Nine Reasons Why Psychiatrists Believe In Drugs

It is very tempting sometimes to blame the evil psychiatrists for everything, as if they were in some kind of conspiracy against the rest of us. It is obvious, however, that such a large and diverse group of people cannot maintain any conspiracy for long. Besides, many psychiatrists I've seen are very nice people.

Of course there are financial "incentives," but they would not mean much if the doctors did not really believe that their drugs work.

I've been trying to think of the reasons why they believe it. It looks like the practice of a typical psychiatrist is organized in such a way that the more medications he prescribes, the more convinced he becomes in their helpfulness - sometimes in spite of his own logic and common sense. It is a classic self-reinforcing loop, and drug prescription almost becomes a bad habit.

Once you start prescribing drugs, you are practically doomed to continue, unless something causes you to strongly suspect that something is not right, and make a forceful effort to break out of the vicious circle. (Incidentally, this is probably the moment when the financial incentives play a major role, as the sudden exacerbations of suspiciousness in a psychiatrist are soothed by the large doses of cash.)

So far I have though of nine mechanisms of the erroneous self-reinforcement that the psychiatrists fall prey to.

1. Placebo response.
2. Lack of control group.
3. "Could be worse" logic.
4. Selective memory.
5. Selective interpretation.
6. Short-term efficacy of drugs.
7. Long-term dependence on drugs.
8. Lying to psychiatrists.
9. Attributing success to drugs instead of doctors.

I will discuss each one in more detail in the following posts.

Psychiatry Critique and Antipsychiatry

I would like to make myself clear: I am not an antipsychiatrist.

The easiest way to change your point of view is by changing its sign to create the opposite. In this manner, religion is converted into atheism, love into hatred, promiscuity into puritanism, and psychiatry into antipsychiatry. Although the result is as far from the origin as possible, the similarity between the two points of view is still apparent.

An atheist spends as much time and effort as a preacher thinking about God, only trying to prove His non-existence instead of existence. An antipsychiatrist still limits his thinking to the arguments of psychiatry, only trying to prove them wrong. And all of these people remain rigidly faithful to their points of view.

I don't know if psychiatry - in general - is good or bad. I think that psychiatry could be used to help people. I think it could be one of the most humane and rewarding professions. This is why I had become a psychiatrist (I wouldn't like to practice in the United States today, but that's another story). I am fascinated by the works of Jung, Assagioli, Laing and others who took the art of psychiatry one step further, from simply "fixing" people to fit the social average, to helping them achieve self-realization and spiritual growth.

This said, I can't help noticing that today psychiatry in America is practiced in a very strange fashion. It is no longer art, but science. It is not uncommon to meet a psychiatrist who knows a lot about biology and chemistry but has no idea how to talk to people. (You wouldn't go to a concert where the musicians know all about the physics of sound and theory of composition, but cannot actually play, would you? What if they had shown you their certificates?)

People are being lied to or confused on every step of the way. Every first-time patient that I saw at the hospital was convinced that since he had signed in voluntarily, he may leave at any moment - which was of course not the case. People are distracted from solving their real-life problems by the unnecessary talks of genetics and chemical imbalance. People are told that the prognosis of schizophrenia is better with drug treatment, but it is not proven. People are told that what matters is the symptoms, and not the cause of their depression, but it is ridiculous. They are told that modern drugs are safer than the older ones, but it is a lie. They are told that the drugs are scientifically proven to work, but it is a mystification.

At the same time, most of the doctors are very nice people, and they really believe that what they do is good. I don't know how that happens, but I see that for some reason many professionals have adopted rather simplistic and superficial views of human nature, reducing it to mere behavior, and refusing to understand its depths. I have seen psychiatrists making a diagnosis of schizophrenia and prescribing a drug to the patients complaining of hearing voices, without even so much as asking what those voices were saying. They are simply not interested - and with good reason: the drug that they prescribe will still be the same.

I am not even going to mention here the enormous financial pressures that psychiatry now has to endure. It is a subject for a long discussion.

To sum it all up: psychiatry in general is not good or bad per se, but at this point of its development in America it seems to be hurting more people than it helps, while proclaiming the opposite. Thus, although psychiatry may be helpful to some people, in dealing with it a healthy degree of skepticism and common sense needs to be maintained.

History of Hysteria

There is a little exhibition in the library today, and one of the images is the famous linotype depicting Charcot's lecture on hysteria. This picture almost requires no comments.

You could accuse me of imagining things, as in the famous anecdote. A psychiatrist shows some pictures to the patient, of simple geometric figures, and asks to interpret them. About a triangle the patient says: "It is a tent where they are having sex," and about a square: "It is a dark room where they are having sex". After a while the patient looks suspiciously at the doctor and asks: "Doctor, but where have you got such nasty pictures from?"

Risking to look like this patient, I nonetheless dare ask: Could you deny that this image of Charcot and colleagues treating a young hysteric woman is profoundly sexual? And sexual not in a natural way, but in a way that masks the natural urges behind the facade of scientific interest. Just think of all these bearded men scratching their chins and going: "Um... Hmm... This is a truly remarkable case! Very exotic and stimulating!", as they think about their future practice, in which they will be now scientifically approved to spend hours talking to young ladies about all the intricate details of their sexual lives.

In a society where sexuality was suppressed, and hard to practice especially by the men of education and social status, the discoveries of Charcot, and his student Freud, provided a very nice avenue for the sublimation of sexual desires - a process that Freud himself attributed to his hysteric patients. It created a way to practice "intellectual sex" - by talking about it - which was safer, and to some people more enjoyable, than the natural one. The diagnosis of hysteria, once coined, was destined to prosper.

From this does NOT follow that since the reality of hysteria is questioned, hence the modern biological views are more correct. Of course not. The binary logic "hysteria versus genetics," or "neurosis versus psychosis" is artificial and arbitrary. The defeat of the one does not mean the victory of the other; instead each one needs to be proved or disproved separately.

In fact, the two points of view are rather alike than different. The modern views are a continuation of the general direction of understanding the human issues by way of framing them into medical diagnoses. First there was hysteria, then schizophrenia, then depression, then homosexuality, then PTSD and so on. I am not saying with affirmation that each of the diagnoses was artificially invented - I don't know. The fact is, however, that each of them kept, and continues to keep, many influential people busy and satisfied.

Software Problems

When your text processor displays the wrong font size, you don't typically reach for a screwdriver to look for a problem in the hardware of your computer. The software is not directly caused by the hardware, although there is certainly a relationship between them. This relationship, however, is of a remote, abstract, and dynamic nature.

Psychiatrists deal with even less clear objects than computer scientists do. Yet they usually disregard the abstractness of the connection between the brain and the mind, and treat it in a straightforward fashion.

Take the neurotransmitters idea as an example. Saying that a mental disease is caused by too much neurotransmitter is like saying that your incorrect font size is caused by too much electricity. While true in some sense, it has little practical significance. Neurotransmitters are too simple molecules to be anything more than local electrochemical signals. And it is not the amount of signals that is the problem, but their dynamic distribution patterns. Simply modifying the level of a neurotransmitter in the brain makes as much sense as plugging a computer to 220 volts outlet instead of 110 and hoping for the best.

An Excellent Piece Of Writing

I have found this as a comment to this article on the alternet.org portal. There was no link to the comment itself, and it was buried under the pile of other comments, so I decided to re-post it here in its entirety. It is really an excellent piece of writing.

Quote:

Human progress is not a given consequence of new technology.

Posted by: Coleman on Jun 18, 2008 8:29 AM

Fifty years ago social scientists were writing utopian pamphlets wondering what ordinary folks were going to do with all their free time. The buzzword of the day was "automation." With modern machines, it took fewer and fewer people to reproduce the conditions necessary for the current standard of living. For example only a very small percentage of the population is engaged in agriculture, yet industrialized nations consistently yield food surpluses.

However, as we all know, the surpluses in agriculture, like every other commodity, are scandalously squandered while many go hungry. At every point in our system there is waste, from the excess restaurant food scraped off plates into the trash, to the most high-tech industrial processes which are - again, scandalously - devoted to producing the latest electronic trifles. This very act of wasting may be inherent in our notion of the "good life". And even if you don't agree with that, it's certainly central to the functioning of capitalism.

People who don't like work, or school, or cops, or the job options of their ghetto, people who are bored, people who don't identify with chauvinistic sexuality, people who are bad at performing their correct social roles are, by definition, a problem. They're a contradiction. They know, deep down, that nearly everything our society celebrates and champions - cutthroat competition, narrow and artificial standards of beauty, "efficiency" (the most Orwellian of popular terms) - are bankrupt notions emptied of their meaning.

However, as the aspiring social worker pointed out above, even with the best intentions (like becoming a social worker!), it is increasingly difficult to escape. The age-old social injunction to "get with the program," has always been delivered by parents, schools, judicial authorities, etc. Now, all of these entities have the option to medicate their subjects and abort the self-reflection and growth that comes with the individual negotiating her place in the world. It proves to be far cheaper, but like most cost-cutting, it might be fatally short-sighted.

The great irony is that a largely drugged populace may prove to be devoid of the dynamism and struggle that enabled the progressive aspects of capitalism in the first place. The bourgeoisie myth of the free, rebellious, maverick individual who flees his home and makes his own way seems is not only a relic of another time, but in the advanced capitalist nations is physically impossible. There is nowhere unthreatened by the great Sameness of our dumbed-down discourse, of our distracted and alienated corporate culture. There is nowhere to flee where you won't be trespassing.

Which is not to say that we shouldn't have anti-psychotic drugs or automation. Clearly we want these things, to some extent. And it is also not the case that we shouldn't have universal symbols for "get food here" or "get computers here", which is the benevolent aspect of easily recognized brands. The question is, as always, who is in control? Is their claim to rule legitimate? And why do they need to put so many people in jail? And why do they need to put so many people on drugs? And why are our schools like prisons, too? And why, if my job is unnecessary to life on earth, indeed, if my job is wasteful and thus detrimental to life on earth, why, then, do I work so hard?

Prozac As Good As Placebo

In a PLoS Medicine article, a British professor Irving Kirsch and his colleagues have reported that the antidepressant drugs like Prozac are not more efficient then placebo in the treatment of depression.

The authors have gained access to, and analyzed the data from the unpublished trials of these medications.

Even before that, according to the most optimistic data from the published studies, the drug and placebo response rates were around 50% and 40% respectively. Now when the unpublished studies are taken into account, it turns out (perhaps not surprisingly) that the drug-placebo difference is almost non-existent.

A Guardian article comments on this more extensively, and describes some drug producers's reaction to these findings.

To Become Or Not To Become

Martin says I must become a psychiatrist precisely because I understand so much about how the enterprise really works - so I could help many people. This makes a lot of sense, but to me it's still not very convincing. It is a bit like recommending someone who understands everything about politics to go ahead and become a politician. A layman has the luxury to be optimistic; when you know the organization well enough, you may also know that it cannot be changed.