How Not to Write a Health News Story

Health communicators are keen on making the point that stories are more persuasive than data for nudging people toward making better health decisions. Recitations of evidence and data, no matter how comprehensive and accurate, can be dwarfed in people’s minds by even a single highly charged personal narrative.

That may be why journalists so often focus their stories about science and health on gripping personal stories rather than supplying facts, which often makes sense as a tactic but can sometimes go awry. An unfortunate case of this occurred in a March 17  New York Times article titled “Leading a Movement Away From Psychiatric Medication.” The very title of the article implies a sweeping uprising of people joining a “movement” to stop taking psychiatric medications.

But read on into the story and it is almost entirely about one person named Laura Delano, who “is not a doctor; her main qualification, she likes to say, is having been ‘a professional psychiatric patient between the ages of 13 and 27.’” She’s written a book, Unshrunk: A Story of Psychiatric Resistance, and the New York Times article gleefully declares that “Fourteen years after taking her last psychotropic drug, Ms. Delano projects a radiant good health that also serves as her argument—living proof that, all along, her psychiatrists were wrong.”  Whether that portrayal is accurate we will discuss a bit later.

Ms. Delano’s personal experience is explored in depth in the article. She was apparently diagnosed with bipolar disorder as a child and over more than a decade “was prescribed 19 psychiatric medications, often in combinations of three or four at a time.” She went to Harvard University, where she was a nationally ranked squash player but suffered from a host of psychological demons. Then, she determined that her problems did not stem from psychiatric illness but rather from psychiatric drugs and she decided to stop taking them. Ms. Delano reports feeling better after stopping her medications and went on to start a nonprofit called Inner Compass Initiative that supports people who want to stop their psychiatric drugs. She also charges people for her consultations with them about getting off psychiatric medications. The New York Times article claims that she is at the heart of a “subculture focused on quitting psychiatric medications [that] has expanded and begun to mature into a service industry.”

Presenting One Narrative Can Be Misleading

The emphasis in all of this on one person’s story, while emotionally riveting, is misleading. It gives the impression that scores of people are in similar situations as Laura Delano, that psychiatric medications are harmful especially when more than one of them is prescribed at the same time, and that there is great benefit from getting off them. Of course, later in the story there are a few quotes from academic psychiatrists who urge caution about stopping psychiatric medications without medical supervision, but even here the article states that “In recent years, mainstream psychiatry has begun to acknowledge the need for more support for patients getting off medications.” This implies that “mainstream psychiatry” has only recently woken up to the supposedly clear need to get people off their medications.

Most of the article is about Laura Delano’s personal experience, with the dramatic stories of a few other people who felt the need to stop their medications also thrown in. What is missing here is a single story of someone who was actually helped by taking psychiatric medications. Nor is there any mention of the overwhelming number of carefully conducted research studies demonstrating the effectiveness of antidepressant and antipsychotic medications. We are left with the impression of an exponentially growing number of people around the world who are sharing Laura Delano’s “epiphany” and recognizing that their psychiatric medications are harming them. Even “mainstream psychiatrists” are supposedly being forced to wake up and realize this is the case.

If it is true that stories carry more weight than data, why not balance a story like this one with personal narratives from all sides of the issue? Psychiatrists can tell many stories of people whose lives were dramatically improved by psychiatric medications, of people suffering from serious depression who went on to have nearly depression-free lives with the use of antidepressants, of patients with bipolar disorder and schizophrenia who were kept out of the hospital and functioning with the use of mood stabilizers and antipsychotic medications.

At least three important facts are never mentioned in the New York Times story. First,  most antidepressant medications are prescribed by non-psychiatrists. Hence, if a person is not taking appropriate medication for a mental health condition it may not be a problem with “mainstream psychiatry” but rather a lack of available psychiatrists. Second, psychiatrists are trained to provide psychotherapy, not just medication, and advocate for  expanded availability of evidence-based psychotherapy for a host of conditions. The implication that psychiatrists are unidimensionally focused on overmedicating their patients is fictitious. Third, psychiatric disorders, like many medical conditions, sometimes require more than one medication to achieve a desired outcome. No one complains when a person with diabetes needs to take two or three different types of insulin to maintain adequate blood glucose levels or a person with hypertension requires more than one antihypertensive medication to keep blood pressure within safe limits. Given that the brain is infinitely more complicated than any other organ in the body, it should be no surprise that one medication is often insufficient to treat a complex condition like depression or schizophrenia.In the absence of more complete understanding of the biological basis for psychiatric illness and of biomarkers to help with diagnosis, finding the right medication for each patient is a difficult and sometimes cumbersome task for both patient and doctor. Despite this, there are many success stories.

A More Balanced Account

A more balanced take on Laura Delano’s story was provided by a review of her book in the Washington Post. The review notes that the symptoms and behaviors that led to Laura Delano’s first encounter with psychiatry were dire. “Drinking, cutting, screaming at her mother and sisters, and begging her parents for a way out of the pressures of her wealthy Greenwich, Connecticut, prep school community.” As an adult “Delano’s description of her life off meds, liberated from the ‘mental health industry’ isn’t exactly a portrait of wellness…Delano still experiences ‘intense emotional pain and paranoia and debilitating anxiety and unhelpful impulses.’” The review concludes that “There’s much more accurate information, and deeper insight, available in the work of other sophisticated critical yet less polemical authors.”

What we have then, is one individual who has not been helped by the psychiatric treatment she received. Why that is the case is unclear and one can easily feel for Laura Delano’s personal struggles and pain and understand why she became so disgruntled with psychiatry. Is her situation representative of most people suffering with mental illness? The New York Times gives us the impression it is but offers not a hint of evidence to support that notion.

This comes at a dangerous time for the provision of mental health care in the US. Newly appointed Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. has railed against antidepressant medications and psychostimulants for attention deficit hyperactivity disorder (ADHD). He has  wrongly stated that antidepressants increase violence and are addictive. He has incorrectly disputed the efficacy of ADHD medications, which have solid evidence for effectiveness across hundreds of studies. This is definitely not the time to elevate one person’s struggle with psychiatric illness and create the impression of a groundswell of popular sentiment against medications.

In fact, the real problem that journalists should focus on is the global inadequacy of access to high-quality mental health care. A recent study published in the journal  JAMA Psychiatry found that across 21 countries fewer than seven percent of people with a psychiatric or substance use disorder received effective treatment. The study also found that the biggest predictor of inadequate treatment was a low perceived need for it. In the US, of course, a major barrier to effective psychiatric treatment is  lack of access.  Shortages of mental health professionals, lack of insurance coverage, and narrow provider networks all contribute to mental health care being inaccessible to most US Americans.

When a patient winds up taking many psychiatric drugs at the same time, some of which may be unnecessary, the cause is likely attributable to our fragmented healthcare system that denies people continuity of care by qualified clinicians. In this scenario, a patient sees one new physician after the next, gets new prescriptions, and continues to take outdated ones. No one gets the patient’s full picture or sees them long enough to make necessary changes in medication, including stopping what is no longer working. The problem is more likely to be our healthcare system than the effectiveness of psychiatric medications.

Journalists have a responsibility to provide context, evidence, and balance in their stories. Even when they choose to emphasize personal narratives, it is incumbent on them to offer narratives that demonstrate all aspects of an issue. Providing some of the relevant data in a format non-experts can grasp is also important. In the case of the New York Times story about Laura Delano this was not done. Instead, we have a biased and potentially harmful picture. Especially in this new era of attacks against public health and scientific evidence, it is vital that journalists tell the right stories in the right way.