In a nearly 6,000-word essay, Louis Menand asks the question of the hour in the March 1 edition of The New Yorker. Menard lays out in excruciating detail the questions revolving around psychiatry these days, including the recent research into drug trials that suggests that some of the science psychiatry is founded upon is sometimes … Well, how shall we put it? Lacking.
But it is a thoughtful piece that just doesn’t review two recent books — Gary Greenberg’s Manufacturing Depression and Irving Kirsch’s The Emperor’s New Drugs — but provides a fairly balanced set of observations and valuable historical insights about these never-ending arguments that seem to pervade psychiatry (and psychology and mental disorders in general). Questions such as:
- What is the basis for labeling something a disease?
- Are these problems new or unique to psychiatry, or have they occurred previously in medicine?
- Do antidepressants work, or is it all just a glorious placebo effect?
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 23 May 2013
|
The Era of the Biologically Based Brain Disorder, the Decade of The Brain, and the Decade of Discovery brought nothing to the routine diagnosis and treatment of mental illnesses. My peers and I were promised so much where science was to govern our treatment and yield vastly superior outcomes. In the end we found that to refute charges of anosognosia it become essential to assert that something was intrinsically wrong with the seat of all intellect and emotion sans any evidence of the same, ex. “My brain is sick”, “I have a genetic disorder which impacts my behavior”, “I lack (pick one or more neurotransmitters)” and so forth. Afterall, this was supported by science or so we were told.
I liked your thoughtful discussion of the NYer piece almost as much as the article itself!
The following is not an argument against empirical psychological research — we need more of it, unbiased, tons more! — but it does point to one of the limits in that research: Few psychological conditions present with the singularity of many biological illness. You got malaria? You got malaria. You got lupus? You got lupus. Ditto diabetes, colitis, or even bunions. Yes, yes, of course. You can have heart disease complicated by diabetes complicated by psoriatic arthritis complicated by a acute and intermittent pancreatitis, but at least you know what you’re dealing with, and most if not all of the disease can be empirically diagnosed and not be reliant on patient self-report.
Psychological conditions? Oy vey. As complex and interwoven as life itself, which poses enormous challenges for research design and analysis.
Again, this is not to say that the research should not be done, nor that too many therapists rely on anecdotal information and their own experience rather than looking to what the weight of the empirical evidence might suggest. It’s merely to underscore that as a science, we’re still in our infancy, with miles to go before we sleep.
The difference between a main effect and a side effect is the intended use of a given medication. But I’ve notice an interesting tendency among the opponents of psychiatry. They dismiss main effects as nothing more than placebo effects, but they readily attribute side effects and adverse reactions to the “real” action of the drug.
So if your depression lifts on imipramine, the outcome was due to spontaneous remission or placebo effect. Your dry mouth, on the other hand, was caused by the drug.
The reason why the side effects are stressed as the only effects of the drugs is that for the majority of people thise toxic poisons do nothing but harm. Please check out books like THE MYTH OF THE CHEMICAL CURE, YOUR DRUG MAY BE YOUR PROBLEM, ANATOMY OF AN EPIDEMIC, RETHINKING PSYCHIATRID DRUGS. What is being ignored is that psychiatry’s bogus, junk science stigams invented to push the latest lethal drugs in bed with BIG PHARMA are being FORCED by law on thousands of unwilling victims who do not wish to be Dr. Mengele malpractice experiments, but all too many have been without informed consent. Those blithely advocating these stigmas and lethal poisons/ECT for those they’ve deceived themselves are subhuman are obbiously psychopathic malignant narcissists who have no conscience, empathy, compassion, ethics, honesty or humanity, which sums up the entire history of the psychiatry. So much of these arguments are self serving and totally ignore the so called patients or victims here!!
It all boils down to results. Does psychiatry really fix mental anguish and create a psychologically health society? Not really.
As TPG noted, “we’re still in our infancy, with miles to go before we sleep.” In other words, the past 100 years of psychiatry has been one long experimentation on people’s minds — that yet sells itself as “science.”
Psychiatric guinea pig? No thanks.
Psychiatry
Hank wrote:
“In other words, the past 100 years of psychiatry has been one long experimentation on people’s minds — that yet sells itself as “science.””
That’s what science is–ongoing experimentation. There can be no scientific medicine without experimentation. The experimentation may begin in the lab, but in the end human beings are the test subjects. In psychiatry, the psychiatrist has a hypothesis and he tests it with the intention of finding some medication or medications that will alleviate suffering and dysfunction. What is overlooked again and again in the discussion is that anti-depressants do help with severe depression and anti-psychotics, when they aren’t over-prescribed, make an enormous difference in the lives of chronically mentally ill persons.
Consider that 40% of all cancer diagnoses end in death. The treatments for some cancers produce excellent results, but for other the treatment results are abysmal. And what do we see very often with cancer patients? Patients and family members often search desperately for opportunities to participate in trials–to become human guinea pigs in the ongoing experimentation.
Treatment for heart disease was almost completely ineffectual until the 1970s. Survival rates for patients with heart disease have improved greatly, but people still undergo treatments that fail to cure. Treatment of chronic autoimmune diseases are an ongoing experiment with no cures yet found. Treatments are about disease management and the treatments can cause side effects and adverse reactions.
Many of the most common disorders fall into the category of experimental and incurable conditions. How do we treat COPD, asthma, arthritis, severe diabetes, chronic pain and Crohn’s Disease? We don’t cure these diseases and efficacy of treatment varies greatly. Physicians must work with patients and experiment with treatments.
Though I am not a advocate for medication to eradicate normal sadness and anxiety, there is a place for medication in the treatment of serious psychiatric disorders. It would be cruel to deny to the psychotic person or the severely depressed person the chance to make life-destroying symptoms more manageable. I would no more deny an anti-psychotic medication to a schizophrenic person than I would deny chemotherapy to a cancer patient, even if that treatment is experimental and even if the treatment comes with side effects and risk of adverse reaction.
I do believe that patients should properly informed of the problems and risks associated with medication. I don’t believe that occurs very often. Patient decisions should be well-informed. If I have criticism with psychiatry, that would my primary criticism.
Maybe the question that should be asked is this:
Why are the brain disorders Parkinsons, Alzheimers, epilepsy…researched and treated through neurology while the brain disorders depression, anxiety, bipolar…researched and treated through psychiatry?
I can only echo Kevin’s great comment and reply.
Questioning – we can cut into the brain postmortem and literally see these diseases in the brain through a microscope. We cannot do the same for people with depression, anxiety, etc. (MRI, fMRI, EEG and PET scans are not the same; and they also do not reliably detect the aforementioned diseases.)
Therapy will become more “science-like” when the ‘therapists new clothes’ undergo some form of efficacy testing as comparative and comprehensive as drug testing. The tendency to attribute to therapist interventions which are truly helpful, without quantitative, measurable results and accurate feedback, simply further support approved fallacies. Clients are more likely to desire to please the therapist than when they are given tacit approval. When their feedback is less than positive or challenging, the therapist can then disregard this information and pathologize the client. Not that different than the current debate about drugs. Just as side effects are more likely attributed to the drug, but efficacy disputed to denied. Clients are not encouraged to challenge their therapists interpretations and interventions,or develop their own self mastery in many cases. Whether they are prescribed drugs or not. The real “drug” is the ego driven process, the need for validation for both therapist and client.Along with tacit approval of therapeutic dynamics, creating an endless cycle of dependency and distortion of the “emperors new “clothes’ on both sides. Scientific it is not. Measurable, quantifiable with any true efficacy,who knows?! Addictive with side effects, most certainly!
RE :I can only echo Kevin’s great comment and reply.
Questioning – we can cut into the brain postmortem and literally see these diseases in the brain through a microscope. We cannot do the same for people with depression, anxiety, etc. (MRI, fMRI, EEG and PET scans are not the same; and they also do not reliably detect the aforementioned diseases.)
- This is my question… Is there a single person who has lived an adult life and has never felt despressed?? If you cant see depression in a microscope, why do you treat it with something you can see under a microscope? It seems to me that they only combat basic human emotions.. Not actual diseases. Maybe there is some science behind depression and anxiety.. But with the method that is being used.. A simple person who is having a bad day could be diagnosed as Bi polor. The standards of deciding what is a disease is miserably flaued. Health isnt profitable.. Sickness is.. Has an antidepressant ever cured depression? Has a patient taken Paxel for 2 months and find their depression is gone and since got off the pills and living happliy ever after? Usually people who takes pills for despression find their depression is still present and also can not get off the pills.. Ill stick with the depression.. Go for a walk.. Reflect.. Make a change.. Life goes on.