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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.
If they want a replacement they will need to provide one. Until then, people are being treated, with varying degrees of success, with the current model. Even if the model isn't actually an accurate description of what is going on, it is still a fairly useful guide to approaching the problems. Sort of like classical physics versus relativity. A real breakthrough in understanding would be great - and maybe with all of the brain imaging and various other things going on, that will emerge. But so far it seems to mainly be individual studies that aren't producing a cohesive theory or useful guide to treatment. They will need to find their equivalents of Einstein and Dirac.
Another problem with the recent releases of the DSM is that what is considered a disorder sometimes seems to be a question of politics or political correctness.
much of left-wing thought is a kind of playing with fire by people who don't even know that fire is hot - George Orwell
It is worth noting that the central distinction between psychiatrists and psychologists is that generally psychiatrists can prescribe medications (they are doctors). It's therefore not surprising that some psychologists would issue a statement like this. Honestly, this single statement by what appears to be a spokesperson discredits their entire ramblings: "it was unhelpful to see mental health issues as illnesses with biological causes". It's quite shocking to see professionals show such ignorance of their own field, just because they specialize in one aspect of it. 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. We have many decades worth of research that specifically shows you what goes wrong in a person's brain with many psychiatric illnesses.
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.
I agree. And so do I.
Would most people be better off undiagnosed?
In a word, yes. Since "most people" would not be ill, neither physically nor mentally. This new edition of the DSM risks to change that, as in it provides a convenient way to slap "diagnostic" labels on quite a few people who're today considered pretty much normal.
Cue the observation occasionally voiced that what today is called "ADD" (and but yesterday called "ADHD") and results in prescriptions of ritalin, only a few short decades ago was called "being a kid". We are going a little bonkers with the mental, yes.
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I completely agree with you. In fact, the rambling statement by these psychologists (which does not appear to be scientific) is readily disproven by the biggest and most successful example of medical treatment of a mental health disorder: schizophrenia ( http://en.wikipedia.org/wiki/Schizophrenia#Medication ) and the 1950's discovery of an antipsychotic medication which greatly improved the hallucinations and psychotic breaks undergone by schizophrenic patients: chlorpromazine was found while looking for anti-histamines (for allergies).
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The wikipedia article on chlorpromazine points out: In 1955 it was approved in the United States for the treatment of emesis (vomiting). The effect of this drug in emptying psychiatric hospitals has been compared to that of penicillin and infectious diseases.[50] But the popularity of the drug fell from the late 1960s as newer drugs came on the scene. From chlorpromazine a number of other similar antipsychotics were developed. It also led to the discovery of antidepressants.[53]
Chlorpromazine largely replaced electroconvulsive therapy, psychosurgery, and insulin shock therapy.
In other words, chlorpromazine actually worked so well that the psychiatrists no longer had to resort to ECT, brain surgery, or screwing with the patient's sugar and insulin levels.
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You'd have to be a complete moron to claim that there is no evidence for medical and pharmacologic treatment of schizophrenia: the evidence is almost 60 years old. The only conclusion to draw from this is that the British Psychological Society is, in fact, composed of vast groups of complete morons who do not believe in science or the scientific method.
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.
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!
Would be nice if true. Fact of the matter is most people get 15 minutes, a prescription, and sent home.
Violence is like duct tape. If it doesn't solve the problem, you didn't use enough.
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.
I was diagnosed as bi-polar about 6-7 years ago after suffering a serious manic episode with full scale hallucinations. While it was not the first time this had happened to me, it was "the final straw" that led to me being diagnosed.
Since then I've been on Resperidone to control the manic phases, and Effexor to limit the depressive phases. I've had no hallucinations, breakdowns, suicidal thoughts, or any other problems since being put on the medication, except when I've run out of medication, thinking "Maybe I don't need it any more."
But the return of symptoms after 2-3 weeks without medication has me convinced that the diagnosis is valid and the medication effective.
I do not fail; I succeed at finding out what does not work.
As someone on venlafaxine, I concur about the ups and downs being gone more than through CBT. CBT requires such an effort that at least to me it seemed that if I could seriously benefit from CBT, I wouldn't need it in the first place since then I wouldn't have the problems I've had functioning. Venlafaxine is not an ideal medication for me but because I have epilepsy, it reduces the options what doctors can prescribe me. Out of curiosity, I ask if you notice the effects some other way? For me, an unfortunate effect has been a lowered ability to concentrate. At first, I noticed that every time I was getting a bad, depressive thought, I just forgot it and thus didn't end up in my depression cycle. It's, however, not a "precision weapon" so other thoughts are often "collateral damage" so I often forget what I'm thinking of even if I try to concentrate really hard. In the past, I instead associated to something negative in my life from almost anything and thus my productivity was lower not because I forgot thoughts but precisely because I didn't - I was able to constantly make jumps like "I heard this unusual word the first time when I saw movie X and there was a poster for movie X in location Y which was where I met girl Z for the last time" and even much more far-fetched associations to anything that made me feel sad and I just couldn't stop those associations from being constantly formed. Now that i no longer do that, I'm also a lot less angry with myself and that might have harmed my productivity in a different way, I'm more forgiving to myself if I skip exercising, do a shitty job and so on (although I know that prior to my medication, my perfectionism was quite extreme by most peoples' standards). So how has your productivity level changed on lithium?
And to "normal" people, i.e. those few that have never gone through depression or had to take antidepressants: If you're curious to find out what it can be like, you can first think about what it's like to suddenly be reminded of something by making an association Then imagine that you constantly associate things with something negative - as if you had had e.g. pictures of all bad things you've ever experienced and all people that have hurt you placed all over your room/cubicle/house...
"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.
CBT is a wonderful advance in psychology.
but most honest practitioners of it will concede that a short course of (the correct) meds will make CBT a lot more effective.
how do you tell someone to calm down when they can't hear you above their own screaming? sometimes people get into a state where they're simply not going to be receptive of any talk-based therapy. if this happens to somebody in your life, you'll be glad that drugs exist, and in enough variety that one of them is quite likely to be just the ticket.
an analogy i've heard is that the patient is like someone walking through snow wearing nothing but underwear. giving them meds is like handing them a coat and scarf. it'll work, but eventually that person has to get themselves out of the snow because it's pretty damn cold.
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.
I suffer from major depression. When I go off my mess I feel like crap. I stop being able to concentrate and I feel overwhelming hopelessness. On the wrong medication I was failing basic courses at uni. On the right medication I got credit/distinctions on average and have not only held down a job for 3 years but excelled at it.
I have gone off my medication in the past because I wasn't convinced that the problem was chemical rather than environmental. When I go off my medication I'm sometimes fine for months. But eventually things get worse. I've been on the same medication for 4 years now, I've yet to have any issues.
I explored several options before settling on medication. Even then I explored the possibility that the depression was environmental or situational. I've been proven wrong each time.
Are some people incorrectly medicated? Definitely. But the idea no-one needs this medication to live a fulfilling life is reckless and ill informed.