It's in peer-reviewed print: no mental illness "chemical imbalance"

Great Debates
21

I don’t think that’s what he was saying (or anyway, it’s not what I was saying). The term “mental illness” has a stigmatizing effect and always has had one. In a sense, psychological disorders are a sort of ghetto where a number of behavioral, probably-brain-based diseases go before scientists decide to start figuring out their causes and cures (and medication is not the same as a cure). As the OP mentioned, the category of mental illness once included epilepsy, which is now categorized as a neurological disorder. Until these diseases are recognized as fully medical, they will always be treated with skepticism. Taking certain disorders out of the DSM would do a lot towards legitamizing them and increasing the search for cures or at least better stopgap treatments.

There is no doubt in my mind that schizophrenia and bipolar disorder (among other diseases) are physical diseases. What some people have a problem with is putting all these disparate problems into a made-up category when there is already a category for brain-based diseases, neurological disorders.

22

Psychiatric nurse checking in. I have no specific data to cite. Some people benefit from drugs. Some people benefit from cognitive therapy, meditation, stress management. Others seem to fit nowhere, and as a result have become instituionalized, and don’t survive anywhere outside the hospital. Yes, it is terribly terribly sad.

Im not fond of some of the things the mental health uh profession do to people we have chosen to lable patients or consumers, or whatever the hip word du jour happens to be. I do not like the idea of warehousing people for the rest of their lifes. I do not like the dependence we create in our patients. Many of my colleauges and I agree where drugs are concerned, less is more.

On the other hand, some people are seriously ill, cannot function on their own. They need to be somewhere safe until such time as they can live on their own. Or can make arrangements to live somewhere safe. Sometimes these people are difficult to have on a ward with others. There may not be any great harm in a tiny old lady who wants to get home to her (condemned by the city) house full of cats, but when she wanders around and taps or grabs someone who is also currently having hallucinations, and paranoia, then there is a threat to everyone’s safety, including staff. So we medicate the paranoid, and we medicate the dementia sufferer, so they both can continue to live within our ward, where they are at least sheltered, fed, clothed.

Its not a perfect system. I have ethical and moral doubts every day. I do not deny some truth in the OP. I also see results of some people stabilized on medication. Some people have quirky personalities that should not be olanzapined away. But quirky is one thing, putting self and others at risk is another. So I do my job, and daily remind myself “there but for the grace of [Og] go I”. Im not better or worse than the person I pass pills to. Just currently more fortunate.

23

A few things:

PLOS Medicine may be a peer-reviewed journal, but it does not to my knowledge have much standing in the medical/scientific community.

What I get from the cited opinion piece is that it is dubious to claim that low serotonin levels are the mechanism for a wide range of mental disorders, and that the SSRIs are likely overprescribed. Not much to argue with there. Even their strong supporters are unlikely to claim that all users will benefit, that the side effects won’t be too much for some patients, or that alternate meds (or no meds) won’t be better for certain sufferers.

I’ve seen the occasional study showing that a popular antidepressant doesn’t work better than placebo. And other studies demonstrating significant effects.

My take is that drugs for psychiatric disorders have taken us out of the dark ages, and given life back to a whole lot of people who otherwise would be institutionalized or not functioning to any major degree. God (or alternate deities) help us if we ever had to go back and rely on having variously warped mental health professionals digging into our ids and superegos.*

*In my psych rotation in med school, it was illuminating seeing the difference between the clinical staff who embraced the new medical therapies, and the old guard, who reacted at times as though someone had taken their candy away.

24

Former severe suicidal depression patient checking in here.

I’m on a middle-of-the-road ground between the two extremes of Shagnasty and AHunter here, I think. My depression was caused by a host of factors, and required a multi-pronged attack of medication and therapy to completely control (I still have severe mood swings, now that I’m unmedicated, but I have psychological tools available to help prevent them from becoming full-blown depressions).

On one hand, I agree with AHunter that the psychiatric establishment needs to immediately and publically come to terms with the fact that, in many cases, they have no idea what medicines will work or why. I also think that involuntary committments ought to be far more carefully examined than they currently are.

On the other hand, I’m with Shagnasty on scaring people away from help with horror stories. There are a lot of folks out there like me, who don’t want to talk to a therapist or a pshrink of any type for fear we’ll be declared crazy and locked away, or drugged into a stupor (yeah, I know, paranoid much?).

On the gripping hand, I think following AHunter’s guidelines halfway with regards to meds and involuntaries would help accomplish Shagnasty’s apparent goal of people getting the help they need, whether that’s drugs or therapy or just being left alone to figure it out themselves.

25

That is so appropriate. Are you the originator, or did you pick up on it somewhere? That’s how I’m going to spell it (in the propoer context) from now on, and I urge everyone else to do so as well.

26

Shagnasty:

You regard it as dangerous that some people, on being familiarized with the MH system’s lies, would decide against trying psychiatric treatment. Since some people do benefit from MH drugs (as I acknowledged in the OP), that’s probably true.

But because of the lies, many people will suffer, have their lives badly derailed, experience permanent brain damage, and/or even die as a consequence of being led to place unearned trust in the psychiatric system.

I regard the latter as the bigger danger, having been there and having met many other veterans of the system with horror stories to tell. You are entitled to your opinion; you may differ in your evaluation of the relative dangers here.

But, moreover, this is a board dedicated to fighting ignorance, and the point is that the psych + pharma people claim a degree of knowledge that they simply don’t possess, and that’s a bad thing. Ignorance that pretends, with the authority of medical license and police powers backing their pretention, to knowledge and certainty that just ain’t so, is ignorance squared. Dangerous ignorance.

davenportavenger:

I deny that they are even necessarily / always diseases. They are conditions. Not always undesirable conditions. Not always conditions that represent departures from the range of healthy processes. Certainly they are often debilitating, unpleasant, destructive, and of course undesirable. But not always.

And no I don’t think they are physical conditions. I think they have physical components. None of the three central psychiatric diagnoses — clinical depression, bipolar disorder, or schizophrenia —are applied to people whose mental, emotional, and behavioral state cannot, far more often than not, be explained in large part by circumstances, events, situations. I would guess that there are physical components that predispose some people’s minds to fall into the observed patterns more readily than other folks’ do under comparable circumstances. I would also guess that there isn’t a person alive whose mind will not, under the proper stimulus of events, go into those patterns.

jackmanii:

A common but massively invalid assumption exists in our culture — that prior to the advent of thorazine and other psych meds, the primary treatment for the mental illnesses consisted of having schizophrenics, bipolar-disordered folks, and depressives lie down on a couch and free-associate or talk about their potty training and get past their Oedipal phases or what have you.

Didn’t happen. The portion of the population who did the couch-lying thing was confined to the relatively wealthy folks who sought out psychoanalysis on a voluntary basis. The mainstream treatment for schizophrenia, manic-dep (bipolar), and depression in the era before neuroleptic psych meds consisted of less effective medicating (e.g., barbituates), physical restraints (including straitjacket, “wetsheet” wraps, six-point tiedowns, padded cells, immobilizing chairs, and other such therapeutic devices), and shock therapy (ECT and insulin). The kinds of folks who went in for Freudian couch analysis still exist and many still go to Park Avenue shrinks who still do Freudian as well as Adlerian and Jungian and a host of other “deep talk” therapies, as well as more recent trendy behavior-mod focused talk therapy. Quite a few of them also take SSRIs nowadays, too, talk therapy and med therapy aren’t mutually exclusive).

davenportavenger :

I know. In general, the MH system’s claims about “chemical imbalances” has been given less credit with regards to schizophrenia and somewhat less with regards to bipolar disorder than for depression. They make the claim across-the-board to the patients, but it is with depression that the marketing has targeted the mainstream, and with the SSRIs many folks who would doubt that schizophrenia is a neuroleptic-deficiency disease were inclined to think that, with depression, the profession really did have it nailed. So yeah, I shorthanded my argumentative way across some logical leaps here. The article doesn’t address whether bipolar disorder is a lithium-deficiency disease, but it shows in a generic way that the profession has claimed knowledge that it doesn’t possess in making similar claims about depression.

Meanwhile, plenty of folks do indeed get involuntarily incarcerated for clinical dep every year.

27

I’m a little confused here . . . I know homosexuality was famously taken out of the DSM in the '70s, for the purpose of “legitimizing” it in the sense of redefining it as a non-pathology – a psychological characteristic which is not a disorder and requires no cure or treatment. You would not want to see bipolarity, schizophrenia, or even depression reclassified in that way, would you?

28

Sorry about your particular circumstances; I hope you feel well soon.

Meanwhile, in my observation and (non-professional) opinion, this is (notes which forum we’re in) garbage. The people I’ve known with these disorders, and I include myself in this category, have these states regardless of circumstances, events and situations. To use my own experience, it’s sure nice now to be able to go outside on a beautiful day, and honestly *feel * great about it, as opposed to having a gray cloud over it all and think, “Gee, I guess this is the kind of day on which some people are happy.” And to not feel horribly afraid all the time. All from a simple daily dose of one pill. I doubt it’s just a placebo – I tried a lot of things before, honestly believing that better nutrition, or more sunlight, or more exercise, or any of a variety of supplements, would finally help.

I saw one friend who was (unbeknownst to me) taking lithium suddenly become an abusive, paranoid, nastly person when he quit the treatment. It destroyed his marriage and the life thereafter of his ex-wife. He simply became another person entirely.

Sure, I imagine that there are situations where psychopharmacology is used inappropriately. I bet there are situations where penicillin is used inappropriately, too. Doesn’t mean there’s a giant conspiracy of lies. I doubt if I’ll convince you, though.

29

Question: What difference would it make if they changed the label? I understand the physical difference between the two, but if you can’t prove either one, and they still treat people involuntarily, what impact would it have on the issue at hand?

30

This is a great problem for me. I have a suspicion that many psychoactive medications may in fact alter the brain, often irrreperably, and beyond the original symptoms, often for the worse, and in exacerbation of symptoms upon discontinuation. Where is the research into how much these drugs are permanently disabling people and harming them more? I think these chemicals often damage the brain in their “efficacy”, often leaving a person who is less of what they were and dependant on the harmful chemicals. The current prescription happy pshrinks (love that term) nonchalance and over(ab)use of some of these medications seems unethical to me.

Also, simply that somebody has become “something” according to somebody else’s judgement also smacks of witch hunt accusations and really is the heart of the problem and contention that Ahunter3 is making. Many of the diagnoses are purely subjective and dependant on mere mortals who wield great power over another’s life.

31

I think there might be a day sometime in the not to distant future when we will all say, that Tom Cruise was right.

32

Well, in the situation I observed, I was told that after his self-imposed lithium withdrawal, he reverted to a state similar to what he’d been in prior to its prescription. So a pretty basic case of being o.k. when medicated vs. definitely NOT o.k. when unmedicated. He was most assuredly on the verge of needing to be kept away from others for their safety. Thiscould be observed quite objectively – anyone who goes from being a nice, gentle man to throwing his wife against the wall and causing permanent injury is not just some subjectively-observed tendency.

After the breakup of the marriage (complete with restraining orders), I lost contact with this individual. However, years later I heard from another friend that he had apparently gotten treatment of some sort again, and was most apologetic about all the damage he had done to others.

33

umm, some of this stuff still happens. you didn’t think they did away with ect did you?

34

And speaking as someone who just had a very close relative who had become severely depressed treated with ECT, I can tell you that it can be a life-saver. She was severely depressed for over 4 months, in-and-out of hospitals, on various psychiatric drugs, and nothing was helping very much. The ECT treatments completely returned her to her normal self in a matter of a few weeks (with a fair bit of memory loss of the events for the few months leading up to the ECT, but I don’t think this is stuff she’d really want to remember). The change was really incredible.

Of course, this isn’t to say that ECT is the cure for everyone or even that all mental illnesses are caused by whatever chemical / electrochemical imbalances that a treatment like ECT can cure. But, I think it is dangerous to be too absolutist in the other direction either. The mind is incredibly complex and resists the ability of us to completely characterize it, whether we be pharmaceutical companies, proponents of ECT, or opponents of pharmaceutical solutions or ECT.

35

I would say that we should back off from the bigger claims here regarding the ethics of institutional medicine, and acknowledge that Ahunter3 and his article do have a number of very salient points that really aren’t all that radical. The article isn’t arguing that there are no biological basis for psychiatric disorders, it’s arguing that the connection between simple serotonin levels and depression is tenuous at best. For certain disorders like schizophrenia and dopamine, we have a very consistent set of theories, clinical trials, and other evidence that supports our view of the biological basis of schizophrenia. We have drugs that actually clearly affect dopamine levels and a lot of data about typical dopamine levels in different populations. At high levels, we see schizoid behaviors, at low levels we see Parkinsonian disorders, and in between we see healthy people. When drugs are used to correct either side, we see actual levels of dopamine change, and when we treat schizophrenics with antipsychotics we often see “Parkinson’s disease” through tardive dyskinesia, and when we treat Parkinson’s disease, we occasionally see schizoid behaviors. The model works, it has plenty of support, and our clinical findings consistently back up these models of thinking.

For the link between serotonin and depression, the relationship is a lot muddier. We can use tryptophan to vastly increase serotonin levels, but this doesn’t seem to ameliorate depression, and we have a huge number of drugs used for clinical treatment of depression that only seem to vaguely affect the levels of serotonin present. I’m not arguing that SSRI’s don’t work, and neither does the article. The point is that they don’t work well (57% of RCT’s on SSRI’s don’t show significant effects between placebo and SSRI’s, of course once that number reaches 95% we should *really * be worried) and we don’t really understand how they work very well at all. They don’t raise serotonin levels dramatically, if at all, and the way in which they work doesn’t seem to make a lot of sense. If more serotonin yields less depression, why do they take 6 to 8 weeks before they start working? Neurons can fire hundreds of time per second and SSRI’s should be biologically available within hours, so why don’t they start working quickly? Maybe this suggests that they somehow alter, “cortical organization,” or whatever else some other posters have hinted at. Basically, the point is that the simple model presented by the Zoloft commerical of some weird little bouncing happy/sad face that asks, “feeling blue? You don’t have enough seratonin! Here, we’ve got a pill that will raise your serotonin, buy it!” It’s certainly a convenient explanation for pharmaceutical companies, and the way that peer-reviewed journals are/were set up until this year without pre-trial registration causes publication bias that tends to only get the one study that supports our cobbled-together explanation of serotonin and depression published but ignores the other 19 studies that showed opposite or null effects.

We’ve got plenty of reason to be skeptical of the serotonin-deficit model of depression, and we need better science to help us figure it all out. In the mean time, psychiatry and pharmaceuticals shouldn’t act all pissy when people go around questioning the ethics of compelling people to use treatments of questionable efficacy.

36

I’m well aware that ECT is still around, and not only that, still forced upon people against their will, in long repeating series.

Another treatment for which the profession should be held accountable. It is grandfathered in (wouldn’t stand a prayer of FDA approval if introduced now) and every time we try to get legislation passed that simply records morbidity and mortality rates on ECT in a comprehensive manner, fucking NAMI and the electro-shrinks (or electro-pshrinks, heh heh) mobilize against it, claiming (accurately) that our intention is to restrict ECT by acquiring data that shows it’s not good for people.

I didn’t mean to imply that psych drugs made the older modalities go away. They also still tie people to beds in six-way restraint and wrap them in straitjackets and put them in padded seclusion rooms. I dunno about wrapping them naked in cold wet sheets but I woudn’t be surprised.

37

Considering he gets his beliefs from the wacked out cult known as Scientology, I highly doubt that will ever happen. For crying out loud, he referred to Paxil and Ritalin as “anti-psychotics.”

38

Just because Scientoligy is considered a cult by some doesn’t make the truth any less true.

39

What truth-that all disease is caused by clusters of alien souls known as “thetans” sticking to you and that you have to spend thousands of dollars to get rid of them?

Trust me, Tom was talking out of his ass. He doesn’t know jackshit about psychology (no Tom, methadone was NOT invented by the Nazis, or originally called Adolphene. And no, vitamen overdoses will NOT cure post-partum depression.)

40

MLS:

That happened with author Kate Millett, also. She just happens to prefer the state she’s in when not on lithium. Her right, her choice. Her book on it is available via your local library: The Looney Bin Trip.

BrainGlutton:

I would. While I would not take it upon myself to define these as non-ailments for everybody, consider the following:

• Go back circa 1955 and if you polled gay folks about the desirability versus pathology of their “condition”, from what I’ve read you’d have gotten pretty high concurrence that it was an undesirable thing, to be homosexual. Without being able to visualize a world in which they were (more) accepted, it would have been hard to distinguish between “these are the consequences of being this way” and “these are the social consequences of people’s fucked-up reaction to me being this way”.

• Of those of us who have been involuntarily psychiatrized and/or were sufficiently disappointed with psychiatric treatment to discontinue it, you’ll find many who say, in essence, “I’m not schizo/bipolar/whatever because there’s no such thing”, you’ll find some who say “I’m not schizo/depressed/etc because they misdiagnose left and right, maybe some people are but there’s nothing wrong with me”, and you’ll find some who say “I am different from the folks who don’t tend to get psychiatric diagnoses, I don’t know if there’s such thing as ‘schizophrenia’ or whatever or not, but whatever it is, it’s who I am and I like it and don’t want to be ‘cured’.” As long as it remains true that mental illnesses are defined as their observable symptoms, it is meaningless to distinguish between having the symptoms but not being schizophrenic (etc) and actually being schizophrenic. I would say furthermore that there’s no traction in claiming, as some do, that there’s “no such thing”. (Sure there is, if we define a constellation of behaviors as a disease and we can clearly observe the occurrence of that constellation of behaviors. Regardless of what it “is”, the patterns exist!). So yeah, damn right you have quite a few people who are by that definition schizophrenic (or bipolar, etc) but who do not consider it to be a pathology. Damn right, I’d love to follow the lead of the gay-rights movement, at least in part — at a minimum, pride in who we are despite whatever difficulties our condition may impose on us (as with disabilities-rights folks), and for those of us who feel that way about it, pride in our condition, embrace of it as a positive, and demands that people not only stop discriminating against us in the sense of putting up undue barriers or having laws that pertain to us but not other people, but also get over their mentalism and be neither hateful nor pitying towards us. We are everywhere :slight_smile:

I should also add that once forced treatment is uprooted, there’s a lot more flexibility for choosing to accept a psych diagnosis and seek treatment or rejecting the identity and the treatment, and if under those circumstances you still get people embracing the identity while refusing the treatment, that’s an affirmation.

Whereas, as long as the label is one that gets stuck on you by others, the option of rejecting the diagnosis is an option limited to the fortunate, and embracing the identity that is imposed and declaring “OK, fine, well in that case not only am I “one of them”, I’m glad I am, proud of it, and I’m putting it on my fuckin’ T-shirt” becomes a tactic.