By Shankar Vedantam
First of three parts
When UCLA researchers reviewed the best available studies of psychiatric
drugs for depression, bipolar disorder, schizophrenia and attention deficit
disorder, they found that the trials had involved 9,327 patients over the
years. When the team looked to see how many patients were Native Americans,
the answer was . . .
"I don't know of a single trial in the last 10 to 15 years that has been
published regarding the efficacy of a pharmacological agent in treating a
serious mental disorder in American Indians," said Spero Manson, a
psychiatrist who heads the American Indian and Alaska Native Programs at the
University of Colorado Health Sciences Center in Aurora. "It is stunning."
Native Americans are not the only group for whom psychiatrists write
prescriptions with fingers crossed, the researchers at the University of
California at Los Angeles found as they reviewed the data for a U.S. surgeon
general's report: Of 3,980 patients in antidepressant studies, only two were
Hispanic. Of 2,865 schizophrenia patients, three were Asian. Among 825
patients in bipolar disorder or manic depression studies, there were no
Hispanics or Asians. Blacks were better represented, but even their numbers
in any one study were too small to tell doctors anything meaningful.
In all, just 8 percent of the patients studied were minorities.
It is but one example of a larger pattern: Scientists have broadly played
down the role of cultural factors in the diagnosis, treatment and outcome of
mental disorders. In part, this is because modern psychiatry is based on the
idea that mental illnesses are primarily organic disorders of the brain.
This medicalized approach suggests that the symptoms, course and treatment
of disorders ought to be the same whether patients are from the Caribbean,
Canada or Cambodia.
This model has produced striking successes. Neuroscientists have uncovered
key details about how the brain functions and malfunctions, and drug
companies have found many effective medications. More patients than ever
before have received treatments that have been proven to work.
As the population of the United States grows ever more diverse, however,
this approach is facing challenges from within the profession's own ranks. A
growing number of advocates for "cultural competence," many of whom are
minorities themselves, warn that doctors are harming patients by ignoring
evidence about the effects of ethnicity, sex, religious beliefs, social
class and national origin on mental health and mental illness.
"The [drug] companies are thinking about the average Caucasian, male
patient," said psychiatrist Michael Smith, at UCLA's Research Center on the
Psychobiology of Ethnicity, who bemoaned the vacuum of information about
drug metabolism and side effects among various groups. Some minorities'
distrust of drug trials further compounds the problem, he and other
"This thing called psychiatry -- it is a European-American invention, and
it largely has no respect for nonwhite philosophies of mental health and how
people function," agreed Carl Bell, a psychiatrist at the University of
Illinois at Chicago.
"A lot of minority groups perceive psychiatric interventions as an
ideological approach that discounts their own cultures," added Marcello
Maviglia, a psychiatrist who has worked extensively with Native American
patients in New Mexico. "A lot of people wouldn't be able to verbalize this,
but patients know when you are discounting them, their traditions."
Leaders of mainstream psychiatry vehemently reject this critique. Darrel
Regier, director of the division of research for the American Psychiatric
Association, said biomedical treatments for mental disorders had been
objectively shown to be superior to any other system.
"To say you want to go back to nature and have all the benefits of
close-knit families take the place of psychotropic medications -- that is
wishful thinking and likely dangerous," he said.
(more available at the Washington Post...)