There is an interesting article in last month’s issue of the British Journal of Psychiatry. The article, titled Psychiatry beyond the current paradigm, was authored by Pat Bracken, an Irish psychiatrist, and 28 other British and Irish psychiatrists.
The gist of the piece is that the current psychiatric paradigm, which the authors describe as “applied neuroscience,” is not supported by the evidence and needs to be abandoned.
Here are some quotes:
“The technological paradigm underscores a trend towards the medicalisation of everyday life, which, in turn, is associated with expanding markets for psychotropic agents.”
“This process has also led to the corruption of sections of academic psychiatry through its entanglement with the pharmaceutical industry, damaging the profession’s credibility in the process.”
“There is strong evidence that improvement in depression comes mainly from non-technical aspects of interventions. Recent meta-analyses of drug treatments for depression demonstrate that drug–placebo differences are minimal.”
“Overall, available evidence does not support the idea that antidepressants work by correcting a pre-existing ‘chemical imbalance’”
“None of the studies reviewed… found significant differences between real and sham ECT after the treatment period.”
“By 6 months, there was actually a two-point difference in scores …in favour of the sham treatment.”
“A meta-analysis of randomised controlled trials investigating the effectiveness of first- and second-generation antipsychotic drugs found that, at best, the improvements seen in two commonly used rating scales…were ‘disappointingly limited’. Although the authors’ caution against the conclusion that antipsychotics have ‘negligible effects in clinical practice’, given their findings, and those of other groups, such a conclusion does not seem unreasonable. Over-reliance on psychopharmacology as the primary response to serious mental illness created the conditions for a blindness towards the serious adverse effects of some psychiatric drugs, and for a shameful collusion with the pharmaceutical industry’s marketing campaign that sold the illusion of major innovations in antipsychotic drugs. The claimed therapeutic advances were, in fact, ‘spurious’. As Kendall put it recently ‘the story of the atypicals and the SGAs [second-generation antipsychotics] is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing’. These drugs are associated with increased cardiovascular risk. Such iatrogenic effects have been cited as one of the reasons for the significantly decreased life expectancy of people with mental illness.”
“The evidence is becoming clear that to improve outcomes for our patients, we must focus more on contexts, relationships and the creation of services where the promotion of dignity, respect, meaning and engagement are prioritised.”
“Psychiatry is not neurology; it is not a medicine of the brain.”
And this was written by practicing psychiatrists!
They are calling for a demedicalization of the “mental health” field, and their critical self-appraisal in this regard is to be commended. Amazingly, however, they conclude the piece by asserting: “Psychiatry has the potential to offer leadership in this area.” In other words: we realize that for the past hundred years or so we’ve promoted spurious concepts, and have done enormous damage to the people who came to us for help. But now, with a great deal of prodding from individuals whom, for decades, we ridiculed as brainless cranks, we recognize the error of our ways. We don’t have the decency to resign, however, but instead we will stay at the helm and do a much better job in the future.
My question is this: Why should psychiatrists stay at the helm, if the problems in question are not illnesses? Would we ask plumbers to head up a highway safety commission, or engineers to lead a government spending committee? Why should psychiatrists imagine that they have a lead role to play in helping people with problems of living?
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