Prozac’s Worst Enemy

By some yardsticks, Dr. Peter Breggin seems to be a successful — perhaps even influential — psychiatrist. He has earned impressive academic credentials, published a string of books and shown up on Today and The Oprah Winfrey Show. Many patients rave about the doctor. “He’s a wonderful person,” says one satisfied customer. “He cares so much about his clients. He gave me the will to get better.”

So why are so many other people saying such nasty things about him? The head of the National Alliance for the Mentally Ill calls Breggin “ignorant” and claims he’s motivated by a lust for fame and wealth. The former director of the National Institute of Mental Health brands Breggin an “outlaw.” The president of the American Psychiatric Association says the doctor is the modern equivalent of a “flat earther.”

What causes these critics to lose their professional cool at the mere mention of Breggin is his relentless crusade against the conventional wisdom of psychiatry — and his increasingly high profile. What causes Breggin to rail against his profession is its eagerness to embrace technology, from the early zeal for lobotomies and electroshock to the modern reliance on such psychoactive drugs as Thorazine and lithium. In looking for the quick fix, Breggin argues, too many psychiatrists have forgotten the importance of love, hope and empathy in maintaining sanity. The power to heal the mind lies in people, he says, not pills.

For many years no one paid much attention to Breggin, 58, but that was before the dawn of the Prozac Age. The immense popularity of the drug, which is most often prescribed for depression but is gaining a reputation as an all- purpose personality enhancer, has given Breggin his best ammunition yet. In his new book Talking Back to Prozac (co-written with his wife Ginger Ross Breggin), he says the drug is merely a stimulant that does not get to the root of depression and is probably dangerous when used over long periods. He has dumped on Prozac in TV and radio debates with Dr. Peter Kramer, whose best seller Listening to Prozac describes the drug’s powers in generally favorable terms. In the process, Breggin has infuriated Prozac’s manufacturer, Eli Lilly, prompting the firm to deluge journalists with material intended to discredit the maverick psychiatrist.

Breggin didn’t start out to be a renegade. As his book jackets proudly point out, his background is pure establishment: Harvard College, Case Western Reserve Medical School, a teaching fellowship at Harvard Medical School. But early in his career, he became deeply disturbed by the treatment of psychiatric patients, particularly the many long-term residents of mental hospitals who spend their lives in a drugged-out state. In 1971 Breggin declared his rebellion, launching the Center for the Study of Psychiatry in Bethesda, Maryland, as a way to push for reform.

At issue is the very nature of mental illness. For the past few decades, the majority of researchers have worked to show that psychiatric disorders are triggered by chemical imbalances in the brain that can be rectified with medication. Breggin, by contrast, clings to an old-fashioned view: the emotional problems that land a person on a psychiatrist’s couch result from traumas caused by outside forces, like sexual abuse during childhood. Drugs can’t erase these traumas, he asserts, and aren’t even appropriate for such severe conditions as schizophrenia and manic depression. “These are not illnesses,” he says. “They are ways people become when they are hurt or frightened. The fact that something is extreme doesn’t make it an illness.”

This bizarre notion takes no account of mountains of evidence to the contrary. But, like a slick lawyer, Breggin has answers for every argument. Researchers have, for example, observed distinctive physical features in the brains of people with schizophrenia. A study of identical twins found that one portion of the brain was 15% smaller in the person with schizophrenia than in the normal sibling. Breggin says the difference could be the result of brain damage caused by the drugs given to control the disease. Of course, it is difficult to test his hypothesis because that would require studying people with schizophrenia who are deliberately left untreated — a practice that most psychiatrists would deem unethical.

Breggin is also a master of capitalizing on embarrassing lapses in psychiatric research. Several times, scientific teams have trumpeted the news that they have isolated a genetic marker for manic depression. In all cases, the results could not be replicated by others, and the conclusions were withdrawn — something Breggin delights in pointing out at every opportunity. Nor is he impressed by genealogical studies that trace schizophrenia through several generations. “Things run in families,” he counters. “Speaking English runs 100% in American families. It’s not surprising that being emotionally upset would run in families.”

What galls psychiatrists most are Breggin’s attacks on the usefulness of antipsychosis drugs. He doesn’t content himself with describing possible side effects, such as uncontrollable jerky movements and facial ticks, but claims the drugs rarely have any benefit. He likens lithium, which is used to treat manic depression, to lead and compares Prozac to amphetamines.

Breggin’s preachments would be laughable, say critics, if they weren’t so dangerous. Though he warns his readers against stopping their psychiatric drugs too abruptly or without medical supervision, at least one schizophrenic man threw away his medications after listening to Breggin on TV. The patient became suicidal and was hospitalized for two weeks. “Breggin reinforces the myth that mental illness is not real, that you wouldn’t be ill if you’d pull yourself up by the bootstraps,” says Susan Dime-Meenan, president of the National Depressive and Manic-Depressive Association. “His views stop people from getting treatment. They could cost a life.”

The psychiatrist’s credibility is not helped by the air of flakiness that surrounds his life and work. Lilly regularly links him to the Church of Scientology, which has long been a rabid opponent of psychiatry. Breggin admits that he was once an ally of the group and that his wife was a member. But he insists they both renounced Scientology more than two decades ago. Lilly, meanwhile, has combed through his old books and articles in search of anything embarrassing — just like the conservatives who used Lani Guinier’s writings to scuttle her nomination to serve in the Justice Department. In Breggin’s case, his opponents found a doozy: the doctor once wrote approvingly of sexual relations between children. “I don’t agree with that anymore,” Breggin says now, accusing Lilly of character assassination. “That’s from a period in the ’60s, and I’ve certainly left that far behind.”

Unfortunately, what gets lost in the cross fire is any serious consideration of Breggin’s ideas. Amid extremely dubious assertions like the notion that drugs don’t help schizophrenics, Breggin makes some points that many psychiatrists would agree with. Among them: too many doctors prescribe drugs for minor depression or anxiety without talking to patients long enough to understand their problems. Too many patients look for pills to smooth out the inevitable ups and downs of everyday life. And powerful psychoactive drugs can indeed be dangerous if used cavalierly.

It would be better if Breggin, the loudest voice making those points, were less shrill and more reasonable. But then, the calmer voices never seem to make it onto Oprah.