Psychiatry – The Sham Science

There is an interesting article in last month’s issue of the British Journal of Psychiatry.  The article, titled Psychiatry beyond the current paradigm, was authored by Pat Bracken, an Irish psychiatrist, and 28 other British and Irish psychiatrists.

The gist of the piece is that the current psychiatric paradigm, which the authors describe as “applied neuroscience,” is not supported by the evidence and needs to be abandoned.

Here are some quotes:

“The technological paradigm underscores a trend towards the medicalisation of everyday life, which, in turn, is associated with expanding markets for psychotropic agents.”

“This process has also led to the corruption of sections of academic psychiatry through its entanglement with the pharmaceutical industry, damaging the profession’s credibility in the process.”

“There is strong evidence that improvement in depression comes mainly from non-technical aspects of interventions.  Recent meta-analyses of drug treatments for depression demonstrate that drug–placebo differences are minimal.”

 “Overall, available evidence does not support the idea that antidepressants work by correcting a pre-existing ‘chemical imbalance’”

 “None of the studies reviewed… found significant differences between real and sham ECT after the treatment period.”

 “By 6 months, there was actually a two-point difference in scores …in favour of the sham treatment.”

 “A meta-analysis of randomised controlled trials investigating the effectiveness of first- and second-generation antipsychotic drugs found that, at best, the  improvements seen in two commonly used rating scales…were ‘disappointingly limited’.  Although the authors’ caution against the conclusion that antipsychotics have ‘negligible effects in clinical practice’, given their findings, and those of other groups, such a conclusion does not seem unreasonable. Over-reliance on psychopharmacology as the primary response to serious mental illness created the conditions for a blindness towards the serious adverse effects of some psychiatric drugs, and for a shameful collusion with the pharmaceutical industry’s marketing campaign that sold the illusion of major innovations in antipsychotic drugs. The claimed therapeutic advances were, in fact, ‘spurious’. As Kendall put it recently ‘the story of the atypicals and the SGAs [second-generation antipsychotics] is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing’. These drugs are associated with increased cardiovascular risk. Such iatrogenic effects have been cited as one of the reasons for the significantly decreased life expectancy of people with mental illness.”

“The evidence is becoming clear that to improve outcomes for our patients, we must focus more on contexts, relationships and the creation of services where the promotion of dignity, respect, meaning and engagement are prioritised.”

“Psychiatry is not neurology; it is not a medicine of the brain.”

 

And this was written by practicing psychiatrists!

They are calling for a demedicalization of the “mental health” field, and their critical self-appraisal in this regard is to be commended.  Amazingly, however, they conclude the piece by asserting: “Psychiatry has the potential to offer leadership in this area.”  In other words:  we realize that for the past hundred years or so we’ve promoted spurious concepts, and have done enormous damage to the people who came to us for help.  But now, with a great deal of prodding from individuals whom, for decades, we ridiculed as brainless cranks, we recognize the error of our ways.  We don’t have the decency to resign, however, but instead we will stay at the helm and do a much better job in the future.

My question is this:  Why should psychiatrists stay at the helm, if the problems in question are not illnesses?  Would we ask plumbers to head up a highway safety commission, or engineers to lead a government spending committee?  Why should psychiatrists imagine that they have a lead role to play in helping people with problems of living?

  • William Hommel

    I agree with much of your sentiment about DSM methodologies and about bipolar diagnoses, excepting only that you present things in very sweeping terms as if everyone should throw the baby out with the bathwater.

    I note from your other posts that you have had psychiatry squarely in your sights, all the while not commenting on psychology. How about you make it easy for a layperson, and tell us why psychology is any better than psychiatry?

  • Phil_Hickey

    William,

    Thanks for coming in with such interesting comments.

    My essential point is that the human problems listed in the DSM, firstly, do not fall neatly into the stated categories and, secondly, are not illnesses. The medicalization of these problems is spurious and destructive, but is pursued as a deliberate policy by the APA and psychiatrists generally for their personal gain. For me, based on my observations and experience, this is one of the great evils of our time, and I am forthright in my condemnation of these ideas and practices.

    By suggesting that I am throwing out the baby with the bathwater, I guess your point is that I am undermining, by association, whatever positive attributes the “mental health” system might have. And there may indeed be merit to this position. I do from time to time encourage commenters to seek help from counselors, provided the latter are divorced, at least somewhat, from the pernicious practice of assigning “diagnoses.” But perhaps I need to address these kinds of issues further. It would be really helpful if you could share some thoughts in this area. What do you think is good about the mental health system that I am missing or even maligning?

    With regards to the psychology-psychiatry issue, the matter is very complex. In my third post, Psychologists, Social Workers, and Counselors in the Mental Health Field (March 19, 2009), I wrote:

    “Many psychologists …when they sign their bills … are certifying that the client has a mental disorder, and they are lending their support to the spurious notion that mental disorders are the underlying cause of human problems…”

    However, you are correct in saying that, in general, I make little mention of psychologists within my general criticisms of the mental health system. This is emphatically not because I think the psychologists are any better than the psychiatrists. Most of the psychologists within the system have embraced the spurious DSM nosology as whole-heartedly as the psychiatrists, and for the same reasons – a share of the profits. If anything, I consider psychologists the more culpable, because our training alerts us to the errors embodied in the DSM system. For instance, most psychology courses contain references to the damaging effect of labels, the differences between spurious and genuine classification systems, and – most particularly – the importance of context in understanding human behavior. It is a fundamental principle of the DSM system that the “mental illness” resides in the client and is not to be conceptualized as a function of context, social or otherwise. This flies in the face of a hundred years of behavioral research, and ought to have elicited howls of protests from psychologists. Instead, they embrace the nonsense with enthusiasm – and at the present time are lobbying strenuously for prescription privileges in several jurisdictions.

    The reason I don’t belabor the involvement of the psychologists in the spurious and destructive “mental health” system is simply because I see them as bit players in this tragic farce. The psychiatrists designed the system and have kept tight hold of the reins. With them resides the primary responsibility for the damage done. Psychologists – to their shame – just tag along.

    Once again, thanks for the feedback. Please come back. These are important issues, and I welcome your further input.