It is sometimes an appropriate response to reality to go insane
- Philip K. Dick
II – The Drugs
One of my most popular posts discusses this area, but it’s worth clarifying some points.
My motive is simple – to get the best possible care for people suffering from sometimes debilitating problems.
The question is what does the evidence say is the best solution?
Much like a pain killer is most welcome when suffering with appendicitis, so some drugs can be beneficial to deal with the worst of the symptoms for some of these conditions. However, to stretch the appendicitis analogy, if you only took the drugs to dull the pain, then the appendix may rupture and the results of that ain’t pretty. Besides pain – while unpleasant – is key to diagnosing the cause of the problem.
Similarly with mental problems, drugs can often mask issues. For example I’ve seen a number of people I know suffering from such issues be subdued with a cocktail of anti-psychotics and anti-depressants. Yes, it reduced their worst symptoms, but it also removed all their emotions, all their motivations and drives. One said to me “I feel like an automaton“, another “I’m just a zombie“. Max movingly says “I don’t know how else to explain them except mental handcuffs“. I’ve heard similar comments from other people. I very much appreciate that this approach took away the worst of their distress and behaviour, but it did not get to the root of their issues and help them deal with the causes of their distress. In fact in some cases I’ve seen, the ‘abnormal’ behaviour was a way of the person working through their underlying emotional problems, and this approach stopped their progress in its tracks.
The problem is, these treatments tend to be predicated on the assumption of a biological cause.
Psychiatrist Dr Joanna Moncrieff says “psychiatric drugs…”work” by producing drug-induced states which suppress or mask emotional problems, which may suppress the symptoms of psychiatric disorders, along with other intellectual and emotional functions. That sounds good. If your brain is not functioning properly“, however what if these reactions to environmental and psychological triggers are in fact adapted functions of the mind, evolved methods of coping with negative situations?
Professor Peter Kinderman says “Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in “chemical imbalances“. This leads us to be blind to the social and psychological causes of distress. More importantly, we tend to prescribe medical solutions – anti-depressants and anti-psychotic medication – despite significant side-effects and poor evidence of their effectiveness. This is wrong.”
Allen Frances says that “Medication should be a last resort used only for the clearest, most impairing, and most persistent disorders. Instead the meds are often prescribed carelessly-almost like candy“.
It should be added that most of these conditions cannot be considered in the same way as physical diseases – the pathologies just aren’t there. They are arbitrary assignations that enable us to understand and treat certain common behaviours and feelings. (And that’s not to deride or belittle them in anyway.)
People say ‘But, but, look at all these people that call it an illness, that treat it with drugs’ – Appeal To The Crowd.
‘But this doctor with a white coat prescribed these drugs’ – Appeal To Authority.
‘But they have been treated this way for decades’ – Appeal To Tradition.
People talk about chemical imbalances: correlation? Yes. Causation? Not necessarily. In fact, such markers should be thought of as the result of difficult life circumstances. This is how the brain responds to external events. Hunger is a chemical imbalance. You don’t take drugs to make the feeling go away, you look to the cause of the hunger. You eat food.
While there is evidence of genetic markers that mean people are more prone to, say, depression than others, it’s still their environment that triggers those reactions. Epigenetics is still in its infancy, but it’s clear that environment can activate and deactivate genes.
The gene blame game makes popular headlines but is not scientifically accurate. It’s a little more subtle than that.
The biological / genetic model is appealing. Its reductionist and simplistic approach makes it easy to understand and to treat. However that doesn’t mean it’s always correct.
So beware the seductive but pernicious idea that medication heals people in all of these situations. The evidence shows it doesn’t. It only manages symptoms. Or worse, is used to make people manageable.
Part III – Stigma in the next post…
Part I in the previous post.