Tuesday, April 26, 2022
Towards a psychiatry fit for purpose
Monday, April 25, 2022
Blaming chemical imbalance in the brain for depression does not make sense
The article therefore confirms that the serotonin theory has been endorsed by the professional and academic community. Psychiatrists need to take responsibility for promoting the theory (see previous post). Psychiatry has always held out the hope that it will find the answer to mental illness but it needs to accept its limitations (see eg. another previous post). Although it may seem to make sense to us that we should be able to find a biological cause for mental illness, such as chemical imbalance in the brain, that doesn't justify wish-fulfilling unproven phantasies and even their publication in the academic literature (see yet another previous post). In fact, it's people that become depressed, not their brains, whether chemically imbalanced or not (see previous post).
Sunday, April 24, 2022
Doctors have made too many people dependent on antidepressants
Although NICE admits that there is considerable debate about the definitions of dependence and addiction, it clearly states that antidepressants cause withdrawal symptoms even though they have not historically been classified as dependence-forming medicines. It sees dependence as characterised by tolerance and withdrawal symptoms. Addiction is said to include the additional characteristics of cravings, lack of control, overuse and continued use despite harm, associated with problematic behaviours.
Dependence and addiction in common parlance tend to mean difficulty in managing without the drug (see my webpage). An effort may be required to do without the drug. It is a psychological state, although it can also be physical. The drug may need to be continued or withdrawal symptoms may occur in its absence.
Regular and frequent use of some substances, such as alcohol and opiates, can cause tolerance, so that people experience withdrawal symptoms in the absence of the drug. This is what is meant by physical dependence. Dependence on antidepressants, and more generally, is not just physical (see previous post).
People are being indoctrinated into believing they need antidepressants (see eg. previous post). No wonder they may have difficulty in stopping them. Doctors need to take responsibility for making so many patients dependent on antidepressants.
The mereological fallacy in psychiatry
Psychiatric critique needs to challenge the common mistake in psychiatry that it is the brain that perceives, thinks, feels and intends to do things. Such reasoning doesn’t make sense. Psychiatry treats people living in relationships, not their brains.
Saturday, April 02, 2022
More on taking psychiatric critique seriously
Psychiatry is the science and practice of biological, psychological and social relationships of people and their disorders. Despite what Pariante says, this is not a dualist position (see eg. previous post). A correctly understood biological psychiatry requires an adequate concept of biology, namely that of life bound to the entire organism and its interaction with the environment (see eg. previous post). Psychiatry's primary object, despite Pariante again, is not the brain but the person living in relationships. This fundamental failure to appreciate this philosophical reality is damaging psychiatry.
Pariante, therefore, does not realise that it is not possible in principle to reduce mental illness to brain disease (see previous post). He believes what he calls "the humongous evidence that there are neurochemical abnormalities in people with depression" must be true. But he neglects to say that such evidence is plagued by so many confounders and inconsistencies that it's not possible to say what the biological causes, as such, of depression are. He doesn't say what they are because he can't.
As I said in my last post, biomedical psychiatry needs to take seriously its critique. Pariante has a long way to go to do that.
Friday, April 01, 2022
Taking psychiatric critique seriously
Aftab et al clearly find it difficult to give up hypotheses of antidepressants (and presumably ECT) correcting biological dysfunction, speculating that antidepressants may enhance synaptic neuroplasticity. They do not seem to fully appreciate that enactive accounts of psychiatry, such as that by Sanneke de Haan (see previous post), provide a philosophical and conceptual critique of naturalistic-reductive approaches to human understanding by focusing on the person as embodied and alive (see eg. another previous post). Aftab et al’s view is what Manschrek & Kleinman (1977) called semi-critical as it doesn’t follow through sufficiently on its critique of the biomedical model (see eg. my article). As I have been arguing throughout this blog, psychiatry needs to move on from its eclectic biopsychosocial view (eg. see previous post and another and yet another) and return to Engel’s original concept of the biopsychopsychosocial model, which was a critique of reductionism in psychiatry and medicine in general (see eg. another previous post). Critical/relational psychiatry is explicitly anti-reductionist and anti-positivist whereas Aftab et al are not. Their approach to psychiatry is still not sufficiently person-centred.