Drug Treatment in Medicine and Psychiatry: Papering Over Important Differences

Joanna Moncrieff, MD
55
2006

The treatment of mental disorders with drugs is not the same sort of activity as the use of drugs in medicine. Psychiatric drugs do not target underlying disease or symptom-producing mechanisms; they create an altered state of mental functioning that is superimposed on underlying feelings and behaviours. The ethical implications of the two situations are different.

I am grateful to the editor of Epidemiology and Psychiatric Sciences, Corrado Barbui, for publishing my article about the drug-centred model of understanding drug action in psychiatry back in the autumn of last year, and to Carmine Pariante and Catherine Harmer and Phil Cowen who provide commentaries on the article.1 Responding to the commentaries and engaging in a live debate with Professor Pariante has been helpful in sharpening my ideas, and I am also indebted to some persistent questioners at recent talks I have given!

Pariante, Harmer and Cowen have all conducted interesting research that cuts across diagnostic boundaries. It is particularly striking, therefore, that both commentaries confirm the importance of the disease-centred model of drug-action for modern psychiatry. Both commentaries assert that psychiatric drugs work by targeting underlying brain-based abnormalities that are hypothesised to produce psychiatric symptoms. Harmer and Cowen refer to research on the association of dopamine and psychosis, and to work on antidepressant effects on emotional processing. They conclude that “increasing 5-HT [serotonin] function reverses a pathophysiological function central to the experience of depression.”2 Pariante describes experimental work with anti-inflammatory drugs as “targeting a biochemical system in the body, to induce downstream effects in the brain, to eventually affect processes relevant to depression.”

Both Pariante and Harmer and Cowen argue that drug action in psychiatry is essentially the same as it is in the rest of medicine. Pariante pleads “why can’t we accept that psychotropic medications are like all other drugs in medicine.”3

Pariante correctly points out (as have I) that most medical drugs do not target the ultimate cause of the diseases they are used to treat. Anti-inflammatory drugs do not treat the cause of an infection, for example, but may be useful in reducing the swelling, pain and irritation that is produced by the body’s inflammatory response to an infective agent. Anti-asthma drugs, like salbutamol, do not address the biological mechanisms that cause asthma in the first place, but they relieve the symptom of breathlessness by reversing airways constriction.

But the point is that in psychiatry, despite what these authors argue, we have no idea what mechanisms are behind the patterns of feelings and behaviours we call symptoms, and no evidence that the drugs we use act on these mechanisms. We have no idea what biological processes are even associated with depression, schizophrenia or any other mental disorder, let alone evidence of any causative processes. Even if we did, this would not be sufficient to enable us to ignore the general effects that psychiatric drugs exert on mental activity.

Harman and Cowen argue that there is sufficient research implicating dopamine dysfunction as the basis of psychosis. I have already provided a comprehensive critique of this research.4 Just to repeat a few points: some antipsychotics like clozapine have relatively weak effects on the dopamine system, and stronger effects on other neurochemical systems; we do not know the neurochemical basis of the psychosis-inducing effects of amphetamine, and amphetamine affects a range of neurotransmitters, not just dopamine; most tests of dopamine activity show no differences between people with psychosis or schizophrenia and those without; tests which do show differences have not controlled for the many other things that are known to affect dopamine activity including stress, movement, smoking and in many studies the residual effects of current or prior antipsychotic treatment.

Harmer and Cowen also cite their work on the effects of antidepressants on emotion processing. This work is interesting, and Harmer and Cowen are to be congratulated on trying to investigate the way antidepressants alter ‘normal’ mental functioning, and for considering the impact of subjective alterations like sedation, but the results are not consistent or convincing.

Take one typical example.5 The researchers gave 24 volunteers a single dose of the antidepressant duloxetine or a placebo, and measured their responses to pictures of emotional expressions and their ability to correctly classify and recall words representing agreeable and disagreeable personality characteristics 6 hours later. The strongest finding was that people who took the duoloxetine were more likely to recognise the expression of disgust than those who took placebo (p=0.002). They were also slightly more likely to recognise a happy expression (p=0.05). There were no differences in recognition of anger, fear, sadness, surprise or neutral expressions. There were no differences in classification or correct recall of personality characteristics, but people taking duoloxetine were slightly more likely to falsely recall ‘positive’ personality descriptors than those taking placebo (p=0.04). Duoloxetine made people feel dizzy, anxious, nauseous and sad, and they reported impaired mood and energy levels. The authors concluded that the experiment demonstrated rapid effects on emotional processing that are independent of the subjective alterations reported, but results do not support the hypothesis that duloxetine reduces negative thinking (bias) or increases positive thinking, especially as there was no correction for multiple testing.

Even if we had evidence that dopamine activity causes psychosis, or low serotonin causes depression, we still have to account for the fact that changing the brain through drugs, surgery, injury or disease alters the nature of our subjective experience and behaviour in various ways. Changing the brain can reset the substrate of our mental life, by superimposing a new and altered state of brain functioning. This new state interacts with and can override pre-existing mental states and their associated behaviours, including those we refer to as depression, anxiety, psychosis etc., without necessarily having any specific impact on the neurological processes that may be associated with or productive of these states.

We all know this if we think about the effects of alcohol. We talk about using alcohol to “drown our sorrows,” without implying that we think alcohol is specifically targeting the mechanism of that sorrow. The phrase refers to the fact that the altered state produced by alcohol is superimposed on underlying feelings, temporarily overriding them. All drugs that have what we might call ‘psychoactive effects’ can superimpose the alterations they produce on existing emotions, cognitive functions and behaviour, and this includes all the drugs commonly prescribed for mental health problems.

Psychoactive drugs affect normal mental activities including thinking, perception, emotion and behaviour in characteristic ways. We are familiar with the sort of alterations produced by recreational drugs, but have paid less attention to those produced by other drugs prescribed for mental disorders, and some drugs prescribed for physical disorders (steroids, for example). Nevertheless, like alcohol, opiates and cannabis, drugs like antipsychotics, antidepressants and lithium produce particular mental alterations, that are linked with some of the physical alterations they produce (see the Table of psychoactive effects in this 2015 paper, p. 2316). The point is that unless we discount the impact of these alterations in some way, we cannot conclude that a particular drug achieves its effects through targeting a particular brain mechanism.

Pariante correctly points out that medical drugs change the whole body in various ways too. Chemotherapy for cancer alters cell reproduction processes in general, and is not restricted to effects in cancer cells, hence its debilitating and sometimes dangerous adverse effects. Nevertheless, it impacts on cancer cells through inhibiting their tendency for uncontrolled reproduction. It acts specifically, therefore, on the abnormal biological mechanism that produces cancer. If chemotherapy did not act on mechanisms relevant to the production of cancer it would not work. It is not its general effects that are useful, these are in fact harmful; its benefits result from its specific effects on the processes that drive cancer. In contrast, with psychoactive drugs their general impact on normal mental and behavioural functioning can, in and of itself, account for their impact on symptoms of mental disorders. There is no need to postulate action on particular ‘disease’ or symptom-producing mechanisms at a cellular, chemical or physiological level.

The mechanism of effects of psychoactive drugs on symptoms of mental disorder differs therefore from the manner in which most medical drugs achieve their effects. Most drugs used in general medicine can be understood to work according to a disease-centred model by acting on physiological mechanisms that produce symptoms, even if they also affect other systems. As I described in my original article, there are a few exceptions which involve the use of psychoactive drugs, such as opiates for pain relief. Unlike some other pain killers, opiates are psychoactive drugs that produce general mental alterations along with their direct effect on pain conduction systems. The emotional indifference produced by opiates means that people sometimes say that they still have some pain, but do not care about it anymore. The state of emotional indifference is superimposed on people’s experience of pain, lessening its impact, and this effect can be distinguished from the ability of opiates and other pain killing drugs to reduce pain sensations directly.

In my theory of drug action, I do not argue that it is impossible to find drugs that target the mechanisms underlying mental disorders, I just point out that we have no evidence that any of our current drugs work in this way. But we will not be able to conclusively demonstrate that any psychoactive drugs have a disease-targeting action unless we can discount the impact of their general psychoactive effects.

The fact that we have failed to pin down the mechanisms of ‘normal’ mental states or of ‘mental disorders’ so far may reflect more general differences between the nature of human beings and their biology. Human behaviour consists of complex, intentional and unpredictable responses to the unique history and circumstances of each individual. Unlike physical systems, including biological ones (i.e. human bodies), it cannot be captured or understood using universal formulae. Human behaviour can be explained and understood, but it is not ‘caused’ by other events in an inevitable fashion, as events follow each other in a mechanical system (see my previous blog on the philosophy of knowledge7). Although there are undoubtedly neurophysiological events taking place when someone feels depressed, for example, it is not clear that we will ever be able to map these precisely and consistently onto the emotional state. Indeed, for all the reams of research conducted on them, we still do not even know the precise functions of neurotransmitters, nor even, for example, the neurochemical basis of something as basic as arousal.

So, more funding for more research into identifying drugs with targeting actions as advocated by Carmine Pariante may just be pouring good money after bad. Instead of hankering after a situation we may never achieve, what I am calling for is a more sophisticated, transparent and appropriately cautious approach to the use of existing mind-altering chemicals.

Take the example of ‘antipsychotics’, and remember that these drugs were initially referred to as ‘neurological inhibitors’ and ‘major tranquilisers’ by people who recognised the alterations they produce. In human volunteers and animal studies they produce a state of reduced activity and responsiveness to the environment, and reduced emotional reactivity, initiative and motivation (albeit with distinctions between individual agents). We can see immediately that this state will impact on someone who is preoccupied with delusional beliefs or internal experiences, reducing the intensity of psychotic symptoms and their emotional salience, along with other aspects of subjective experience, without necessarily having any effect on specific mechanisms underlying psychosis. We can also see that although the effects may be helpful in reducing the intensity of psychotic symptoms, they may have a detrimental effect on an individual’s functioning and quality of life.

Despite Pariante’s desire to align the use of drugs in psychiatry with the rest of medicine, the use of drugs that ‘reset’ normal mental processes to modify feelings and behaviour is a fundamentally different sort of activity from using drugs to target recognised bodily pathologies. There are some points of commonality, of course. In psychiatry, as in medicine, the decision to intervene with drugs or other means depends on a consideration of the relative harms and benefits of doing so. Use of anti-epileptic drugs may cause more harm than good after one or two fits, for example, but when fits are recurrent and life-changing, the adverse effects may be worth putting up with. Similarly, the benefits of using an antipsychotic to suppress psychotic symptoms may outweigh the harms that may be incurred when someone is acutely psychotic, but the balance may be more uncertain after they have recovered.

Assessing the benefits and harms of interventions that change people’s thinking and behaviour is more complicated than weighing up the effects of a drug with purely physical effects, however. Our mental life is what makes us what we are. It is fundamental to our individuality and sense of ourselves. Moreover, people have different views on the desirability of the feelings and behaviours we refer to as ‘mental disorders’. Mental health legislation exists because when people are in states of mental turmoil and confusion, they may not see their situation in the ways that others see it. They may not agree that anything is wrong or that anything is in need of changing. When we use drugs to change people’s behaviour in such situations, we are doing something akin to restraining them. We are using force to prevent behaviour we do not like (possibly for good reason, if that behaviour is dangerous). Some people will thank us when they have recovered, but we know that many do not. Many will never see the world quite as others see it.

Typical medical treatment and the use of drugs in psychiatry have different ethical implications, therefore. There is usually agreement that treating harmful bodily variations is desirable. There is less likely to be agreement about inducing certain mental and behavioural changes. Insisting on equating the two situations obscures these differences and presents the use of drugs for mental distress and disorder as less controversial than it actually is.

55 COMMENTS

    • Not all of us. In the years prior to his dropping out of psychiatry, Abram Hoffer used to tell his “schizophrenic” patients they actually suffered from a form of vitamin-resistant pellagra (he was one of the founders of megavitamin therapy), which he was going to treat accordingly.

        • No- what you might consider a vitamin dependency, a situation where so-called normal levels of a vitamin are inadequate to maintain one’s functioning. Think of ability to effectively use a nutrient effectively and efficiently as a bell curve with most people in the middle of the curve. At one extreme, you have individuals who can get by on a junk food diet because they can function with very low nutrient levels, while at the other end, you have individuals who need very high levels of the same nutrient in order to function at all, such as vitamin dependent rickets, where an individual needs hundreds more units of vitamin D than most people to maintain his/her bone health. The same thing also exists with the B vitamins, which are necessary for mental functioning.

          • Yes, Hoffer claimed that some people naturally need higher levels of the B vitamins and this tends to run in families. Pellagra was rampant at the turn of the last century (1900s) especially in the southern United States about the same time that commercial white bread became popular. (I’m going from memory here on what I recall from reading Hoffer’s books.) I don’t know why pellagra was so acute in the South compared to other parts of the country.

  1. It is not, to my way of thinking, this pretense of medicine that one should be debating. When the drugs cause medical conditions, diseases themselves, in the form of Tardive Dyskinesia and metabolic syndrome, and these medical conditions are more debilitating than any condition the drug might have been designed to counter. Where are you? With psychiatry we’re not talking about terminal conditions as no “psychiatric disorder” ever directly killed anybody. This is not true of the drugs that have been developed to manage “mental disorders”. People maintained on these drugs are dying 15 to 25 years earlier than the rest of the population. This mortality rate has increased with the development of atypical neuroleptics as efforts to temper, or contain, Tardive Dyskinesia, and lower some of the more annoying effects of the drugs, have increased the incidence of a metabolic syndrome that has proven deadly. It’s not like we have a little technical glitch which will be resolved through more research and development. There is absolutely no guarantee that any future research and development will decrease or increase this mortality rate. Research and development, in the past, has only increased it. If these professionals are trying to say that “death” is the most effective “cure” for “schizophrenia” going, okay, but I myself kind of doubt that that is the best argument to be making. “Kill the disease and spare the patient”. Alright, I can see that, but the “disease” remains a hypothesis while the patient is flesh and blood.

    • Well said, Frank. The more I’m listening to my clients’ experience with psych drugs, the more I see the obvious harm that is being done to them. TD, akathisia, diabetes, metabolic syndrome seem to be minimized by psychiatry, as though clients should just be grateful they hear fewer voices or whatever. I can’t tell you how many clients express dismay once they start gaining weight on these pills. We put too much trust into doctors.

      • You must be exceptional then. The problem I have had within the “mental health” system is to get anybody to really register the extent of the damage. They can’t do so. Real health concerns, in the “mental health” field, are the kind of things that get people fired. The public “mental health” system has one method of operation, and that is to drug the patient. Concerns about the drugs effect on health have to be coming from the private sector because everybody in the public “mental health” system is so implicated in this thing. How do you fight, in other words, a multi-billion dollar industry, that has the implicit blessing of the government. The only way I can imagine doing so is by putting some distance between oneself and what the government is doing. If you work for that system, by and large, you can only be guilty, and very guilty at that, of complicity.

        • That is totally correct and as we have heard just recently, including Dr Moncrieff –

          https://youtu.be/k84XEurAtuA?t=2927

          “Suicide is maybe a completely different issue, I think. My view is that suicide rates are if related to anything, relate to much more fundamental socioeconomic factors, actually, rather than antidepresant prescribing one way or another.”

          And it is not just in psychiatry. (although psychiatry has to be the most appauling) It seems in the UK, if a patient presents as elderly/frail they are game to be ‘made comfortable’. ( killed with a heroin driver ) And non of the so called ‘regulatory bodies’ did/has done anything for decades nor will do anything until change to stop this is utterly demanded.

    • Tardive dyskinesia could likely be made a curiosity if manufacturers of psych drugs added 2mg. of manganese to every “antipsychotic” or maybe SSRI tablet they manufactured. Whether this actually made psych drugs more effective therapeutically is another story, but it would likely make them less damaging than they presently are.

  2. Dear Dr Joanna,

    It’s nice to see you back on Mad in America.

    I recovered through tapering from “medication” with the help of Psychotherapy.
    I can describe how the Psychotherapy worked, and why it worked, and my longterm Recovery can be substantiated.

    I was “diagnosed” originally in 1980 with Schizophrenia then with Chronic Schizophrenia and finally in 1984 with Schizoaffective Disorder.

    But in my own case, in my opinion, the drugs were not used to benefit.

      • The doctors also diagnose people with “chronic” problems, when doctors caused the problem, and the “hammers” they have won’t cure that “nail.”

        For example, I had a doctor claim a short term back problem, that was the result of her husband’s “bad fix” on a broken ankle of mine, which threw off how I walked, and my normal symmetry, claimed to be “chronic back pain” – after about a month.

        A number of treatments with an excellent, old school chiropractor, paid for outside my insurance, cured that “chronic” back pain right up.

        Although, “chronic schizophrenia” would be another example of iatrogenic harm. Since the “schizophrenia treatments” do create both the negative and positive symptoms of “schizophrenia.” The negative symptoms are created via NIDS, and the positive symptoms are created via antipsychotic induced anticholinergic toxidrome.

        https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
        https://en.wikipedia.org/wiki/Toxidrome

        “Our mental life is what makes us what we are. It is fundamental to our individuality and sense of ourselves.” And trying to change who someone is can be considered quite an evil thing to do, especially when the psychiatrist doesn’t even know the person, or the reasons for that person’s legitimate distress.

        My psychiatrist wanted me to believe 9/11/2001, and the never ending wars that resulted from that event, aren’t horrific events. My psychiatrist wanted me to stop believing in God. My psychiatrist thought I shouldn’t be disgusted by child rapists. My psychiatrist wanted me to believe my entire life was a “credible fictional story.” My psychiatrist didn’t succeed in changing any of my beliefs, but he did succeed in making me think he was a disgusting, evil, hypocritical, and insane person.

      • Unlike your son Rossa, I started out depressed and anxious after years of bullying and 2 months of homelessness in high school. Saw Dr. M who gave me the SSRI anafranil. Kept me awake for 3 weeks straight. I went bonkers. Might have recovered if allowed to sleep and get over the trauma. But by golly the shrinks weren’t about to let that happen!

  3. “The treatment of mental disorders with drugs is not the same sort of activity as the use of drugs in medicine.”

    No pun intended, but this is a no-brainer. Why? Because there are no such thing as “mental disorders.” Furthermore, it is impossible to “treat” a “mental disorder.” If anything, drugs CAUSE severe brain damage, in ways that Frank mentions above, also including neuroleptic malignant syndrome.

    “Psychiatric drugs do not target underlying disease or symptom-producing mechanisms; they create an altered state of mental functioning that is superimposed on underlying feelings and behaviours.”

    This is not quite right either. First of all, the term “psychiatric drugs” is a bit misleading in and of itself. Terms like “antidepressant,” “antipsychotic,” “mood stabilizer,” and so forth are misnomers. These drugs are not “medications.” They are dangerous, brain damaging, toxic chemical compounds that are wrecking havoc in the lives of millions of innocent men, women, and children, including helpless infants, the homeless, and the elderly.

    Second, these toxic chemicals don’t simply create an “altered state of mental functioning.” They DAMAGE the physical brain. This has nothing to do with “mental functioning.” That’s what these dangerous drugs are DESIGNED to do… to damage the brain while deceiving people into thinking that they are being healed through “medication.” These drugs produce a type of “medication spellbinding,” as Peter Breggin likes to call it. Thus the innocent victims of psychotropic drugging believe that they are being “treated” when in reality they are being drugged into oblivion.

    Psychiatry is a pseudo-scientific system of slavery that ought to be abolished. Discover the truth about psychiatry:

    https://psychiatricsurvivors.wordpress.com/2016/05/10/the-truth-about-psychiatry/

  4. Corinna,

    I feel fine right now, I haven’t got much on my mind at all. But when I wake up in the morning I’ve got all kinds of realistic concerns – the trick for me is not to think about them in the morning.

    I know that sometimes people are caught in longterm impossible situations, I don’t know what they can do then.

    (I do suffer from longterm neuroleptic withdrawal syndrome).

  5. I just want to say that psychiatrist whose job is to silence the psyche by drugs/fetish is an egoic fundamentalist who has got nothing in common with empathy or phenomenology, with HUMANITY. Someone who want to get rid of psyche and make someone normal (apollonian ego state of psyche) is not someone who gives a human psyche meaning, he is the antipsychological fundamentalist. Psychiatry is what it is and psychiatrists – they are PSYCHE HATERS, while they should be EMPATHS OR PHENOMENOLOGISTS LIKE HILLMAN and should stay away from PSEUDO MEDICAL judgements. IF YOU WON’T GIVE PSYCHE A phenomenological MEANING USING PROPER LANGUAGE, AND ITS RIGHT PLACE IN THE psychological HIERARCHY, YOU WILL BE DESTROYED (AUTHORITARIANS – LAW RELIGION AND THE DSM USERS) THE SAME WAY APOLLONIAN EGO DESTROYS TRAITS OF HADES- with great ease and cruelty.

    We should remember that Dionysus and Hades were rarely on the surface, they weren’t welcome at the Olimpus, however every god knelling down only BEFORE HADES, because he was respected, you don’t have to like Hades, you don’t have to love him and agree with him, but you must respect him or he will beat you down. I am talking about REAL traits of character and mechanisms of the authoritharian antipsychological games -arrogance of Apollo (science, law, theology =DSM AND PSEUDO BIOLOGICAL PSYCHE), that arrogance and scientism, which destroy the meaning of the other gods THAN APOLLO, will destroy Apollo (state). And that would be collective psychosis.

    The problem is that you can’t recognize psyche and separate it from completely antipsychological APOLLONIAN EGO HEGEMONY, FROM satan,evil, from empty dehumanising nominalism, from theology, the same way you can’t separate psyche from the brain. And one believe in satan, and the other in mental illness, ALL ARE WRONG.
    Because you should believe in HUMAN PSYCHE and do not give greater meaning to NORMALCY (APOLONIAN EGO) money, theology, or pseudo medicine. You don’t have to love Hades, you – Apollonian psychiatrists – but you ought to respect its traits. When I am talking about Hades, I mean all the traits that are valuable for psychological reality/logic and everyone knows that this treasures are not treasures for apollonian ego -authoritarians -who are too shallow and the least psychological, to accept its great meaning, the same way Aryans did not not accept Gypsy/Poles/Jews and steal away their identity.

    We are talking about discrimination of the psychological minorities, not about CURE mental illnesses, CURE is not the point, the point is attitude psychiatrists towards psyche. AND CURE THE MENTAL ILLNESS MEANS IN authoritarian LANGUAGE – TO GET RID OF TRAITS OF THE PSYCHE (people) BY APOLLONIAN FUNDAMENTALISTS. GET RID OF MENTAL ILLNESS – MEANS TO KILL -IN THAT OR THE OTHER WAY. The problem is that authoritarians thinks they control psyche, psychological HADES, the death. No you are not, because psyche is not your property, it belongs to realm of the death and this is far beyond apollonian ego claims, and the death is not your property either. Read Hillman and give away that, what you have stolen long time ago. TRUTH.

    The problem is that the state is ruled by apollonians and they want to cure psyche which means to get rid of people who represents other traits of character/psyche than apollonian(psychiatrists). It is IDEOLOGICAL discrimination – to fight with sb PSEUDO mental illness. BECAUSE HE DON’T HAVE MENTAL ILLNESS ———- HE REPRESENT THE TRAITS OF THE PSYCHE other than APOLLONIAN ——-and STATE IS A DEATH CAMP FOR PSYCHE, AND PSYCHE IS A GYPSY FOR STATE. WE ARE TALKING ABOUT DISCRIMINATION OF THE UNACCEPTED PSYCHOLOGICAL MINORITIES/TRAITS WHICH STATE WANTS TO GET RID OF USING PSYCHOPATIC APOLLONIAN PSYCHIATRY.

    And that discriminations is because of toxic ideologies psychopatic language and lack of meaning of the psyche which was stolen by theologians, scientism, medicine (psychological apollonians) SHALLOW LOGIC,

    LACK OF EMPATHY IS MAIN TRAIT OF APOLLONIANS RULERS. HOW CAN THEY HELP? THEY ARE IMAPIRED!

  6. This may not be directly responsive, but I find it beyond discouraging that so many “alternative” clinicians have adopted the same flawed biological model in claiming to be able to treat mental health issues with amino acids, vitamins, diet, etc. Perhaps the “root cause” that alternative medicine loves to bandy about is not some chemical process in most cases, but the circumstances of one’s life.

    • Well said, Peter. I think a vitamin deficiency would need to be documented before suggesting treatment for it. Life is stressful and traumatic, and no doubt this heavily impacts how we feel and how healthy we are (ACEs Study). I would say, however, that if psychiatrists just prescribed amino acids and vitamins, significantly less harm would be done!

      • Oh no doubt, there is a world of difference on the harm scale. But to see the same low serotonin causes depression low GABA causes anxiety nonsense spouted by alternative medicine types, enrages me though not nearly as much I suppose when the proposed solution is only an amino acid not a drug.

      • Unfortunately psychiatrists could do real harm with vitamins, dont doubt it! Alternative practitioners are currently often doing harm with vitamins, because they make these outlandish claims and base treatment on them. I experienced this myself.

        What I think needs to happen, is that doctors need a robust differential diagnostic process before just sticking someone on psych drugs. Patients should be screened for real disorders known to cause cognitive changes.

        I do believe that nutritional deficiencies as a cause of psychiatric change is more common than thought. But I would never trust an alt practitioner to be able to comprehend it correctly.

      • They absolutely can cause serious harm. One of the fad vitamin regimens out there right now has a startling number of people reporting agitation, paranoia, anger, migraines, and psychosis. It’s marketed as safe, natural, and nontoxic.

        What I suspect is happening is that the fad regimen might be precipitating or exacerbating b12 deficiencies, which are known to cause neurological and psychiatric changes.

        There are also some fad vitamin regimens which are damaging to the thyroid.

    • They can be both. You’re not going to solve life problems if you’re constantly addled by stressors (or easily become so). Besides, unlike the conventional shrink, you have the means to find specific things with biological testing for things like heavy metal and copper poisoning, excessive changes in blood sugar, overlooked neurological ailments. When one knows these things, psych drugging becomes much less necessary. The problem is in finding a reputable practitioner, as alternative medicine’s an attractive profession for humbugs.

        • Hi, I know Hoffer, I read his works and also Andrew W Saul, I do not agree with them. Because there was a time when I took suplements and I felt better and then after some time I feel nothing at all. And some other time I feel worse taking it. The problem is that your psyche makes you AVAILABLE for FEELING BETTER OR NO, AND THIS IS NOT A BRAIN, it is something more, it is psyche, and Hillman writes about it. I really think that FLESH BLOOD medicine without connections with psyche phenomenology is something useless nad yes, souless psychopatic. Without role of the pain and sickness in life we built a wellness(theologic )utopia, and illness OF THE BODY and the psyche are enemies (satan,sin), not the part of life. And then people says about those who are in pain mentally or physically -, what a terrible life this poor thing must have…and that’s is all THEY CAN SEE, because they are living in their small utopian reality of constant well being.This is fixation.

          There is a connections between your psyche and body, and sometimes feeling bad is necessary for the psyche. I do not like Hoffer, because he was an utopist. I read that his witamins helped the half of the patients, and the other half were completely inert to witamin therapy, AND NO ONE GIVES A DAMN ABOUT THEM.
          They stayed in the hospital, because that was their role, to represent sth which was beyond normalcy, it was psychological work.
          It would be nice if someone give them something more than empty dull mourning about mental health fixation and niacin theories. We want to find a way out out of labirynth, and finding the way out is a trap, because we lose the meanig of the path itself. Because you are not here and now, you are looking/waiting for utopia. Hoffer gave people false hopes and, and sometimes it works. But it was not the witamins that cure, we are more than biology. And brain is only a TV screen, the program not belongs to TV or Hoffer, but to the station. So take away your screwdrivers from psyche, please.

          Everyone just want to feel good, it is not enough. Mental health fixation is destructive utopia, we need courage and truth about psyche, not mental health utopists and their drugs or witamins or theologic BS, for building that utopia.

          Like I say, you may have half brain and still act normal, because psyche need it, and you may die because of Staphylococcus on your tampoon, because death was looking for you. This is psyche.
          Hillman knows that, I know it too. You can’t choose the program, the programm choose you, and then psychiatry calls that schizophrenia, because they are the guardians of their fixations over controlling everything (apollonian ego). And they are not psyche defenders, Hofeer was not either. They are only guardians of their fixations their own utopian believes in their fetish, like psychiatrists and theologians. And who is watching over psyche? Rats.
          Sorry for mistakes, it is not my native language.

          • Everyone just want to feel good, it is not enough. Mental health fixation is destructive utopia, we need courage and truth about psyche, not mental health utopists and their drugs or witamins or theologic BS, for building that utopia.

            Language barriers suck. But this is pretty easy to understand. “Feeling good” is overrated when the world remains colonized and enslaved to corporate profiteers.

        • Yes. My early adventures in underground psychiatry yielded enough evidence to respect these chaps’ notions. Although I wouldn’t suggest you do one of these, I did a couple of alcohol withdrawals and a physical withdrawal from heroin (though my smack user didn’t have a heavy habit), in addition to more conventional uses on psych treatment failures. Since I couldn’t, I didn’t use drugs.

          • Don’t their theories ultimately reduce to the same notions about neurotransmitter determinism as those of the drug companies? Isn’t some claimed neurotransmitter imbalance the result of what they call pyroluria and under/over methylation?

    • I agree with your assessment that people preaching alternatives have the same biological model in mind as those pushing pharma. These people are well intentioned, and some people do get better using their treatments, so I’m glad about that. A lot of people don’t become as well as the proponents claim that their patients do, however. Lots of hopes are being raised that are then dashed. Abram Hoffer was a medical doctor/psychiatrist with a Ph.D. in vitamins. Vitamin therapy looks like a gentler way to overcome psychosis that chemical lobotomies, but how effective is it? We spent a lot of time and money chasing the vitamin/nutrient path for my son, who reacted well at first, but couldn’t sustain a non-drug “recovery”.

      • Rossa, one of my biggest problem with the bio bio bio model is–assuming odd or extreme thoughts/emotions are pathological–they still don’t know WHAT is causing them.

        They pretend to know things no one does because smart as scientists are the human brain remains a mystery. All psychiatry offers is random acts of violence to something they know little about.

        If they actually found an organic cause that would be the death of psychiatry as we know it. We have neurologists who could take over from there. They are the real brain experts.

        Because of this psych doctors are all talk and no action when it comes to discoveries. Like 20 term career demagogues blabbing about budget balancing or deficit reduction to get reelected. Only psych doctors are even less motivated since they don’t want to go out of business.

        • Hey, people with syphilis get dementia, that proves that the brain & mind are connected, so who are you to suggest that SSRI’s are junk science? There are connections in the brain between nerves for sure, which must mean something, so why not just leave the details to the experts? That’s what they’re paid for. 🙁

  7. I think the idea of a drug centred model has won “I agree with Joanna”.
    Its extraordinary to think that there was any other model.
    That message has not got through on the ground, however.

    But to me the problem is far worse.
    Leading Doctors are lying to us, that’s one thing, evidenced by that SMC page and also the persisting myth in the clinics of rectifying an imbalance.
    The drugs are either useless and damaging, or have short term benefit and highly damaging, as you and others have demonstrated.
    So, the rules of informed consent, “do no harm” and honesty are violated every day, and this is what people are up in arms about.

    • As an example of how many of today’s psychiatrists think, I recently saw one with stellar credentials. I was trying to explain to him how I had a very difficult time internalizing the notion that certain of my somatic symptoms were psychogenic in origin notwithstanding medical assurance that there was no physical damage — a very common problem for people in chronic pain. His response? He characterized my thinking as borderline psychotic and said I should take Seroquel. This is where we are at.

  8. And if there ever was such a fictional thing as an antipsychotic, it sure as hell isn’t seroquel. Joanna co-wrote a great paper with Paul Hutton to find out where, after all the dropouts in the trials, the effect size for seroquel actually was. They reckon 0.33 – irrelevant. Your Doctor just wants to send you to sleep, whatever you are paying him , it’s too much!

  9. “when fits are recurrent and life-changing, the adverse effects may be worth putting up with.”

    This statement is troublesome because it leaves it up to the patient to decide whether it can put up with the adverse effects or not. It is punisable if you hurt the patient on purpose and a doctor who knows his medicine are toxic and cause harm (the adverse effect) should stop the treatement imediately. Leaving it up to the patient to decide whether or not he should get his health harmed (even till handicaps and deaths) is a wrong thing to leave open. Knowing you bring damage and continuing with bringing this damage makes the damage making on purpose. Damaging on purpose is punisable and is what the real issue should be.

  10. Dr. Moncrieff is probably busy. I would highly value her opinion if she could give it.

    But a lot of laypeople here know about drugs. What do you guys think about the new drug to target Alzheimer’s? A friend of mine swears it has improved the cognitive abilities of a friend of ours suffering from the disease. (I haven’t seen or talked to the latter for a long time.)

    That sounds exactly the opposite of how neuroleptic or antineurological pills help by dumbing you down and numbing you. Of course they said they have detected excess build ups in dementia victims’ brains. That might explain the ability to help them. If it’s true.