Biopsychiatry controversy

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". [cite book
last = Pam
first = Alvin
title = "Biological psychiatry: science or pseudoscience?" in Colin Ross and Alvin Pam "Pseudoscience in Biological Psychiatry: Blaming the Body", NY: Wiley & Sons, pp. 7-84
year = 1995] 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.

Research issues

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 [ [http://www.news.vcu.edu/news.aspx?v=detail&nid=396 Most psychiatric disorders share a small number of genetic risk factors, VCU study shows] , Virginia Commonwealth University] and reports show significant associations between specific genomic regions and psychiatric disorders. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15722956&query_hl=10&itool=pubmed_docsum Candidate psychiatric illness genes identified in ... [Psychiatr Genet. 2005 - PubMed Result ] ] [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15249933&query_hl=10&itool=pubmed_docsum A genome scan and follow-up study identify a bipol... [Mol Psychiatry. 2004 - PubMed Result ] ] Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions. [van Belzen MJ, Heutink P. Genetic analysis of psychiatric disorders in humans. "Genes Brain Behav." 2006;5 Suppl 2:25-33.] [Meyer-Lindenberg A, Weinberger DR. Intermediate phenotypes and genetic mechanisms of psychiatric disorders. "Nat Rev Neurosci." 2006 Oct;7(10):818-27.] 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. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16293762&query_hl=10&itool=pubmed_docsum DISC1 and PDE4B are interacting genetic factors in... [Science. 2005 - PubMed Result ] ]

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. [Wendy R. Kates, Inroads to Mechanisms of Disease in Child Psychiatric Disorders, "Am J Psychiatry" 164:547-551, 2007] 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." [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14515135&query_hl=16&itool=pubmed_docsum Genetics of personality: are we making progress? [Mol Psychiatry. 2003 - PubMed Result ] ] .

Theodore Lidz, [cite book
last = Lidz
first = Theodoreand S. Blatt
title = "Critique of the Danish-American studies of the biological and adoptive relatives of adoptees who became schizophrenic", "American Journal of Psychiatry", 140: 426-35
year = 1993] Jay Joseph [cite book
last = Joseph
first = Jay
title = The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope
publisher = Algora
date=2003
location =New York, NY
url = http://www.algora.com/93/book/details.html
id = ISBN 0-87586-344-2 ] [cite book
last = Joseph
first = Jay
title =The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes
publisher = Algora Publishing
date=2006
location = NY
id = ISBN 0-87586-410-4 ] 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. [ [http://www.jayjoseph.net/MissingGene.html Jay Joseph Psy.D. The Missing Gene ] ]

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. [ [http://ajp.psychiatryonline.org/cgi/content/abstract/122/5/509 THE CATECHOLAMINE HYPOTHESIS OF AFFECTIVE DISORDERS: A REVIEW OF SUPPORTING EVIDENCE - SCHILDKRAUT 122 (5): 509 - Am J Psychiatry ] ] [ [http://www.touchneurology.com/looking-beyond-monoamine-hypothesis-a5616-1.html Looking Beyond the Monoamine Hypothesis ] ] 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. [cite book
last = Valenstein
first = Elliot
title = Blaming the Brain: The Truth about Drugs and Mental Health
publisher = The Free Press
year = 1998 ]

Economic influences on psychiatric practice

cquote|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"cite journal
last = Sharfstein
first = Steven S.
authorlink =
coauthors =
title = Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly
journal = Psychiatric News
volume = 40
issue = 16
pages = 3
publisher = American Psychiatric Association
location =
date = August 19, 2005
url = http://pn.psychiatryonline.org/cgi/content/full/40/16/3
doi =
id =
accessdate = January 2008]
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. cite journal| last =Zipkin, MD | first =Daniella A | coauthors = Steinman, MD, Michael A | title =Interactions Between Pharmaceutical Representatives and Doctors in Training | journal =Journal of General Internal Medicine | volume =20 | issue =8 | pages =777–786 | publisher =Springer on behalf of the Society of General Internal Medicine | location =New York | date =August 2005 | url =http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1490177 | doi =10.1111/j.1525-1497.2005.0134.x. | accessdate =2008-01-08 | pmid =16050893]

Antidepressants have been shown to have only a minimal effect, over that of a placebo, on patients.In an an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the 6 most widely prescribed antidepressants approved between 1987 and 1999, it was found that "Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale. Improvement at the highest doses of medication was not different from improvement at the lowest doses. The proportion of the drug response duplicated by placebo was significantly greater with observed cases (OC) data than with last observation carried forward (LOCF) data. If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants."
— cite journal
last =Kirsch
first =Irving
authorlink =
coauthors =Moore, Thomas J.; Scoboria, Alan; Nicholls, Sarah S.
title =The emperor's new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration.
journal =Prevention & Treatment
volume =5
issue =1
pages =
publisher =
location =
date =2002
url =http://content.apa.org/journals/pre/5/1/23
doi =
id =
accessdate = January 2008 ] 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. [cite web
author=Jeffrey R. Lacasse, Jonathan Leo
title=Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
url=http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0020392
accessdate=2008-01-07 ] 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. [cite web
author=Jeffrey R. Lacasse, Jonathan Leo
title=The Media and the Chemical Imbalance Theory of Depression
url=http://www.springerlink.com/content/u37j12152n826q60/
accessdate=2008-01-07 ]

See also

*Anti-psychiatry - A movement critiquing psychiatry from the human rights perspective.
*Bipolar disorders research - biopsychiatric analysis into the cause of bipolar disorders.
*Elliott Valenstein - a psychologist and neuroscientist, author of "Blaming the Brain".
*The Gene Illusion - a book by clinical psychologist Jay Joseph.
*Causes of schizophrenia
*Controversy about ADHD

External links

Criticisms from psychologists & the medical profession
# [http://pn.psychiatryonline.org/cgi/content/full/40/16/3 Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly] , American Psychiatric Association president Steven S. Sharfstein
# [http://psychiatrictimes.com/showArticle.jhtml?articleID=185300954 Against Biologic Psychiatry] - an article by David Kaiser, M.D., in Psychiatric Times (1996, Vol. XIII, Issue 12).
# [http://www.umaine.edu/JMB/archives/volume11/11_3-4_1990summerautumn.html Challenging the Therapeutic State] - special issue of "The Journal of Mind and Behavior" (1990, Vol.11:3).
# [http://www.moshersoteria.com/resig.htm 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.
# [http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42we13.htm Memorandum from the Critical Psychiatry Network to the United Kingdom Parliament] - Written evidence to the House of Commons Select Committee on Health, April 2005.

Methodological issues
# [http://www.columbia.edu/cu/psychology/courses/1010/mangels/Uttal.html 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).

References