Square Pegs into Round Holes—Psychiatry’s Pursuit of Medical Status

https://grantcoulson.files.wordpress.com/2014/04/incentiveseverywherepicturecorrect1.jpg?w=444&h=288

    Do not think about, write about or deal with  human behavior without determining the effects of incentives. It’s not their money, of course they’ll waste it.

   Psychiatry needs to be a science so it must find biological markers of disease. This means that “mental illness” must be a disease and there must be markers which can be found by the same kinds of diagnostic techniques using microscopes, centrifuges and other paraphernalia of science. This hasn’t worked so far, but efforts continue with taxpayer’s money.

A Response to the Hyper-focus on Brain-based Research and “Disease”
By Noel Hunter & William Schultz
Featured Blogs August 20, 2015

The past several years have born exciting developments for those critical of the current psychiatric paradigm. We have witnessed outright criticism of the DSM by prominent psychiatrists (i.e., Thomas Insel, Allen Frances) while others have admitted that no “biological markers” exist for any DSM-defined disorder (Kupfer, 2013). Amazingly, however, the suggested response to these problems is to continue pursuing the search for the biological underpinnings of so-called “mental illness” through an almost evangelical hyper-focus on brain research. In other words, the leaders of mental health are essentially saying “We have spent 100 years diligently categorizing all the ways that people may suffer emotionally, searched for genetic, brain, and chemical abnormalities, and developed hundreds of drugs to target these ‘diseases’, yet we are no better off than we were 100 years ago. So, we have decided to double-down and spend more money and dedicate more intense efforts at doing the exact same thing in the future”.

This response is problematic for so many reasons. The International Society for Ethical Psychology & Psychiatry (an organization whose mission is to educate the public about the “de-humanizing and coercive aspects of many forms of mental health treatment, and the alternative humane ways of helping people who struggle with very difficult life issues”) has issued a publicly available paper scientifically challenging these efforts and suggesting ways in which our finite resources may be more effectively directed. The paper is available for download here.

http://psychintegrity.org/wp-content/uploads/2015/08/White-Paper-Brain-Scan-Research.pdf

We begin this paper by discussing the controversies surrounding the DSM diagnostic system and the current efforts being made to increase our understanding of the brain. Notably, $100 million has been committed to the BRAIN initiative in the United States, largely funded by pharmaceutical companies and organizations that design brain scanning technologies. Other countries are developing similar initiatives. Clearly, there is a high level of financial and corporate interest in pursuing these efforts.

Not all is corrupt, for there are many reasons that the government and its citizens, more specifically, are interested in supporting these efforts. For instance, many believe that extreme behaviors can be better understood if we know what is occurring in the brain, stigma may be reduced if we see that there is a “real” disease process occurring, or that tax-payer and private money is being spent effectively. While many of these reasons may be logical and well-intentioned, biologically reductive “mental illness” research is likely (or “very likely” or “almost certainly”) to fail because it is based on erroneous assumptions. These erroneous assumptions are contradicted by robust research findings. While there are certainly brain correlates with various traumatic and stressful environmental circumstances, these do not insinuate disease nor can they be separated from the environment in which they developed. Additionally, many current brain-based research studies have shown the powerful effects of psychotherapy, meditation, dietary changes, and other non-pharmaceutical or biological interventions.

While brain research is certainly interesting as an academic exercise, and may, in fact, provide us with some interesting ideas for effective interventions, the consequences of the search for “disease” in the brain cannot be ignored. These include: skewed research funding, biased treatment preferences, and clinically harmful assumptions and prejudices. Though brain-based initiatives for understanding human behavior should have its place, limited funds need to be redistributed in line with current research findings. Poverty, trauma, child abuse and neglect, discrimination, loneliness, bullying, drug use, and inequality are directly associated with such conditions, and are also correlated with certain kinds of observable changes within our brains. Psychosocial support that directly addresses these issues has been consistently associated with long-term benefits superior to those of biological interventions. We need to acknowledge that the resources available for mental health research and care are limited, and that every dollar and person-hour spent pursuing brain-based solutions to psychological distress comes at a direct cost to those resources available for psychosocial research and support.

We conclude with the following:

"One final important component of such a system that needs to be mentioned is that of prevention—identifying and eliminating the seeds of potential psychological distress. Considering that factors such as poverty, inequality, family disharmony, and various forms of social discrimination lie right at the root of so much of those distressing conditions that are called “mental illness,” this forces us to acknowledge that if we really want to address “mental illness,” then we really need to work together as a society and explore how we can address these broader social problems. This is no easy task, for sure, but if we honestly want to ask the question, “What causes ‘mental illness’ and how do we best ‘treat’ it,” then we need to be willing to look honestly at the research and accept the answers that emerge."

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   Our efforts are failing so this is a clear signal that we must redouble them. If psychiatric illnesses are not like others how can they be treated with drugs? They must be. They just must be illnesses like all others. Otherwise what good are we?

Government Job or Respect–Which’ll It Be?
Cheerio and ttfn,
Grant Coulson, Ph.D.
Author, “Days of Songs and Mirrors: A Jacobite in the ‘45.
Cui Bono–Cherchez les Contingencies

 

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