Issues in Psychiatry - A Closer Look at Psychopharmacology, by Louis Kirby, MA

"When researchers are beholden to companies for much of their income, there is an incredible tendency to get results that are favorable to the company." Dr. Jerome Kassirer, former editor of The New England Journal of Medicine, concerning results of clinical studies on pharmaceutical drugs.

·  Extreme drowsiness, loss of motor control, even drooling can occur.

·  When typical antipsychotics such as Haldol and Prolixin are over-used, they have been dubbed "chemical straightjackets".

·  Haldol is sometimes used on the elderly with dementia if they might tend to fight or bite or be otherwise difficult to control.

The Medical Model of Mental Health

Over the last several decades psychological treatment in the United States has been increasingly dominated by two trends: labeling patients by consulting lists of symptoms, and then treating them with drugs. This biopsychological approach rests on the theory that mental abnormalities are caused by chemical abnormalities in the brain which can be cured by drug treatment that returns brain chemistry to its normal state. While proponents claim that their remedies rest on hard science, other scientists disagree, pointing out that we do not yet have a thorough or sophisticated enough understanding of the brain and its chemistry to identify specific physiological causes of symptoms or to devise corresponding chemical remedies. The widespread acceptance of biopsychological treatment, however, makes it important that those seeking help for themselves or another be aware of its limitations.

Psychiatric Diagnostics - DSM-IV

In the United States the standard psychological diagnostic tool is the Diagnostic and Statistical Manual (DSM), [today DSM-IV] which consists of classifications of disorders defined by groups of symptoms.

The symptoms listed are often so broad that over 60% of Americans could be diagnosed as mentally ill, and much ordinary human behavior and feeling can increasingly be labeled as pathological. Official recognition of these disorders and their diagnostic symptoms is bestowed by majority vote of a committee of the American Psychiatric Association, (off-site link) which reviews them periodically.

Politics and Profit in Psychiatry

Lobbying, "gift-giving" and marketing efforts from big business has profoundly affected the medical field and their recommendations for treatments. Photo: U.S. Pharmaceutical company facilities. (This company is only used to illustrate big business as it relates to pharmaceuticals and is not in any way indicative of any ethical breeches for this particular company). Photo and blurbs not part of Kirby article.

It is a political as well as a scientific process often reflecting intense lobbying from various parties, such as patient-advocates and pharmaceutical companies, as well as conflicts within the psychiatric community. Some of the conditions that have been included as disorders and then excluded from later editions of the DSM (e.g., homosexuality and self-defeating personality disorder) show the powerful role of social and other biases in these decisions.

Once a DSM diagnosis has been determined, there is a strong economic incentive for HMOs, other insurance providers, and pharmaceutical companies to encourage physicians* to prescribe medication as the main form of therapy. In this way doctors spend very little time with each patient, the cost of diagnostic testing is minimized, and sales of psychological drugs increase. Insurance companies are increasingly reluctant to fund psychological counseling, though medication without other therapy is more likely to have negative long-term consequences for the patient.

* Psychologists in most states cannot prescribe drugs, though a campaign is underway seeking to change this law throughout the United States.

Neuroleptics - Typical Antipsychotic drugs

The rationale for biopsychological treatment appeared with the neuroleptics. Hailed as a "chemical lobotomy" when the lobotomy was most popular, the first neuroleptic [thorazine] was used originally to control behavior of mental patients. However, its US manufacturer claimed it was a "cure" for schizophrenia, a claim still not accepted in Europe or by the drug's French discoverers.

[Some common typical antipsychotic drugs are Haldol (haloperidol), Prolixin (fluphenazine), and the first, Thorazine (chlorpromazine), used in psychiatric facilities from around 1959.]

While neuroleptics do suppress many undesirable aspects of schizophrenia, such as delusions and hallucinations, they actually intensify other important symptoms such as lethargy and emotional withdrawal. As time passed, neuroleptics were administered to an ever wider range of people -- including juvenile delinquents -- to control their behavior. The practice stopped after Congress restricted their use to those with an appropriate psychiatric diagnosis. Lawmakers acted not only in response to testimony by US citizens, but to harrowing accounts by Soviet dissidents given this drug by their government as a way to "chemically manage" dissent.

After the acceptance and profitability of neuroleptics, other types of drugs followed which claimed to cure conditions such as depression, hyperactivity, and bipolar disorder by correcting specific chemical imbalances in the brain. That they manipulate brain chemistry is undoubted, but it has never been proved that these drugs do more than mask certain characteristic symptoms identified with the disorders. Because they alter brain chemistry, the brain readjusts its chemical functioning and becomes dependent on them.

The fact that such drugs can cause permanent damage if used over long periods or if they are suddenly withdrawn is little publicized. Like the neuroleptics, some of the new drugs have been prescribed for increasing numbers of people who are not seriously mentally ill, and are often presented as a harmless and relatively effortless solution to their problems, a concept many people find appealing.

Mental Health Treatment - Treating Symptoms

Although the biopsychological model [medical model] enjoys increasing support in the psychiatric and medical communities, there are criticisms within the field. One of these concerns the growing neglect of physiological causes of mental symptoms. In A Dose of Sanity: Mind, Medicine and Misdiagnosis (1996), psychiatrist and neurologist Sydney Walker III emphasizes that being labeled with a disorder does not address the symptoms' cause: "Patients who have been 'diagnosed' as having manic depression, anxiety disorder, attention deficit hyperactivity disorder, and so on, haven't been diagnosed; they've merely been described," he points out.

Dr. Walker likens those relying on the DSM to physicians diagnosing a person with a cough as having "coughing disease" and treating it with a drug that masks its symptoms without investigating whether it is caused by a cold or tuberculosis.

Other Types of Mental Health Treatment

Another consequence of having drugs as the preferred therapy is the neglect of other types of treatment. Very often conditions such as depression or anxiety are triggered by events, relationships, or patterns of thought and action. By dealing with these factors, whether through changing the environment, relationships, or the patient's attitudes, behavior, or choices, patients can usually resolve the problems and come to terms with their lives in a positive way without drugs or with only minimal and temporary drug use.* Problems and challenges are an integral part of life, and human beings grow largely through these difficult experiences.

A perpetually contented, calm, extroverted, positive attitude is not the normal human state, and to tell people struggling with the usual ups and downs of life to take drugs which may have serious side effects, and which often cause physical [and more often psychological] dependency, is ultimately hurtful rather than helpful. Research by the World Health Organization and others has shown that even in severe conditions -- for example, schizophrenia -- those not treated with powerful psychological drugs are more likely to recover fully from a crisis within three years, whereas those given drugs such as the neuroleptics are much less likely ever to return to normal functioning.

* For a discussion of three of the many contemporary approaches that take the whole human being into account, see "Helping Ourselves" by Jean B. Crabbendam, Sunrise, April/May 2002.

Pressure from Pharmaceutical Industry Influences Use of Drug Treatment

Many of the major problems with drug treatment can be traced to the pharmaceutical industry itself. Its strong monetary influence over the medical and academic communities [studies in major universities are more often than not funded by pharmaceutical companies themselves] compromises their ability to study these products objectively or publish adverse findings. The fact that pharmaceutical manufacturers often design and control the testing of their products, as well as the information given to physicians and the public, makes finding scientifically objective information difficult.

From the point of view of current neurophysiological research, there is insufficient evidence to support the theory that the lack or abundance of a particular neurochemical causes a particular disorder: knowledge about the function in the brain and throughout the body of these recently discovered biochemicals is still rudimentary. There is equally little evidence that various drugs cure mental "abnormalities" or that patients diagnosed with serious mental conditions need to take psychological drugs for the rest of their lives in the same way that diabetics need to take insulin -- as such patients have commonly been told. In fact, there is growing evidence to the contrary.*

Mental Health Books and Resources Favoring Non-Pharmaceutical Treatment

*Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill by Robert Whitaker (2001) contains a sobering historical overview of the treatment of schizophrenia in the US since colonial times and the development of neuroleptics; while the Anti-Depressant Fact Book by Dr. Peter R. Breggin (2001) reviews the properties and dangers of anti-depressants such as Librium, Valium, Zoloft, Paxil, Celexa, and Luvox. Dr. Breggin has also authored Talking Back to Prozac (1994), Talking Back to Ritalin (1998), and Your Drug May Be Your Problem (1999). Sydney Walker III critically evaluates hyperactivity as a "disease" in The Hyperactivity Hoax (1998)

Scientific Research Does Not Necessarily Support Heavy Use of Psychotropic Drugs in Treatment of Mental Health Disorders

The history of twentieth-century psychiatric treatments is a checkered and sometimes horrifying one. Certainly different treatments work well for different people, but most schools of psychotherapy, including biopsychology [psychopharmacology], do not have a solid scientific justification despite often presenting themselves in that light. Psychology and psychiatry generally have been criticized for the lack of scientific research to determine the effectiveness of their methods, and for ignoring research findings. As Rom Harre put it:

"It is a remarkable feature of mainstream academic psychology that, alone among the sciences, it should be almost wholly immune to critical appraisal as an enterprise. Methods that have long been shown to be ineffective or worse are still used on a routine basis by hundreds, perhaps thousands of people. Conceptual muddles long exposed to view are evident in almost every issue of standard psychology journals." -- "Acts of Living," Science, 289 (25) August 2000, p. 1303

Conclusion on Biopharmcology and Drug Treatment for Mental Health Disorders

Those seeking psychological help for themselves or others do well to exercise caution and adopt a conservative attitude. While large numbers of people have been helped by various treatments, including pharmaceuticals, others have had very negative experiences. An increasing number find themselves uncured but dependent on drugs or with drug side effects that increase their life problems. As in other cases where it is up to the buyer to beware, one's own independent research into the pros and cons of various forms of therapy repays the time spent many times over.

Louis Kirby a Masters of Library Science from the University of Southern California. This article on psychopharmacology is from Sunrise magazine, October/November 2003; copyright 2003. Reprinted with permission.