David Cohen on Madness Radio:
The Meaning of Medications


Why does the same psychiatric drug help one person – but harm another? Do psychiatric medications “work” by chemistry alone – or through expectation, placebo, and social factors? 

Clinical research and outcome studies, as discussed in-depth by Robert Whitaker in Anatomy of an Epidemic, don’t support the current widespread use of psychiatric medications. Medication risks often outweigh any benefits, not only in studies that downplay or ignore long-term use issues, but even over the short term. Clinical trials results are manipulated and hidden to promote medications for marketing purposes. 

Moving from aggregate research data to individual experience and choice has been a challenge for people concerned about these startling facts about psychiatric drugs. How do we engage a single unique individual from a framework of statistical assessment of medications, when that single individual may very well be the outlier exception found in statistical data – or even represent new data with no precedent in existing studies?

In this edition of Madness Radio, David Cohen, social work professor at Florida International University and co-author of Your Drug May Be Your Problem, discusses the role of social context in constructing how we experience psychiatric medications and all drugs. In my work with people around medications and withdrawal, I’ve noticed a parallel between worse side effects and lower empowerment and control. It turns out animal studies on drug addiction show the same importance of the social factor of control and choice in drug effects. I’ve met people in my counseling practice who are physiologically devastated by regular lithium use, and then talked with other people on the same dosage for the same time period who are thriving in their life with the assistance of lithium. David’s work begins to address this paradox: how medication effects are not simply chemical impacts on a biological brain, but rather the complex interactions of social factors, expectation, placebo, “nocebo,” and learning. As a harm reduction approach to withdrawal emphasizes, empowerment may be the most important consideration for supporting people’s wellness.

David asks us to consider medications from a standpoint of substances that alter consciousness. We know for example that alcohol has “objective” chemical risks — and that alcohol can be of perceived practical benefit to many people nervous in social interactions — but the impact of alcohol use is radically diverse depending on the person. Alcohol is a very, very dangerous drug that causes brain injury and carries extraordinary social harms alongside it — and is also tolerated without problems by many people.

In challenging the biological model of mental illness, it may also be important to go beyond the biological model of medication effects. Can we acknowledge drug risks and toxicities while also acknowledging the variability of response based on the social experience of medication? Is the meaning of medications for each individual more than just a biological question, just as the meaning of “mental illness” for each person is more than just a biological question? Do we need a recovery model of medications instead of a biomedical model of medications?

After all, the key ingredient to the success of the Soteria Project and Open Dialogue – innovative low-medication treatments with high recovery rates – seems to be the expectation of recovery offered by caring clinicians. Sounds a lot like the placebo effect to me.



Meaning Of Medications – David Cohen on Madness Radio



Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. A very important topic that has many people arguing about the “efficacy” of psychiatric drugs!

    Was just writing about this last evening. Here is what I have written,

    “For some people, taking psychiatric drugs on a short term basis provides a suspension from emotional distress, while ideally talk therapy or other intervention is started. This suspension from having to cope does not mean the cause of the problem is resolved. It just gives them a break from thinking.

    But there is more to it than that. In 1932 Tolman wrote about expectancy theory in his book “Purposive Behaviour in Animals and Man”, which highlights that we are more than just cognitive responses to stimuli. Evolving this theory into mental health currency today, Professor Irving Kirsch has conducted research into the placebo effect and hypnosis. He has found that anti-depressants are no more effective than sugar pills, also known as the placebo effect. He believes the operational process behind the placebo effect is response expectancy. In his research Kirsch shows that people will derive benefit from what they expect out of such treatment. What Kirsch suggests is how powerful the placebo effect truly is, and just how powerful the mind truly is.

    But there is more still, and this is very important. The environment is crucial to healing. Bruce Lipton showed in 1967 that the environment shapes genetics and behaviour with his stem cell experiments. So we know for sure the environment is crucial to shaping behaviour that leads to healing.

    In this context of environment, the treatment of the practitioner is very important. Practitioners who are compassionate and empathetic naturally want their “patients” to feel well. Through this caring attitude, the patient is in a better position to receive better care than from a practitioner who is cold and detached. Moreover, if the person has a good support network in his or her environment, through family, friends, community, and so forth, then re-stabilizing and recovery is more likely. But as research in Open Dialogues has shown, recovery is possible without the use of long term drugs.

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  2. I believe there is hope if we recognize the truth of these words: “David’s work begins to address this paradox: how medication effects are not simply chemical impacts on a biological brain, but rather the complex interactions of social factors, expectation, placebo, “nocebo,” and learning. As a harm reduction approach to withdrawal emphasizes, empowerment may be the most important consideration for supporting people’s wellness.”

    For decades, mental health professionals have been attempting to put the mind and soul in a box that can be “treated” with labels, behavior modification, programs, and psychotropic medications – none of which have been proven significantly to be an exact solution for mental and emotional distress. The effectiveness of any treatment, medication, or type of therapy is only as good as the connection between the “provider” and the “patient” or “client.” Even more importantly, it is the connections people have access to and are able to foster in their lives outside of treatment that make a lasting difference as people attempt to work through difficulties of any kind.

    The more I learn in books, the more I realize that my greatest schooling has been by personally experiencing extreme states of mental and emotional distress, as well as working side by side – connecting with – others who have also experienced it. Even as a professional in the mental health field, my primary goal is to connect meaningfully with my “clients.” When real healing is occurring in my office, it is the reciprocity of the relationship, combined with the effect of a power both beyond and within our Self, that changes people.

    Thanks for posting!
    –Mary Anne

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