Biopsychiatry controversy

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The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include disparate groups such as the antipsychiatry movement and some academics.

Contents

Overview of opposition to biopsychiatry

Biological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial measures of a primarily somatic[ clarification needed ] nature.

This has been criticized by Alvin Pam for being a "stilted, unidimensional, and mechanistic world-view", so that subsequent "research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance". [1] According to Pam, the "blame the body" approach, which typically offers medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances.

Research issues

2003 status in biopsychiatric research

Biopsychiatric research has produced reproducible abnormalities of brain structure and function, as well as a strong genetic component for a number of psychiatric disorders (although the latter has been shown to be correlative rather than causative). It has also elucidated some of the mechanisms of action of medications that are effective in treating some of these disorders. Still, by their[ who? ] own admission, this research has not progressed to the stage that they can identify clear biomarkers of these disorders.

Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer's disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.

—  American Psychiatric Association, Statement on Diagnosis and Treatment of Mental Disorders [2]

Focus on genetic factors

Researchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of dimensions of genetic risk [3] and reports show significant associations between specific genomic regions and psychiatric disorders. [4] [5] However, to date[ when? ], only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions. [6] [7] For example, one reported finding suggests that in persons diagnosed with schizophrenia as well as in their relatives with chronic psychiatric illnesses, the gene that encodes phosphodiesterase 4B (PDE4B) is disrupted by a balanced translocation. [8]

The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways; for example, by personality, temperament or life events. [9] Therefore, while twin studies and other research suggest that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is "at least as hard as the search for genes involved in other complex disorders." [10] Theodore Lidz [11] and The Gene Illusion. [12] [13] argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies. [14]

Focus on biochemical factors

The chemical imbalance hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric conditions and that these conditions can be improved with medication which corrects this imbalance. In that, emotions within a "normal" spectrum reflect a proper balance of neurotransmitter function, but abnormally extreme emotions which are severe enough to impact the daily functioning of patients (as seen in schizophrenia) reflect a profound imbalance. It is the goal of psychiatric intervention, therefore, to regain the homeostasis (via psychopharmacological approaches) that existed prior to the onset of disease.

This conceptual framework has been debated within the scientific community, although no other demonstrably superior hypothesis has emerged. Recently, the biopsychosocial approach to mental illness has been shown to be the most comprehensive and applicable theory in understanding psychiatric disorders. However, there is still much to be discovered in this area of inquiry. As a prime example, while great strides have been made in the field of understanding certain psychiatric disorders (such as schizophrenia), [15] others (such as major depressive disorder) operate via multiple different neurotransmitters and interact in a complex array of systems which are (as yet) not completely understood.

Reductionism

Niall McLaren emphasizes in his books Humanizing Madness and Humanizing Psychiatry that the major problem with psychiatry is that it lacks a unified model of the mind and has become entrapped in a biological reductionist paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism's efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the last atom; however, this does not reveal the program that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of openness to Self-criticism, "a smugness that stops the very engine of scientific progress". [16] He has proposed his own natural dualist model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers and Alan Turing and does not fall into the "dualist's trap" of spiritualism. [17]

Economic influences on psychiatric practice

American Psychiatric Association president Steven S. Sharfstein, M.D. has stated that when the profit motive of pharmaceutical companies and human good are aligned, the results are mutually beneficial for all: "Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works[ citation needed ]. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists." However, Sharfstein acknowledged that the goals of individual physicians who deliver direct patient care can be different from the pharmaceutical and medical device industry. Conflicts arising from this disparity raise natural concerns in this regard including: [18]

Nevertheless, Sharfstein acknowledged that without pharmaceutical companies developing and producing modern medicines - virtually every medical specialty would have few (if any) treatments for the patients that they care for. [18]

Pharmaceutical industry influences in psychiatry

Studies have shown that promotional marketing by pharmaceutical and other companies has the potential to influence physicians' decision making. [19] Pharmaceutical manufacturers (and other advocates) would argue that in today's modern world, physicians simply do not have the time to continually update their knowledge base on the status of the latest research; that by providing educational materials for both physicians and patients, they are providing an educational perspective; [20] and that it is up to the individual physician to decide what treatment is best for their patients. has been replaced by educationally-based activities that became the basis for the legal and industry reforms involving physician gifts, influence in graduate medical education, physician disclosure of conflicts of interest, and other promotional activities. [21]

In an essay on the effect of advertisements on sales for marketed anti-depressants, evidence showed that both patients and physicians can be influenced by media advertisements, and that this influence has the possibility of increasing the frequency of certain medicines being prescribed over others. [22]

See also

General

Groups critical of the biomedical paradigm

Criticisms from psychologists and the medical profession

  1. APA Fights Attempt to Limit Access to Psychoactive Drugs, American Psychiatric Association president Michelle Riba, M.D., M.S.
  2. Against Biologic Psychiatry [ permanent dead link ] - an article by David Kaiser, M.D., in Psychiatric Times (1996, Vol. XIII, Issue 12).
  3. Challenging the Therapeutic State – special issue of The Journal of Mind and Behavior (1990, Vol.11:3).
  4. Letter of Resignation from the American Psychiatric Association – from Loren R. Mosher, M.D., former Chief of Schizophrenia Studies at the National Institute of Mental Health.
  5. Memorandum from the Critical Psychiatry Network to the United Kingdom Parliament – Written evidence to the House of Commons Select Committee on Health, April 2005.

Methodological issues

  1. On the Limits of Localization of Cognitive Processes in the Brain – an essay by William R. Uttal, Professor Emeritus of Psychology at the University of Michigan, based on his book The New Phrenology (MIT Press, 2001).

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind–body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia (psychosis) and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorder including anxiety disorders.

Edwin Fuller Torrey, is an American psychiatrist and schizophrenia researcher. He is associate director of research at the Stanley Medical Research Institute (SMRI) and founder of the Treatment Advocacy Center (TAC), a nonprofit organization whose principal activity is promoting the passage and implementation of outpatient commitment laws and civil commitment laws and standards in individual states that allow people diagnosed with severe mental illness to be involuntarily hospitalized and treated throughout the United States.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

<span class="mw-page-title-main">Waxy flexibility</span> Catatonia psychomotor symptom

Waxy flexibility is one of the twelve symptoms that can lead to the diagnosis of catatonia. It is a psychomotor symptom that results in a decreased response to stimuli and a tendency to remain in an immobile posture. If one were to move the arm of someone with waxy flexibility, the patient would keep that arm where it had been positioned until moved again as if positioning malleable wax. Attempts to reposition the patient are met by "slight, even resistance".

<span class="mw-page-title-main">DISC1</span> Protein-coding gene in the species Homo sapiens

Disrupted in schizophrenia 1 is a protein that in humans is encoded by the DISC1 gene. In coordination with a wide array of interacting partners, DISC1 has been shown to participate in the regulation of cell proliferation, differentiation, migration, neuronal axon and dendrite outgrowth, mitochondrial transport, fission and/or fusion, and cell-to-cell adhesion. Several studies have shown that unregulated expression or altered protein structure of DISC1 may predispose individuals to the development of schizophrenia, clinical depression, bipolar disorder, and other psychiatric conditions. The cellular functions that are disrupted by permutations in DISC1, which lead to the development of these disorders, have yet to be clearly defined and are the subject of current ongoing research. Although, recent genetic studies of large schizophrenia cohorts have failed to implicate DISC1 as a risk gene at the gene level, the DISC1 interactome gene set was associated with schizophrenia, showing evidence from genome-wide association studies of the role of DISC1 and interacting partners in schizophrenia susceptibility.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

Biological psychopathology is the study of the biological etiology of mental illnesses with a particular emphasis on the genetic and neurophysiological basis of clinical psychology. Biological psychopathology attempts to explain psychiatric disorders using multiple levels of analysis from the genome to brain functioning to behavior. Although closely related to clinical psychology, it is fundamentally an interdisciplinary approach that attempts to synthesize methods across fields such as neuroscience, psychopharmacology, biochemistry, genetics, and physiology. It is known by several alternative names, including "clinical neuroscience" and "experimental psychopathology." Due to the focus on biological processes of the central and peripheral nervous systems, biological psychopathology has been important in developing new biologically-based treatments for mental disorders.

The causes of schizophrenia that underlie the development of schizophrenia, a psychiatric disorder, are complex and not clearly understood. A number of hypotheses including the dopamine hypothesis, and the glutamate hypothesis have been put forward in an attempt to explain the link between altered brain function and the symptoms and development of schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

The following outline is provided as an overview of and topical guide to psychiatry:

Schizophrenia is a primary psychotic disorder, whereas, bipolar disorder is a primary mood disorder which can also involve psychosis. Both schizophrenia and bipolar disorder are characterized as critical psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). However, because of some similar symptoms, differentiating between the two can sometimes be difficult; indeed, there is an intermediate diagnosis termed schizoaffective disorder.

Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network. She is a prominent critic of the modern 'psychopharmacological' model of mental disorder and drug treatment, and the role of the pharmaceutical industry. She has written papers, books and blogs on the use and over-use of drug treatment for mental health problems, the mechanism of action of psychiatric drugs, their subjective and psychoactive effects, the history of drug treatment, and the evidence for its benefits and harms. She also writes on the history and politics of psychiatry more generally. Her best known books are The Myth of the Chemical Cure and The Bitterest Pills.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

<span class="mw-page-title-main">Lori L. Altshuler</span> American psychiatrist

Lori Altshuler was a professor at the University of California, Los Angeles (UCLA) Department of Psychiatry and Biobehavioral Sciences and held the Julia S. Gouw Endowed Chair for Mood Disorders. Altshuler was the Director of the UCLA Mood Disorders Research Program and the UCLA Women's Life Center, each being part of the Neuropsychiatric Hospital at UCLA.

<span class="mw-page-title-main">Biology of bipolar disorder</span> Biological Study Of Bipolar Disorder

Bipolar disorder is an affective disorder characterized by periods of elevated and depressed mood. The cause and mechanism of bipolar disorder is not yet known, and the study of its biological origins is ongoing. Although no single gene causes the disorder, a number of genes are linked to increase risk of the disorder, and various gene environment interactions may play a role in predisposing individuals to developing bipolar disorder. Neuroimaging and postmortem studies have found abnormalities in a variety of brain regions, and most commonly implicated regions include the ventral prefrontal cortex and amygdala. Dysfunction in emotional circuits located in these regions have been hypothesized as a mechanism for bipolar disorder. A number of lines of evidence suggests abnormalities in neurotransmission, intracellular signalling, and cellular functioning as possibly playing a role in bipolar disorder.

Epigenetics of bipolar disorder is the effect that epigenetics has on triggering and maintaining bipolar disorder.

References

  1. ↑ Pam, Alvin (1995). "Biological psychiatry: science or pseudoscience?". In Colin Ross and Alvin Pam (ed.). Pseudoscience in Biological Psychiatry: Blaming the Body. NY: Wiley & Sons. pp. 7–84. ISBN   978-0-471-00776-0.
  2. ↑ APA statement on Diagnosis and Treatment of Mental Disorders Archived 2012-07-13 at the Wayback Machine , American Psychiatric Association, September 26, 2003
  3. ↑ Most psychiatric disorders share a small number of genetic risk factors, VCU study shows Archived 2009-05-11 at the Wayback Machine , Virginia Commonwealth University
  4. ↑ Pickard BS, Malloy MP, Clark L, Lehellard S, Ewald HL, Mors O, Porteous DJ, Blackwood DH, Muir WJ (March 2005). "Candidate psychiatric illness genes identified in patients with pericentric inversions of chromosome 18". Psychiatric Genetics. 15 (1): 37–44. doi:10.1097/00041444-200503000-00007. PMID   15722956. S2CID   46458951.
  5. ↑ Macgregor S, Visscher PM, Knott SA, Thomson P, Porteous DJ, Millar JK, Devon RS, Blackwood D, Muir WJ (December 2004). "A genome scan and follow-up study identify a bipolar disorder susceptibility locus on chromosome 1q42". Molecular Psychiatry. 9 (12): 1083–90. doi: 10.1038/sj.mp.4001544 . PMID   15249933.
  6. ↑ van Belzen MJ, Heutink P (2006). "Genetic analysis of psychiatric disorders in humans". Genes, Brain and Behavior. 5 (Suppl 2): 25–33. doi:10.1111/j.1601-183X.2006.00223.x. PMID   16681798. S2CID   22726139.
  7. ↑ Meyer-Lindenberg A, Weinberger DR (October 2006). "Intermediate phenotypes and genetic mechanisms of psychiatric disorders". Nature Reviews. Neuroscience. 7 (10): 818–27. doi:10.1038/nrn1993. PMID   16988657. S2CID   10966780.
  8. ↑ Millar JK, Pickard BS, Mackie S, James R, Christie S, Buchanan SR, Malloy MP, Chubb JE, Huston E, Baillie GS, Thomson PA, Hill EV, Brandon NJ, Rain JC, Camargo LM, Whiting PJ, Houslay MD, Blackwood DH, Muir WJ, Porteous DJ (November 2005). "DISC1 and PDE4B are interacting genetic factors in schizophrenia that regulate cAMP signaling". Science. 310 (5751): 1187–91. Bibcode:2005Sci...310.1187M. doi:10.1126/science.1112915. PMID   16293762. S2CID   3060031.
  9. ↑ Kates WR (April 2007). "Inroads to mechanisms of disease in child psychiatric disorders". The American Journal of Psychiatry. 164 (4): 547–51. doi:10.1176/appi.ajp.164.4.547. PMID   17403964.
  10. ↑ Van Gestel S, Van Broeckhoven C (October 2003). "Genetics of personality: are we making progress?". Molecular Psychiatry. 8 (10): 840–52. doi: 10.1038/sj.mp.4001367 . PMID   14515135.
  11. ↑ Lidz T, Blatt S (April 1983). "Critique of the Danish-American studies of the biological and adoptive relatives of adoptees who became schizophrenic". The American Journal of Psychiatry. 140 (4): 426–34. doi:10.1176/ajp.140.4.426. PMID   6837778.
  12. ↑ Joseph, Jay (2003). The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope. New York, NY: Algora. ISBN   978-0-87586-344-3. Archived from the original on 2012-11-05. Retrieved 2007-12-24.[ page needed ]
  13. ↑ Joseph, Jay (2006). The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes. NY: Algora Publishing. ISBN   978-0-87586-410-5.[ page needed ]
  14. ↑ "Jay Joseph The Missing Gene". Archived from the original on 2009-04-17. Retrieved 2006-06-16.
  15. ↑ McEwen BS, Chattarji S, Diamond DM, Jay TM, Reagan LP, Svenningsson P, Fuchs E (March 2010). "The neurobiological properties of tianeptine (Stablon): from monoamine hypothesis to glutamatergic modulation". Molecular Psychiatry. 15 (3): 237–49. doi:10.1038/mp.2009.80. PMC   2902200 . PMID   19704408.
  16. ↑ McLaren, Niall (2007). Humanizing Madness. Ann Arbor, MI: Loving Healing Press. pp. 3–21. ISBN   978-1-932690-39-2.
  17. ↑ McLaren, Niall (2009). Humanizing Psychiatry. Ann Arbor, MI: Loving Healing Press. pp. 17–18. ISBN   978-1-61599-011-5.
  18. 1 2 Sharfstein SS (August 2005). "Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly". Psychiatric News. 40 (16). American Psychiatric Association: 3. Archived from the original on 19 November 2007.
  19. ↑ Dana J, Loewenstein G (July 2003). "A social science perspective on gifts to physicians from industry". JAMA. 290 (2): 252–5. doi:10.1001/jama.290.2.252. PMID   12851281.
  20. ↑ "Code on Interactions With Health Care Professionals". PhRMA. Archived from the original on 12 March 2018. Retrieved 11 March 2018.
  21. ↑ Zipkin DA, Steinman MA (August 2005). "Interactions between pharmaceutical representatives and doctors in training. A thematic review". Journal of General Internal Medicine. 20 (8): 777–86. doi:10.1111/j.1525-1497.2005.0134.x. PMC   1490177 . PMID   16050893.
  22. ↑ Huskamp HA, Donohue JM, Koss C, Berndt ER, Frank RG (2008). "Generic entry, reformulations and promotion of SSRIs in the US". PharmacoEconomics. 26 (7): 603–16. doi:10.2165/00019053-200826070-00007. PMC   2719790 . PMID   18563951.
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