In Comfortably Numb, author Charles Barber reports that in 2002, 16% of the inhabitants of Winterset- a quintessentially American town in Iowa-had an antidepressant prescribed for them and asks, “Why did Winterset want to get numb?” With this question, Barber begins a journey through the world of psychiatry and psychopharmacology that spans most of the book.
Comfortably Numb: How Psychiatry Is Medicating a Nation
by Charles Barber; New York:
Pantheon Books, 2008
304 pages • $26.00 (hardcover)
In Comfortably Numb, author Charles Barber reports that in 2002, 16% of the inhabitants of Winterset- a quintessentially American town in Iowa-had an antidepressant prescribed for them and asks, “Why did Winterset want to get numb?” With this question, Barber begins a journey through the world of psychiatry and psychopharmacology that spans most of the book. None of his arguments are really new; they have been made in a number of articles and books that address medicalization of human behavior and the overprescribing of psychiatric medications. However, Barber offers his historical overview of how psychiatry moved from rudimentary and clumsy treatment approaches to what he describes as the triumphs of “corporate psychiatry” with the “commercialization of mood and blockbuster drugs.”
Barber believes that “the wrong people are taking the medications.” In Comfortably Numb, he ascribes the excessive use of antidepressants to aggressive marketing that takes advantage of the culturally pervasive pursuit of happiness and the sense of entitlement that, in the author’s view, started after World War II. Barber comments on the overmedicalization of our society, from the time of the rise and fall of the British Empire to the mourning of the loss of the frontier, which was providing a sense of purpose to this country. He argues that Americans use mind-numbing pills to avert the weltschmerz from which they can no longer be distracted after the loss of the frontier. Along the way,Barber makes several good, albeit not new, points. We are poignantly reminded of the incomplete picture that the biological psychiatry revolution has given us of the human brain and mind.
Obviously, aggressive marketing can have an undue influence on drug prescribing, which can make the most widely used treatments not necessarily the most cost-effective ones. Indeed,marketing has a pervasive and not always benign influence on our behavior. This situation,however, is not specific to psychiatry: in all likelihood, antibiotics, lipid-lowering drugs, and hormonal replacements have all been overused at some point. This concern is not even specific to medicine; it can apply to the commercial promotion of any commodity, including books. One unintended consequence of the “Miserable- Not Otherwise Specified” diagnosis that the author applies to many of the current users of antidepressants may be that it discourages some from considering psychiatric care for clinically significant symptoms that are not severe enough to cause disability.
Comfortably Numb covers a large territory. The writing is rather uneven and repetitive across the different chapters, some of which are better organized and referenced while others basically repeat media articles without any apparent attempt at independent research or more indepth analyses.
Perhaps the most informative chapters are those about alternative approaches to pharmacotherapy-in particular, cognitive-behavioral therapy (CBT). Even though Barber tends to overestimate the effectiveness of cognitive-behavioral interventions, several chapters provide the lay reader with a well-articulated description of the basic theoretical principles and practical applications of CBT.