- psychiatric drug efficacy
- mental health and society
- ethical mental health treatment
- long-term effects of antidepressants
- child pathologisation
- chemical imbalance myth in psychiatry
- serotonin and depression
- sustainable mental health care
- risks of antipsychotics
- rethinking anxiety and depression treatment
- Details
- Hits: 5
The Power of Placebo
The 20th century represented a remarkable turning point in medicine. It also marked the beginning of a tragic misunderstanding of mental health. After millions of years of successful evolution, humans were suddenly victims to brain chemistry gone awry. We were sold on the idea that chemical imbalances are the cause of anxiety and depression, not a biological effect created by environmental conditions. Antidepressants predominantly treat a symptom, not the cause, of our malaise.
From a pharmaceutical point of view, if you can create a narrative that the discomfort of life is a biological condition, you’re going to expand your market dramatically. Before 1980 - which is when panic disorder was first identified as a specific disorder - the group of things that were seen as biological was pretty small. It was going to be hard for the pharmaceutical market to expand beyond that.
Why did psychiatry want to tell this tale? Psychiatry in the fifties and sixties had a lot of Freudian impulses and psychodynamic thinking. Then in the seventies, you see a guild whose survival as a medical discipline was under attack. As the benzodiazepines were popping up - those were the first real popular psychiatric drugs -there were problems with addiction, withdrawal, and lack of efficacy over time.
In the seventies, the American Psychiatric Association as a guild felt threatened. Diagnoses were being challenged. It was in competition with talk therapy counseling and other ways of approaching wellness. They said, “We need to put on the white coat. If we call these diseases of the brain, we’re now in that field of (almost) infectious disease medicine.” You can see psychiatry trying to convince itself that these diseases are chemical imbalances.
In addition, when a pharmaceutical company wants to get a drug approved, they’re going to design the study in ways that make their drug look good. There are all sorts of tricks. If you know of certain side effects, don’t put them on the checklist of problems that you look for and you won’t get nearly as many spontaneously reported actions. People who are funding the studies of these drugs by and large have a vested interest in seeing them approved.
But the problems start way earlier in life! If you look at the harm done from pathologising childhood, it’s so broad-based. Kids are taught to monitor their own self. If they find themselves sad, that’s wrong, that’s abnormal. Whereas in the past, you might think, “I’m sad today”, you’re expected to be happy, and if you’re not happy, that’s a problem. We’ve created a situation where kids are primed to think, “something is wrong with me,” and parents are primed to think, “something is wrong with my child.”
And then the industry comes and says something like "We’re going to fix something wrong with the inside of your head." Yet, when you look at the latest research, none of this is really correct!
Two World Health Organisation studies report on outcomes for schizophrenia patients. They were cross-cultural studies in nine different nations, and both times they found outcomes were much better in poor countries than “developing” countries. India, Colombia, and Nigeria fared better than the US and other rich countries. The World Health Organisation actually concluded that living in a developed country is a strong predictor you will have a bad outcome if you are diagnosed with schizophrenia. WHY does living in a developed country, with all of our advances in medicine, be a predictor of a bad outcome.
The common narrative was: How we were making progress in treating mental disorders. We were finding that they were due to chemical imbalances; we had drugs to fix those chemical imbalances. Yet here were cross-cultural studies finding something much different. Similarly, other research indicates that the serotonin model, on which all SSRI medications such as antidepressants are based, is simply not correct! Many antidepressants show no better efficacy than placebo or talk therapy in long-term usage.
We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders, and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. It is very bad to give patients this message because the truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract.
SSRIs, SNRIs, and antipsychotics have the worst record for withdrawal symptoms. Antidepressants can produce pain, numbness, depression, stroke-like symptoms, and much more. With SSRIs, impaired memory, sexual dysfunctions, panic attacks, and pathological gambling can continue for up to a year after discontinuation, even if the patient tapers off slowly.