Biopsychiatry controversy
Encyclopedia
The biopsychiatry controversy is a dispute over which viewpoint should predominate and form the scientific basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view
of psychiatric thinking
. Its critics including disparate groups such as the antipsychiatry movement and some academics. A recovery model
has in many countries become a substantial portion of the mental health treatment.
This has been criticized by Alvin Pam for being a "stilted, unidimensional, and mechanistic world-view", so that subsequent "research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance". According to Pam the "blame the body" approach, which typically offers medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances.
that encodes phosphodiesterase
4B (PDE4B) is disrupted by a balanced translocation
.
The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways, for example by personality, temperament or life events. Therefore while twin studies and other research suggests that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is "at least as hard as the search for genes involved in other complex disorders." Theodore Lidz
and The Gene Illusion. argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies.
hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric conditions and that these conditions can be improved with medication which corrects this imbalance. In this hypothesis, emotions within a "normal" spectrum reflect a proper balance of neurochemicals, but abnormally extreme emotions, such as clinical depression
, reflect an imbalance. This conceptual framework has been challenged within the scientific community, although no other demonstrably superior hypothesis has emerged. While the hypothesis has been shown to be simplistic and lacking (especially regarding psychotropic drugs with novel mechanisms such as tianeptine
), there is sufficient evidence to consider it as a useful heuristic in the aiding of our understanding of brain chemistry and explaining pharmacotherapy.
On the other hand, Elliot Valenstein
, a psychologist, neuroscientist and prominent critic of biopsychiatry, states that the broad biochemical assertions and assumptions of mainstream psychiatry are not supported by evidence.
paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism's efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the very last atom, however this does not reveal the program that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of openness to self-criticism and therefore halts the very engine of scientific progress.
He has proposed his own natural dualist
model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers
and Alan Turing
and does not fall into the dualist's trap of spiritualism
.
president Steven S. Sharfstein has stated that when the profit motive of pharmaceutical companies and human good are aligned, that the results are mutually beneficial and that "Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists." However, too often "[t]he practice of psychiatry and the pharmaceutical industry have different goals and abide by different ethics." He states a number of concerns exascerbating this situation which he suggests require remedying, including:
Nevertheless, Sharfstein concluded that "[a]s psychiatrists, we should all be grateful for the modern pharmacopia and the promise of even more improvements in the future."
Economic motives are not necessarily limited to pharmaceutical treatments; those providing other forms of treatment may also have economic motives.
Antidepressants have been shown to have only a minimal effect, over that of a placebo
, on patients. In an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the six most widely prescribed antidepressants approved between 1987 and 1999, it was found that In an essay on advertisements for anti-depressants published in PLoS Medicine
, social work
academic Jeffrey Lacasse and neuroanatomist
Jonathan Leo state that, despite this, the chemical imbalance theory is promoted by the medical industry as an explanation to depression and that their medicines correct the chemical imbalance. They also state that there is some evidence that both patients and professionals are influenced by the advertisements and patients may get prescribed medicines when other interventions are more suitable.
In a further article they state that chemical imbalance has also been cited in media as an important cause of depression despite a lack of scientific literature that shows this causality.
Biological psychiatry
Biological psychiatry, or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and...
of psychiatric thinking
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
. Its critics including disparate groups such as the antipsychiatry movement and some academics. A recovery model
Recovery model
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
has in many countries become a substantial portion of the mental health treatment.
Overview of opposition to biopsychiatry
Over centuries of progress medical science has developed a variety of therapeutic practices that have made many illnesses more treatable or even fully eradicable. Biological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial measures of a primarily somatic nature.This has been criticized by Alvin Pam for being a "stilted, unidimensional, and mechanistic world-view", so that subsequent "research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance". According to Pam the "blame the body" approach, which typically offers medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances.
Current status in biopsychiatric research
Biopsychiatric research has produced reproducible abnormalities of brain structure and function, and a strong genetic component for a number of psychiatric disorders (although the latter has never been shown to be causative, merely correlative). It has also elucidated some of the mechanisms of action of medications that are effective in treating some of these disorders. Still, by their own admission, this research has not progressed to the stage that they can identify clear biomarkers of these disorders.Focus on genetic factors
Researchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of dimensions of genetic risk and reports show significant associations between specific genomic regions and psychiatric disorders. Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions. For example, one reported finding suggests that in persons diagnosed as schizophrenic as well as in their relatives with chronic psychiatric illnesses, the geneGene
A gene is a molecular unit of heredity of a living organism. It is a name given to some stretches of DNA and RNA that code for a type of protein or for an RNA chain that has a function in the organism. Living beings depend on genes, as they specify all proteins and functional RNA chains...
that encodes phosphodiesterase
Phosphodiesterase
A phosphodiesterase is any enzyme that breaks a phosphodiester bond. Usually, people speaking of phosphodiesterase are referring to cyclic nucleotide phosphodiesterases, which have great clinical significance and are described below...
4B (PDE4B) is disrupted by a balanced translocation
Chromosomal translocation
In genetics, a chromosome translocation is a chromosome abnormality caused by rearrangement of parts between nonhomologous chromosomes. A gene fusion may be created when the translocation joins two otherwise separated genes, the occurrence of which is common in cancer. It is detected on...
.
The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways, for example by personality, temperament or life events. Therefore while twin studies and other research suggests that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is "at least as hard as the search for genes involved in other complex disorders." Theodore Lidz
Theodore Lidz
Theodore Lidz was an American psychiatrist best known for his articles and books on the causes of schizophrenia and on psychotherapy with schizophrenic patients...
and The Gene Illusion. argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies.
Focus on biochemical factors
The chemical imbalanceChemical imbalance
Chemical imbalance is one hypothesis about the cause of mental illness. Other causes that are debated include psychological and social causes....
hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric conditions and that these conditions can be improved with medication which corrects this imbalance. In this hypothesis, emotions within a "normal" spectrum reflect a proper balance of neurochemicals, but abnormally extreme emotions, such as clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, reflect an imbalance. This conceptual framework has been challenged within the scientific community, although no other demonstrably superior hypothesis has emerged. While the hypothesis has been shown to be simplistic and lacking (especially regarding psychotropic drugs with novel mechanisms such as tianeptine
Tianeptine
Tianeptine was discovered by The French Society of Medical Research in the 1960s. Under the trade-names it is a drug used for treating major depressive episodes ....
), there is sufficient evidence to consider it as a useful heuristic in the aiding of our understanding of brain chemistry and explaining pharmacotherapy.
On the other hand, Elliot Valenstein
Elliot Valenstein
Elliot S. Valenstein, PhD, is a professor emeritus of psychology and neuroscience at the University of Michigan. His theories challenge the conventional assumption that mental illness is biochemical, rejecting the 'chemical imbalance' theories used by drug companies in marketing their products,...
, a psychologist, neuroscientist and prominent critic of biopsychiatry, states that the broad biochemical assertions and assumptions of mainstream psychiatry are not supported by evidence.
Reductionism
Niall McLaren emphasizes in his books Humanizing Madness and Humanizing Psychiatry that the major problem with psychiatry is that it lacks a unified model of the mind and has become entrapped in a biological reductionistReductionism
Reductionism can mean either an approach to understanding the nature of complex things by reducing them to the interactions of their parts, or to simpler or more fundamental things or a philosophical position that a complex system is nothing but the sum of its parts, and that an account of it can...
paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism's efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the very last atom, however this does not reveal the program that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of openness to self-criticism and therefore halts the very engine of scientific progress.
He has proposed his own natural dualist
Dualism
Dualism denotes a state of two parts. The term 'dualism' was originally coined to denote co-eternal binary opposition, a meaning that is preserved in metaphysical and philosophical duality discourse but has been diluted in general or common usages. Dualism can refer to moral dualism, Dualism (from...
model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers
David Chalmers
David John Chalmers is an Australian philosopher specializing in the area of philosophy of mind and philosophy of language, whose recent work concerns verbal disputes. He is Professor of Philosophy and Director of the Centre for Consciousness at the Australian National University...
and Alan Turing
Alan Turing
Alan Mathison Turing, OBE, FRS , was an English mathematician, logician, cryptanalyst, and computer scientist. He was highly influential in the development of computer science, providing a formalisation of the concepts of "algorithm" and "computation" with the Turing machine, which played a...
and does not fall into the dualist's trap of spiritualism
Spiritualism
Spiritualism is a belief system or religion, postulating the belief that spirits of the dead residing in the spirit world have both the ability and the inclination to communicate with the living...
.
Economic influences on psychiatric practice
American Psychiatric AssociationAmerican Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
president Steven S. Sharfstein has stated that when the profit motive of pharmaceutical companies and human good are aligned, that the results are mutually beneficial and that "Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists." However, too often "[t]he practice of psychiatry and the pharmaceutical industry have different goals and abide by different ethics." He states a number of concerns exascerbating this situation which he suggests require remedying, including:
- that the psychiatric profession has allowed the biopsychosocial modelBiopsychosocial modelThe biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...
to become entirely dominated by biological factors; - a "broken health care system" that allows "many patients [to be] prescribed the wrong drugs or drugs they don't need";
- "medical education opportunities sponsored by pharmaceutical companies [that] are often biased toward one product or another";
- "[d]irect marketing to consumers [that] also leads to increased demand for medications and inflates expectations about the benefits of medications";
- drug company gifts to doctors, that have become sufficiently problematical as to warrant legislative constraints; and
- "drug companies [paying] physicians to allow company reps to sit in on patient sessions allegedly to learn more about care for patients and then advise the doctor on appropriate prescribing."
Nevertheless, Sharfstein concluded that "[a]s psychiatrists, we should all be grateful for the modern pharmacopia and the promise of even more improvements in the future."
Economic motives are not necessarily limited to pharmaceutical treatments; those providing other forms of treatment may also have economic motives.
Pharmaceutical industry influence on the psychiatric profession
Studies have shown that medical students and residents are susceptible to undue influence from pharmaceutical companies due to the companies involvement in medical school programs.Antidepressants have been shown to have only a minimal effect, over that of a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
, on patients. In an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the six most widely prescribed antidepressants approved between 1987 and 1999, it was found that In an essay on advertisements for anti-depressants published in PLoS Medicine
PLoS Medicine
PLoS Medicine is a peer-reviewed medical journal covering the full spectrum of the medical sciences. It began operation on October 19, 2004. It was the second journal of the Public Library of Science , a non-profit open-access publisher. All content in PLoS Medicine is published under the Creative...
, social work
Social work
Social Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
academic Jeffrey Lacasse and neuroanatomist
Neuroanatomy
Neuroanatomy is the study of the anatomy and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defined nervous systems, and thus we can begin to speak of...
Jonathan Leo state that, despite this, the chemical imbalance theory is promoted by the medical industry as an explanation to depression and that their medicines correct the chemical imbalance. They also state that there is some evidence that both patients and professionals are influenced by the advertisements and patients may get prescribed medicines when other interventions are more suitable.
In a further article they state that chemical imbalance has also been cited in media as an important cause of depression despite a lack of scientific literature that shows this causality.
General
- Anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
- A movement critiquing psychiatry from the human rights perspective. - Bipolar disorders researchBipolar disorders research-Heritability or inheritance of the illness:More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a genetic component. Studies seeking to identify the genetic basis of bipolar...
- biopsychiatric analysis into the cause of bipolar disorders. - Elliott Valenstein - a psychologist and neuroscientist, author of Blaming the Brain.
- The Gene IllusionThe Gene IllusionThe Gene Illusion is a book by clinical psychologist Jay Joseph, published in 2003, which challenges the evidence underlying genetic theories in psychiatry and psychology. Focusing primarily on twin and adoption studies, he attempts to debunk the methodologies used to establish genetic...
- a book by clinical psychologist Jay Joseph. - Causes of schizophreniaCauses of schizophreniaThe causes of schizophrenia have been the subject of much debate, with various factors proposed and discounted or modified. The language of schizophrenia research under the medical model is scientific...
- Controversy about ADHDControversy about ADHDThe causes, diagnosis, and the treatment of attention-deficit hyperactivity disorder have been the subject of active debate at least since the 1970s. For various reasons, ADHD remains one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis...
- A Brief History of Anxiety (Yours & Mine)A Brief History of Anxiety (Yours & Mine)A Brief History of Anxiety is a 2008 nonfiction book by Canadian journalist and author Patricia Pearson...
, a book by journalist Patricia PearsonPatricia PearsonPatricia Pearson is a Canadian writer and journalist. She's published three non-fiction books and two novels.-Life and work:...
Groups critical of the biomedical paradigm
- Mindfreedom - A group which advocates for "choice" regarding psychopharmaceuticals.
- ICSPP (International Center for the Study of Psychiatry and Psychology)
- isps (International Society for the Psychological Treatment of the Schizophrenias and other Psychoses)
Criticisms from psychologists & the medical profession
- Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly, American Psychiatric AssociationAmerican Psychiatric AssociationThe American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
president Steven S. Sharfstein - Against Biologic Psychiatry - an article by David Kaiser, M.D., in Psychiatric Times (1996, Vol. XIII, Issue 12).
- Challenging the Therapeutic State - special issue of The Journal of Mind and Behavior (1990, Vol.11:3).
- Letter of Resignation from the American Psychiatric Association - from Loren R. Mosher, M.D., former Chief of Schizophrenia Studies at the National Institute of Mental HealthNational Institute of Mental HealthThe National Institute of Mental Health is one of 27 institutes and centers that make up the National Institutes of Health...
. - Memorandum from the Critical Psychiatry Network to the United Kingdom Parliament - Written evidence to the House of Commons Select Committee on Health, April 2005.
Methodological issues
- On the Limits of Localization of Cognitive Processes in the Brain - an essay by William R. Uttal, Professor Emeritus of Psychology at the University of Michigan, based on his book The New Phrenology (MIT Press, 2001).