Elliot Valenstein

Elliot S. Valenstein, PhD, is a professor emeritus of psychology and neuroscience at the University of Michigan. His theories challenge the conventional assumption that mental illness is biochemical, rejecting the 'chemical imbalance' theories used by drug companies in marketing their products, contending people should be suspicious of such claims while suggesting the targets of the marketing are usually medicating themselves unnecessarily.

In his 1988 book, "Blaming the Brain: The Truth about Drugs and Mental Health", Valenstein argues that while psychotropic drugs sometimes do work, they do not even begin to address the real cause of mental disorders, since in his view biochemical theories are an entirely "unproven hypothesis" used to excuse what he sees as often unconscionable marketing practices of the drug industry. Valenstein acknowledges a combination of medications and psychotherapy often offers the best chance of success at treating common disorders, but stresses no one knows exactly why.

Valenstein examines the various special interests behind the ascent in the latter half of the 20th century of purely biopsychiatric hypotheses, which appeal strongly to pharmaceutical companies. Their commercial motives are driven by the enormous, multi-billion dollar stakes involved in the intensely competitive marketing for such drugs as Prozac, Zyprexa, and Zoloft. Aggressive marketing, Valenstein contends, has dramatically changed practices in the mental health profession. He explores other aspects of the growing influence of drug companies, which sponsor research, lobby government officials, market directly to both consumers and primary care physicians (the primary prescribers of psychiatric drugs), and pressure psychiatric journals to downplay studies casting doubt on drug safety and efficacy.

In 2000, Valenstein presented "A Critique of Current Biochemical Theories of Mental Illness" as the keynote speaker at the Behavior Analysis Association of Michigan (BAAM) convention.

In his 1986 book "Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness", Valenstein explores the history of lobotomy’s heyday, in the 1940s and 1950s, while questioning the legitimacy of widespread use of such unproven medical treatments. The truth, says Valenstein, is that we are only at the dawn of an understanding of mental illness. "The factors that fostered (the operations’) development and made them flourish," explains Valenstein, "are still active today."

Chapters of the book "Blaming the Brain"

Chapter 1: Introduction

Chapter 2: Discoveries of Psychotherapeutic Drugs

* The discovery of LSD and the events that followed
* Three early chemical treatments of mental disorders
* The beginning of modern era
* Discovery of drugs for treating schizophrenia - Chlorpromazine: the drug that ushered in the new era
* Haldol: a new class of antipsychotic drugs
* Discovery of drugs for treating depression - The monoamine oxydase inhibitors
* The tricyclic antidepressants
* Discovery of lithium treatment for mania and other mood disorders
*The discovery of the minor tranquilizers: the anxiety drugs

Chapter 3: Theories of Drug Action and Biochemical Causes of Mental Disorders

* Some historical background - Resistance to chemical explanations
* The war between the “sparks and the soups”
* A parallel development; the emotional brain
* The discovery of a brain circuit for pleasure and reward
* Chemical stimulation of the brain
* Biochemical explanations of psychotherapeutic drugs
* Theories of depression and the action of antidepressants
* Reserpine – India’s miracle drug
* The neuropharmacology of Reserpine: an important model
* Reserpine and the biogenic amine theory of depression
* The puzzle of tricyclic antidepressant drugs explained
* The biogenic amine theory of emotion becomes established
* Antipsychotic drugs and schizophrenia
* The dopamine theory of schizophrenia
* Lithium and mood disorders
* Anxiety, anxiolytics, and benzodiazepine receptors
* A brief look ahead

Chapter 4: A Closer Look at the Evidence

* Antidepressant drugs and depression
* The biogenic amine receptor sensitivity hypothesis
* Prozac and other selective serotonin reuptake inhibitors: the science of serenics
* What we really know about serotonin
* New advances in drug development
* An alternative hypothesis to biogenic amine deficiency theory of depression
* Antipsychotic (neuroleptic) drugs and schizophrenia
* The argument for the “dopamine theory of schizophrenia”
* A critical examination of the dopamine theory
* Is schizophrenia a disease?
* Current status of antipsychotic drugs
* Looking beyond simplistic theories of mental illness
* The limbic system, emotions, and mental illness

Chapter 5: The Interpretation of the Evidence

* The confusion of cause and effect
* Experience can modify brain anatomy
* Experience and changes in brain function
* The dexamethasone suppression test: an illustrative case
* On treatment, causes, and diagnosis
* The relation of the origin of disease to the most effective treatment
* And vice versa
* Scientific explanations and reductionism
* Neurotransmitters are not all of biology
* It’s not all genetics
* Drug specificity and the search for the magic bullet
* Politics of fashion in diagnosing mental disorders

Chapter 6: How the pharmaceutical industry promotes drugs and chemical theories of mental disorders

* Pharmaceutical companies: “There’s gold in them thar pills”
* The selling of Thorazine
* Drugs and deinstitutionalization
* Increasing drug studies
* Prozac and the SSRIs: good for whatever ails you
* Drugs and patient advocacy groups
* Psychopharmaceutic drugs and primary care physicians
* Continuing education for psychiatrists
* Why does industry sponsor research?
* Putting the best spin on the data
* Some ways that pharmaceutical companies influence research
* A potential brain drain?

Chapter 7: Other special interest groups

* Psychiatry and the chemical theories of mental illness
* Effectiveness of different treatments of mental disorders
* Health maintenance organizations (HMOs) and medical insurers
* Psychologists: if you can’t beat them, join them
* Patients would rather have a physical than a mental disorder

Chapter 8: Reprise, conclusions, and reflections

Quotes

"Even a surgeon who was convinced that he was not obtaining good results seldom gave up lobotomy. It was difficult to admit that the effort had been completely wasted, especially when other surgeons were reporting success. Rather than abandoning psychosurgery, neurosurgeons much more commonly introduced some change in the operation in the hope of increasing the success rate." Elliott Valenstein, in "Great and Desperate Cures" (1986).

"The influence of the pharmaceutical companies is so great these days because of the resources they have at their disposal. There are tremendous economic factors distorting the practice of medicine, just as there were in the lobotomy period. It is hard to find any clinicians or researchers who don’t have vested interests in the development of procedures or drugs. I mean that. Of course, they will deny that funding from drug companies has an influence, but it is so subtle that they’re unaware of it themselves." Elliott Valenstein ("Stay Free!" interview, Fall 2003).

"After dopamine was acknowledged to be a separate neurotransmitter, several lines of evidence suggested that it might play the critical role in schizophrenia's etiology and treatment. From the outset, it was observed that practically all of the available anti psychotic drugs produced motor symptoms that resembled parkinsonism. When it was discovered that parkinsons patients were suffering from a dopamine deficiency, it was reasonable to hypothesize that anti psychotic drugs must be blocking dopamine activity. These observations led directly to the hypothesis that schizophrenics must suffer from excessive dopamine activity, which anti psychotics could correct" Elliot Valenstein, "Blaming the brain" (1998).

Published books

* "Brain Control: A Critical Examination of Brain Stimulation and Psychosurgery" (1973)

* "Brain Stimulation and Motivation: Research and Commentary" (Ed.) (1973)

* "Great and Desperate Cures: The Rise and Decline of psychosurgery and other Radical Treatments for Mental Illness" (1986)

* "Blaming the Brain: The Truth About Drugs and Mental Health" (1988)

* "The War of the Soups and the Sparks: The Discovery of Neurotransmitters and the Dispute over how Nerves Communicate" (2005)

ee also

* Biopsychiatry controversy
* Chemical imbalance theory
* Psychiatric drugs

External links

* [http://www.stayfreemagazine.org/archives/21/lobotomy.html StayFreeMagazine.org] - 'Better Living Through Lobotomy: What can the history of psychosurgery tell us about medicine today? An Interview with Elliot Valenstein', Allison Xantha Miller (Fall, 2003)