By now, we've grown accustomed to expecting successive new waves of psychotropic medications to make their much ballyhooed appearance on the market, each set of drugs accompanied by claims that they're far more effective than their predecessors, with fewer side effects.

Antidepressant tricyclics gave way to SSRIs, which have more recently led to SSNRIs (which affect norepinephrine levels as well as serotonin); the first generation of antipsychotics was followed by the atypical antipsychotics. But beginning last winter, a series of surprising announcements indicated that even the mighty psychopharmaceutical industry has hit hard times. Claiming that researching and developing psychotropics has become too expensive and unprofitable, both GlaxoSmithKline and AstraZenica said they were suspending or curtailing research on drugs targeting depression, anxiety, and other psychiatric conditions.

These announcements challenged the widespread belief that psychiatric medications were earning billions for the companies that manufactured them. The July 10 issue of Science maintains that, in fact, the special difficulties of developing psychotropic meds have dragged profits down. It takes pharmaceutical companies close to nine years to bring to market a psychotropic (known as a central nervous system or CNS drug), and companies have been shying away from timelines beyond five or six years, according to psychiatrist Ronald Diamond, author of the textbook Instant Psychopharmacology. The long timeframe is partly because the approval process is particularly arduous for CNS meds. They have the lowest FDA approval rate of all medications: only 8.2 percent make it, compared to 8.7 percent for cardiovascular formulations, 19.4 percent for oncological and immunizational ones, and 23.9 percent for anti-infective ones. Moreover, CNS drugs are likelier than other meds to fail in late-stage clinical trials, after millions have already been spent. Psychotropic development costs an average of $849 million, compared to an average of $750 million for other kinds of drugs. Then there's the matter of legal liability. Lilly has paid out an estimated $1.42 billion in lawsuits over its antipsychotic Zyprexa, and GlaxoSmithKline reportedly paid more than $1 billion in Paxil-related lawsuits.

Some observers remain skeptical about the drug companies' motivation in cutting back on psychotropic research. They claim that the pullback may be partly intended to force the government to take over early research and absorb the millions of dollars of costs that eat into profits. Although Congress has allocated about $500 million annually to the National Institutes of Health to accelerate drug development, much of that funding is likely to go to newer anti-infective agents and diseases associated with aging, rather than psychiatric disorders.

So at the moment at least, few new psychotropics are working their way through the FDA's approval pipeline. Nevertheless, there's still some excitement about the prospects of a new generation of psychotropics involving glutamates—neurotransmitters below the level of such familiar ones as serotonin and dopamine, and thought to be among the brain's basic building blocks. But here too the development process involves tremendous precision and possible risks, leaving uncertain how much innovation we can expect from the psychopharmaceutical industry in the coming years.

Can Therapists Save the World?

As the intensity and scale of global issues we face seem to mount daily, many therapists are searching their souls, wondering how to use their clinical knowledge to address the world's problems more directly. But while therapists presumably understand a lot about individual psychology, it remains unclear what role they might play in highlighting issues within the broader culture or elevating the tone of public debate.

This summer, a group of prominent therapists, invited by bestselling authors and prominent couples therapists Harville Hendrix and Helen LaKelly Hunt, codevelopers of Imago Relationship Therapy, met for a weekend as a self-appointed think tank to see how they might join together to address the stresses and challenges faced by couples today outside the consulting room. The group shared a perception that the emerging science of intimate relationships and the insights drawn from couples therapy are having a limited impact on the wider culture. The participants—including Susan Johnson, John Gottman, Daniel Siegel, Michele Weiner-Davis, Marion Solomon, Judith Anderson, Ellyn Bader, and Jette Simon, who all brought their spouses—unanimously agreed that in a society already dominated by high divorce rates and negative attitudes toward marriage, the media continually presents an overwhelming cavalcade of dysfunctional partners. But what might therapists have to offer to address the beleaguered condition of couplehood in America today?

What drew the group together was Hendrix's initial idea that global conflicts are rooted in dysfunctional family dynamics, and that beginning to enhance empathy and connection within couples might have larger ripple effects around the world. Hendrix started the weekend with an emotional plea to the group to help create "a new marital narrative" that would address what he termed "the core human tragedy—the loss of connection." He proposed that the group brainstorm about ways to make the tools and relational awareness that are the hallmarks of couples therapy more visible and accessible to the wider culture.

By the weekend's conclusion, two ideas emerged as organizing principles. The first was that the nature of effective social movements has been transformed by the digital revolution, so whatever the organizing tactics of the successful movements of the past, those methods need to be rethought in light of the power of the Internet as a low-cost, high-impact way of galvanizing large numbers of people today. The other was that, as the Networker pointed out in its last issue, the digital revolution has become a "relationship revolution." In the age of Web 2.0, we've learned that the Internet is a vital lifeline, not only of information, but also of connection and conversation with others. However, bombarded with messages of all kinds every moment of the day, we've become exquisitely attuned to attempts to engage us in genuine conversation, as opposed to being proselytized or sold to. The group agreed that, whatever path its efforts might take, the goal was not to "sell" anybody on a particular idea or model of relationship, but to provide a forum where science-based information and a range of illuminating conversations about the challenges of contemporary relationships could be made available to a much wider population than will ever see the inside of a therapist's office.

Dubbing itself the Couples Education Think Tank (CETT), the group reached few concrete conclusions, other than that they'd continue to meet, and try to involve other prominent therapists and therapy organizations in their ongoing discussions about practical means to achieve their lofty goals. What may be most important for other therapists about CETT isn't any official pronouncements it might make or concrete actions it might take, but the example of professionals entering into collaborations and taking the time and trouble to go beyond their individual self-interest to find ways to address the larger issues of the day. There are no shortcuts to making a difference in the wider world, but the key is certainly a willingness to transcend the sense of powerlessness and of the disheartening immensity of the task. As Hendrix put it at the conclusion of the weekend, "The best thing we can do for the world is to help couples understand that the best thing that they can do for the world is to have a great relationship. That means starting from where we are, wherever we may be."

Preventing Combat Trauma

While much of this issue is devoted to the ways the mental health professions can best serve the needs of the troops serving in Iraq and Afghanistan, the focus is almost entirely on what can be done after a soldier has been traumatized. But during the last year, the Army has made a huge investment in trying to lower the rate of traumatization among troops by using the old community psychology principle of primary prevention. Alarmed by a RAND Corporation study finding that one in five veterans serving in the war zones of Iraq and Afghanistan were suffering from PTSD or major depression, as well as an epidemic of suicides among military personnel around the country, the Army has implemented the Comprehensive Soldier Fitness Program (CSF), a $117 million project to teach emotional resiliency to prevent traumatization. CSF marks the first time the Army has attempted to address and track the mental fitness of its soldiers from training through postdeployment.

Spearheaded by former American Psychological Association president Martin Seligman, and drawing from the principles of Positive Psychology, the program is based on the premise that psychological resilience, taught ahead of time, can help immunize people from disorders arising from stress and trauma. All new Army recruits already take the Global Assessment Tool (GAT), which evaluates their strengths in physical, social, emotional, spiritual, and family domains, but CSF calls for them to retake the GAT throughout their military careers. In addition, all soldiers will receive resilience training in the GAT domains, with a focus on teaching soldiers "cognitive skills that increase core competencies including optimism, mental agility, self-regulation, self-awareness, character strengths, and connection." More than 1,323 trainers are now in place.

Unprecedented in its scope and application of psychological principles to military training, the program, not surprisingly, has drawn criticism. Seligman and other proponents of CSF argue that it's largely adapted from Battlemind, a debriefing program administered to soldiers after exposure to trauma, which has been shown to reduce traumatization and depression in combat troops. Seligman has pointed to the successful resilience programs that he's developed for suburban Philadelphia schoolchildren, but psychologist James Coyne, from the University of Pennsylvania's School of Medicine, has challenged the generalizability of some of Seligman's research findings. "Marty stayed away from studying whether those ideas would work with inner-city kids who are actually exposed to trauma," he says.

Trauma expert Richard Gist, who trains and studies emergency-response teams around the world, points out that the less individualized prevention programs are, the less effective they seem to be. Although each soldier takes the GAT annually, he contends that the functions it assesses and the resilience-training modules of CSF are too broad to do much good. "To treat trauma, you have to know each individual's system of belief, and how they normally face challenges to them," he contends.

Others argue that if CSF helps even a small percentage of soldiers to avoid postdeployment PTSD, depression, homicides, suicides, and substance abuse, it's worth the money and effort. "When critics have some positive efficacy results using something else, I'll be happy to read it," says Brigadier General Rhonda Cornum, director of the CSF program. Gist believes there's a potential danger to CSF, however. "Good intentions can lead to harmful results," he says, recalling the days when Critical Incident Debriefing teams rushed into trauma scenes, providing immediate counseling to everyone: eventually, they learned that the presence of such teams was associated with an increase in PTSD. "The most likely way you can do harm with psychological interventions," cautions Gist, "is to believe there's no possibility of doing harm."

Whatever Happened to Empathy?

The Rutgers University student who allegedly videostreamed over the Internet, without permission, scenes of his roommate having sex with another man probably never thought his action would trigger the roommate's suicide. But this seeming invasion of privacy and its fatal consequence raise the question of whether this was merely a random incident, seized upon by a tabloid press ever-hungry for sensational stories, or an indication of the jaded sensibilities and self-absorption of today's college students in general.

In a series of studies and books, social psychologist Jean Twenge, author of Generation Me and The Narcissism Epidemic, has argued strongly that today's younger people score considerably higher on narcissistic scales than previous generations at the same age. As causative factors, she points to three cultural trends: the rise of electronic communication, which has drastically cut down on face-to-face social interaction; increasingly violent and more sexually saturated mass media, which desensitize kids to others; and an avalanche of consumerism and materialism.

Social psychologist M. Brent Donnellan and developmental psychologist Kali Trzesniewski, however, insist that Twenge's use of birth cohorts is rife with methodological problems that compromise her conclusions. Using different statistical analyses, they find that today's 12th-graders score about the same as 12th-graders in the 1970s did on measures of egotism. Other critics point out that it's difficult to determine what a high score in "narcissism" means in day-to-day interactions, or what the term actually refers to. While narcissists' primary motivation may be garnering greater approval, their vehicle for doing so may be generosity and socially desirable actions.

Now a study by University of Michigan psychologist Sara Konrath, who coauthored one of Twenge's previous narcissism studies, looks more precisely at empathy among college students. Among 13,739 college students who took the Interpersonal Reactivity Index (IRI) between 1979 and 2009, her study finds that empathy has plummeted. In Twenge's studies, narcissism rose steadily from the early 1980s through 2006. Konrath finds that empathy stayed stable and then started declining after 2000. "Taking those studies together," she says, "it looks like the narcissists grew up and had kids."

The IRI breaks empathy into several subscales, and the subscale in which students showed the greatest drop, 48 percent, was in empathic concern—feeling sympathy for others. The second-highest drop was in perspective taking, a measure of people's innate tendency to imagine others' points of view, which fell 34 percent. Of the four IRI subscales, these two are the likeliest to lead to prosocial behavior, she says.

Despite the downward tendencies her studies revealed, Konrath notes that the definitive research about which environmental factors influence narcissism and empathy remains to be done. While there's a genetic component to narcissism and empathy, we know that cultural trends can oscillate and reverse. As Konrath puts it, "We dare not conclude that empathy is declining and nothing can be done about it."


Psychotropics: Science 329 (July 30, 2010): 502-04. Empathy: Konrath's study is in the online edition of Personality and Social Psychology Review August 5, 2010, and forthcoming in print; Twenge's study and Trzesniewski's response: Journal of Personality 76, no. 4 (August 2008): 919-28 and 903-18.

Garry Cooper

Garry Cooper, LCSW, is a therapist in Oak Park, Illinois.


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