What Underlies Psychopharmacology?

Published on Dissident Voice, by Allan M. Leventhal, May 4th, 2011.

Three Systems: The 20th century witnessed the development of three quite divergent explanatory systems to account for mental illness, each offering a distinctly different approach to treatment: psychoanalytic theory and treatment by psychoanalysis and its variants; a genetic theory of chemical imbalances of neurotransmitters in the brain, with treatment by prescription of psychiatric drugs; and a behavioral learning theory, offering treatments designed to eliminate the behaviors that characterize the mental disorders. Enough time has now passed to allow for a good reading as to the value of these different systems … //

… (2. The Chemical Imbalance Theory:) … Psychiatric Diagnoses:

How has the transformation of psychiatry affected diagnoses of mental illness? 

In 1985, epidemiological studies found the lifetime incidence of diagnoses of depression for males to be 3-5% and for females, 6-9%; in 1994, the rates were estimated as 15% for males and 24% for females; in 2005 it was reported that the combined lifetime prevalence of diagnoses of depression by age 75 was 60%. Since we know that genetic changes take many thousands of years, these figures make no sense as reflective of genetics. They also make no sense in terms of environmental influences since cultural changes of this kind and magnitude very rarely occur so quickly. This pathologizing of normality also has been given a name, “disease mongering,” which is defined as the practice of expanding the definition of illness to increase markets for those who sell or offer treatments.

DSM-III, published in 1980 as one of the building blocks in the biological transformation of psychiatry, has been central to inflation of diagnoses of mental illness. Previous editions of the DSM had been found to be embarrassingly unreliable, failing to meet the most elementary requirements for a sound diagnostic system. Beginning with its publication in 1980, DSM-III was heralded as correcting the problem, but this claim is in full consonance with the false claims made for the chemical imbalance theories. No studies have demonstrated DSM-III or DSM-IV’s reliability to be improved.12, 13 Moreover, because the number of diagnoses in these newer editions has more than tripled, room for error was expanded. Since reliability sets the ceiling for validity, there is considerable reason to view psychiatric diagnoses as having dubious validity.

As noted above, diagnoses of depression also have been profoundly affected by a change instituted with publication of DSM-III when sadness was conflated with depression. Prior to that time sadness was regarded as a normal response to loss. Experiences of loss are a salient aspect to ordinary life, which often includes losses of important relationships, status, limitations imposed by one’s own ill health and that of loved ones, financial losses, etc. A great deal of empirical evidence verifies a connection between losses in life and feeling sad.

Sadness, like fear, signals distress. Our capacity to experience these negative emotions is of genetic origin, but this does not mean fear and sadness are abnormal states. They qualify as normal because they are time limited functional reactions to threats to survival. The connection between fear and the flight/fight response was selected genetically as an integrated survival mechanism. Similarly, the connection between loss and sadness reveals the importance to survival of establishing and maintaining social relationships and holding onto valued conditions and objects. Because fear and sadness accompany behaviors that are disruptions of other behaviors necessary for survival, of necessity these states ordinarily operate only temporarily. When the stressors to survival that elicited fear disappear the organism returns to normal behaviors that sustain life. Likewise, with respect to sadness, with time the losses that elicited sadness are replaced by accommodation or compensation, enabling the individual to return to normal activities. Since fear and sadness serve a purpose as temporary survival mechanisms, they do not ordinarily represent illnesses.

Fear becomes abnormal when it continues to govern actions in the absence of objective danger. Fear then functions to maintain recurring dysfunctional behaviors. Phobias are a readily recognizable example of this abnormality. Sadness also becomes abnormal, i.e., is properly diagnosed as depression, when the behaviors necessary to replace what has been lost are blocked.14 When this happens sadness is transformed into depression because, as is the case with fear, the individual comes to function in such a way as to maintain recurring dysfunctional behaviors. Contrary to current practice, diagnoses of depression should be reserved for patients who meet this standard. There is abundant evidence that normal states of sadness are today being diagnosed as illnesses, with many people who are not ill being prescribed antidepressant drugs.

Safety:

What evidence do we have bearing on the safety of these drugs? There are significant reasons to believe psychiatric drug treatment often is iatrogenic. The first wave of drugs associated with the biological revolution in psychiatry were the anti-anxiety (anxiolytic) drugs. These were the benzodiazepines (xanax, valium, librium) and they proved to be dangerous. They are highly addictive, with estimates of 10 million valium addicts in this country. Many automobile accidents were found to be associated with the anxiolytic drugs and the interaction of these drugs with alcohol can be life threatening. Recognition of the serious adverse effects of the anti-anxiety drugs led to Congressional hearings, provoking much negative publicity and stronger restrictions on their prescription.

Unfavorable publicity about anti-anxiety drugs and curtailment in their prescription served to usher in, instead, greatly increased diagnoses of depression and prescription of antidepressants. With plenty of allegedly safe and effective antidepressant drugs on hand, depression soon replaced anxiety as the prime psychiatric diagnosis. However, there is considerable evidence that the harmful effects of psychiatric drugs are not restricted to the benzodiazepines.15 Harmful effects of antidepressants and antipsychotic drugs may be less immediately apparent, but they are substantial. Whitaker points out that since the introduction of these drugs the disability rates for mental disorder have multiplied six times what they were in 1955. With respect to schizophrenia, before the arrival of thorazine, 65% of patients were able to live independently in the community five years after initial hospitalization; today only 5% of medicated patients end up “recovered” and able to work over the long term. In 1955 about 50,000 patients were hospitalized for affective disorders (depression and bipolar disorder); today, 1.4 million adults receive a federal payment because they are disabled by an affective disorder. Since the SSRIs began being prescribed to children twenty years ago, the disability rates for children have increased thirty five times. Prescription of antidepressants, anti-psychotics, and anti-seizure drugs to military personnel parallels an increase in suicides.16 There is evidence of significant under-reporting of increased suicidality associated with antidepressants17 and of a significant association between antidepressants and acts of violence toward others.18 Whitaker sums up the great increase in disability rates that has accompanied the psychiatric drug era, taken together with the explosion in prescription of psychiatric drugs written for children, as indicating the likelihood of an impending catastrophe of widespread iatrogenic illnesses.15

In summary, we now have better than thirty years of experience available to us to examine the effectiveness of psychoanalysis and another thirty plus years available to examine the effectiveness of psychopharmacological treatment for mental disorder. And for each of these treatments we have at least as many years testing the theories on which these approaches rest. Both of these theories and both of these treatments have failed to be substantiated when exposed to scientific scrutiny – and drug treatment has raised serious concerns about safety. Failure to validate these two systems should not be surprising since neither of these systems grew out of replicated empirical research, as characterized the development of our understanding and treatment of physical illness … (full long long text).

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