Mosher: Rethinking The Mental Illness Industry - August 27, 2003

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August 27, 2003

 

A FAST FOR FREEDOM IN MENTAL HEALTH

 

RETHINKING THE MENTAL ILLNESS INDUSTRY

 

By Loren R. Mosher M.D. and Mary Boyle Ph.D.

 

" Depression is a flaw in chemistry, not character "

 

Eight story sign at Amsterdam Ave and 72nd St., New

York City

 

The American public is constantly being told that

various forms of mental and emotional distress and

disordered behavior are 'illnesses like any other' -

depression is just like diabetes. Yet, does the public

know that the American Psychiatric Association's

Diagnostic and Statistical Manual now has 374 'mental

disorders' versus 112 in 1952 and, even though we now

have all these new 'diseases', that not one has given

up its biological secrets? The US Surgeon General

concluded in 1999 that there is no biochemical,

anatomical or functional sign that reliably

distinguishes between the brains of mental patients

and anyone else.

 

Who benefits from this proliferation of mental

disease? An obvious beneficiary is the drug industry,

for if behavior and distress look like physical

illnesses, then 'treatment' naturally looks like

drugs. In 2000, 23 billion dollars were spent on

psychotropic drugs, twice the 1995 cost.

 

And, although psychiatric drugs don't have specific

effects on emotions and behavior (they sedate,

tranquilize and stimulate in non-specific ways) they

are marketed as if they specifically treated

particular mental disorders. The result is a strong

symbiotic relationship between the DSM's ever-growing

list of disorders and the marketing and sales of

drugs. Perhaps the most striking aspect of this has

been the dramatic growth in the children's drug

market, to the point where an estimated 5-7 million

American children now take stimulant drugs for

'attention deficit disorder'.

 

We would be less concerned about this situation if the

outcomes were positive. But, on the contrary,

long-term outcomes for people diagnosed as

schizophrenic are no better now, and may even be

worse, than before the introduction of major

tranquilizers (misleadingly called anti-psychotics).

Not only that, but the World Health Organization found

that outcomes for people with schizophrenia in

developing countries, where these drugs are used much

less, are actually better. Similarly, research

indicates that antidepressants have not significantly

reduced the suicide rate, and, as the Journal of

Clinical Psychiatry recently reported, that these

drugs may " actually increase biochemical vulnerability

to depression and worsen long term outcomes " . There

are also serious concerns about the adverse effects of

these drugs. The major tranquilizers can produce

incurable movement disorders. The minor tranquilizers

are addictive. The newer antidepressants induce

suicidal and homicidal behavior in some persons and

can be addictive. Given these problems, it's difficult

to see that the medicalization of emotion and

behavior, and its 'treatment' with drugs, has overall

had positive effects.

 

It is not just the lack of positive outcomes that

should concern us. In spite of claims that the

medicalization of human distress is based on

biomedical science, research paints a quite different

picture. The strongest evidence about causes of

distress and disordered behavior comes from research

on social and environmental factors. For example, if

at least 50-60% of those admitted to psychiatric

hospitals, regardless of diagnosis, have been

physically or sexually abused, is it not reasonable to

assume that this may have something to do with the

distress they are experiencing? If various types of

family dysfunction, poverty, trauma, unemployment and

other environmental factors are consistently and

strongly related to psychiatric problems, is this not

significant? Are we seriously to assume that the best

answer to these psychosocial issues is drugs?

 

What is especially tragic about this situation, apart

from the human cost, is the closing down of open and

honest debate. Readers who thought that the issue of

'mental illness' has been settled in favor of

biological psychiatry may be surprised to learn that

many people with impeccable academic and professional

credentials continue to produce valid critiques of

biological psychiatry's research and practice. There

is also grave concern about the methods it uses to

hide its lack of scientific respectability. But

critics' views rarely receive media attention, while

authoritative sounding medical assertions are given

immediate credibility and publicity. Frequent

pronouncements of genetic or biological

" breakthroughs " in our understanding or treatment of

'mental illness' keeps the public in a constant state

of positive anticipation. When the breakthrough comes

to nothing, as it always has, no trumpets are heard

and, in any case, another will be along soon.

 

As the President's New Freedom Commission report

recently concluded, the current model of care has

proven to be a failure. Given this context it is

surely time to re-think biological psychiatry. The

public deserves to be better informed about the

scientific and ethical issues so that they can

question critically how public money is being spent

and about the standards of evidence on which claims

about biological causation and treatment are based.

More open and honest debate can only be good for the

field and especially for users of mental health

services.

 

Loren R. Mosher is Clinical Professor of Psychiatry at

the University of California at San Diego and former

Chief of the Center for Studies of Schizophrenia at

the National Institute of Mental Health and first

Editor-in-Chief of the Schizophrenia Bulletin.

 

Mary Boyle is Professor of Clinical Psychology, Head

of the Doctoral Program in Clinical Psychology at the

University of East London, UK and author of

" Schizophrenia: A Scientific Delusion? "