Biopsychiatry and critical thinking
Again, this post is not what I have been meaning to write, but it’s what I’ve got at the moment. My brain has had several posts lined up, but I have not been able to follow through with trying to write them.
Right now I’m tired, but still just about able to write. I only remembered last night, trying to figure out what might be causing the recent fatigue, why I stopped taking cetirazine (Zyrtec) before. I’d remembered the just not working well bit–which also applies to the other one-a-day antihistamines I’ve tried–but had managed to forget about the fatigue and depression side effects. Between that and less alone time and ready keyboard access lately, it’s been frustrating.
Flipping through Nigel’s latest issue of Skeptical Inquirer last night, I ran across an article which got me back onto a topic I’d meant to write something about before. Unfortunately, it’s not available online through their site (yet), but I just found it at Science-Based Medicine: Harriet Hall’s The One True Cause of All Disease.
I couldn’t help but think of biopsychiatry while reading this article.
Are these practitioners treating the underlying cause, or are they simply applying their one chosen tool to treat everything? Chiropractors treat every patient with chiropractic adjustments. What if a doctor used one treatment for everything? You have pneumonia? Here’s some penicillin. You have a broken leg? Here’s some penicillin. You have diabetes? Here’s some penicillin. Acupuncturists only know to stick needles in people. Homeopaths only know to give out ridiculously high dilutions that amount to nothing but water. Therapeutic touch practitioners only know to smooth out the wrinkles in imaginary energy fields. They are not trying to determine any underlying cause: they are just using one treatment indiscriminately.
Substitute “Paxil” or “Abilify” for “penicillin”, and that’s basically the situation we’ve got going with biopsychiatry. Rather than subluxations, candida infections, refined sugar, or any of the more recognizably strange purported causes, they attribute all signs of distress anyone might be showing to neurotransmitter imbalances for which they cannot offer any more evidence.
Unfortunately, there is no more evidence that this is a reasonable model than there is to support the “Spiritual vital force and its dynamic derangement” model–or any of the other models Hall points out. Even the fMRI and PET scan studies produced as evidence these days frequently cannot be replicated.
Nonetheless, adherents to the biopsych model persist in interpreting everything in the light of neurochemical imbalances. Worse, once a person has gained a diagnostic label of mental illness, everything they do and say is liable to be interpreted as a sign of this presumed imbalance–especially if they question how much the treatment is actually helping them, whether it’s the only option available, whether the diagnosis is correct, or if they point out that side effects and adverse effects from medications are causing them far more distress than the original problem ever did.
This would be darkly funny, were it not for the fact that this hurts people. Not only are even such simple causes of distress as “I’ve got a crappy job, and I get no help whatsoever–along with verbal abuse–at home” addressed with medication–thus making it more difficult to identify, much less change, the life situations which might be causing the person problems–some of the medications have horrible side effects and adverse effects, which are frequently dismissed and/or considered an indication that one needs more medication. I’ve written about some of the potential medication effects here, and pointed out studies showing that “life expectancy of those treated in community mental health centers has plunged to an appalling 25 years less than average”.
A lot of really bizarre circular logic gets applied; it’s distressing that this is not more widely seen for what it is. One would expect that if a lot of people receiving a particular treatment continue to experience distress, getting off that treatment can be very difficult, that treatment is known to cause metabolic and other adverse effects, and people using said treatment have a 25-year shorter lifespan–maybe it’s time to try something else, or at least take other factors into account. No, any signs of distress or that the medication is not having the intended effect, are frequently interpreted such that the person is very sick indeed and needs more medication.
It’s hard to escape the conclusion that this approach to human distress is pseudoscientific (excellent multi-part series). As that author puts it, “The main assumption is that because a great deal of science (especially chemistry) is involved in psychiatric medication, the psychiatric programs are, themselves, scientific.” This is not necessarily the case, especially given that biopsych is purporting to diagnose incurable physical ailments, and judge improvement or deterioration, based on observed behavior.
To quote Dr. Thomas Szasz, Professor Emeritus of Psychiatry at SUNY, Syracuse:
[discusses thankfully discredited “disorders” such as drapetomania and hysteria] Now none of those behaviors was ever a disease and of course, is not a disease. Nor is Attention Deficit Disorder a disease. No behavior or misbehavior is a disease or can be a disease. That’s not what disease are. So it doesn’t matter how a child behaves. There’s nothing to examine. If he is sick, there must be some objective science to it, which can be diagnosed by physicians and objective tests. That’s why as soon as you go to a doctor, they take a lot of blood and take x-rays. They don’t want to hear how you behave.
Yes, his comments tie in nicely with a neurodiversity approach. Just because a person’s behavior strikes you as strange, and you don’t understand why they’re behaving in that way, that does not automatically make them incurably “sick” and in need of medication to change their observed behavioral “symptoms”. That smacks far more of social control than of science-based medicine.
It can be particularly dangerous when a perceived-as-oddly-behaving group of people also responds atypically to medications, as addressed in my earlier Autistic medication: some serious risks post. In this context, drugs are approved specifically for “behavioral management”. Tampering with things you really don’t understand can hurt people, very badly in some cases.
Another recent report shows that: “children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.” It’s hard not to see this as (a) going for the “easier” option due to lack of funds, and (b) social control. Poor/minority kids’ behavior is too often seen as more problematic, and they’re getting more drugs to control this. “The questions go beyond the psychological impact on Medicaid children, serious as that may be. Antipsychotic drugs can also have severe physical side effects, causing drastic weight gain and metabolic changes resulting in lifelong physical problems.”
Unfortunately, Massimo Pigliucci’s newish Gullibility is Bad for You blog seems to be down. Here is the cached version, and his series on gullibility from Psychology Today. Unfortunately, a lot of what he has to say applies equally well to biopsych approaches as to some of the loopier holistic medical approaches. We need to apply some critical thinking, or it really can hurt us. No field should be exempt–and it only makes sense to be suspicious when supporter and practitioners of a certain approach suggest that there is something wrong with questioning the assumptions they’re basing things on.
It’s particularly suspicious in cases such as Bruce Levine points out in his Scientology vs. Psychiatry piece:
For many Americans who gain their information solely from television, all critics of psychiatry are Scientologists, exemplified by Tom Cruise spewing at Matt Lauer, “You don’t know the history of psychiatry. . . . Matt, you’re so glib.” The mass media has been highly successful in convincing Americans to associate criticism of psychiatry with anti-drug zealots from the Church of Scientology, the lucrative invention of science fiction writer L. Ron Hubbard.
People who base their criticisms, in part, on their own experiences with modern psychiatry are particularly easy to discredit and dismiss. They need to take their meds and shut up.
Levine goes on to observe:
Both the teachings of L. Ron Hubbard and psychiatry’s DSM (the official diagnostic manual in which mental illnesses are voted in and out by elite psychiatrists) have much more to do with dogma than science. Both Scientology and psychiatry embrace science fiction techno-babble that poses as scientific fact…
Scientology and establishment psychiatry have something else in common. They are both orthodoxies that deal harshly with their ex-insiders who have come to reject them. Currently, psychiatry is the more prevailing orthodoxy, and, as George Orwell explained, the mainstream press does not challenge a prevailing orthodoxy. Orwell wrote:
“At any given moment there is an orthodoxy, a body of ideas which it is assumed that all right-thinking people will accept without question. . . . Anyone who challenges the prevailing orthodoxy finds himself silenced with surprising effectiveness. A genuinely unfashionable opinion is almost never given a fair hearing, either in the popular press or in the highbrow periodicals.”
It is my experience that psychiatry, Scientology, and fundamentalist religions are turnoffs for genuinely critical thinkers. Critical thinkers are not so desperate to adjust and be happy that they ignore adverse affects — be they physical, psychological, spiritual, or societal. Critical thinkers listen to what others have to say while considering their motives, especially their financial ones; and they discern how one’s motivation may distort one’s assumptions.
His full article is well worth reading. Dogma and rigid thinking are also discussed in the Things We learned From Therapy and Doctors (by the Amorpha Household) post I linked to earlier; these quotes are gleaned from comments by the guest authors:
However, I actually think that the people who genuinely believe they are doing good, whether in the psychiatric establishment, in religious organizations, in schools, or in families, can be the most dangerous of all. After all, those who are in it just for the money will stop if their financial incentive is taken away; those who are motivated by a belief in their own truly benevolent nature and in their subjects’ need for them will continue to do so regardless of what they get for it…
And I think he really did believe all of this implicitly– he was viewing everything through a mental lens which caused him to systematically discard all of the client’s explanations for their own behavior, and replace it with his own ideas of why they did things. As with a cult, people believe and are told they are doing good if they are “following the teachings,” no matter how cruel or unreasonable those teachings might seem– they’re just curing mental illness instead of saving souls, this time around.
And according to them, we are the ones who are delusional and have a distorted picture of reality. Huh.
These observations agree with my own experiences. Most of these folks actually do believe that they’re helping, and can become very hostile if it becomes obvious that what they’re doing is not actually helping you. (Not to mention if you do not show the expected gratitude, since they’re “helping”, especially if you never wanted the kind of “help” they are forcing on you.) In short, too many of the mental health professionals I have dealt with–completely biopsych in approach or no–were True Believers.
Also see Ron Unger’s piece, Talking to someone convinced mental distress is all biological: “Because mental health professionals and others who belief themselves ‘experts’ are really no different from people who get called clients in one respect: both groups often believe things for emotional reasons rather than due to real evidence or logic.”
My Religion, ethics, and critical thinking post applies in this context, too.