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Tom Cruise vs. the People

There are a lot of people in entertainment who are confused about why Tom Cruise has become something of a pariah. They protest that jumping on couches and sharing his religious beliefs is no stranger than most of the other things that go down in Hollywood.

And you know, they're right.

But they're missing something that seems so obvious that I almost wonder if the missing is deliberate.

When Cruise said there's no such thing as a chemical imbalance in the brain and criticized the use of antidepressants, mis-labeling them "antipsychotic mind control drugs," he was criticizing the 150 million people in the US alone who take antidepressants. He also criticized their families and friends, and their belief (and relief) in something that helped them.

Most of what Cruise was trying to say is legitimate. Many experts argue that certain drug classes, including antidepressants and Ritalin, are overprescribed. They argue that the effect many people are getting is a placebo effect.

Research shows that there is a significant difference in improvement between subjects who get a placebo and those who get an SSRI (Selective Serotonin Reuptake Inhibitor--the most common class of antidepressant medications), but that difference is not as big as most people think. Depending on the medication and the study, the placebo effect has been found to account for up to 50% to 90% of people's improvement.

Of course, there are people who argue that if a placebo is what it takes to help people, what's wrong with that?

And what about the people who wouldn't improve with a placebo? What about that 10% to 50% who genuinely need the medications for their brains to work properly?

Antidepressants shouldn't just handed out because you're feeling blue; there are other problems associated with reduced levels of serotonin and norepinephrine (two neurotransmitters often referred to as "chemicals" in the brain). And serotonin and norepinephrine aren't the only chemicals indicted in imbalances; for example, Parkinson's Disease is caused by inadequate levels of the neurotransmitter dopamine. I doubt anyone would challenge the reality of the disease Michael J. Fox is living with.

The "research" to which Cruise referred was most likely that of Thomas Szasz, who has been an adamant protestor of many practices in psychology and psychiatry.

For example, Szasz believes that terms like "mental illness" (and most likely "chemical imbalance") are used for social control, not to identify true medical problems. After all, he argues, you can't die of depression like you can of cancer. You can't autopsy the body of someone who had depression and say, "Yes, there is the disease. This is what killed him." Szasz also protests any kind of involuntary treatment, so of course he would protest the use of Ritalin with children, who don't understand the medications well enough to make informed decisions about taking them.

And his arguments are important ones. We really love pills here in the US of A. We take pills for pain, to help us sleep, to help us wake up, to lose weight, to clear up our skin, to get us off cigarettes, to improve our sexual performance.

At the same time, here in the US of A we are also free to make our own choices, for better or worse, and many of Szasz's arguments are founded on that very idea. Criticizing the millions of people who have been helped by SSRIs (and Ritalin) and saying their experiences are of questionable legitimacy...well, whether you agree with him or not, you start to understand why Paramount's Sumner Redstone referred to the whole fiasco as career suicide.

Though only time will tell how right he is.


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