Biopsychiatry controversy

This article is an expansion of a section within the article Biological psychiatry. The debate of psychiatry’s political implications is discussed in Anti-psychiatry

The biopsychiatry controversy is an ongoing dispute over the scientific basis of biological psychiatry theory and practice. The debate is focused on criticism of mainstream psychiatric thinking, proposed by a vocal lobby of psychiatrists and scientists who are at present in the minority. Activist organizations support their views. Critics contend the field is flawed in a number of ways. They argue that the lack of biomarkers is a flaw in the evidence for a somatic, biological cause for mental illness. Instead they draw attention to trauma models of mental disorders within the psychiatric literature which have been marginalized as research efforts switched to the biological model since the 1980s.

Overview

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. This task is apparently consonant with the spirit of science; for example, in pharmacology biopsychiatry has adhered to the standards of testing psychoactive drugs.

An organization critical of biopsychiatry, the International Center for the Study of Psychiatry and Psychology, points out that the dominant reductionist approach postulates somatic variables as causative factors in mental disorders. Consequently, research in biopsychiatry is confined to the medical illness model. In the words of a clinical professor of psychiatry, Alvin Pam (1995), "Given this stilted, unidimensional, and mechanistic world-view, research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance". 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.

History

In Madness and Civilization, Michel Foucault contends that the psychiatric profession originated in the 17th century as a method of bypassing legal restraints on the incarceration of poor people. State asylums, within which the profession originated, were basically lockups for the homeless. The medical profession only took over the poor houses in the 19th century.

By the 1930s the giant lockups of psychiatric hospitals had become too large and unmanageable. Lobotomy and various shock treatments were developed. In the 1950s new drugs were developed for tranquilizing the inmates.

Elliot Valenstein claims that, in the popular imagination molded by the media, biopsychiatry has become more scientific recently; has many effective drugs, has demonstrated the genetic foundation of schizophrenia and is moving ever forward into more specific psychopharmacology. However, in contrast to brain diseases such as tumors, multiple sclerosis, meningitis, epilepsy or neurosyphilis, after more than a century biopsychiatrists have not demonstrated that the major disorders that they diagnose are related to brain lesions. What is popularly known as the “Bible” of the psychiatric profession ^*, the Diagnostic and Statistical Manual of Mental Disorders or DSM does not assert the existence of biomarkers for the list of DSM behaviors. In the words of psychiatrist and veteran critic of his own profession Thomas Szasz:

The gist of my argument is that men like Kraepelin, Bleuler and Freud were not what they claimed or seem to be — namely, physicians or medical investigators; they were, in fact, religious-political leaders and conquerors. Instead of discovering new diseases, they extended, through psychiatry, the imagery, vocabulary, jurisdiction, and hence the territory of medicine to what they were not, and are not, diseases in the original Virchowian sense 1979, p. 21.

Psychiatry is the only medical specialty in which involuntary treatment and even involuntary hospitalization are commonly used. Szasz’s main concern is that a specialty in which the Virchowian, or cell pathology, criterion of disease or illness has been abandoned may drive societies into what he calls political medicine or the Therapeutic State.

General criticisms

Modern biopsychiatric practice strives to create and use explicit diagnostic criteria for mental illness, the DSM. This method of practice is often called neo-Kraepelinian after Emil Kraepelin, and later Eugene Bleuler, who advocated such an approach.

One of the paradigms of the DSM manual, the concept of schizophrenia, has been challenged from various perspectives. Shannon Sumrall and others contend that despite media publicity it has yet to be proven that schizophrenia is a bio-medical condition More significantly, the traumatogenic cause of some types of schizophrenia has been considered by some as a revolutionary approach in the mental health field [http://www.amazon.com/gp/product/0789022699/qid=1150749786/sr=1-1/ref=sr_1_1.

The fourth edition of the DSM is a list of 374 conditions. Only two of them, Post-traumatic stress disorder and Dissociative identity disorder are thought to be psychogenic or caused by traumatic experiences. Biopsychiatrists maintain that many other disorders are biomedical entities of unknown etiology. For example, in a statement released in September 2003 the American Psychiatric Association, which represents 36,000 physician leaders in mental health, conceded that “brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group Mental disorders will likely be proven to represent disorders of intracellular communication; or of disrupted neural circuitry” [http://www.mindfreedom.org/mindfreedom/hungerstrike1.shtml.

Psychiatrist Duncan B. Double complains about the futuristic stance (“will likely be proven...”) in this field ^*. In the psychiatric profession people labeled with a DSM disorder are usually treated with psychiatric drugs, and occasionally, electroshock (Breggin 1994). Hence the lack of biological markers in the profession has been an issue of concern for Robert Whitaker, author of Mad in America. Similarly, the fact that millions of children are being treated with methylphenidate (Ritalin) or other psychiatric drugs has also been an issue of concern for psychiatrist Peter Breggin, a leading critic of biopsychiatry, and his ICSPP colleagues.

Unjustified focus on biochemical factors

Most biopsychiatrists believe that, among other factors, the balance of neurotransmitters in the brain is a biological regulator of mental health. In this theory, emotions within a "normal" spectrum reflect a proper balance of neurochemicals, but abnormally extreme emotions, such as clinical depression, reflect an imbalance. Psychiatrists claim that medications regulate neurotransmitters and also claim they treat abnormal personalities by removing a neurochemical excess or replenishing a deficit (though the efficacy of antidepressants and antipsychotics is not undisputed ^*). On the other hand, Elliot Valenstein, a psychologist and neuroscientist, claims that the broad biochemical assertions and assumptions of mainstream psychiatry are not supported by evidence (Valenstein 1998). However, these beliefs have no doubt come about from the highly geared and pervasive efforts of the pharmaceutical companies sales and marketing departments. The techniques used can be traced back to methods first developed by Edward Bernays who was the first public relations practitioner to be hired to change public opinion on medical matters. Richard Smith (former editor of the British Medical Journal) wrote about how the drug industry can subtly influence what doctors think is scientifically valid. He said "I must confess that it took me almost a quarter of a century editing for the BMJ to wake up to what was happening." Since then he spends some of his time alerting the medical world to the dangers in the current system of distributing new medical knowledge.

Unjustified focus on genetic factors

According to biopsychiatry, genetic and environmental factors both appear to be of vital importance in determining mental state and therefore certain genetic factors can predispose people to particular mental illnesses To date — and in contrast to diseases affecting almost every other human organ but the brain — only a few genetic lesions have been proposed to be mechanistically responsible for psychiatric conditions ^*" target="_blank" >twin studies and other research suggests that personality is heritable to some extent, the genetic basis for particular personality or temperament traits, and their links to mental health problems, is currently unclear [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14515135&query_hl=16&itool=pubmed_docsum" target="_blank" >^*.

Theodore Lidz, Jay Joseph (2003, 2006) and others argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach, for example by referring to findings of the genetic basis for illnesses and weaknesses, rather than the role of other factors which may make some problems more likely in some environments and societies. Some propose that the biochemical differences observed in some mental illnesses are not the genetic cause, but rather the effect of a condition caused solely by psychological trauma Others argue that there is no significant genetic component involved at all, suggesting instead that observed patterns of family transmission are neutral with respect to genetic versus environmental etiology ^*" target="_blank" >[http://www.healthsurvey.com/schizophrenia.htm.

Imaging techniques

Modern brain imaging techniques, PET, MRI and CT scans are widely used in the medical profession. However, despite media publicity in the professional medical literature the potential value of imaging data for detecting genuine brain lesions is not undisputed ^*. For example, blood perfusion that can be seen with the imaging techniques is not considered a biomarker in the medical profession. In neurological science a biomarker could be physiopathology, histopathology or the presence of pathogen microorganisms in the nervous system. Biopsychiatrists recognize that they cannot demonstrate any of these biomarkers in the major DSM disorders (Nancy C. Andreasen, 2004).

Biopsychiatry as a pseudo-science

Many of the above issues lead to the common claim that psychiatry is a pseudo-science (Warme 2006).

According to the generally-accepted philosophy of science, for a theory to qualify as hard science it needs to exhibit the following characteristics:

parsimony, as simple as the phenomena to be explained allow (see Occam's Razor);
empirically testable and falsifiable (see Falsifiability);
changeable, i.e. if necessary, changes may be made to the theory as new data are discovered;
progressive, encompasses previous successful descriptions and explains and adds more;
provisional, i.e. tentative; the theory does not attempt to assert that it is a final description or explanation.

Psychiatrist Colin Ross and Alvin Pam (1995) maintain that biopsychiatry does not qualify as a science on many counts; John Modrow (1996, p. 239), that most biological hypotheses in psychiatry are untestable and thus unfalsifiable.

References

Joseph, Jay, The Gene Illusion: Genetic research in psychiatry and psychology under the microscope, PCCS Books, 2003.

Joseph, Jay, The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes, Algora Publishing, 2006.

Lidz, Theodore and S. Blatt (1993), “Critique of the Danish-American studies of the biological and adoptive relatives of adoptees who became schizophrenic", American Journal of Psychiatry, 140: 426-35.

Modrow, John, How to Become a Schizophrenic: The Case Against Biological Psychiatry, Apollyon Press, 1996 (a revised and expanded 2003 edition published by Writers Club Press is on print).

Pam, Alvin, “Biological psychiatry: science or pseudoscience?” in Colin Ross and Alvin Pam Pseudoscience in Biological Psychiatry: Blaming the Body, NY: Wiley & Sons, 1995, pp. 7-84.

Ross, Colin, “Errors of logic in biological psychiatry” in Colin Ross and Alvin Pam Pseudoscience in Biological Psychiatry: Blaming the Body, NY: Wiley & Sons, 1995, pp. 85-128.

Szasz, Thomas, Schizophrenia: the Sacred Symbol of Psychiatry, Oxford University Press, 1979.

Szasz, Thomas, Pharmacracy: Medicine and Politics in America, Praeger, 2001.

Valenstein, Elliot, Blaming the Brain: The Truth about Drugs and Mental Health, The Free Press, 1998.

Warme, Gordon, Daggers of the Mind: Psychiatry and the Myth of Mental Disease, Canada: House of Anansi, 2006.

Whitaker, Robert, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, Perseus, 2001.

External links

Criticisms from psychologists & the medical profession

Against Biologic Psychiatry - an article by David Kaiser, M.D., in Psychiatric Times (1996, Vol. XIII, Issue 12).
Challenging the Therapeutic State - special issue of The Journal of Mind and Behavior (1990, Vol.11:3).
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.
Memorandum from the Critical Psychiatry Network to the United Kingdom Parliament - Written evidence to the House of Commons Select Committee on Health, April 2005.

Methodolical problems

Schizophrenia: Medical Students are Taught it's All in the Genes but are they Hearing the Whole Story? - see Selected Publications by Jonathan Leo, PhD, Associate Professor of Anatomy, Western University of Health Sciences.
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).
Neuroimaging and psychological theories of human memory - introductory text for a symposium to be held in August 2006 at the Cognitive Psychophysiology Lab, Philipps-University Marburg, Germany (the text is in English).

Other critiques

Bad Neuro-Journalism archive - The James S. McDonnell Foundation maintains an archive of the worst examples of journalism about the brain from the popular press.

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