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The Misfortune of Gogo Lidz
Maia Szalavitz, January 8, 2006
The story behind New York Magazine’s story of a depressed teen is that the media need to grasp the importance of evidence-based medicine in mental health care.

Last week’s New York Magazine includes an article by the Dickensian-sounding Gogo Lidz, which illustrates – if not outright malpractice – a strong case for the use of evidence-based medicine in mental health and for improving consumer education about psychiatric treatments.

Between the ages of 16 and 21, Lidz was given fifteen different medications; while some of these seem to help for various periods of time, her psychiatrist did not monitor her closely for side effects. When her symptoms worsened in college, rather than re-evaluating her diagnoses and treatments, he sent her to a wilderness program aimed at teen drug addicts.

Although Lidz had gone through a period of drinking and marijuana-smoking (like a large proportion of her fellow college students), there was no indication that she met the criteria for a diagnosis of addiction (called substance dependence in psychiatry’s diagnostic manual) or alcoholism. Months of urine testing immediately prior to the suicidal behavior that prompted the wilderness recommendation had produced only negative results. But during her time in the program Lidz was repeatedly confronted to force her to admit to an addiction she didn’t have.

There are no controlled trials that support wilderness programs as treatments for addictions, let alone suicidal depression. Research also shows that compelling people to admit to addiction doesn’t even help those who actually have drug problems, let alone those who do not. In fact, whether or not one admits addiction has no bearing on recovery; what matters is deciding to change behavior, not deciding to accept a pejorative label. And that particular label, once applied in medical records can have profound consequences such as insurance discrimination and refusal to adequately treat pain.

For “aftercare” for the addiction she did not have, Lidz was sent to a program in California, which refused to accept her unless she once again admitted to her “problem.” When she became depressed, the program punished her.

The wilderness program had censored her mail for items that might, among other things, suggest alternative treatments,but she eventually received a letter from her parents that advised cognitive-behavioral therapy.  Her psychiatrist had dismissed this treatment, which is one of the most strongly-supported depression and anxiety treatments in the literature! [see here and here]

When Lidz started cognitive therapy, her psychologist realized that she didn’t have addiction and probably had bipolar disorder, a condition that can be worsened by many of the medications she was still taking. At one point, her psychiatrist had warned her that she should stop taking one antidepressant he prescribed if she became “manic;” but because he didn’t define the term, she didn’t recognize the symptoms.

Our mental health care system is filled with interventions based on little more than clinical myth, and addiction treatments are especially divorced from evidence-based practice. To avoid repeats of this sorry story, patients and their family members need to inform themselves about what is known to work and what isn’t-- and then demand that of providers. 

The “troubled kid turned around by tough love in the wilderness” has long been a media staple, but it has created a terrible legacy. The media has got to start covering how such widely-promoted treatments like wilderness programs and confrontational addiction rehabs do not have the scientific evidence backing them that should exist for health care that, like many interventions, can carry risk.