Wednesday, July 15, 2009

Addiction Science and the Problem of Perception

Why don’t mental health professionals get it?

Dr. Joanna Moncrieff, identified by the BBC News as a “mental health expert,” gave the world the benefit of her view on the use of drugs for mental disorders in a July 15 article titled “The Myth of the Chemical Cure.”

Joanna Moncreiff’s version goes like this:

“If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it. “


“Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.”


“People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin. The trouble is there is little justification for this view of psychiatric drugs.”

Deeply, undeniably false.

“First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.”

False—but a new and increasingly popular line of attack. None of the major findings about the relationship between serotonin metabolism and clinical unipolar depression has been overturned. The Serotonin hypothesis of unipolar depression is still a fundamentally sound and useful model, as evidence by the stunning success of serotonin-boosting antidepressants.

But wait! The success of SSRIs is proof that serotonin has nothing to do with it! Moncrieff writes: “It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis. Psychoactive drugs make people feel different; they put people into an altered mental and physical state. They affect everyone, regardless of whether they have a mental disorder or not.”

False—all three statements. A trifecta of untruths. Psychoactive drugs for mental illness are not necessarily chemically akin to alcohol and cannabis, many of the drugs do not “make people feel different” or vault them into an altered mental state, and the drugs do not effect most “normal” people who do not have one of the underlying mental disorders the drugs are designed to treat.

“In my view it remains more plausible that they ‘work’ by producing drug-induced states which suppress or mask emotional problems.’

False—and happily, her view on the matter is not shared by many reputable neurologists. The quotation marks around the word “work” would seem to tell us all we need to know about Ms. Moncrieff’s relationship to modern medicine.

“At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.”

True--and we should thank our lucky stars that we have progressed out of the dark ages when it comes to the treatment of mental illness.

“If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.”

True—but on another hand, uncounted numbers of addicted people might find the prospect very appealing, if only they could afford it, or were under the care of a health professional who understood what the medication could do for her patients.

Graphics Credit: 1800blogger


mr ross said...

I guess for some "mental health experts" it is advantageous when patients never get better.

Unknown said...

I love "AI": generally balanced and sober. as a bipolar alcohlic-user w/ moderate cerebal palsy I've had bad experiences w/ various hastily prescribed SSRI's (akathesia,extreme insommnia, mood swings,diarrhea as drug levels stabilized, then general ineffectiveness). I think they are overprescribed and docs sometimes pooh-pooh side effects. looking forward to reading your book.

Dirk Hanson said...

"I think they are overprescribed and docs sometimes pooh-pooh side effects. looking forward to reading your book."
I agree, they are sometimes overprescribed--and it tooks years for doctors to believe their patients about SSRI discontinuation effects.

On the OTHER hand, these drugs are also simultaneously underprescribed for patients who need them, based on misinformation about the mechanism of action ("I'd give you this antidepressant pill but it will make you into an unfeeling zombie.")

Hope you enjoy the book; it contains abundant material about the invention of antidepressants and their connection to addiction treatment.

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