Pharma-psychology - more on Faith based medicine.

Some time ago I wrote about Psychology and that in my view psychological “cures” based on pharmacology (i.e. drugs) is founded on faith and may be considered as a pseudo-science. This aroused a fair bit of interest and one informed comment by an unidentified contributor. This post is really a continuation of my original.

There is a profound ignorance about the connection (if there is one) between mind and brain. It is all very well for neuroscientists to point out that with the various brain scanning techniques now available it can be seen that different parts of the brain “light up” when a patient is talking about an enjoyable experience or when thinking about a mathematical problem. But HOW does the excitation of neurons translate into memories of the experience or the solution to a maths problem? And what comes first – is it the activity of the neurons which creates the thoughts and memories or does the creation of the thoughts and memories activate the neurons? No one knows.

Consider now, from a psychological point of view, our freedom to choose – known as the “problem of mental causation”. Regarding the multitude of properties attaching to the human brain, in terms of its physical activity, there are occurrences that in strictly scientific terms should be impossible:- How can it be that subjective (non-material) thoughts of the “self” can so influence the function of the brain that it compels the brain to direct one course of body action rather that another?

It is a fundamental fact of science - a precept - that nothing can happen that is not governed by natural laws of material causation (i.e. physical things cause physical effects). Thoughts are non-physical (they are subjective), therefore by definition cannot cause anything physical to happen....!!

The one and a half kilogram brain is certainly an incredible organ.

But why, Oh why, if we know so little about how and why the brain works do psychiatrists, when presented with a so called “mental disease” persist in pumping the brain full of drugs? They prescribe drugs even for children – some as young as 2 and 3 years old. This is inexcusable; this is unethical. In this regard an over reliance on pharmacology is fraught; a “chemical imbalance” in the brain means what, exactly? What is the “correct” chemical balance and how is this determined? It should not be forgotten that behaviour can never be considered a “disease”, as an illness. A person may be ill at ease and this may affect their behaviour but they are not “sick” – unless there is a pathological reason, which would then be beyond the scope of psychology.

All this may be a bit technical for the casual reader but as many people a possible should try to understand the basic facts – Firstly, that no one knows what actually causes any individual to suffer from a mental problem (and make no mistake people do suffer); Secondly, that the “Bible” of Psychologists and Psychiatrists, the American Psychological Association’s DSM-IV (Diagnostic and Statistical Manual of Mental Disorders edition IV) lists over 360 disorders – which I find bizarre; Thirdly, using the diagnostic tools listed in the DSM-IV mental health professionals have reported to the Australian Bureau of Statistics that 19% of Australians, will in their lifetime, suffer from some form of mental disorder! That is 1 in 5 Australians will need some form of treatment (most probably drugs). This I also find bizarre.

All this is determined on a highly problematical and yet to be proven “scientific” basis. For instance after nearly one hundred years of research there is no objective test for psychosis (classic psychotic experiences involving, for example, feelings of persecution, thought interference and auditory hallucinations) – it's a matter of a health professional’s judgement regarding the apparent behavioural and thought disorder patterns presented by an individual (as determined using the DSM-IV diagnostic tools - in other words ticking multiple choice boxes on a list). Furthermore if psychosis is deemed to have a genetic base – as some psychologists now claim - the questions relating to any evolutionary advantage will need to be answered.

Then there is the grave issue of side effects of these drugs – they can be very severe indeed. For instance the West Australian Government’s Chief Psychiatrist warns as follows – quoting from the American Food and Drug Administration (FDA):-

FDA Product Information Warning

Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient’s presenting symptoms.

Still happy about taking these drugs??

Finally I include the following email I received from a correspondent which may be of interest to some readers (I suppress his name for obvious reasons): 

“A year ago you wrote about your take on the perceived horrors of the West Australian Mental Health Act and its so called 'Chief Psychiatrist'.

I am an Australian, and in another State. But I can tell you all of the states in Australia have the same kind of heinous 'mental health acts'.

 You are completely, and utterly correct in your assertions. I am a survivor of forced psychiatric drugging in Australia and I can tell you, far more than it being 'worse than prison' (which is correct), it is enough to make you lose all faith in humanity and all agreement in the false assertion that this Australia is a 'free society'. If your brain can be raped, on the say so of one man, without court hearing, without charge, without opportunity to hire a lawyer, you're living in a piece of shit fascist state.

It took me years to even be this articulate in response, and I am one in 10,000 in terms of the survivors of forced psychiatry in this country. The vast majority are rendered drooling zombies, and I'm not frigging around.

 It is always nice, always ever so slightly encouraging, to see an Australian even remotely  empathising with the people targeted by these laws. It is challenging enough, to not arbitrarily HATE all Australians who would dare vote for governments who continue such heinous laws.  Which includes 99.99 percent of Australians.

.....which makes for a lonely existence nonetheless. 

Kudos to you, for at least acknowledging what disgusting torture governments dish out in this country.”

(I hasten to add that I have nothing personal against the Chief Psychiatrist – I have never met or spoken to him. I am sure he is a man with the mental welfare of the Western Australian population at heart).

NOW are you still happy about being prescribed and taking antidepressant medication??

What is Schizophrenia?

What is schizophrenia? The short answer is that no one knows. The effects are well documented even though they are not necessarily unique to schizophrenia. Since the term was first used by Eugen Bleuler in 1911, intense research has so far failed to identify the condition’s causes though it is thought to be a combination, in varying degrees, of genetic, environmental and neurological factors. This debilitating mental disorder is believed to affect about 1% of the World’s population and is generally first diagnosed in late teenage and early adulthood. For reasons not yet established more males than females are affected.

Not only is schizophrenia difficult to define but is without any confirmed pathological, molecular or genetic origin – it has no confirmed biological basis. Diagnosis is made from observed behaviours meeting the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV Axis 1) criteria. These criteria relate principally to the determination of an afflicted individual’s mental state, from their speech patterns and perceptions which may indicate possible hallucinations and/or delusions. This is supported by observed unusual behaviour which may affect the afflicted person’s ability to function effectively in the broader community. Therefore any diagnosis cannot be objectively “scientifically” proven, it is subjective - someone’s opinion and interpretation of behaviour. Furthermore it is not an illness which prescription medication can cure. It is certainly an unfortunate and debilitating condition but it is not an illness – and to call it such is misleading and wrong.

There appear to be many factors involved in the causes of schizophrenia. Obstetric complications, such as foetal hypoxia (foetus deprived of oxygen); viral infections the mother may have experienced during pregnancy; even the season of the year when giving birth, (winter being statistically the least favourable); the patient’s social status; even where the patient resides - in an urban or rural locality (urban being the least favourable), all appear to have a bearing on the incidence of this condition.

While not one single factor has been identified as common to all patients with the condition researchers are working on some evidence that schizophrenia may be a polygenic disorder (influenced by many genes) which is further influenced by environmental factors and a person’s emotional vulnerability while developing in teenage years. Stress appears also to be a factor in the development of schizophrenia as it is recognised in playing a significant role in many medical conditions. It is now thought, with some individuals, that certain levels of stress experienced may exceed their adaptive capacity and thus compound the vulnerabilities of the person concerned. Comments critical of the patient’s demeanour and behaviour together with the alternative of an over-protective relationship have a significant bearing on the course of schizophrenia – this is called a high level of Expressed Emotion. Some patient’s may suffer a relapse from a relatively stable condition which allowed for their discharge from a treatment centre. There is, however, no agreement on the meaning of relapse.

It is now known that people suffering schizophrenia are more likely to recover and less likely to suffer a relapse if they live in a calm, non-critical, non-overprotective environment – a low level of Expressed Emotion. It is well documented that early intervention programmes are of vital importance in determining a favourable outcome for schizophrenia patients but there appears to be no agreement on what recovery actually means. Recovery varies considerably in effect from individual to individual – is it a “clinical” objective recovery (decided by using DSM IV criteria) or an individual’s subjective assessment of their quality of life? It was believed that, once diagnosed with schizophrenia, there was no chance of recovery. There is now, however, a body of evidence suggesting that the situation, for many sufferers, may not be quite so dire, particularly with those individuals not using street drugs and not drinking to excess. With a correct balance between antipsychotic drug treatments and other psychosocial and psychological interventions it is now known that between 20% to 30% recover sufficiently to lead relatively normal lives, with a further 20% to 30% manifesting continuing moderate symptoms. Other reports show that the recovery rate is actually quite high though generally under-reported and is actually somewhere between 50% and 60%. All this shows that the “experts” still don’t really know.

Given the astonishing lack of knowledge about what causes schizophrenia, expressed emotion, relapse and recovery together with the limited understanding of how they relate to one another, how scientists can claim statistical “evidence” and validity proves anything is really surprising. Research is consistent in reporting that high levels of expressed emotion are likely lead to a relapse by patients with schizophrenia. Why this should be, however, is not fully understood. The many factors involved may possibly be partly genetic but certainly involve subjective elements which are difficult to define and measure. No one knows what it really means to recover or relapse nor is it understood from “what” a recovery or relapse is occurring! Also no one knows why high levels of expressed emotion (an “un-calm” environment) may be a predictor of a patient’s relapse.

A mental condition as complex as schizophrenia cannot be artificially restricted to fit the requirements of the DSM-IV. Nature will not be governed by man-made conditions which attempt to force it to answer questions required for statistical analysis to satisfy the ideals of “scientific research”. Statistics are unable to adequately assess the nuances and subtleties of words, gestures, feelings, imaginings, desires and beliefs that, in varying degrees, are so tied to and characteristic of each individual and which are known to have an effect on the outcome of schizophrenia and any relapse or recovery.

To force a patient suffering from schizophrenia to take medication – without knowing what the medication actually does or how it works (and with significant side effects) – is ethically questionable and quite wrong in my opinion. The better way is to look at the physical and emotional environment and conditions which spawned the patient’s affliction. It is necessary to find out what all this means to the patient – their interpretation of the events and how it has affected his or her thinking.

Schizophrenia is as much a mysterious condition as it was 100 years ago, certainly the "experts" have no idea what it really is or how to "cure" the condition.