Tuesday, May 14, 2013

Spin of a very high order

I found Phil Hickey’s blog Behaviorism and Mental Health via a link from Mad in America. There’s plenty there I disagree with, but also some good posts. I especially enjoyed “The Empire Strikes Back: APA Responds to NIMH,” which describes Kupfer’s statement as “spin of a very high order.” I was amused at how closely it resembled my own Spin-to-English translation.

From my post:
We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.
We haven’t actually been telling people this at all. We and our friends at the pharmaceutical corporations have been leading people to believe for decades that our diagnoses reflected brain disorders for which we had scientific evidence. The chemical imbalance myth? Ours. And we’ve grown rich and powerful in the process. Where would we be if we’d been open all along about how unscientific our diagnoses are?
From Hickey’s:
“We’ve been telling patients for several decades that we are waiting for biomarkers.”
I suggest that this is simply not the case. Psychiatrists have been telling their ‘patients’ for decades that they have chemical imbalances in their brains, that the chemicals involved are known, that the pills correct these imbalances, and that the pills are safe. All of these statements are patently false and extremely destructive. I have never heard (or even heard of) a psychiatrist who said to his [sic] ‘patients’ or to anyone else that “we are waiting for biomarkers.” The entire house of cards has been built on the illusion of scientific certainty, which the psychiatric profession promoted shamelessly.
He also links in another post to the full text of an article by Brett Deacon (University of Wyoming) in - it appears - the April issue of Clinical Psychology Review: “The Biomedical Model of Mental Disorder: A Critical Analysis of its Tenets, Consequences, and Effects on Psychotherapy Research.” I thought the extended discussion of nondrug treatments and research was extraneous, but it provides a fairly thorough yet still concise description of the problems with biopsychiatry.

Of most interest for this post are the two tables it features with quotations from people in the same organizations, and often the same people, claiming at one moment that the model is scientifically valid and admitting at another that it’s not (and that they never really believed it at all). (This reached the height of bad faith in the exchange following Marcia Angell’s two posts in the New York Review of Books, in which two of Angell’s detractors accused her of attacking a straw man by criticizing the chemical imbalance idea while their colleague reproduced it on the same page.)

But the concluding section of Deacon’s article is worth quoting:
…[I]n light of the evidence reviewed in this article, we cannot afford the societal costs of failing to engage in open and honest discussion about the validity and utility of the biomedical paradigm. The predominant approach to mental healthcare in the United States has produced neither clinical innovation nor improved outcomes, and is founded upon tenets that are acknowledged as scientifically premature or even fallacious by some of the very individuals and organizations who promote them…. The quality of care provided to individuals with mental health problems, the societal burden of mental disorder, and the credibility of professionals who treat patients with mental disorders will remain at risk until an honest and public dialogue occurs in response to questions that include, but are not limited to, the following:

• How can mental disorders be considered biologically-based brain diseases, or valid medical conditions, when researchers have not identified any biological variable capable of reliably diagnosing any mental disorder, distinguishing between individuals with or without a mental disorder, or distinguishing different mental disorders from each other?

• How can mental disorders be caused by a chemical imbalance in the brain when scientists lack a baseline standard of what constitutes a chemical balance with which to discern an imbalance, and do not possess a direct measure of neurotransmitter levels in the brain that possesses diagnostic validity or clinical utility?

• Given the historical lack of scientific evidence for the chemical imbalance theory of mental disorder, why have biomedical advocates promoted this story? Why have the APA, NIMH, and NAMI (among others, see Table 1) failed to publicly acknowledge that this story is unfounded? What have been the historical consequences of these actions? How have these actions been influenced by these organizations’ involvement with the pharmaceutical industry?

• If decades of biomedical research have not resulted in the development of clinically useful biological tests, innovative psychotropic medications, or improved mental health outcomes, should billions of dollars of taxpayer money continue to be preferentially allocated to biomedical research? Should zealous advocates of the biomedical model continue to head governmental agencies that determine national research and policy agendas?

• If psychotropic medications are safe and effective, why has the rate of mental health disability risen in close temporal association with their increasing use? Shouldn’t the widespread use of safe and effective psychotropic medications lead to less severe, chronic, and disabling mental disorders, as opposed to the opposite?

• If attributing mental disorder to biologically-based brain disease reduces mental health stigma, why has stigma not improved in the context of widespread promotion and increased public acceptance of the biomedical model?

• If the biomedical model of mental disorder is less valid and psychotropic medications are less effective than is commonly acknowledged, what are the implications for the unique legal authority granted to psychiatrists to involuntarily hospitalize and forcibly treat individuals with mental disorders?

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