Brain-Disabling Treatments in Psychiatry:

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Brain-Disabling Treatments in Psychiatry:

Drugs, Electroshock, and the Role of the FDA

by Peter R. Breggin, M.D.

Springer Publishing Company (1997)

Reprinted with permission of Springer Publishing Company & Dr. Peter Breggin,

M.D.

 

Chapter 1: The Brain-Disabling Principles of Psychiatric Treatment

The last decade has seen escalating reliance upon psychiatric drugs, not

only within psychiatry, but throughout medicine, mental health, and even

education. Nearly every patient who is psychiatrically hospitalized is

encouraged or forced to take medications. There is a movement within psychiatry

to make it easier to force clinic outpatients to take long-acting injections of

drugs. In private practice psychiatry, it is common to give patients a

medication on the first visit and then to instruct them that they will need

drugs for their lifetime. Family practitioners, internists, and other

physicians liberally dispense antidepressants and minor tranquilizers.

Nonmedical professionals, such as psychologists and social workers, feel obliged

to refer their patients for drug evaluations. Managed care aggressively pushes

drugs to the exclusion of psychotherapy. Adult medications are increasingly

prescribed for children.

 

 

Laypersons have joined in the enthusiasm for drugs. Because of media support

for medication, as well as direct advertising and promotion to the public,

patients frequently arrive at the doctor’s office with the name of a psychiatric

drug already in mind. Teachers often recommend children for drug evaluation or

treatment.

 

 

As a part of this overall resurgence in biological psychiatry, electroshock has

become increasingly popular. Even psychosurgery once again has its vociferous

advocates (reviewed in Breggin & Breggin, 1994b).

 

 

This “drug revolution” views psychiatric medications as far more helpful than

harmful, even as an unmitigated blessing. Much as insulin or penicillin, they

are frequently seen as specific treatments for specific illnesses. Often they

are said to correct biochemical imbalances in the brain. These beliefs have

created an environment in which emphasis upon adverse drug effects is greeted

without enthusiasm and criticism of psychiatric medication in principle is

uncommon heresy.

 

 

This book takes a decidedly different viewpoint – that psychiatric drugs achieve

their primary or essential effect by causing brain dysfunction, and that they

tend to do far more harm than good. I will show that psychiatric drugs are not

specific treatments for any particular “mental disorder.” Instead of correcting

biochemical imbalances, psychiatric drugs cause them, sometimes permanently.

 

 

The critiques in this book coincide with an alternative view that

psychological, social, educational, and spiritual approaches are the most

effective in helping individuals to overcome their personal problems and to live

more fulfilling lives. I have described some of these approaches elsewhere

(e.g., Breggin, 1991a, 1992a, 1997; Breggin & Breggin, 19941; Breggin & Stern,

1996). Many others have continued to voice strong criticism of the biological

model and physical treatments from a variety of perspectives (Armstrong, 1993;

Breeding, 1996; Caplan, 1995; Cohen, 2990; Colbert, 1995; Fisher & Greenberg,

1989; Grobe, 1995; Jacobs, 1995; Kirk & Kutchins, 1992; Modrow, 1992; Mosher &

Burti, 1989; Romme & Escher, 1993; Sharkey, 1994). Here I want to re-evaluate

the underlying assumptions used to justify drug and shock treatment in

psychiatry, and to document their brain-disabling and brain-damaging effects.

 

 

The principles that are introduced in this chapter will be documented and

elaborated throughout the book. Therefore, citations will be omitted in chapter

1.

 

 

Principles of Brain-Disabling Treatment

Modern psychiatric drug treatment gains its credibility from a number of

assumptions that professionals and laypersons alike too often accept as

scientifically proven. These underlying assumptions qualify as myths: fictions

that support a belief system and a set of practices. In contrast to these

myths, this book identifies principles of psychopharmacology that are based on

scientific and clinical evidence, as well as on common sense. Together these

form the brain-disabling principles of psychiatric treatment. While the book in

its entirety provides the evidence for these principles, this chapter will

summarize them:

 

I. All biopsychiatric treatments share a common mode of action – the disruption

of normal brain function.

Pharmacologists speak of a drug’s therapeutic index, the dosage ratio

between the beneficial effect and the toxic effect. The first brain-disabling

principle of psychiatric treatment reveals that the toxic dose is the

therapeutic effect. This same principle applies to electroshock and

psychosurgery.

 

 

The brain-disabling principle states that as soon as toxicity is reached the

drug begins to have a psychoactive effect, that is, it begins to affect the

brain and mind. Without toxicity, the drug would have no psychoactive effect.

 

 

II. All biopsychiatric interventions cause generalized brain dysfunction.

Although specific treatments do have recognizable different effects on the

brain, they share the capacity to produce generalized dysfunction with some

degree of impairment across the spectrum of emotional and intellectual function.

Because the brain is so highly integrated, it is not possible to disable

circumscribed mental functions without impairing a variety of them.

 

For example, even the production of a slight emotional dullness, lethargy, or

fatigue is likely to impair cognitive functions such as attention,

concentration, alertness, self-concern or self-awareness, and social

sensitivity.

 

 

Shock treatment and psychosurgery always produce obvious generalized

dysfunction. Some medications may not obviously produce these effects in their

minimal dose range, but they may also lack any substantial “therapeutic effect”

in that range.

 

 

III. Biopsychiatric treatments have their “therapeutic” effect by impairing

higher human functions, including emotional responsiveness, social sensitivity,

self-awareness or self-insight, autonomy, and self-determination. More drastic

effects include apathy, euphoria1, and lobotomy-like indifference.

Higher mental, psychological, and spiritual functioning are impaired by

biopsychiatric interventions as a result of generalized brain dysfunction, as

well as specific effects on the frontal lobes, limbic system, and other

structures. Sometimes there is a lobotomy-like indifference to self and to

others – a syndrome that I have called deactivation (see chapters 2 and 4 of

this volume).

 

 

Biopsychiatric treatments are deemed effective when the physician and/or the

patient prefer a state of diminished brain function with its narrowed range of

mental capacity or emotional expression. If the drugged individual reports

feeling more effective and powerful, it is most likely based on an unrealistic

appraisal, impaired judgment, or euphoria. When patients on “maintenance doses”

do not experience noticeable effects, either the dose is too low to have a

clinical effect or the patient is unable to perceive the drug’s impact.

 

 

IV. Each biopsychiatric treatment produces its essential or primary

brain-disabling effect on all people, including normal volunteers and patients

with varied psychiatric diagnoses.

Despite the deeply held convictions of drug proponents, there are no

specific psychoactive drug treatments for specific mental disorders.

 

 

There is, of course, a certain amount of biological and psychological variation

in the way people respond to drugs, shock treatment, or even lobotomy or an

accidental head injury. However, as a general principle, biopsychiatric

interventions have a nonspecific impact that does not depend on the person’s

mental state or condition. For example, it will be shown that neuroleptics and

lithium affect animals and normal volunteers in much the same way as they affect

patients.

 

 

V. Patients respond to brain-disabling treatments with their own psychological

reactions, such as apathy, euphoria, compliance or resentment.

There is some variation in the way individuals respond to drugs. For

example, the same antidepressant will make one person sleepy and another

energized. Ritalin quiets many children but agitates others.

 

 

It can be very difficult to separate out drug-induced form psychologically

induced responses. For example, nearly all of the antidepressants can cause

euphoria and mania2. At the same time, some of the people who receive these

drugs have their own tendency to develop these mental states. Similarly, a

variety of drugs are capable of generating agitation and hostility in patients,

yet people can develop these responses without medication. The docility and

compliance seen following the administration of neuroleptics can be caused by

the drug-induced deactivation syndrome, but can also result from the patient’s

realization that further resistance is futile or dangerous.

 

 

Later in this chapter, I will introduce the concept of iatrogenic helplessness

and denial which addresses the combined neurological and psychological impact of

biopsychiatric treatment. In chapter 11, I will discuss some of the criteria

for determining that a drug can itself cause abnormal mental and emotional

responses, including destructive behavior.

 

VI. The mental and emotional suffering routinely treated with biopsychiatric

interventions have no known genetic and biological cause.

Despite more than two hundred years of intensive research, no commonly

diagnosed psychiatric disorders have been proven to be either genetic or

biological in origin, including schizophrenia, major depression,

manic-depressive disorder, the various anxiety disorders, and childhood

disorders such as attention-deficit hyperactivity.

 

 

At present, there are no know biochemical imbalances in the brain of typical

psychiatric patients – until they are given psychiatric drugs. It is

speculative an even naïve to assert that antidepressants such as Prozac correct

underactive serotonergic neurotransmission (a serotonin biochemical imbalance),

or that neuroleptics such as Haldol correct overactive dopaminergic

neurotransmission (a dopamine imbalance). The failure to demonstrate the

existence of any brain abnormality in psychiatric patients, despite decades of

intensive effort, suggests that these defects do not exist.

 

 

It seems theoretically possible that some of the problems treated by

psychiatrists could eventually be proven to have a biological basis. For

example, mental function often improves when certain physical disorders, such as

hypothyroidism or Cushing’s Syndrome, are adequately treated.

 

 

However, the vast majority of problems routinely treated by psychiatrists do not

remotely resemble diseases of the brain (see chapters 5 and 9). For example,

they do not produce the cognitive deficits in memory or abstract reasoning

characteristic of brain disorders. They are not accompanied by fever or

laboratory signs of illness. To the contrary, neurological and

neuropsychological testing usually indicate normal if not superior brain

function, and the body is healthy. There seems little likelihood that any of

the routinely treated psychiatric problems are based on brain malfunction rather

than on the life experiences of individuals with normal brains.

 

 

If some patients diagnosed with major depression or schizophrenia do turn out to

have subtle biochemical imbalances, this would not justify current

biopsychiatric practice. Since these presumed imbalances have not yet been

identified, it makes no sense to give toxic drugs, including the currently

available antidepressants and neuroleptics, all of which grossly impair brain

function.

 

 

To claim that an irrational or emotionally distressed state in itself amounts

to impaired brain function is simply false. An analogy to television may

illustrate why this is so. If a TV program is offensive or irrational, it does

not indicate that anything is wrong with the hardware or electronics of the

television set. It makes no sense to attribute the bad programming to bad

wiring. Similarly, a person can be very disturbed psychologically without any

corresponding defect in the “wiring” of the brain. However, the argument is

moot, since no contemporary biopsychiatric interventions can truthfully claim to

correct a brain malfunction the way an electronics expert can fix a television

set. Instead we blindly inflict toxic substances on a brain that is far more

subtle and vulnerable to harm than a television set. We even shock or mutilate

the brain in ways that would appall TV repair persons or their customers, while

ruining their television sets.

 

 

It is often suggested that persons suffering from extremes of emotional

disorder, such as hallucinations and delusions, or suicidal and murderous

impulses, are sufficiently abnormal to require a biological explanation.

However, the emotional life of human beings has always included a wide spectrum

of mental and behavioral activity. That a particular mental state or action is

especially irrational or destructive does not, per se, indicate a physical

origin. If extremes require biological explanation, then it would be more

compelling to ascribe extremely ethical, rational, and loving behaviors to

genetic and biological causes, since they are especially rare in human life.

 

 

The fact that a drug “works” – that is, influences the brain and mind in a

seemingly positive fashion – does not confirm that the individual suffers from

an underlying biological disorder. Throughout recorded history, individuals have

medicated themselves for a variety of spiritual and psychological reasons, form

the quest for a higher state of consciousness to a desire to make life more

bearable. Alcoholic beverages, coffee and tea, tobacco, and marijuana are

commonly consumed by people to improve their sense of well-being. Yet there’s

no reason to believe that the results they obtain are due to an underlying

biochemical imbalance.

 

VII. To the extent that a disorder of the brain or mind already afflicts the

individual, currently available biopsychiatric interventions will worsen or add

to the disorder.

The currently available biopsychiatric treatments are not specific for any

known disorder of the brain. One and all, they disrupt normal brain function

without correcting any brain abnormality. Therefore, if a patient is suffering

from a known physical disorder of the brain, biopsychiatric treatment can only

worsen or add to it. A classic example involves giving Haldol to control

emotionally upset Alzheimer patients. While subduing their behavior, the drug

worsens their dementia.

 

 

After psychiatric drugs are developed and marketed by drug companies, attempts

are made to justify their use on the basis of correcting presumed biochemical

imbalances. For example, it is claimed that Prozac helps by improving

serotonergic neurotransmission. Even electroshock and lobotomy are justified on

the grounds that they correct biochemical imbalances. There is no likelihood

that these intrusions correct a biochemical imbalance. Too wide a variety of

brain-disabling agents are used to treat every disorder – everything from Prozac

to Xanax to electroshock is prescribed for depression – and each treatment ends

up disrupting innumerable brain functions. In reality, all currently available

biopsychiatric interventions cause direct harm to the brain and hence to the

mind without correcting any known malfunctions.

 

VIII. Individual biopsychiatric treatments are not specific for particular

mental disorders.

It is often said that psychiatry has specific treatments for specific

diagnostic categories of patients: for example, neuroleptics for schizophrenia,

antidepressants for depression, minor tranquilizers for anxiety, lithium for

mania, and stimulants, such as Ritalin, for attention-deficit hyperactivity. In

actual practice, many individual patients labeled schizophrenic to be initially

treated with neuroleptics or for depressed patients to be initially prescribed

to be initially prescribed antidepressants, this is, in part, a matter of

convention within the profession.

 

 

When a drug seems more effective in a particular disorder, it often depends on

whether it has a suppressive or an energizing effect on the CNS. For example,

if depressed patients are already emotionally and physical slowed down, giving

them a neuroleptic that causes psychomotor retardation would tend to make them

look worse. These patients are more likely to seem improved when artificially

energized. Conversely, if schizophrenic patients are agitated and difficult to

control, it would not make sense to give them stimulants. They are more likely

to be judged “improved” when taking a neuroleptic that reduces or flattens their

overall emotional responsiveness. These gross behavioral effects, however, are

a far cry from having a “magic bullet” for a specific disease.

 

IX. The brain attempts to compensate physically for the disabling effects of

biopsychiatric interventions, frequently causing additional adverse reactions

and withdrawal problems.

The brain does not welcome psychiatric medications as nutrients. Instead,

the brain reacts against them as toxic agents and attempts to overcome their

disruptive impact. For example, when Prozac induces an excess of serotonin in

the synaptic cleft, the brain compensates by reducing the output of serotonin at

the nerve endings and by reducing the number of receptors in the synapse that

can receive the serotonin. Similarly, when Haldol reduces reactivity in the

dopaminergic system, the brain compensates, producing hyperactivity in the same

system by increasing the number and sensitivity of dopamine receptors.

 

 

It is difficult if not impossible to accurately determine the underlying

psychological condition of a person who is taking psychiatric drugs. There are

so many complicating factors, including the drug’s brain-disabling effect, the

brain’s compensatory reactions, and the patient’s psychological responses to

taking the drug.

 

 

Because the brain attempts to compensate for the effects of most psychoactive

drugs, patients can have difficulty withdrawing from most psychiatric

medications. Physically, the brain cannot recover from the drug effects as

quickly as the drug is withdrawn, so that the compensatory mechanism can require

weeks or months to recover after the drug has been withdrawn. Sometimes, as in

tardive dyskinesia, the brain fails to recover. Psychologically, individuals

fear that their emotional suffering will worsen without the medication. They

may have been told by psychiatrists that they require the medication for the

rest of their lives. This can make withdrawal even more difficult.

 

X. Patients subjected to biopsychiatric interventions often display poor

judgment about the positive and negative effects of the treatment on their

functioning.

Generalized brain dysfunction tends to reduce the individual's ability to

perceive the dysfunction. Impaired individuals not only tend to minimize their

dysfunction, they often see themselves as performing better than ever.

Individuals intoxicated with alcohol, for example, often show poor judgment in

estimating their capacity to drive an automobile or to carry on a sensible

conversation. Many individuals who chronically smoke marijuana believe that it

improves their overall psychological and social functioning, but if they

withdraw from the drug, it may become apparent to them that their memory, mental

alertness, emotional sensitivity, and social skills have been impaired while

using the drug. People intoxicated with stimulants, such as amphetamine, may

feel they have superior or even superhuman capacities, when they are often

seriously impaired. The same is true of all psychiatric drugs. Often the

patient will have little appreciation for the degree of mental or emotional

impairment until the drug has been stopped for some time and the brain has had

time to recover.

 

 

In my experience as a clinician and forensic medical expert, I have seen

patients remain for years in severe states of intoxication from one or more

psychiatric drugs without realizing it. Attributing their condition to their

own emotional reactions or to stresses in the environment, they may ask for more

medication.

 

 

After shock treatment and psychosurgery, patients may also fail to understand

the iatrogenic source of their mental dysfunction and instead believe that they

need further interventions.

 

 

The failure to perceive the extent of treatment-induced impairment can have

several interrelated psychological and physiological bases:

 

Psychological denial. Individuals overcome by emotional suffering are

likely to deny the degree of their psychological dysfunction. They don't want

to admit to being severely mentally impaired. If they are hoping to fell

better with the use of a drug, their denial can be further reinforced.

 

 

Placebo effect. Patients have faith that biopsychiatric interventions will be

helpful rather than harmful, encouraging them to disregard drug-induced

dysfunction or to mistakenly attribute it to their emotional problems.

Compliance. To an extraordinary extent, patients will tell doctors what the

doctors want to hear. If a psychiatrist clearly wants to hear that a drug is

helpful, and not harmful, many patients will comply by giving false information

or by withholding contradictory evidence.

 

 

Psychologically induced confusion. Emotionally upset individuals can easily lose

their judgment concerning the cause of their worsening condition. They can

easily mistake a negative drug effect, such as rebound anxiety from a minor

tranquilizer or depression from a neuroleptic, for a worsening of their

emotional problems. Typically, they blame themselves rather than the

medication. This confusion is abetted when the physician exaggerates the drug's

benefits and fails to inform the patient of its potential adverse effects.

 

 

Drug-induced confusion. Almost all biopsychiatric interventions can at times

induce confusion, impairing the patient's awareness of the drug-induced mental

dysfunction.

 

 

Drug-induced anosognosia. Anosognosia refers to the capacity of brain damage

to cause denial of lost function. Anosognosia is a hallmark of central nervous

system (CNS) disability (see below and chapter 5). It has physical basis in

addition to a psychological one.

 

XI. Physicians who prescribe biopsychiatric interventions often have an

unrealistic appraisal of their risks and benefits.

In recent years, doubt has been thrown on the objectivity of controlled

clinical trials in which drugs are compared to placebo or to alternative

medications (see chapters 6 and 11). Too often the investigators are influenced

by their conscious or unconscious biases.

 

 

If clinical and scientific studies can be distorted by bias, it is even more

likely that routine clinical practice will be affected by the hopes and

expectations of the prescribing physician. Physicians in great numbers have

prescribed drugs with unbounded enthusiasm for years before the agents have

proven to be worthless or unacceptably dangerous. Amphetamines, for example,

were freely dispensed for many years to millions of patients for both depression

and weight control without regard for their lack of efficacy and addictive

potential. Similarly, minor tranquilizers, such as Valium, were given to

millions of patients before the profession recognized that they have little or

no long-term benefit and can become addictive. Both psychosurgery and

electroshock continue to be utilized, despite obviously devastating effects on

the mental life of the patients and the absence of proven efficacy.

 

 

IATROGENIC HELPLESSNESS AND DENIAL (IHAD)

 

I have coined the term iatrogenic helplessness and denial (IHAD) to

designate the guiding principle of biopsychiatric interventions. (Breggin,

1983b). It describes how the biological psychiatrist uses authoritarian

techniques, enforced by brain-disabling interventions, to produce increased

helplessness and dependency on the part of the patient.

 

 

Iatrogenic helplessness and denial include the patient's and the doctor's

mutual denial of the damaging impact of the treatment, as well as their mutual

denial of the patient's underlying psychological and situational problems.

Overall, iatrogenic helplessness and denial account for the frequency with which

psychiatry has been able to utilize brain-damaging technologies, such as

electroshock and psychosurgery, as well as toxic medications.

 

 

Before the potential patient encounters a psychiatrist, he or she has usually

been feeling helpless for some time. In my formulation, helplessness is the

common denominator of all psychological failure. Helplessness is at the core of

most self-defeating approaches to life (Breggin, 1992a, 1997). People who feel

helpless tend to give up using reason, love, and self-determination to overcome

their emotional suffering, inner conflicts, and real-life stresses. They

instead seek answers from outside themselves. In modern times, this often means

from " experts. "

 

 

Iatrogenic helplessness and denial go far beyond relatively benign suggestion

(as used in medicine and psychiatry, for example, to help overcome physical pain

or addiction). First, in iatrogenic helplessness and denial the psychiatrist

compromises the brain of the patient, enforcing the patient's submission to

suggestion through mental and physical dysfunction. Second, in iatrogenic

helplessness and denial the psychiatrist denies to himself or herself the

damaging effects of the treatment as well as the patient's continuing

psychological or situational problems.

 

 

Often denial is accompanied by confabulation - the patient's use of

rationalizations and various " cover stories " to hide the extent of mental

dysfunction. Confabulation is well understood in psychiatry and neurology, but

is generally ignored in regard to treatment-induced effects. Many patients

confabulate good results from drug therapy when they are obviously impaired by

it.

 

 

Denial is closely linked to indifference. Sometimes it is difficult to tell if

the patient doesn't care, or if the patient cares so much that he cannot bear to

face up to his mental and physical dysfunction. Denial is also related to

euphoria. After lobotomy or shock treatment, and sometimes during drug

treatment, the patient can develop an unrealistic " high. " 3

 

 

Denial is one of the most primitive ways of responding to threats. The person

avoids facing problems and thereby becomes unable to make headway with them.

Denial as a basic defense tends to result in ineffective, impotent lives.

 

 

Brain damage and dysfunction from any cause, including accidents and illness,

frequently produces helplessness and denial; but only in psychiatry is damage

and dysfunction used as " treatment " to produce these disabling effects.

 

 

CONCLUSION

As I have discussed in earlier books (1991a, 1994a, 1994b), I believe that

the concepts of " mental illness " and " mental disorder " are misleading, and that

none of the problems commonly treated by psychiatrists are genetic or biological

in origin. The terms " schizophrenia " and " major depression, " for example, are

based on concepts whose validity can easily be challenged. However, the

brain-disabling principles remain valid even if some of the mental phenomena

that are being treated turn out to have a genetic or biological basis. All of

the currently available biopsychiatric treatments - drugs, electroshock, and

psychosurgery - have their primary or therapeutic effect by impairing or

disabling normal brain function.

Footnotes:

1. The term euphoria as used in psychiatry indicates an exaggerated, irrational,

or unrealistic sense of well-being. It can be psychological in origin but is

commonly caused by brain damage or drug toxicity.

2. Euphoria is unusual in patients treated with the neuroleptics because of the

suppressive effects on the CNS (see chapter 2). It is more common among

patients treated with antidepressants, stimulants, and minor tranquilizers.

3. See fotnote 2, (above).

 

 

 

 

 

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