RETHINKING THE MENTAL ILLNESS INDUSTRY

[Guest guest]

http://www.redflagsweekly.com/extra/2003_aug27.html

 

 

August 27, 2003

 

A FAST FOR FREEDOM IN MENTAL HEALTH

 

RETHINKING THE MENTAL ILLNESS INDUSTRY

 

By Loren R. Mosher M.D. and Mary Boyle Ph.D.

 

" Depression is a flaw in chemistry, not character "

 

Eight story sign at Amsterdam Ave and 72nd St., New York City

 

The American public is constantly being told that various forms of mental and

emotional distress and disordered behavior are 'illnesses like any other' -

depression is just like diabetes. Yet, does the public know that the American

Psychiatric Association's Diagnostic and Statistical Manual now has 374 'mental

disorders' versus 112 in 1952 and, even though we now have all these new

'diseases', that not one has given up its biological secrets? The US Surgeon

General concluded in 1999 that there is no biochemical, anatomical or functional

sign that reliably distinguishes between the brains of mental patients and

anyone else.

 

Who benefits from this proliferation of mental disease? An obvious beneficiary

is the drug industry, for if behavior and distress look like physical illnesses,

then 'treatment' naturally looks like drugs. In 2000, 23 billion dollars were

spent on psychotropic drugs, twice the 1995 cost.

 

And, although psychiatric drugs don't have specific effects on emotions and

behavior (they sedate, tranquilize and stimulate in non-specific ways) they are

marketed as if they specifically treated particular mental disorders. The result

is a strong symbiotic relationship between the DSM's ever-growing list of

disorders and the marketing and sales of drugs. Perhaps the most striking aspect

of this has been the dramatic growth in the children's drug market, to the point

where an estimated 5-7 million American children now take stimulant drugs for

'attention deficit disorder'.

 

We would be less concerned about this situation if the outcomes were positive.

But, on the contrary, long-term outcomes for people diagnosed as schizophrenic

are no better now, and may even be worse, than before the introduction of major

tranquilizers (misleadingly called anti-psychotics). Not only that, but the

World Health Organization found that outcomes for people with schizophrenia in

developing countries, where these drugs are used much less, are actually better.

Similarly, research indicates that antidepressants have not significantly

reduced the suicide rate, and, as the Journal of Clinical Psychiatry recently

reported, that these drugs may " actually increase biochemical vulnerability to

depression and worsen long term outcomes " . There are also serious concerns about

the adverse effects of these drugs. The major tranquilizers can produce

incurable movement disorders. The minor tranquilizers are addictive. The newer

antidepressants induce suicidal and homicidal behavior in

some persons and can be addictive. Given these problems, it's difficult to see

that the medicalization of emotion and behavior, and its 'treatment' with drugs,

has overall had positive effects.

 

It is not just the lack of positive outcomes that should concern us. In spite of

claims that the medicalization of human distress is based on biomedical science,

research paints a quite different picture. The strongest evidence about causes

of distress and disordered behavior comes from research on social and

environmental factors. For example, if at least 50-60% of those admitted to

psychiatric hospitals, regardless of diagnosis, have been physically or sexually

abused, is it not reasonable to assume that this may have something to do with

the distress they are experiencing? If various types of family dysfunction,

poverty, trauma, unemployment and other environmental factors are consistently

and strongly related to psychiatric problems, is this not significant? Are we

seriously to assume that the best answer to these psychosocial issues is drugs?

 

What is especially tragic about this situation, apart from the human cost, is

the closing down of open and honest debate. Readers who thought that the issue

of 'mental illness' has been settled in favor of biological psychiatry may be

surprised to learn that many people with impeccable academic and professional

credentials continue to produce valid critiques of biological psychiatry's

research and practice. There is also grave concern about the methods it uses to

hide its lack of scientific respectability. But critics' views rarely receive

media attention, while authoritative sounding medical assertions are given

immediate credibility and publicity. Frequent pronouncements of genetic or

biological " breakthroughs " in our understanding or treatment of 'mental illness'

keeps the public in a constant state of positive anticipation. When the

breakthrough comes to nothing, as it always has, no trumpets are heard and, in

any case, another will be along soon.

 

As the President's New Freedom Commission report recently concluded, the current

model of care has proven to be a failure. Given this context it is surely time

to re-think biological psychiatry. The public deserves to be better informed

about the scientific and ethical issues so that they can question critically how

public money is being spent and about the standards of evidence on which claims

about biological causation and treatment are based. More open and honest debate

can only be good for the field and especially for users of mental health

services.

 

Loren R. Mosher is Clinical Professor of Psychiatry at the University of

California at San Diego and former Chief of the Center for Studies of

Schizophrenia at the National Institute of Mental Health and first

Editor-in-Chief of the Schizophrenia Bulletin.

 

Mary Boyle is Professor of Clinical Psychology, Head of the Doctoral Program in

Clinical Psychology at the University of East London, UK and author of

" Schizophrenia: A Scientific Delusion? "