Psychiatry must stop misleading people about the nature of mental illness

As I've said many times (see eg. last post), psychiatry must stop misleading people about the nature of mental illness. It wants to hold on to the possibility that primary mental illness is caused by the brain but the reality is that the vast majority of presentations to mental health services are not caused by the brain. 

Psychiatry likes to make out that it takes psychosocial as well as biological factors in mental illness into account. It is true that the degree to which individual practitioners do varies. But too often, the message heard by patients is that there is something wrong with their brain. After all, why are psychiatrists so keen to prescribe medication if they don't think that mental health problems are caused by brain dysfunction which needs correcting by the medication?

Of course brain dysfunction can lead to organic mental illness, such as dementia and delirium. These conditions can generally be separated in clinical assessment from the bulk of functional psychiatric presentations because of symptoms of cognitive impairment, such as disorientation in time and place. But misleading people that their functional mental health problems are due to brain dysfunction can have consequences for people's understanding of themselves. Taking psychiatric medication can be identity altering, for example making people feel different or damaged and reliant on medical expertise. Psychiatry must be clear with people with primary mental health problems that they are not biologically flawed.

Movement against overpsychiatrisation

The Mental Health and Overmedicalization Summit organised by the Make America Healthy Again (MAHA) Institute was livestreamed (see youtube video) and led to the launch of the MAHA Action Plan to Curb Psychiatric Overprescribing (see press release). The Summit was supported by Inner Compass, founded by Laura Delano, author of the book Unshrunk: How the mental health industry took over my life - and my fight to get it back. Look at least at the first part of the livestream for the personal testimonies of several young people, like Laura, who feel they were 'psychiatrised' as children. 

As I've said several times (see eg. previous post), when I first started in psychiatry, medication was rarely used in children and adolescents (see also my Lancet Neurology book review). Historically, child and family studies tended to take a more holistic approach to personal and social problems (see eg. my article), but have become increasingly biologised over recent years (see eg. another previous post). Calls to review the use of medication for behavioural problems in children have gone unheeded (see eg. yet another previous post). This has meant that there are now young people who have grown up feeling that their identities have been taken over by being prescribed psychiatric medication from a young age.

Daniel Bergner, author of The mind and the moon: My brother's story, the science of our brains, and the search for our psyches, has an article about the Summit in The New York Times Magazine entitled 'The strange alliance trying to remake American psychiatry'. By this he means that although Inner Compass may not seem like a natural Trump ally, it is supportive of Robert F Kennedy Jnr, as Secretary of the Department of Health and Human Services, in his attempt to curb psychiatric prescribing (see podcast interview of Laura Delano by Kennedy). As I said in a previous post, "Maybe only the politicians can effectively counter ... [the] institutional bias [of psychiatry]".

Psychiatry needs to stop misleading people. including children, about the nature of mental illness. The vast majority of presentations to psychiatric services, certainly child and adolescent services, are not due to a brain disorder. This is not what people always hear because psychiatry wants to fudge the issue, even remains hopeful that an underlying physical cause may be found. It's merely tautologous to say that the brain mediates our thoughts, feelings and behaviour. That doesn't mean they are caused by the brain and psychiatry needs to be explicit about this for a new generation.

Psychiatrists are not very good at recognising how psychologically dependent they have made people on medication

As I've said before (see eg. previous post), psychiatrists have made too many people dependent on psychiatric medication. Relying on the placebo effect can have consequences (see eg. another previous post). We might like to think that psychiatric medications can solve our personal problems. We may be suspicious initially of such claims, but if psychiatrists believe them, maybe they need to be taken seriously. After all, psychiatrists have set themselves up as experts in solving such personal problems.

As I’ve also said in yet another previous post, psychiatrists rarely think about the impact of medication on other than brain chemicals. Any initial reluctance to take medication may be overcome by feeling so desperately ill that taking medication seems a viable option, maybe thinking there is no alternative, or that it’s worth seeing if it works, especially if there do not seem to be very good alternatives. Once people have given medication a trial, they may even think it has caused an improvement, when that apparent improvement is really more due to chance or the passage of time or merely to the belief and hope of improvement. 

Over time, people may come to some sort of mental equilibrium taking medication. There may be uncertainty about how much that equilibrium is being maintained by the medication, but rather than upset any apparent balance, it may be easier just to continue taking it. Trouble is that taking medication may also leave a sense that personal problems have not really been solved, maybe because the focus has seemed to have been on treating them as a brain problem.

The problem I want to highlight is that the dynamic of taking medication may create a dependency. People can come to rely on psychiatric medication because of the fear, at least, of not being able to manage without it. Withdrawal symptoms are very common and, if experienced, may well be interpreted as physical dependence caused by the medication. Such withdrawal symptoms may even occur some time after stopping. In fact, people may initially seem to feel better after discontinuing medication, maybe relieved that they can manage without it. But over time such benefits may be lost with the need to restart medication. People can be left in a vicious cycle of wanting to discontinue medication but feeling compelled to continue (see eg. previous post). 

Psychiatric medication may therefore be started because it seemed to be the only option available; can easily become associated with the sense of being biologically flawed, if only because of such myths as chemical imbalance; leave people feeling they haven’t really returned to their true self and that their real problems have been masked; and compelled to take medication when they no longer want to (see eg. another previous post). Such dynamics of taking psychotropic medication do need to be taken seriously and into account by doctors.