Future of Mental Health Interview Series: Interview with Joanna Moncrieff on The Myth of the Chemical Cure

Eric Maisel, PhD
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The future of mental health interview series continued this past week with many interesting interviews: Claudia Gold on The Silenced Child; Bill D. on Alcoholics Anonymous; Jackee Holder on Life Coaching and Emotional Health; Rorie Hutter on Innisfree Village; Lori Sylvester on residential treatment for adolescent girls; Joanna Moncrieff on The Myth of the Chemical Cure; and Rosie Kuhn on Transformation Coaching. Below is the Joanna Moncrieff interview. Below that are links to the other interviews and a link to a roster of the whole series.

Interview with Joanna Moncrieff

Joanna Moncrieff makes a clear distinction between a disease-centred model of drug action, where actual diseases exist and are being treated, and a drug-centred model of drug action, where chemicals-with-powerful-effects are employed to produce certain effects (as often negative as positive). She argues that the former is what the current, dominant paradigm purports to be engaged in and that the latter is what is actually going on, much to the detriment of many of “medication” for “mental disorders.” Here is Joanna Moncrieff on this important subject.

EM: Your first book was The Myth of the Chemical Cure. Can you tell us a little bit about its top points or findings?

JM: There is an assumption that the drugs prescribed for mental health problems work by targeting and reversing an underlying chemical imbalance (or some other brain abnormality). What I wanted to tell people in this book is that there is no evidence that this is the case, and that there is an alternative way of understanding what drugs do which is much more plausible.

I called these two ideas the ‘disease-centred’ and ‘drug-centred’ model of drug action. The disease centred model is the idea that the drugs target an underlying disease or abnormality; the drug centred model is the idea that drugs exert psychoactive (or mind-altering) effects in everyone regardless of whether or not they have a psychiatric diagnosis. These effects can interact with the symptoms of mental distress. For example, antipsychotic drugs dampen down thinking processes and emotions because they have a generalised inhibiting effect on the nervous system. This is what appears to reduce psychotic symptoms, not the targeted reversal of underlying chemical imbalances.

In this book I look at the history of the disease centred model of drug action and how its development was driven by the vested interests of the psychiatric profession, the pharmaceutical industry and the State. I demonstrate the lack of evidence for this model for every major class of psychiatric medication, including antipsychotics, antidepressants, ‘mood stabilisers’ and stimulants. I flesh out the nature of the mind-altering effects of these different drugs and the implications for their use in clinical practice.

EM: Another of your books is The Bitterest Pills: The Troubling Story of Antipsychotic Drugs. How does that differ from The Myth of the Chemical Cure, and what top points from it would you like folks to know?

JM: In The Bitterest Pills I look at the history of antipsychotic drugs, from their ‘discovery’ and introduction into psychiatry in the 1950s, to the massive expansion in prescribing that has occurred over the last 10 years. In the 1950s, antipsychotics were regarded as special sorts of tranquilisers, drugs that worked by inhibiting and restricting the nervous system. This idea gradually got forgotten, however, and got replaced by the view that they are sophisticated treatments that target an underlying brain disease. In other words, they came to be understood according to the disease-centred model of drug action, although there was never an evidence base to support this.

This way of understanding antipsychotics has produced a rosy tinted view of their effects. Evidence of serious adverse effects, including tardive dyskinesia (a neurological abnormality), brain shrinkage and diabetes, has been suppressed or glossed over. On the other hand, evidence of their benefits, especially for long-term treatment and early intervention has been over-stated. The book also describes the recent epidemic of prescribing of antipsychotics for bipolar disorder and looks at the role of the pharmaceutical industry in driving this expansion. Concerns are raised about the level of adverse effects this pattern of prescribing is likely to produce in the future.

EM: You are a practicing psychiatrist. How would you like to see psychiatry change?

JM: Firstly, I think psychiatry is trying to address problems which it has no hope of helping. The misery that is caused by social problems, poverty, unemployment, difficult relationships and social isolation cannot be helped by drug treatment, like antidepressants. National governments and local communities need to address these problems, and people need to understand that they are not illnesses, and will not be magicked away by medication.

For more severe mental conditions like psychosis, what I would like to see is facilities and services that can provide alternatives to drug treatment so that people have more choice. Drug treatment can be useful when someone is acutely unwell, but even then, some people will recover without it, if they are in a supportive environment. I am particularly concerned about long-term medication, however. I would like people to have the option to try without it, if they want, with the support of mental health services, rather than feeling obliged to take it forever.

EM: What are your thoughts on the current dominant paradigm of “diagnosing and treating mental disorders”?

JM: The idea of diagnosis is misleading. The DSM and ICD are classification systems, not diagnostic systems. They are attempts to organise the myriad of mental health ‘symptoms’ or problems into categories, based on our experience of the sort of patterns that people manifest. Classifications do not indicate the causes of conditions, they are merely a way of organising experience, and they are highly subjective. Mental health problems are highly individual, so there is no universally valid or useful way of classifying them. Pre-determined categories do not capture the essence of a particular individual’s problems, and rarely tell you much that is useful.

The problem with our current approach to treatment is that it is presented as targeting a putative underlying brain disease or abnormality. It is based on a presumption that drugs act according to the disease-centred model of drug action. Therefore we have ignored the psychoactive (mind-altering) properties of the drugs we use. We should have a greater knowledge of all the alterations that drugs produce in body and mind. The psychoactive properties of some drugs may be useful in some situations, but they can also be unpleasant and disabling, and this is not recognised widely enough.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

JM: It completely depends on the nature of the problems. I do not think it is useful to have a blanket approach to mental health problems, or even to single disorders or diagnoses. Everyone with a diagnosis of depression will have a different set of problems, for example, and a different story leading up to those problems. It is the individual’s unique problems, and not a diagnostic label, that should determine what sort of help will be useful. That help may involve practical support to address social and inter-personal difficulties, it may include therapy to help the individual identify the origins of their feelings and develop strategies for managing them better, and it may sometimes include drug treatment to reduce the intensity of pre-occupying thoughts or feelings of distress.

* * *

Joanna Moncrieff is a Senior Lecturer at University College London and also works as a consultant psychiatrist in the NHS in London. Her academic work consists of a critical appraisal of drug treatment for mental health problems, as well as work on the history, philosophy and politics of psychiatry and mental health.

* * *

2/7. Claudia Gold on The Silenced Child

2/8. Bill D. on Alcoholics Anonymous

2/9. Jackee Holder on Life Coaching, Self-Coaching and Emotional Health

2/10. Rorie Hutter on Innisfree Village

2/11. Lori Sylvester on Residential Treatment for Adolescent Girls

2/12. Joanna Moncrieff on The Myth of the Chemical Cure

2/13. Rosie Kuhn on Transformational Coaching

To view the roster for the whole series:

http://ericmaisel.com/interview-series/

15 COMMENTS

  1. “Firstly, I think psychiatry is trying to address problems which it has no hope of helping. The misery that is caused by social problems, poverty, unemployment, difficult relationships and social isolation cannot be helped by drug treatment, like antidepressants. National governments and local communities need to address these problems, and people need to understand that they are not illnesses, and will not be magicked away by medication.”

    Truer words were never said. This is one reason why most drug-happy psychiatrists are doomed in their efforts to help.

    • I agree that quote from Joanna is an excellent one, BPDT. Although she neglected to mention the seemingly most important issue, according the the medical evidence. Which is child abuse and ACEs appears to be the apparent actual etiology behind 2/3’s of all “schizophrenia” today, according to Read’s research. And the governments absolutely need to start arresting the child molesters again, rather than having the psychiatrists profiteer off covering up this appalling crime, since raping and abusing children is actually illegal, and really disgusting and detrimental to humanity as a whole.

      Although, I believe this is true, too. “Joanna Moncrieff makes a clear distinction between a disease-centred model of drug action, where actual diseases exist and are being treated, and a drug-centred model of drug action, where chemicals-with-powerful-effects are employed to produce certain effects (as often negative as positive). She argues that the former is what the current, dominant paradigm purports to be engaged in and that the latter is what is actually going on, much to the detriment of many ….”

      Which is probably why so many child abuse victims, actual crime victims not brain diseased children or people, are wrongly labeled as “schizophrenic.” And, the ADRs of the neuroleptics are likely much worse for victims of a crime, than for a person who may actually benefit from the drug, due to actually being “psychotic.” And Read’s research does point out this problem seems to be true, too, if I recall correctly.

      Not to mention the problematic reality that the neuroleptics, alone, can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, which frequently gets misdiagnosed, also in those diagnosed “bipolar,” resulting in higher neuroleptic levels.

      https://www.madinamerica.com/2016/02/researchers-call-for-reappraisal-of-adverse-mental-effects-of-antipsychotics-nids/

      And the neuroleptics, and combining today’s “gold standard” recommended “bipolar treatments,” can also create these symptoms: “memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.” Which are the central symptoms of neuroleptic or poly pharmacy induced anticholinergic intoxication syndrome, aka anticholinergic toxidrome. And these symptoms, too, are indistinguishable from the “classic symptoms of schizophrenia,” to today’s psychiatrists.

      I agree with Joanna, that it’d be better to acknowledge both the good and adverse effects of the drugs, rather than have today’s psychiatric industry continue to delude the world into believing in the scientifically invalid and unreliable “disease model.”

      • It’s misleading to say that AA has a success rate of 1-5%. If success is defined as never drinking again, sure. But if success is defined as drinking less frequently, making new friends, feeling and functioning better, and being able to take control in many areas of life, the success rate of AA is far higher. In groups I was in, in another 12 step group, I’d say the majority of individuals who stayed around for at least several months met this criteria for success to different degrees.

      • I don’t believe this is true at all. I would say that the AA has near enough got a 100% success rate for people that stick around.

        It’s not just the drinking problem that the ‘fellowship’ helps but the background problems which tend to be as serious as you can get (and as serious as ‘schizophrenia’).

        • Um, in the words of A.A. itself, from the title page of the
          Big Book of A.A.: “Alcoholica Anonymous”:
          “The Story of How Many Thousands of Men and Women
          HAVE RECOVERED From Alcoholism”….
          (emphasis added)
          The “success rate” of A.A. is 100% dependent on the alcoholics’
          DESIRE to get sober, work the 12 steps, and find a way to live sober….
          And, also from the book: “Rarely have we seen a person fail, who has thoroughly followed our path.”…. just sayin’….

        • I think from the outside in, the measures BP mentioned (quality of life, harm reduction) show that AA is more successful than 1-5%. But having spent years (too many?) in AA before departing, AA doesn’t measure it’s own success as a program by those measures. It’s an abstinence-based program, which is fine for those who have that goal and choose that path to reach it. When I went to my first D/A “professional” and told them I’d like to cut back on my drinking but that I was having trouble, BAM! I was in rehab. Anosognosia was the claim. If I said it wasn’t that bad, I was in denial and therefore sick. If I said it was sick, I was…well…sick. I was told that if I really wanted to quit drinking (I didn’t, I wanted to drink less but why should my goals matter) that I would have to give up my job (I hadn’t lost it) give up my relationship (which wasn’t bad,) move (for reasons unclear,) and get a God in my life (mmhmm.)

          • Thank-you, “seltz6912”, for letting me reply. By “D/A “professional”, I’m assuming you mean “Drug&Alcohol”counselor, etc., correct? It’s ironic, but one of A.A.’s cofounders, “Dr. Bob”, -as he’s known, – told another co-founder, “Bill W.”, from his death-bed, “Let’s not louse this thing up!”. What he meant was, A.A. should remain “forever NON-professional.” There’s lots of good drug 7 alcohol counselors, and lots of BAD ones. I’m sorry you got one of the bad ones!
            I would have respected your decision – and RIGHT – to keep drinking, and helped you do just that. And as for the “get a God” thing – yeah, that also happens far too often. Too many “Bible-thumpers”, and “Holy-rollers” are in A.A. They’re everywhere, it seems! But I’d say the true core of A.A., the Orthodox A.A., so to speak, is much more “live-and-let-live”.
            Sounds like they did more harm than good for you!
            I always enjoy telling any atheists I meet, that “I still don’t believe in the God that you don’t believe in, either!.” I was raised Protestant, am Buddhist as an adult, and very comfortable with that apparent “contradiction”. Hey, it WORKS for ME!…Hope you find this response helpful, too…

      • I’m going to formally challenge your assertion that:

        “AA has a success rate of between 1-5%. Most peoples’ success is to find an amenable drinking buddy.”

        In the 80 years that A.A. has been in existence, NUMEROUS studies have been done on it’s “success rate”….
        I’ve read MANY of them, and I’ve never seen such a low figure cited.
        Can you cite ANY study that supports the “statistic” you claim?

  2. Maybe I am too old skool minimal. I didn’t consider it unreasonable to measure success in an alcohol cessation group by the how many people lastingly remained alcohol-free.

    Goes without saying that a group can bring more success to a person than simply not drinking alcohol, and the data bears that out, as only about 1-5% of AA members achieve lasting alcohol-free lives.

    I agree with the subtext that has emerged here, though. Making an alcohol-free life a personal goal is not a realistic undertaking for almost everyone.

  3. rasselus.redux,

    When I stopped taking my medication I joined a ‘mental health twelve step group’
    http://programme.exordo.com/nursingmidwifery2013/delegates/presentation/100/

    I didn’t agree with the approach but I stayed for what I could benefit from ; and I got the support I needed from the group to remain on my feet (I think this is what 12 Step is about anyway i.e. there are no strict rules).

    If I thought there was something better around I would certainly try it out, but these groups have sucessfully helped me to remain independent of the ‘services’.

  4. I clearly recall my first A.A. meeting 35 years ago….(WOW!, *really*????….yeah. Anyway….)
    Yes, much of the success of A.A. is simply that it’s a form of “group therapy”, if you want to see it that way.
    BUT, the real heart of A.A. is the 12 Steps. The 12 steps is the personal recovery program, and the 12 Traditions is the GROUP’s recovery program. And, the 12 Steps are specifically designed as a self-help
    program. Yes, steps 4 & 5 do involve another person, but it’s up to the individual, even within the Group,
    to find the best other person to work with on those steps. And, the 12 Steps only work if YOU WANT them
    to work. The steps DO WORK, but only if YOU WORK them…. It’s not an overnight “cure” for anything,
    even alcoholism. It’s about finding a way to live a good life alcohol-free. Yes, many people do get hung up on “the God thing”, but, yes, even a devout atheist can recover in A.A., with the 12 Steps.
    The so-called “Bible” of A.A. is called “Alcoholics Anonymous”, and it can be found in ANY Public Library, or ANY book store. Chapter 5 is titled “How It Works”, and that’s generally the Chapter to read, to understand how the 12 Steps work. I would much rather have A.A. without psych drugs, than the other way around. And what I’m doing here is sharing my experience, strength, and hope, and
    passing along some of what I’ve learned about A.A…..
    A.A. people generally say this at every A.A. meeting:
    “When anyone, anywhere, reaches out for help, I want the hand of A.A. to always be there – and for that, I AM RESPONSIBLE.” I hope this helps you, too….
    ~Bradford