A psychiatrist takes on Tom Cruise

[David Baxter PhD]

A psychiatrist takes on Tom Cruise
Tuesday, July 5, 2005
By Ronald Pies MD, Guest Columnist, MetroWestDailyNews.com

Any contest between and psychiatry is bound to be an uneven one. After all, Mr. Cruise is buffed and beautiful, whereas most psychiatrists tend to the portly or scruffy. (OK-this is a crude stereotype...there are many beautiful, buffed psychiatrists, but I shall never walk among them.) On the other hand, Mr. Cruise comes to the battle devoid of any medical training, whereas psychiatrists - as specialized physicians - have had at least eight years of training in virtually all aspects of human physiology, psychology, and brain function.

Nevertheless, given his notoriety, psychiatrists must now respond to some of the charges and claims Mr. Cruise has made. Let's start with the claim that there is no evidence of any sort of "chemical imbalance" in persons with depression, attention deficit disorder, or other psychiatric illnesses. Actually, if we have in mind some simple "blood test" that can detect these disorders, we have to acknowledge a grain of truth to Mr. Cruise's claim - but not much more than a grain. The chemical imbalances that underlie most severe psychiatric disorders are, indeed, subtle - and not a matter of, say, checking someone's blood sugar, as we can do in the detection of diabetes.

And yet, the evidence that major psychiatric disorders have a biochemical basis is overwhelming. This is not to discount the importance of social, cultural, and psychological factors; it is simply to say that the individual's genetic and biochemical endowment exert a profound and powerful influence on how these other factors are played out on the stage of the person's life.

Let's take the example of major depression - a devastating illness that afflicts as many as 15-20 percent of the American public at some time in their lives. What is the evidence pointing to some kind of "chemical imbalance" in those who develop major depression?

First, there is convincing evidence of a strong genetic influence in major depression. The "concordance" rates (occurrence in both individuals) of this disorder are much higher in identical twins than in fraternal twins, or in the general public - meaning that if your twin sibling develops major depression, you are far more likely to develop it than would be predicted by chance alone.

This remains true regardless of whether or not you are raised in the same home as your identical twin.

Second, there are countless studies of body chemistry and brain function pointing to several abnormalities in those suffering from major depression, though there does not seem to be a single, uniform abnormality that always distinguishes these individuals. This should not surprise us. After all, anemia (low red blood cell count) can arise from numerous underlying biological causes. There's no reason to suppose that major depression is any different. A number of studies of severely depressed patients have demonstrated abnormalities in several hormones known to influence mood.

For example, cortisol - a hormone made by the adrenal gland - is often abnormally elevated in patients with major depression. Thyroid hormones may also show subtle abnormalities in depressed individuals. As these persons recover from depression, we often find that these hormonal changes also normalize.

The brains of individuals with major depression may also show abnormalities in structure, function, or both. For example, studies of how the brain uses sugar to make energy suggest that in those with major depression, certain brain regions are under-active: they show decreases in blood flow or the ability to "burn" sugar. Some studies suggest that with clinical recovery, or treatment with antidepressants, these brain regions achieve normal rates of blood flow or energy use.

We also find such normalization associated with some types of psychotherapy - suggesting that the depressed brain may respond favorably to more than one type of therapeutic "input."

There is good reason to believe that medication and psychotherapy work synergistically to improve brain function in the depressed individual. This is consistent with the observation that medications often improve the "somatic" (physical) aspects of depression, such as low energy, whereas psychotherapy often reduces the "psychic" aspects of depression, such as self-loathing and guilt.

It's a shame that Mr. Cruise's comments about depression may have discouraged some depressed individuals from seeking professional treatment. The same could be said for those struggling with bipolar disorder, schizophrenia, panic disorder, and many other serious illnesses. For these conditions, too, there is ample evidence that biological factors play a prominent role, and excellent evidence that psychiatric treatment can help.

 

[ThatLady]

Heh. What's the old adage about coming to a war of the wits unarmed? I think Mr. Cruise finds himself in that condition. ;o)

 

[David Baxter PhD]

Actor stirs up mental health debate
July 06, 2005
DAVID OWENS, Clarksdale Press Register

Hollywood celebrity Tom Cruise has made many stand up and take notice following some rather heated comments on NBC's The Today Show.

Cruise's comments regarding psychiatry stirred up several organizations and also drew concern from Clarksdale resident Dr. Michele Carroll.

Carroll, executive director for Region One Mental Health Center, said she hopes his comments didn't put someone in jeopardy.

"He's entitled to his own opinion, but not his own facts," Carroll said. "That's different. Facts are based on research."

In Cruise's interview with Today Show host Matt Lauer, the A-lister made several anti-psychiatry remarks including that it was not real science. "He said there was no such thing as a chemical imbalance," Carroll said. "I guess he wants everyone to meditate and do Scientology. But, what we know is through research done at some of the top universities and the National Institute of Health. We know that medications and psychotherapy work for people with mental illness," she said. "They should do whatever helps them feel better, get into recovery and lead normal lives."

Carroll said it was difficult enough for many with mental illness to come forward. "There's a stigma associated with it," she said. "But, we have made a lot of headway on that front over the last 10-15 years. I would encourage people to continue to seek help because mental illness is treatable. The risk is in not getting help," she said. "It's better to catch these types of conditions early versus waiting for them to get worse."

Some 16 million Americans (adults and children) have mental illness or emotional disturbance.

"It's much better to treat individuals who suffer from these treatable conditions," Carroll said. "An untreated mental illness is devastating to people, family and society."

Carroll said she agreed with comments posted on the American Psychiatric Association's website regarding Cruise. In the statement, APA president Dr. Steven Sharfstein said, "It is irresponsible for Mr. Cruise to use his movie publicity tour to promote his own ideological views and deter people with mental illness from getting the car they need."

Carroll agreed that religion helps, but proper treatment should not be overlooked. "Prayer is very helpful," she said. "It's great to use prayer, but to say the treatments available for the mentally ill are not based on anything is just not true. Mental health treatment is effective and necessary," Carroll said. "It's a sign of strength to seek help. Mental health is just as important as your physical health."

 

[David Baxter PhD]

Brooke Shields Fires Back At Tom Cruise

Brooke Shields Fires Back At Tom Cruise
July 1, 2005

NEW YORK -- Brooke Shields is on the attack, firing back at Tom Cruise's "Today" show rant against antidepressants.

In an op-ed piece published in The New York Times Friday, Shields wrote that she'll take a "wild" guess and said that Cruise has never "suffered from postpartum depression."

Cruise had criticized Shields for taking the drugs before his appearance on Today last week, but became particularly passionate about the issue in an interview with Matt Lauer.

The actor got very serious and kept saying "Matt, Matt, Matt, Matt" every time Lauer said he knew people who were helped by antidepressants.

"You don't know the history of psychiatry. I do," Cruise told Lauer.

Cruise said there was no such thing as chemical imbalances that need to be corrected with drugs, and that depression could be treated with exercise and vitamins.

The debate became more heated as Lauer claimed he knew people who benefited from Ritalin, and Cruise told him he didn't know what he was talking about. "Matt, Matt, you don't even -- you're glib," Cruise said to Lauer. "You don't even know what Ritalin is. If you start talking about chemical imbalance, you have to evaluate and read the research papers on how they came up with these theories, Matt, OK? That's what I've done."

Shields called those remarks "a disservice to mothers everywhere."

She wrote that if anything good can come from what she calls Cruise's "ridiculous rant," she hopes it gives "much-needed attention to a serious disease."

An excerpt of her opinion piece in the New York Times is below:

Experts estimate that one in 10 women suffer, usually in silence, with this treatable disease. We are living in an era of so-called family values, yet because almost all of the postnatal focus is on the baby, mothers are overlooked and left behind to endure what can be very dark times.

And comments like those made by Tom Cruise are a disservice to mothers everywhere. To suggest that I was wrong to take drugs to deal with my depression, and that instead I should have taken vitamins and exercised shows an utter lack of understanding about postpartum depression and childbirth in general.


If any good can come of Mr. Cruise's ridiculous rant, let's hope that it gives much-needed attention to a serious disease. Perhaps now is the time to call on doctors, particularly obstetricians and pediatricians, to screen for postpartum depression.