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Psychiatrists Cast Doubt On Biomedical Model of Mental Illness
jones_supa writes "British Psychological Society's division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a 'paradigm shift' in how the issues of mental health are understood. According to their claim, there is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful. The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out 'reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems', used by psychiatry. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association's Diagnostic and Statistical Manual of Mental Disorders. The manual has been attacked for expanding the range of mental health issues that are classified as disorders."
If mechanics understood cars as well as we understand brains, then dealing with car problems might work like this:
After having cut apart and ground up thousands of working and non-working cars, mechanics would know that a lack of gasoline, oil, or water was a common factor in many common car failures. Thus, whenever a broken car was brought into their shop, they'd pop open the hood and pour a bucket of gasoline, oil, or water over everything (depending on the symptoms) to try and fix the problem.
Those are some unfortunate examples, considering both schizophrenia and bipolar disorder are at least partially heritable and there's other good evidence both have a big biological component.
Psychologists have a good point that considering all mental illnesses to be biologically caused and solely pharmaceutically treatable is not a good thing, but these ones seem to have gone overboard the other way.
An interesting point. However I wonder about this part:
While we are certainly still in the dark ages of neuroscience and psychiatry, there is a reason why we can control a ton of psychiatric illnesses with medications.
Now here's the thing. We can alter the behaviour and mood of ANYONE with drugs. Give them more can-do spirit with caffeine, coke or speed. Relax them with cannabinoids. Make them stupid and overconfident with alcohol. Friendly/loving/empathic with Ecstasy etc.
So of course with drugs we can change the behaviour of people diagnosed with a mental illness to better suit societies expectations, or to lift their mood. But that doesn't mean that their problem was biomedical. There's no theoretical reason why a person whose mental problem has an experiential cause, such as childhood abuse, wouldn't benefit from treatment with drugs.
Successful bio-chemical treatment doesn't prove bio-chemical cause.
My own layman's opinion, for the nothing it is worth, is that there's a mixed bag of biomedical and experiential causes, together with a bunch of people that just don't buy into societies current norms, and are wrongly diagnosed as ill. And that you can change anyone, ill or not, temporarily or permanently, with both drugs and experiences.
But with more people being diagnosed as mentally ill, and thus more people receiving prescription medicines, the profit margins of Big Pharma (tm) will only go up!
Will no one think of the major pharmaceutical companies?
I don't think its a vast conspiracy, so much as generations of doctors being educated that drugs are the solution to mental problems, and that all mental illness can be treated by some drug treatment. Also this wacky idea that we all have to match some theoretical norm of some sort. "When all you have is a hammer..." etc.
"The first time I got drunk, I got married. The second time I bought a chimpanzee, after that I stayed sober" Arian Seid
How about another way of looking at things: These are devastating illnesses. Non medical treatment hasn't been shown to be terribly effective. What the hell else do you do?
While I'm one of the first people to dump on Big Pharma, we've gone to a biopsychosocial model because chaining people up in asylums and beating them just didn't get the job done. The brain is clearly chemical in nature and at some point reductionist medication SHOULD point the way to detailed understanding and treatment. We just aren't there now. Doesn't surprise anyone in the field. We use the SAME drugs for many "different" diseases. How's that supposed to work?
Yes, by limiting discussion to just a certain framework of diseases you can inappropriately narrow thinking and treatment. You can make it so that it's hard to come up with a different paradigm.
The DSM was the first attempt to come up with a reasonable framework and language. It's not very accurate but you have to start somewhere. Everyone is open to suggestions.
Faster! Faster! Faster would be better!
It's a pretty crappy headline. My apologies for the length and tangential nature of this post. This is a very personal subject for me.
The problem is that we really don't have a decent understanding of the brain (or its abnormalities) at all. We have collections of symptoms appearing in varying severities with varying results, and we have treatments that alter those symptoms. As far as medicine goes, that's really about it.
The problem with a diagnosis is that it's a label. Someone who says "I'm bipolar" can expect that every action will be judged harshly as to whether it's actually their intended "normal" action, or the manifestation of their depression or mania, whichever happens to be the case that day (or hour). A child who's inattentive in school may just be bored, but the diagnosis of ADD opens the door to differently-structured classes that may help - as well as opening the door to ridicule for being different. Sometimes, yes, it's better to stay undiagnosed, and sometimes it's better to get the diagnosis and do nothing with it.
On the other hand, diagnosis is necessary for any treatment. Someone can understand "I'm sad all the time, and don't like it", but without the term "depression", it's very difficult to find information about how to improve. I've met several people who, in the 90's when depression was highly stigmatized, had traumatic experiences that they couldn't talk about and couldn't do anything to recover from, partly because they wouldn't consider the possibility of actually being "depressed".
To make matters worse, there are still an enormous number of people who simply deny the existence of any mental illness. They assume that kids with ADHD are just being active children, or people with depression are just sad, or people with bipolar disorder are just moody. The illness isn't what's visible from the outside, though. The illness is what's happening in the brain to cause the outward symptoms. The ADHD child can't calm down and focus - his mind always jumps to doing something else. The depressed people can't cheer up - even happy times are often plagued by a sadness that's always present in their minds. The bipolar person can't control their mood - the emotions are overwhelming.
What's happening now, albeit slowly, is that the stigma is being countered by awareness programs. This story is in a similar vein to the one a few days ago decrying DSM-5 for not being valid regarding mental health. As our understanding and openness about mental illness improves, we're starting to recognize that typical Western medicine may have done some serious harm to our society. A recent Broadway musical explored this question well.
In next to normal, a woman who grieved four months for a dead child was diagnosed as "depressed", and began 16 years of treatment. One of the questions explored is whether her illness was really because of the loss, or whether it was because of the trauma of ongoing treatment. There is no answer. There is no happy ending. There's only the promise of a next-to-normal life, where everything is perfect except for when it isn't, and there's always some new treatment to try.
That's the ongoing problem with our current handling of mental illness. We have collections of symptoms, and drugs that treat them, but we don't really understand how. The DSM-5 is so vague and imprecise that a particular symptom is painted with a wide brush to be a whole set of disorders. With no testing for suitability, medications are tried that aren't fully understood, in the hope that it's the right drug to set everything right quickly. When it doesn't work, another regimen is proposed, also with little or no testing for suitability. As the patient's treatment drags on, whole classes of drugs are ruled out for their side effects, then brought back be
You do not have a moral or legal right to do absolutely anything you want.
Would most people be better off undiagnosed? When it comes to mental "illness", often the only (or at least the best) treatments are behavioral therapy, in which the "illness" is trained away.
[anecdote ahead]
Well, I am currently on lithium, and it has helped me more than the CBT ever did. How do I know? I haven't tried to kill myself in a very long time. I haven't even given it serious thought. IT is the emotional life equivalent of watching widescreen movies on 4:3. The worst ups and worst downs simply are no more. (I blatantly stole this quote from someone)
A diagnosis may also be less useful when the problem is a natural reaction to a social environmental situation and lead to attempting to 'cure' the patient rather than fix the problems causing the reaction. Trying to treat of depression or anxiety caused by stress with long term use of medications is likely to lead to eventual failure of the medication or in the case of anti-anxiety drugs lead to addiction and problems from that, leaving the patient in an even worse situation than before.
"Depression meds work no better than placebo [thedailybeast.com]."
Beware the weasel words. What your link actually says, and what the research shows, is that antidepressants in general have about a 25% effect over and above placebo. They do work. However, you can get 75% of the effect by taking a sugar pill, without all the side effects.
Antidepressants are undoubtedly overprescribed, but they do work.
"the scientific method used in psychology research is crap."
You've shown no evidence for that. Psychiatrists have gotten pill happy, probably at the behest of their patients, just like antibiotics get overprescribed, but that has no bearing on whether antidepressants or antibiotics actually work (both do). It also isn't relevant to whether biologists, psychologists and pharmacologists are doing good science or not.
It may be that diagnosis and treatment would be theoretically beneficial... IF THEY IDENTIFIED THE ACTUAL CAUSE! I don't know about anxiety, but a typical doctor dealing with depression will just throw SSRIs, SNRIs, TCAs, or even MAOIs at the problem. They don't think, they just prescribe. They make no attempt to understand the underlying pathology.
You brought up stress induced depression. The average doctor won't consider stress related disorders when dealing with depression, even if you ask him to. Tell a doctor you have depression and fatigue, and most of them wont even think about hypothyroidism. Tell a doctor you have depression and have trouble sleeping, and they'll tell you that it is a symptom of your depression*. They won't wonder about sleep apnea.
*(This is from the "depression is a disease not a symptom" philosophy. At the very least, there's a high chance of co-morbidity, or that the depression has been exacerbated by a sleep disorder.)
The medical profession really needs to wake up and understand that depression is not a disease. It is a symptom. There are many known causes, and probably many that are unknown. When dealing with a chronic condition, you can't just assume that it is idiopathic and treat the symptom, hoping that it will go away. That's unethical.
(You must make a true, good-faith effort to show that it really is ideopathic first. Just because you don't know what it is off the top of your head is no excuse to slack off.)
The problem seems to be made worse because doctors seem to like depression. Depression, as a diagnosis, is popular. It's almost as if doctors are hoping you'll be a depression patient.
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
You may not be able to fix the brain, but you can use drugs to put a cap on runaway processes that are the result of a miswired brain.
The problem with mental illness is that the brain gets caught in a feedback loop which manifests itself in various ways. This is probably the price we have to pay for the level of intelligence we have - our brains are unusually complex. Many very creative persons are also known to have had a history of mental disorder of some kind. The balance between genius and madness is always close.
Salvador Dalí was from some perspective a bit crazy, but he was also a very smart and creative person. Franz Kafka was riddled with depressions but nevertheless an important author.
As for experiencing depression/anxiety myself - without the drugs I would be stuck in a bad loop most of the time.
If builders built buildings the way programmers wrote programs, then the first woodpecker would destroy civilization.