Psychiatry is doomed to conflict about the value of psychiatric medication

Doctors have always exaggerated the advantages of medication. But medication, including recreational drugs, can’t just be eliminated. There are plenty of people that say that psychiatric medication has helped, despite its disadvantages (see eg. previous post). This experience cannot be denied, even if it is due to the placebo effect. Mainstream psychiatry will never accept that psychiatric medication is not effective.

What is more important is that people are being misled about the nature of mental health problems (see eg. previous post). People are more than their brains. Of course brain abnormalities can produce mental health problems, such as dementia and delirium. But most mental health problems are not due to brain abnormalities.  People are limited by their bodies, true. But it’s their social experiences that determine how mental health problems present. This may be because of their past or present experiences. It’s important to try and understand why people have mental health problems because of their experiences, even if the causes can’t be proven as such. Trouble is that people are looking for definitive answers, which is why they latch on the idea that mental health problems may be due to their brain. 

Psychiatry will continue to take advantage of people, including prescribing them medication. But it needs to change to be more focussed on people rather than its own prestige and financial interests (see eg. previous post). 

Sticking to the argument about whether antidepressants work

I worry that the clash between Joanna Moncrieff and Awais Aftab about her new book Chemically imbalanced has become too personal (see eg. last post). For example, Awais’ recent blog post criticises Jo for her methods rather than necessarily actually what she says. In many ways, how Jo expresses her critique is irrelevant. What matters is the content of what she says.

Awais Aftab wants to see integrative and critical pluralism as a variant of critical psychiatry (see previous post). But he’s only semi-critical and does not follow through properly on his critique. And he believes antidepressants and other psychotropic medications work, whereas critical psychiatrists such as Jo, are more sceptical, if not convinced of their non-effectiveness, which Jo has been brave enough to say.

As we saw with the Simon Wessely debate with Jo on the This morning TV programme (see clip), mainstream psychiatry will not allow Jo to say that antidepressants do not work. I have always been cautious about making such a definitive statement, even if expressing to people, including my patients, my belief that it may well be true. I’m not sure how to prove the so-called placebo amplification hypothesis even if I agree with Jo that there is considerable evidence in its favour (see eg. previous post).

Indoctrinating people into taking antidepressants

People are being misled about the nature of mental illness. Of course brain abnormalities can cause organic mental illness, such as delirium or dementia. But most presentations of mental health problems are not caused by brain abnormalities. 

Using depression as an example, people have been encouraged to see depression as a chemical imbalance in the brain. Because SSRI antidepressants are said specifically to block reuptake of serotonin from the synaptic cleft between neurones, it has been suggested that they must be correcting a serotonin deficiency in the brain. Although doctors may have realised that such an explanation of the effect of antidepressants is at least an oversimplification, they have allowed the general public to go along with the idea. In fact people have often believed the chemical imbalance theory to be proven. They have accepted, even been told, this myth to provide a reason for needing to take their antidepressants. Hence the controversy created by Joanna Moncrieff’s recent book Chemically imbalanced: The making and unmaking of the serotonin myth (see eg. previous post and Jo’s response). 

More generally, depression tends to be seen as a brain disease. Of course people recognise that personal and social factors may also be important, but still the brain causation of depression tends to predominate as an aetiological factor. This is a fundamental misindoctrination of people that their brains determine what they think, feel and do. Of course the brain is needed for human functioning, as is the whole body, but people are more than their brains. It is a mistake to blame the brain for depression as much as it is for what we think, feel and do in general. We are not teaching our children a proper understanding of themselves (see eg. previous post). No wonder the demand for children’s mental health services, and mental health services in general, is out of control (see eg. another previous post).