The biopsychiatry controversy
is the dispute over the scientific basis of biological psychiatry
theory and practice. The debate is focused on criticism of biological psychiatric thinking
from social critics, including the Antipsychiatry
movement and Scientologists
, and a small minority of academics. A recovery model
has in many countries become a substantial portion of the mental health treatment.
Overview of opposition to biopsychiatry
After a century of medical
progress different specialties of medicine
have developed therapeutic practices that have made illnesses more treatable and eradicable. Biological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial somatic measures.
Clinical professor of psychiatry, Alvin Pam, describes this as a "stilted, unidimensional, and mechanistic world-view" and subsequently "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. 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 gene
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, Jay Joseph and others 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 imbalance
hypothesis states that a chemical imbalance within the brain is the main cause of a 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, though no other demonstrably superior hypothesis has emerged. While the hypothesis has been shown to be simplistic and lacking, 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.
Economic influences on psychiatric practice
In a time of economic constraint, a "pill and an appointment" has dominated treatment.|20px|20px|APA president Steven S. Sharfstein|Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly
American Psychiatric Association
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, but that they are too often misaligned, and that "[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 model 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 contraints; 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."
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, on patients.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.
Criticisms from psychologists & the medical profession
- Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly, American Psychiatric Association 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 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.
- 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).