Ru-obert Whitaker, owake waba khona Boston Globe intatheli, yayinelukuluku lokwazi ukuthi kungani kuye kwaba nokwanda okungaka kokugula kwengqondo okukhubaza e-United States. Incwadi yakhe, I-Anatomy of an Epidemic: Izinhlamvu Zomlingo, Izidakamizwa Zengqondo, kanye Nokwanda Okumangalisayo Kokugula Ngengqondo eMelika. (Crown Publishers, 2010), iqala ngala maphuzu edatha: ngo-1987, izinga lokukhubazeka kokugula ngengqondo lase-U.S. lalingu-1 kubo bonke abantu baseMelika abangu-184, kodwa ngo-2007 izinga lokukhubazeka kokugula ngengqondo lase liphindeke ngaphezu kokukodwa kwabangu-1 baseMelika.
Phakathi nalesi sikhathi esifanayo, kube nokwanda okukhulu kokusetshenziswa kwezidakamizwa zengqondo. Ngaphambi kuka-1988 lapho i-Prozac iqala ukudayisa, imali etholwa minyaka yonke yase-U.S. yemithi elwa nokucindezeleka ne-antipsychotic yayingaphansi kwamaRandi ayizigidi eziyizinkulungwane ezimbili, kodwa namuhla lezo zigaba ezimbili zemithi yengqondo zizodwa zenza imali engaphezu kwamaRandi ayizigidi eziyizinkulungwane ezingu-1 ngonyaka e-United States. Umbuzo kaWhitaker wawuthi: ingabe kumane kwaqondana nje ukuthi ukukhubaza ukugula kwengqondo nokusetshenziswa kwezidakamizwa zengqondo kwanda ngokushesha ngasikhathi sinye?
UWhitaker akazehlisi izici zesiko okungenzeka ukuthi zihlobene nalokhu kwanda okumangazayo kokukhubazeka kokugula ngengqondo. Kodwa-ke, wathola ukuthi into ebonakala kakhulu ngokwesayensi yokwanda kwezinkinga ezinzima zengqondo ukwanda kokusetshenziswa kwezidakamizwa zengqondo. Uhlonze ukuthambekela okwethusayo: ukusetshenziswa kwezidakamizwa zengqondo isikhathi eside kubangele izingane kanye nabantu abadala abanezinkinga ezincane ezingokomzwelo ukuba babe nokuphazamiseka okukhulu nokungapheli okuholela ekukhubazekeni kokugula kwengqondo.
Indlela Izidakamizwa Zengqondo Ezidala Ngayo Ukugula Okungapheli
Wi-hitaker ihlole izincwadi zesayensi kule minyaka engu-50 edlule mayelana nemibuzo emi-2 ehlobene. Okokuqala, ingabe imithi yengqondo ishintsha inkambo yesikhathi eside yokuphazamiseka kwengqondo ibe ngcono noma ibe yimbi? Ngokuqondile, ingabe akhulisa amathuba okuthi umuntu angakwazi ukusebenza kahle esikhathini eside noma akhulisa amathuba okuthi umuntu agcine ekhubazekile? Okwesibili, kukangaki iziguli ezinokuphazamiseka okuncane zibe nokusabela okubi emthini wokuqala wengqondo ongaholela ekukhubazekeni kwesikhathi eside? Ngokwesibonelo, kukangaki umuntu onokucindezeleka okuncane ehlanya lapho esabela ekudambiseni ukucindezeleka bese kutholakala ukuthi unokuphazamiseka kwengqondo okuguquguqukayo?
Uthole ukuthi nakuba imithi yengqondo, kwabanye abantu, ingakwazi ukusebenza ngesikhathi esifushane, le mithi, uma isetshenziswa isikhathi eside, yandisa amathuba okuthi umuntu agule okungapheli, okwandisa amathuba okuthi inkinga encane engokwengqondo ibe yimbi kakhulu. ukugula okuqeda amandla. Lokhu kucacile futhi kubuhlungu ikakhulukazi endabeni yezingane.
Esikhathini esingeside kakhulu esidlule, "i-juvenile bipolar disorder" yayingavamile ukutholakala, kodwa namuhla iyanda. UWhitaker uyaphawula, "Uma ucwaninga ngokunyuka kwesifo se-bipolar kwezingane kuleli, uyabona ukuthi sibonakala singahambisani nokunikezwa kwezikhuthazi ze-ADHD kanye nama-antidepressants for depressionโฆ. Lapho odokotela bengqondo sebeqalile ukubeka izingane 'ezingasebenzi kahle' ku-Ritalin, baqala waqala ukubona izingane ezingakazalwa ezinezimpawu zokuhlanya." Izibalo ezikhulayo zezingane nazo zinikezwe imishanguzo yokucindezeleka, njenge-Prozac, futhi amaphesenti abalulekile alaba bantu abasha baye bahlanya ngenxa yokusabela emithini yabo yokucindezeleka.
Lokhu kusabela okwesabisa kobuhlanya kuphumela ezidakamizweni ze-antipsychotic ezisindayo kanye "nama-cocktails ezidakamizwa" akhiwe imishanguzo eminingi yengqondo. UWhitaker uthole ukuthi amaphesenti aphezulu alezi zingane ezisebenzisa imithi zigcina โzingamabhayisikili asheshayo,โ okusho ukuthi zinezimpawu ezinzima ze-bipolar ezizibeka ethubeni lokugula okungalapheki kukho konke ukuphila kwazo. Futhi, ama-antipsychotics afana ne-Zyprexa abangela inqwaba yezinkinga zomzimba, kuhlanganise nesifo sikashukela. UWhitaker uphethe ngokuthi, โUma uhlanganisa lonke lolu lwazi, ugcina usubhala indaba yokuthi izimpilo zamakhulu ezinkulungwane zezingane e-United States zicekelwe phansi ngale ndlela.
Ukwehluleka Kwezokuxhumana Kwebhizinisi
So kungani abantu baseMelika bengazi ngezinkinga ezinzima ezingapheli ezidalwe ukusetshenziswa kwezidakamizwa zengqondo isikhathi eside? Enye impendulo ukuthi izinkampani zezidakamizwa kanye nabalingani bazo ekusungulweni kwezifo zengqondo azikuvezi lokhu. Enye impendulo ukuthi ubuntatheli obujwayelekile baseMelika kanye nezinhlaka zikahulumeni zehlulekile abantu baseMelika.
UWhitaker, owayeyintatheli yezokwelapha, uchaza ukuthi izindaba zezokwelapha zivame ukukhiqizwa kanjani. Izikhungo ezinkulu, njengezinkampani zezidakamizwa nezinhlaka zikahulumeni, zikhipha izintatheli ezithembele kuzo izintatheli. Uma kungakhiphi ukukhishwa kwabezindaba, izintatheli eziningi azizazi noma yiziphi izindaba futhi akukho okubikwayo. UWhitaker, ngokuphambene, akazange athembele ekukhishweni kwabezindaba, kodwa esikhundleni salokho waphenya izincwadi zesayensi futhi waxoxisana nabacwaningi.
Ubala izifundo zocwaningo ezinkulu eziyi-16 eziveza isithombe esikhathazayo ezigulini ezilashwe isikhathi eside kanye nesithombe esingcono seziguli ezingalashwanga. Kodwa lapho uhlola New York Times ezigciniwe kanye nesizindalwazi se-LexisNexis (ehlanganisa iningi lamaphephandaba ase-U.S.), uWhitaker akakwazanga ukuthola nesisodwa isenzakalo lapho imiphumela yalezi zifundo ezinkulu eziyi-16 ibikwe ngokunembile.
Olunye lwalezi zifundo, olungakaze luzwakale iningi labantu baseMelika, kuhlanganise nochwepheshe abaningi bezempilo yengqondo, ucwaningo lwesikhathi eside lweziguli ze-schizophrenic ezalashwa ngemithi yengqondo nangaphandle kwayo. Lolu cwaningo luxhaswe yiNational Institute of Mental Health (NIMH) futhi lwashicilelwa ngo-2007 ohlelweni lwezempilo lwengqondo. Ijenali Yokuphazamiseka Kwemizwa Nengqondo. Isazi sokusebenza kwengqondo esicwaningayo uMartin Harrow e-University of Illinois College of Medicine sathola ukuthi ngemva kweminyaka engu-4.5, amaphesenti angu-39 eqembu elingaphili โayeselulemeโ kanti amaphesenti angu-60 ayenemisebenzi. Ngokuphambene, phakathi naleso sikhathi esifanayo, isimo seziguli ezelashwe ngemithi saba sibi kakhulu, kwalulama ngamaphesenti ayisi-6 kuphela futhi bambalwa ababamba imisebenzi. Ekulandeleni kweminyaka engu-15, phakathi kweqembu elingezona izidakamizwa, amaphesenti angu-28 kuphela ahlushwa noma yiziphi izimpawu zengqondo; ngokuphambene, phakathi kweqembu lemithi, amaphesenti angu-64 ayesebenza ngokwengqondo.
Ngonyaka okwashicilelwa ngawo ucwaningo luka-Harrow, uWhitaker uyabika, "I-NIMH yakhipha izincwadi zezindaba ezingu-89, eziningi ezindabeni ezingabalulekile. Kodwa ayizange ikhiphe okukodwa kulokho okwatholwa u-Harrow, nakuba ngokungangabazeki kwakhe kwaba ucwaningo olungcono kakhulu lwemiphumela yesikhathi eside ye-schizophrenia. iziguli ezake zenziwa e-United States." I-NIMH, njengama-ejensi amaningi kahulumeni wase-US, ibonakala embonini, kulokhu i-Big Pharma, ngeminyango ezungezayo yokuqashwa.
Izishoshovu Ziyinqoba Impi Yokuthola UWhitaker Heard
Mainstream ukubuyekezwa kwe I-Anatomy ye-Epidemic ubengekho, ngaphandle kwezimbalwa ezimbalwa, futhi uWhitaker unikezwe izingxoxo ezimbalwa zabezindaba ezijwayelekile. Ngaphezu kwalokho, okungenani inhlangano eyodwa kahulumeni wase-US izamile ukumthulisa, kodwa abantu bayalwa futhi, okungenani ecaleni elilodwa, bayawina.
I-U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), kusukela ngo-1985, inikeze uxhaso ukuze kuxhaswe iNgqungquthela Yezinye izindlela, ehlanganisa amakhulu ambalwa abathengi bezempilo yengqondo abavela kulo lonke elase-United States. Abahleli beNgqungquthela yezinye izindlela ngo-2010 baqinisekisa isimemo noRobert Whitaker njengesikhulumi esiqavile. Nokho, ngo-July 15, 2010, abagqugquzeli babika ukuthi ukuqinisekiswa kukaWhitaker kuhoxisiwe, bethi bathole ukuphikisa okuvela kuhulumeni wase-US.
Izindaba ezinhle ukuthi umbhikisho wangempela uphumele ekutheni i-SAMHSA ihoxise ukuhoxiswa kwayo futhi uWhitaker wabuyiselwa esikhundleni njengesikhulumi esiqavile eNgqungqutheleni Yezinye izindlela 2010 ehlelelwe uSepthemba 29 kuya ku-Okthoba 3 e-Anaheim, eCalifornia. Ubushoshovu obuphumelelayo babuholwa yi-MindFreedom, inhlangano eyakhiwe "abasindile bengqondo" ezibophezele ekuguquleni ukwelashwa kwezempilo yengqondo ngokunikeza abantu baseMelika ukukhetha okunolwazi lwangempela kanye nezinketho zokwelashwa ezihlukahlukene. Akuwona wonke ama-MindFreedom noma uWhitaker amelene nezidakamizwa. Bobabili bafuna nje ukuthi abantu baseMelika baqaphele indikimba yocwaningo oluningi olusitshela ukuthi ukusetshenziswa kwezidakamizwa zengqondo isikhathi eside kube umqondo omubi, kwabaningi babamukeli bawo. Esigabeni sezixazululo se I-Anatomy ye-Epidemic, uWhitaker uchaza indlela odokotela enyakatho yeFinland abasebenzisa ngayo imithi elwa nokuphazamiseka kwengqondo ngokucophelela nangendlela ekhetha kakhulu, nokuqapha lapho belapha iziguli eziphazamisekile zengqondo zesiqephu sokuqala. Futhi, izinhlobonhlobo zezinye izindlela zokwelapha zinikezwa futhi izinqumo zokwelashwa zenziwa ngokubambisana neziguli nemindeni yazo. Imiphumela? "Imiphumela yesikhathi eside," kuphawula uWhitaker, "kuze kube manje, ingcono kakhulu eNtshonalanga Yezwe."
Impi icacile. Intando I-Anatomy ye-Epidemic, njengoRachel Carson Spring Spring, ixwayise isizwe ngenhlekelele edalwe ukusebenzisa kwemboni amakhemikhali ngokuzidla? Noma labo abahlomulayo ngalesi simo bazokwazi ukuthulisa uWhitaker bangcwabe incwadi yakhe?