, how could it be happening? For Whitaker the answer lies in the effects of drugs on neurotransmitters, a process he calls negative feedback. When a drug blocks neurotransmitters or increases the level of serotonin, for instance, neurons initially attempt to counteract the effects. When the drug is used over a long period, however, it can produce “substantial and long-lasting alterations in neural function,” says Steven Hyman, former director of the National Institutes of Mental Health. The brain begins to function differently. Its ability to compensate starts to fail and side effects created by the drug emerge.
What comes next? More drugs and, along with them, new side effects, an evolving chemical mixture often accompanied by a revised diagnosis. According to Marcia Angell, former editor of “The New England Journal of Medicine”, it can go this way: use of an antidepressant leads to mania, which leads to a diagnosis of bipolar disorder, which leads to the prescription of mood stabilizers. Through such a process people can end up taking several drugs daily for many years.
What may happen after that is deeply troubling. Researcher Nancy Andreasen claims the brain begins to shrink, an effect she links directly to dosage and duration. “The prefrontal cortex doesn't get the input it needs and is being shut down by drugs,” she has explained in The New York Times. “That reduces the psychotic symptoms.” But the pre-frontal cortex gradually atrophies.
Anyone who has been on the psychiatric drug roller coaster understands some of the ride's risks and how hard it can be to get off. But the new implication is that we may be experiencing a medically-induced outbreak of brain dysfunction caused by the exploding use of drugs. One big unanswered question at the moment: What does Big Pharma really know, and when did they learn it?
Drug companies aren't the only ones experimenting with our brains. Bold research is also being pursued to create brain-computer interfaces that can help people overcome problems like memory loss. According to writer Michael Chorost, author of “World Wide Mind” and interface enthusiast who benefited from ear implants after going deaf, we may soon be directly connected to the Internet through neural implants. It sounds convenient and liberating. Ask yourself a question and, presto, there's the answer. Google co-founder Larry Page can imagine a not-too-distant future in which you simply think about something and “your cell phone whispers the answer in your ear.”
Beyond the fact that this could become irritating, there's an unspoken assumption that the information received is basically unbiased, like consulting an excellent encyclopedia or a great library catalog. This is where the trouble starts. As Sue Halperin notes in a New York Review of Books essay, “Mind Control and the Internet,” Search engines like Google use an algorithm to show us what's important. But even without the manipulation of marketing companies and consultants who influence some listings, each search is increasingly shaped to fit the profile of the person asking. If you think that we both get the same results from the same inquiry, guess again.
What really happens is that you get results assembled just for you. Information is prioritized in a way that reinforces one’s previous choices, influenced by suggested assumptions and preferences. As Eli Pariser argues in The Filter Bubble: What the Internet Is Hiding from You, environmental activists and energy executives get very different listings when they inquire about climate science. It looks and feels “objective” but they're being fed data that fits with their existing view – and probably not seeing much that conflicts.
A recent study, reported in “Sociological Quarterly”, looked at this development by following attitudes about climate science over a decade. Here's a weird but significant finding: Although a consensus emerged among most scientists over the years, the number of Republicans who accepted their conclusion dropped. Why? Because the Republicans were getting different information than the Democrats and others who embraced the basic premise. In other words, their viewpoint was reflected back at them.
Does this sound dangerous? Pariser thinks so, and suggests that the type of reinforcement made common by search engines is leading to inadvertent self-indoctrination. For democracy to function effectively, people need exposure to various viewpoints, “but instead we're more and more enclosed in our own bubbles,” he writes. Rather than agreeing on a set of shared facts we're being led deeper into our different worlds.
Whether this is a problem depends somewhat on your expectations. For some people it is merely a bump in the road, a faltering step in the inevitable evolution of human consciousness. Techno-shamen and other cosmic optimists see the potential of drug-induced enlightenment and an Internet-assisted “hive mind,” and believe that the long-term outcome will be less violence, more trust, and a better world. But others have doubts, questioning whether we'll really end up with technological liberation and a psychic leap forward. It could go quite differently, they worry. We could instead see millions of brain-addled casualties and even deeper social polarization.
How will current trends influence democracy and basic human relations? Increased trust and participation don't immediately come to mind. Rather, the result could be more suspicion, denial and paranoia, as if we don't have enough now. In fact, even the recent upsurge in anger and resentment may be drug and Internet-assisted, creating fertile ground for opportunists and demagogues.
In “False Alarm: The truth about the epidemic of fear”, New York internist Marc Siegel noted that when the amygdala — the Brain’s central station for processing emotions – detects a threatening situation, it pours out stress hormones. If the stress persists too long, however, it can malfunction, overwhelm the hippocampus (center of the “thinking” brain), and be difficult to turn off. In the long term, this “fear biology” can wear people down, inducing paralysis or making them susceptible to diseases and delusions that they might otherwise resist. Addressing this problem with drugs that change the brain's neural functioning isn't apt to help. Either will the Internet's tendency to provide information that reinforces whatever one already thinks.
More than half a century ago, Aldous Huxley – who knew a bit about drugs – issued a dire prediction. He didn't see the Internet coming, but other than that his vision remains relevant. “There will be within the next generation or so a pharmacological method of making people love their servitude,” he wrote in “Brave New World”, “and producing a kind of painless concentration camp for entire societies, so that people will in fact have their liberties taken away from them but will rather enjoy it, because they will be distracted from any desire to rebel by propaganda, brainwashing or brainwashing enhanced by pharmacological methods.”
Pretty grim, but there's no going back. Despite any dangers posed by computer algorithms and anti-psychotic drugs, they are with us for the foreseeable future. Still, what we've learned about them in recent years could help us to reduce the negatives. Not every illness listed in the DMS – that constantly growing, Big Pharma-influenced psychiatric bible – requires drug treatment. And the results of your online searches will very likely tell you what you want to know, but that doesn't mean you're getting a “balanced” or comprehensive picture.
Prescription: When in doubt, keep asking questions. If discomfort persists, try Aspirin.