The Dangers of Mental Health Screening
Nathaniel S. Lehrman, M.D.
Former Clinical Director, Kingsboro Psychiatric Center, Brooklyn NY 10 Nob Hill Gate, Roslyn NY 11576; email@example.com Presented by invitation at the Annual Meeting of The Association of American Physicians and Surgeons Arlington, VA, September 23, 2005
The mental health screening program² created by the President¹s New Freedom Commission on Mental Health is a colossal fraud built upon, and aggravating, earlier frauds. It is presented as a way of ferreting out hidden ³mental illness,² first in school children, so they can then get ³appropriate treatment² - medications. It is actually a brazen attempt to hide the injuries caused by 50 years of peddling increasingly harmful and increasingly costly psychiatric drugs. Not only will the program increase America¹s huge, ever-rising, rate of mental disability by dispensing ever more medications which produce and aggravate these disabilities, but it represents the misuse of medicine
to destroy this country¹s basic freedoms. It is also the latest Bush
administration hand-out to the drug companies, so many of which have changed from legitimate businesses into patent-protected rackets.
During the 2005-2006 school year, all American parents will receive notice of the new screening program from their youngsters¹ schools.
It will ³test² for ³mental illness² 52 million students and six million adults working in schools, and expects to find at least 6 million in need of ³treatment.² All the force of government will then urge or compel them to receive it. The heart of that treatment will be medication.
But children aren¹t the only targets. The Commission¹s final report states that ³both children and adults will be screened for mental illnesses during their routine physical examinations.²
In 2003, a pharmaceutical analyst happily predicted (1) that ³the coming years will bear greater witness to the corporate-sponsored creation of illness² - by greatly widening our definitions of illness.
In 2005, the mental health screening program bears even greater witness to the governmentally-sponsored creation of illness - by greatly increasing the use of brain-injuring, disability-producing medications. And by allowing ³experts² to define peaceful, law-abiding citizens as ³ill,² and in need of (increasingly forced) ³treatment,² the program resurrects the witch-hunts of 16th century Europe.
B. What screening really does
The mental health screening of children is supposed to prevent suicide, and to detect mental illness so it can be treated promptly and effectively. It can do the opposite. In doing so, it violates fundamental American freedoms.
In 2003, thirteen-year-old, African-American Aliah Gleason (2) was in the 7th grade in an Austin, Texas, suburb. She was a B and C student
who often ³got in trouble for running my mouth.² The school
authorities saw her as suffering from an ³oppositional disorder² and put her in a special education track. Her parents considered her bright and spirited, but with a tendency to clown and argue.
Early that fall, University of Texas psychologists came to her school to screen 6th and 7th grade girls for mental illness. A few weeks later, a university psychologist phoned that Aliah had scored high on a suicide rating, and needed further evaluation. Reluctantly, the Gleasons agreed to have her see a university consulting psychiatrist.
The doctor referred Aliah to an emergency clinic for further evaluation. Six weeks later, a child protection worker came to the school to interview her, summoned her father to the school and ordered him to take the girl at once to Austin State Hospital, a mental facility. When he refused, the protection worker took Aliah into emergency custody (!) and had a police officer drive her to the hospital. Mental health trumps both parental rights and the Bill of Rights.
Aliah spent five terrible months in hospital, during which her parents were forbidden to see or speak to her. She was placed in restraints more than 26 times and given at least 12 different psychiatric drugs, many of them simultaneously, among them the SSRI antidepressants Zoloft, Celexa, Lexapro and Desyrel; Ativan, an antianxiety drug; and two of the newer, very expensive ³atypical antipsychotics² - Geodon and Abilify. After the hospital, she spent four more months in a residential facility - getting even more drugs.
What, if anything, was wrong with Aliah is still unclear. So is her clinical diagnosis. She reportedly said repeatedly that she was suicidal, and that her father beat her - and then recanted. Her attorney says her statements were due to the high dosages of psychotropic drugs forced upon her.
Fortunately, Aliah survived - unlike some other heavily medicated children. After her parents went to court, and she was finally released into their custody, the professionals they chose to treat her tapered her off all medication and successfully addressed problems within the family. She is now doing well in school, participating in extracurricular activities and, according to her psychologist, Dr. John Breeding of Austin, is once again ³starting to get that gleam in her eye.²
The experience of fifteen-year-old Chelsea Rhoades of Indiana was
equally significant (3). Last December, as part of the national
TeenScreen program, most of her public high school home-room classmates were given a ten minute, yes-or-no computer test, which had no room for alternate answers or explanations. (Those few not given the test had been opted-out in advance by their parents, an option Chelsea¹s
parents had not known about.) Shortly after Chelsea took it, a local
mental health center employee told her that she was suffering from ³OCD² (³obsessive compulsive disorder²) because she said she liked to help clean the house, and ³social anxiety disorder² because she didn¹t party much. The worker then suggested that if her ³condition² worsened, her mother should bring her to the center for treatment - treatment which almost always involves medication.
Chelsea was not the only youngster given this recommendation; she says all of her friends were told something was wrong with them. The only children not supposedly suffering from some ³disorder² or other were those with the opt-out slips. Furious at this intrusion on their privacy, her parents sounded the alarm throughout their community. And with the help of The Rutherford Institute, they have filed a lawsuit against the school district for failing to inform them in advance about the test and to obtain their permission for Chelsea to take it.
What might occur after large-scale screening can be seen from what has already happened when school children are ³diagnosed² with ³attention deficit disorder.² After a school psychologist told Patricia Weathers that her first-grade son suffered from it, she was pressured into medicating him. "The medication eventually made him psychotic,² she says, ³but when she stopped giving it to him, the school reported her to state child protection officials for child
abuse." Weathers, president and co-founder of AbleChild
(AbleChild.org), who has filed a lawsuit against school officials, says "we have 1,000 stories like this.² Meanwhile, her son is now 15 and "doing fine." (4) Congressman Ron Paul, a physician for over thirty years, has also criticized the way ³some parents have been charged with child abuse for refusing to drug their children.² Some have even had their children removed for refusing to give them drugs.
No matter how we define mental illness in children or adults, it cannot be found by simple screening. Nobody can, by merely looking at someone else, or even on the basis of a pen and pencil questionnaire, differentiate the transient emotional disturbances we all have from those which last longer. Screenings won¹t prevent suicide because those who are contemplating it usually won¹t tell. Indeed, the screening process itself can produce significant anxiety among those within whom ³mental illness² is being sought, as it did with Aliah.
Such efforts to find people¹s troubles by aggravating those troubles are ridiculous on its face. Only when gross insanity exists can ³mental illness² be recognized on inspection - and then we need neither experts nor screening.
C. What¹s ³mental illness²? the problem of psychiatric diagnosis
What¹s ³mental illness²? Years ago, the term was limited to the
insane: disabled people with crazy ideas who are unable to function socially and may be dangerous to themselves or others. Psychological distress, such as nervousness, has also been called ³mental illness.² The term has, however, been expanded over the past several decades to include more and more of the ³thousand natural ills the flesh is heir to.² Indeed, a new study (5) by Harvard University and the National Institute of Mental Health claims that 46% of Americans will ³at some point in their lives develop a mental disorder.²
Many of those ³thousand natural ills² are included among the 400-odd ³disorders² listed in the latest edition of the ³psychiatric bible²
- the American Psychiatric Association¹s ²Diagnostic and Statistical Manual of Mental Disorders,² the DSM. But these diagnoses are based almost entirely on symptoms - depression, anxiety and so forth - with little or no mention of the problems producing these symptoms. Basing diagnosis entirely on symptoms can be compared to defining fever as a
diagnosis: both it and anxiety, for example, are really products of other physiological or psychological processes. There are as many causes of depression as there are people suffering from it.
Troubled people can indeed benefit from good mental health care. But good treatment requires addressing voluntarily a patient¹s unique individual problems. For this, screenings are unnecessary.
Any discussion of psychiatric diagnosis, and the nature of mental
illness, should include the subject of homosexuality. The current
Journal of American Physicians and Surgeons examines some of its less recognized aspects - such as its ³laundering² over the past 135 years from sin and/or crime, to mental disorder, to acceptable alternate life style. (6) Let us note here, however, that in view of American psychiatry¹s eager acceptance of homosexuality, ³homophobia² - a term already widely used in both the specialty and mass media, and which may soon be included in the D.S.M. - has already been used in Illinois, along with being a ³defender of the US constitution against the federal government and the UN,² as criteria for labeling people as mentally unstable. (7) And ²sick² ideas can be followed by forced drugging and incarceration - as in the European witch-hunts.
D. Problems with psychiatric treatment: the harmfulness of drugs Thorazine (chlorpromazine) is seen as having ³initiated a revolution in psychiatry comparable to the introduction of penicillin in general medicine.² (8) In 1954, it began psychopharmacology¹s takeover of psychiatric treatment. But evidence recently assembled by Whitaker shows that in addition to these drugs¹ well-known, but frequently down-played, side-effects, treatment with both the neuroleptics and the antidepressants is in itself seriously harmful, with the SSRI (Selective Serotonin Reuptake Inhibitors) antidepressants, such as Prozac, among the most damaging.
In 1996, Steven Hyman, then Director of the National Institute of Mental Health, described (9) how psychiatric drugs ³create perturbations in neurotransmitter functions² after which the brain goes through a series of compensatory adaptations. For drugs like Prozac and the other SSRI antidepressants, which block serotonin reuptake, the brain tones down its whole serotonergic system; the density of serotonin receptors in the brain decreases by 50% or more.
After a few weeks, the brain is functioning in a manner that is ³qualitatively as well as quantitatively different from the normal state.² Similar changes occur with neuroleptics.
This is pathology, produced by drug treatment. Princeton neuroscientist Barry Jacobs (10) makes this point explicit about SSRI antidepressants. He writes that they ³alter the level of synaptic transmission beyond the physiological range achieved under (normal -
RW) environmental/biological conditions. Thus, any behavioral or physiological change produced under these conditions might more appropriately be considered pathologic, rather than reflective of the normal biological role of serotonin.²
The harm these drugs cause is also shown by a different methodology.
Serial MRI pictures taken over 18 months of people newly diagnosed with schizophrenia (all of whom were then started on medication) showed significant and increasing brain changes, including shrinking of the cerebral cortex and enlargement of the basic ganglia. (11) And as the enlargement progressed, the patients¹ negative symptoms (apathy, etc.) worsened. ³Over the long term, the drugs cause changes in the brain associated with worsening of the very symptoms the drugs are supposed to alleviate.²
Also: examination of the literature reveals that use of these drugs increases the likelihood that a person will become chronically ill, and that they cause a significant percentage of patients to become ill in
new and more severe ways. (12) And with all classes of psychiatric
drugs, patients given them have more relapses, and less ability to function afterward, than patients not exposed to them. Disabled populations treated without drugs fare better than those given them.
Finally, since the drugs were introduced, rates for psychiatric disability (Table 1) in America (13) have risen rapidly and steadily:
from 3.38 per thousand in 1954, to 13.75 in 1987, when the ³atypical² anti-psychotics and SSRI antidepressants were introduced, to 19.69 in 2003. The number of ³patient care episodes² - the amount of care given, as measured by the number of people treated each year for mental illness at psychiatric hospitals, residential facilities for the mentally ill and ambulatory care facilities - rose similarly: from
1,028 per 100,000 population in 1955 to 3,295 in 1987 and to 3,806 in 2000. Since the start of the drug era, which supposedly made it possible for the first time for patients with schizophrenia to ³lead relatively normal lives and not be confined to institutions,² the number of mentally disabled people has risen nearly six-fold.
The SSRI¹s apparently play a unique role in transforming the distressed into the disabled. ³A depressed patient treated with an anti-depressant suffers a manic or psychotic episode (a very common side effect), at which time his or her diagnosis is changed to bipolar disorder. At that point, the person is prescribed an antipsychotic to go along with the antidepressant² - as with Aliah. ³Once on a drug cocktail, the person is well along on the road to permanent disability.
Since Prozac was introduced in 1987, the number of disabled mentally ill in the US has risen by 2.4 million people² - from 3.3 million to
5.7 million. (14)
E The atypicals and SSRI¹s
Psychiatry¹s acceptance of psychopharmaceuticals, beginning with Thorazine in 1954, represents one of the greatest triumphs of false advertising in all of history. But by the early 1980¹s, with more than a dozen neuroleptics being sold, the market for them had become relatively unprofitable. The leading drugs, Thorazine and Haldol (haloperidol), were vulnerable to competition from generics because they had lost their patent protection. Generic Thorazine was selling for less than $10 per month and haloperidol for not much more. In the late 1980¹s, sales for all neuroleptics in the United States totaled less than $500 million - ³less than what one Œbreakthrough¹ medication would hope to generate in a year.² (15)
³The market was ripe for a novel antipsychotic, and it came in the form of a drug that, fifteen years earlier, had been discarded as too
dangerous²: Clozapine (clozaril-Sandoz). This was the first of the
new ³atypical neuroleptics,² which, in addition to blocking the dopamine receptors blocked by the earlier drugs, also blocked serotonin receptors. It was supposedly better than existing drugs, but since it also produced agranulocytosis, white blood cell depletion, in up to 2% of the patients, the company bundled the drug with weekly blood tests at a price of $9,000 a year. As the newest and supposedly best drug, psychiatrists prescribed it.
Two new atypicals without agranulocytosis then appeared on the market:
Janssen¹s Risperdal (resperidone) in 1996 and Lilly¹s Zyprexa
(olanzapine) two years later. With price ceilings on psychiatric drugs having been broken by Clozapine - in part because Medicaid paid for an increasing fraction of it - Resperidal¹s price was set at $240 per
month, and Zyprexa¹s at $10 per day. In 1996, U.S. sales of
Risperdal topped $500 million, ³which was greater than revenues for all other neuroleptics combined; ² (16) two years later, Zyprexa topped $1 billion in United States sales alone.
After the appearance of still another atypical, AstraZeneca¹s Seroquel (quetiapine), ³there was no longer any possible doubt about the superiority of these new drugs.² The Los Angeles Times said, for example, ³It used to be that schizophrenics were given no hope of improving. But now, thanks to new drugs and commitment, they¹re moving back into society like never before.² But despite these glowing reports, the largest study of these drugs to date (17) found ³no clear evidence that atypical antipsychotics are more effective or better tolerated than conventional antipsychotics.²
In 2003, total sales of antipsychotic drugs in the U.S. reached $2.3 billion, roughly six times what they had been before the ³atypicals.²
In 2004, the atypicals were the fourth-highest-grossing class of drugs in the U.S., with sales totaling over $8.6 billion - $3.4 of which was paid for by state Medicaid funds. (18)
The new SSRI antidepressants, of which Prozac was the first, followed a similar path. Media stories lauded them even though their level of efficacy was very minor: roughly 41% of patients got better in the short term versus 31% with placebo, and in comparison with an active placebo, which produces a physiological change with no benefit, outcome differences virtually disappeared. (19) And because of the many youngsters given SSRI¹s who then killed themselves or others, the FDA finally placed suicidality warnings on most of these drugs. (20)
I list a few of the many other social changes produced by the psychotropic revolution:
(1) 29 million prescriptions were written last year in the United States for Ritalin and similar drugs to treat attention deficit disorder and hyperactivity, 23 million of them for children, (21);
(2) 60 - 70% of child(ren in foster care in Massachusetts now being given psychiatric drugs (22);
(3) the arrival at some colleges of 40 to 50% of students with psychiatric prescriptions (23);
(4) the revelation that 41% of prescriptions for some 765,000 people over 65 were for psychotropics (24), and
(5) the finding of another study that 75% of elderly, long term care, nurisng home residents are being given psychotropics. (25)
But the drug companies did well. (Table 2) Between 1986 and 2004, the sales of antidepressants and antipsychotics jumped hugely: for antidepressants, from $240 million to $11.2 billion - almost 47 times; and for anti-psychotics, from $263 million to $8.6 billion, almost 33 times. For the two combined, sales rose from $500 million to nearly $20 billion, a forty-fold increase. (26) And for Eli Lilly, whose value on Wall Street in 1987 was about $2 billion, by 2000, with Prozac its number one drug and Zyprexa also in its formulary, its capitalization had reached $80 billion - also a forty fold increase.
(27) But the companies want to do still better - which brings us to the screening program.
F. The current screening plan
This program represents a new and outrageous level of government promotion of harmful psychopharmaceuticals, i.e. federal drug-pushing.
The screenings will define (or create) many new mental patients, almost all of whom will then be given medication. (28) The Texas Medication Algorithm Project (TMAP), which the President¹s New Freedom Commission has commended as a model medication treatment plan which ³illustrates an evidence based practice that results in better consumer outcomes,² calls for the newest and most expensive medications to be used first in the treatment of schizophrenia, bipolar disorder and major depression in adults. This we saw with Aliah. It also calls for specific drugs for specific disorders, as though the latter really exist. (29) Current prices for a month¹s supply of the 3 top antipsychotics, all ³atypicals,² are $342 for Risperdal, $414 for Seroquel and $572 for
Zyprexa. ³Because these drugs are the most expensive on the market,
and are so often paid for by the government, the rampant over-prescribing of these medications is bankupting state Medicaid programs all over the country.² (30)
PennMap is Pennsylvania¹s TMAP-type model for treating the mentally ill in state care. Allan Jones, a former investigator for the state, described it publicly as ³part of a large pharmaceutical marketing scheme designed to infiltrate public institutions and influence treatment practices. Pennsylvania is paying tens of millions of dollars for patented drugs that have no proven advantage over cheaper generic drugs.² Jones was fired for his efforts. (31)
³As part of the overall scheme, on July 27, 2001, Gov. Tom Ridge appointed Gerald Radke, an Eli Lilly Marketing Director, to head the state Office of Mental Health and Substance Abuse. With Radke at the helm, state Medicaid-funded sales of Lilly¹s Zyprexa rose from approximately $26.5 million in 2000 to $34.2 million in 2001, and to
$39.2 million in 2003.² [Under the leadership of Lilly¹s man in state government, spending on Lilly¹s expensive leading drug increased 50% over four years.] ³In state hospitals, hundreds of patient had their medications switched in the absence of medical need or indication, to comply with administrative decisions.² (32)
Zyprexa¹s dangerous side-effects were, however, carefully hidden.
Stefan Kruszewski, M.D., a Harvard-trained psychiatrist engaged to oversee statewide mental health care, pointed out (33) that the new generation of antipsychotics - the ²atypicals² - substantially increase the risk of obesity, diabetes type II, hypertension, cardiovascular complications, heart attacks and stroke, and that the drug-makers had this information but ³simply ignored the problem.² To Dr. Kruszewski, Zyprexa is a drug ³whose massive revenues and promotion are based upon faulty disclosures by the manufacturer, Eli Lilly. The drug causes both a severe metabolic syndrome and cardiovascular problems at the same time that it continues to cause neurological side-effects like the older Œtypical¹ antipsychotics.² Dr. Kruszewski was also fired for his efforts.
In Feb. 2004, the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists and the North American Association for the Study of Obesity published a joint statement (34) confirming the association between Zyprexa and diabetes. In June, 2005, Lilly agreed to pay $690 million to settle lawsuits filed by approximately 8,000 Zyprexa patients who alleged thay had not been warned that the drug might increase the risk of diabetes. More than 2,500 other claimants refused to take part in the settlement, presumably believing that the $62,500 received by each claimant on average was insufficient compensation for their pain and suffering. But Zyprexa earned Eli Lilly $4.4 billion in 2004, a considerable fraction of that company¹s total net sales of $13 billion that year. (35)
The mental health screening program created by President Bush¹s New Freedom Commission is a colossal fraud, based on other frauds, which elevates still further the drug companies¹ already soaring profits.
It will harm thousands of Americans by giving them stigmatizing diagnoses which can follow them for the rest of their lives, and then drugging them.
The greatest fraud underlying the program is that ³mental illness² is
best treated by drugs. The sad fact is that, as a group, psychiatric
drugs impair brain function, thus producing or aggravating mental illness.
Good psychiatric care is voluntary, and based on trust between patient and doctor. This program, as demonstrated by the case of Aliah Gleason, therefore represents the grossest kind of psychiatric malpractice by the government. Her case also demonstrates how the program undermines basic American freedoms. Dr. Karen Effrem, a leading opponent of screening, warns that under it, parental rights are unclear or non-existent, that parents are already being coerced to put their children on psychiatric medication - with some children dying because of it - and that merging screening with the academic standards required by the No Child Left Behind program, as already mentioned in Illinois, leads to diagnosis for political reasons.
By exposing the colossal fraudulence of the screening program and defeating it, we can perhaps start to undo the 50 years of psychopharmacological fraud which has made psychiatry the whore of the drug companies and the enemy of American democratic freedoms. A hundred years ago, President Theodore Roosevelt curbed the oil and
railroad ³trusts.² Today¹s America needs another Teddy Roosevelt
who will curb the pharmaceutical trust.
1. Moynihan R, Cassels A. Selling Sickness: How the World¹s Biggest
Pharmaceutical Companies Are Turning Us All Into Patients. New York,
N.Y.: Nation Books; 2005. Statement quoted in review, N.Y.Times Book Review, Sept. 4, 2005, p. 12.
2. Waters R. Medicating Aliah. Mother Jones, May, 2005
3. Whitehead JW. TeenScreen: One Family¹s Story. Rutherford Institute, Aug. 22, 2005.
4. MacPherson K. Fierce opposition arises to mental health screening in schools. Pittsburgh Post-Gazette, September 18, 2005.
5. Fox News, Aug. 13, 2005.
6. Lehrman NS. Homosexuality: Some Neglected Considerations. J Am Phys & Surg 2005: 10; 80 - 82.
7. Snyder K. Mental-healh screening of children.
8. Shorter E. A History of Psychiatry. New York N.Y.: John Wiley & Sons; 1997.
9. Hyman S, Nestler E. Initiation and adaptation: A paradigm for understanding psychotropic drug action. Am J Psychiatry 1996; 153: 151
10. Jacobs B. Serotonin and behavior: Emphasis on motor control. J Clin Psychiatry 1991; 52 (12 Suppl.): 151 - 162. (cited by Whitaker R. Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. Ethical Human Psychology & Psychiatry 2005; 7: 27 - 31; 27)
11. Gur R, Maany V, Mozley D, et al. Subcortical MRI Volumes in neuroleptic-naive and treated patients with schizophrenia. Am J
Psychiatry 1998; 55: 1711 - 1717
12. Whitaker R. Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. Ethical Human Psychol and Psychiatry 2005; 7: 23 - 33; 27 - 31.
13. Ibid. 23 - 25.
14. Ibid. 32 -33.
15. Whitaker R. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Mass: Perseus; 2001; 257 - 258.
16. Ibid. 260 - 261
17. Geddes J. Atypical Antipsychotics in the Treatment of
Schizophrenia: Systematic Overview and Meta-Regression Analysis. Brit Med J 2000; 321: 1371 - 1376.
18. Waters, op. cit.
19. Whitaker R. Interview by Terry Messman - Psychiatric Drugs: An Assault on the Human Condition.
21. Harris G, NY Times. July 1, 2005
22. Whitaker/Messman, op. cit.
23. Whitaker/Messman, oop. cit.
24. Pringle E.. August 24 DC Protest - Why Are Atypical Drug Users Mad?
25. Pringle op. cit. 7
26. Whitaker/Anatomy 24 - 25
27. Whitaker/Messman, op. cit.
28. Lenzer J. Bush plans to screen whole U.S. population for mental
illness. Sweeping initiative links diagnoses to treatment with specific
drugs. WorldNetDaily June 21, 2004.
29. Waters, op. cit.
30. Pringle, op. cit. 8; for reports on Massachusetts, Florida,
Texas and Illinois see www.ahrp.org.
31. Lenzer J. Whistleblower removed from job for talking tothe press.
BMJ 2994; 328: 1153 (15 May)
32. Pringle op. cit. 9
33. Waters op. cit., Pringle op. cit. 9
34. Kaplan A. Consensus Panel Urges Monitoring for Metabolic Effects of Atypical Antipsychotics. Psychiatric Times, April, 2004; 21: 4
35. CBS.marketwatch.com, Feb. 7, 2005.
Table 1: Mental disability in America
1955 1987 ca.2004
per 1,000 population 3.38 13.75
Patient care episodes
per 100,000 population 1,028 3,295 3,806
Table 2: Psychiatric drug sales, in millions of dollars
$ 8,600 33x
Eli Lilly capitalization $2 billion
$80 billion 40x
Source: Whitaker R. Anatomy of an epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. Ethical Human Psychology and Psychiatry, v. 7, no. 1, spring 2005, 23 - 35.