Psychiatrists Cast Doubt On Biomedical Model of Mental Illness 329
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."
Car Analogy (Score:5, Insightful)
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.
Unfortunate examples (Score:5, Insightful)
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.
Re:Psychology VS Psychiatry (Score:5, Insightful)
An interesting point. However I wonder about this part:
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.
Now here's the thing. We can alter the behaviour and mood of ANYONE with drugs. Give them more can-do spirit with caffeine, coke or speed. Relax them with cannabinoids. Make them stupid and overconfident with alcohol. Friendly/loving/empathic with Ecstasy etc.
So of course with drugs we can change the behaviour of people diagnosed with a mental illness to better suit societies expectations, or to lift their mood. But that doesn't mean that their problem was biomedical. There's no theoretical reason why a person whose mental problem has an experiential cause, such as childhood abuse, wouldn't benefit from treatment with drugs.
Successful bio-chemical treatment doesn't prove bio-chemical cause.
My own layman's opinion, for the nothing it is worth, is that there's a mixed bag of biomedical and experiential causes, together with a bunch of people that just don't buy into societies current norms, and are wrongly diagnosed as ill. And that you can change anyone, ill or not, temporarily or permanently, with both drugs and experiences.
Re:Would most people be better off undiagnosed? (Score:5, Insightful)
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.
Re:Would most people be better off undiagnosed? (Score:4, Insightful)
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.
Re:Would most people be better off undiagnosed? (Score:5, Insightful)
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 [slashdot.org] 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 [wikipedia.org] 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
Re:Would most people be better off undiagnosed? (Score:5, Insightful)
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)
Re:Would most people be better off undiagnosed? (Score:5, Insightful)
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.
Re:Would most people be better off undiagnosed? (Score:3, Insightful)
The brain is not just chemical in nature. Many of the important properties of the brain come from the physical arrangement of neurons. If the neurons are connected in the wrong way, you can't fix that by bathing the entire brain in some chemical, so there are almost certainly problems that can occur in the brain that cannot be fixed by just administering a medication.
Replacement available (Score:4, Insightful)
Mental health is a large subject, let's take a smaller slice for discussion: depression.
Depression meds work no better than placebo [thedailybeast.com]. Depression meds have lots of unpleasant side-effects, so being treated for depression is - on average - worse than going undiagnosed.
Depression is a symptom of many diseases - at least 18 of them commonplace. Many cases of depression are the result of 1) underactive thyroid (40% by one accounting), 2) Low levels of vitamin D [mayoclinic.com], and 3) sleep apnea [wikipedia.org].
And yet, the symptom is treated as a disease in and of itself. Prescription meds which do more harm than good are commonly prescribed under the flimsiest of circumstances:
Patient: "doctor, I feel tired and run down"
Doctor: "It sounds like depression. Try this and see if it goes away".
After all is said and done, a casual reading of the research would suggest that the scientific method used in psychology research is crap. That's a strong statement, but not completely without merit.
Psychiatrists need to stop worrying about publishing the next trivial follow-on paper, and need to stop theorizing by making up stories. Get your evidence first, make theories to explain the evidence, and then throw out theories which have no testable predictions.
Go back to basics, and stop making money from giving people false hope through increased suffering.
(Grrr! A close friend got chewed up and spit out by the medical profession because of depression.)
Psych, Feynmann and Cargo Cults (Score:2, Insightful)
Stuff that isn't science that is sure it "knows" is prejudice. By pretending to be science such "stuff" gets to deprive you of you liberty in a court based on prejudice because you're a bit socially eccentric and someone else doesn't like that for "moral" reasons or whatever and wants to "straighten you out" whatever that means to them. Do you dress funny? Have sex? The wrong skin colour? These kinds of things...
Stuff that isn't science that pretends to be so usually results in evil of the worst, most uncivilised kind. It should always be called for what it is, ie unscientific. Psychology and psychiatry have a history of being right there in the middle of the absolute worst of it, in all our countries. If they want to be treated with any more respect than the utter garbage that is Scientology they need to prove each piece of research is actual science and, as a "discipline", publicly and loudly call out pseudo-science and bs-prejudice masquerading as something more. Starting with their own history ripping everything down that does not make the grade. They have earned themselves the right as a "discipline" to be treated with extreme suspicion.
Dick Feynman is popular around here and rightly so. His commencement address from 1974 on what he calls "Cargo Cult Science" one of the great speeches and worth 5 minutes of your time if you haven't happened to have encountered it yet.
http://neurotheory.columbia.edu/~ken/cargo_cult.html
"So I have just one wish for you--the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity."
What follows is not an argument from authority or even an argument at all, just some well phrased thoughts, you'll make up your own mind.
"Incidentally, psycho-analysis is not a science: it is at best a medical process, and perhaps even more like witch-doctoring. It has a theory as to what causes disease - lots of different "spirits" etc. The witch doctor has a theory that a disease like malaria is caused by a spirit which comes into the air ; it is not cured by shaking a snake over it, but quinine does help malaria. So, if you are sick, I would advise that you go to the witch doctor because he is the man in the tribe who knows the most about the disease; on the other hand his knowledge is not science. Psychoanalysis has not been checked carefully by experiment... " --Richard Feynamn, Six Easy Pieces
"It's a great game to look at the past, at an unscientific era, look at something there, and say have we got the same thing now, and where is it? So I would like to amuse myself with this game. First, we take witch doctors. The witch doctor says he knows how to cure. There are spirits inside which are trying to get out. ... Put a snakeskin on and take quinine from the bark of a tree. The quinine works. He doesn't know he's got the wrong theory of what happens. If I'm in the tribe and I'm sick, I go to the witch doctor. He knows more about it than anyone else. But I keep trying to tell him he doesn't know what he's doing and that someday when people investigate the thing freely and get free of all his complicated ideas they'll learn much better ways of doing it. Who are the witch doctors? Psychoanalysts and psychiatrists, of course."
Third lecture. David Goodstein reports that the entire Psychology department walked out in a huff at this point [7]. -- The Meaning of it All
Re:s/Psychiatrists/PSYCHOLOGISTS (Score:4, Insightful)
Um, he's absolutely correct. The British Psychological Society is the one making the statement. It's the first three words of the summary. The British Psychological Society is full of psychologists. Unlike the Royal Psychiatric Society, which has a lot of psychiatrists as members and is obviously a little peeved.
Re:Would most people be better off undiagnosed? (Score:3, Insightful)
The brain is clearly chemical in nature and at some point reductionist medication SHOULD point the way to detailed understanding and treatment.
[just an example below]
I have a problem with my Windows computer. Now and then Firefox crashes when I visit a certain site. Since the computer is clearly electrical in nature, I'm considering taking this here 120V AC wires and sticking them into various places on the motherboard. Random places, actually - because I have no idea how the motherboard works. Will that help with the problem?
Thinking aloud a bit more now. Will *any* electrical interference with operation of a CPU give me *any* hints how the software works?
Re:Replacement available (Score:5, Insightful)
"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.
Doctors and depression (Score:5, Insightful)
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.
Re:Replacement available (Score:4, Insightful)
My husband has suffered from severe chronic obstructive sleep aponea for a number of years. It initially presented as hallucinations, nightmares and mood swings - he was diagnosed as bi-polar and put on lithium. When that didn't help, in fact he got worse and start to have fits and seizures (both convulsive and vacant) he was diagnosed as epileptic and put on high doses of epilium which did nothing but cause him to massively gain weight due to the way it messed with his satiation triggers and he felt constantly hungry.
Unsurprisingly this led to severe depression.
Due to a serendipity we ended up seeing a different specialist because his regular doctor was off sick which led to him getting a real diagnosis, effective treatment (firstly a CPAP machine and more recently surgery to open up the airways further) and for the first time in years he is feeling better and is nearly off all the medication.
Ironically I just had my thyroid out due to thyroid cancer and am on heavy doses of Vitamin D.
We're generally a happier household than the previous paragraphs would suggest.
Re:Would most people be better off undiagnosed? (Score:5, Insightful)
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.