Mind-brain split splits psychiatry

 

During a frontal lobotomy operation, the surgeon asked the patient, “Do you know where I am now?” to which the patient replied,”You’re in my mind.”! (As quoted in Psychiatry and Philosophy of Science, by Rachel Cooper)

Mind-Brain Split
mind-brain split

mind or brain?

The mind-brain had to raise its head sometime in psychiatry. In a New York Times op-ed recently George Makari, a Professor of psychiatry, said he was disappointed that research recently published by Dr Kane showing adjuncts like family education and social adaptation with lower doses of medication were more effective than medication was such a surprise to so many and made front page news.

The approach, empirically verified by Dr Kane, is known as the biopsychosocial model of illness and is the method of treatment preferred by pragmatically minded, experienced clinicians.

So why hasn’t this biopsychosoical model been used more – or exclusively? Such an inclusive holistic approach has declined, but why?: Big Pharma according to Prof Makari. Treatment he says has veered toward pharmacology. Research leaders have promoted limited positive drug outcomes, “successes” like Prozac and Respiridone. Also, to de-stigmatise mental illness, they promoted the idea of mental illness as a brain (i.e. physical) disease which makes it sound more authoritative and simpler so also making it more convenient for prescribing. A good all round win situation, just that it’s not scientific.

So now, says Prof Makari, mental illness is a dysfunction of brain neurons. This reduction equating mind and brain excludes mental illness due to moral feeling and anything smacking of the metaphysical, in fact anything not due to the biological is justified as fake by the reductionists.

Prof Makari hopes this latest research will encourage the many working in psychiatry who have never accepted such simplistic reductionism. He hopes it will lead to more research and that studies like Dr Kane’s will lead to pragmatic psychological and social treatments, not the neuro-anatomical and biochemical paradigms.

Psychiatry has been prone to pendulum swings as an internal advance or some social force tipped it¹ this way or that, swings which may lead to insights but also to detrimental (excuse the pun!) effects for patients.

Research and Scientific Bias

Sadly the research he hopes for is unlikely. Since 2014, to receive funding for research, the National Institute for Mental Health insists researchers must explicitly focus on a target such as a biomarker or neural circuit. Hence, Dr Kane’s study would not be funded today (nor would Einstein’s for that matter). This is despite the fact, according to Makari, that psychiatry has yet to adequately identify any specific biomarkers or circuits for it major illnesses!

The consequence of such biased funding means only one outcome; “A bonanza for Big Pharma.”

Conclusion

Psychiatry has still to answer what Prof Makari calls the ‘mind-brain problem’. Like the proverbial chicken and egg, which comes first, the mind, the brain or even both together?

In this regard, in mentioning psychology and social treatments, he too is reductionistic – he could refer to mental illness as a constitutional disorder rather than reduce it to brain or mind. In such a case, the cause of mental illness wouldn’t be one or other but both together since how can you separate the two; there is only one person.

While he alludes to the psychological and social, he could go a step further as Hahnemann did and acknowledge disease is often dynamic.

And as Prof Makari concludes, Dr Kane’s research is new evidence for an old idea. Sometimes truth doesn’t change and new drugs aren’t always better.

With such bias in research and no definite knowledge of what constitutes a mentally ill person it’s plain that few in medicine are in a position to criticise homeopathy!

¹ Watch the video above for an insight into how such forces operate.

Further Reading
Prof Makari, a historian, refers to early psychiatrists such as Pinel and Reil. He neglects to mention Samuel Hahnemann who was the first in the history of medicine to treat humanely the mentally ill. Just some of the references from Hahnemann’s experience and insights on mental illness are as follows:
• Letter to patient on cheerful methods of life here or here
• How he took in a patient to treat at home: Samuel Hahnemann: His Life and Work, Volume 2: pp. 38, 39. Available here and here.
• Supplement 25, pp. 36-37 describes how Duke Ernst gave up his castle as a nursing home for Hahnemann to treat the “insane.” See here or here.
• In Hahnemann’s Organon how many references to treating and incorporating the mind? See here
• Vol. 1 of Haehl’s biography gives a description of his treatment of a mentally ill patient, Klockenbring, in the early 1790s: p. 41 following. Link
• The case of which is available here in his Lesser Writings: Description of Klockenbring During his Insanity, p. 243 ff. Such a case today would hardly be treated so wisely and skilfully! Link or here
• Supplement 196 on Psycho-therapy, p. 397 shows how Hahnemann considered the patient’s life and background. Link or here

A Brief Biography of Dr. Samuel Hahnemann who put medicine on a scientific foundation click here

On the ineffectiveness of psychiatry see this research, for example: Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance. Link

Changing the status quo, even for science and truth, is a challenge due to groupthink and the silo effect as this meta-analysis of psychiatry and the placebo effect shows: Challenging Received Wisdom: Antidepressants and the Placebo Effect

Further Reading
In 2012 a psychiatrist called for more homeopathy in psychiatry. See Adopt homoeopathy in mental health care: it can help reduce duration of hospitalisation and quantity of the medicine needed in Gulf News

Addendum
Research published this week in the BMJ gives credence to Prof Makari’s concerns. The research “Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis” concludes therapies are at least as effective as antidepressants – without the side-effects. A summary is available here.

Updates
Jan. 2016: Antidepressants can raise the risk of suicide, biggest ever review finds. Antidepressant use doubles the risk of suicide in under 18s and the risks to adults may have been seriously underestimated, researchers found, according to the Daily Telegraph. The report continues:

Experts said the review’s findings were “startling” and said it was “deeply worrying” that clinical trials appear to have been misreported…

Four deaths were misreported by one unnamed pharmaceutical company, who claimed they had occurred after the trials had stopped.

In summary trial reports from the drugs giant Eli Lilly, suicidal attempts were missing in 90 per cent of cases.

Professor Peter Gøtzsche, the lead author from the Nordic Cochrane Centre said: “Antidepressants don’t work in children, that is pretty clear, in the randomised trials children say that they don’t work for them, but they increase their risk of suicide.

“It is absolutely horrendous that they have such disregard for human lives.”
Professor Peter Gotzsche, Nordic Cochrane Centre

The research is published in the BMJ: Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports
(BMJ 2016; 352  doi: http://dx.doi.org/10.1136/bmj.i65 (Published 27 January 2016)
Cite this as: BMJ 2016;352:i65)

Regarding the above shocking research conclusions, a UK doctor comments:

The down side of antidepressants has never been well exposed to view. Hence regular refreshers and new views important to note.

The advertising pressures from Pharma and time pressures on GPs and psychs have ensured that SSRIs etc continue in wide use despite the efforts of David Healey (” The Antidepressant Era” , “Pharmageddon” ) et al to point out their  dangers, incl suicide, since pre 2000. He is reported to have had a professorial role withdrawn in Toronto after Pharma pressure – unproven. 

An important  Nordic voice ( PCG ) has just recently pointed out that “antidepressants are addictive and increase the risk of relapse.“ This is the conclusion of research published in the BMJ in 2015: Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis

These dangers were pointed out before, for example by Professors of psychiatry: see Antidepressants May be Worsening Depression, Not Treating it

March 2016: Brian Daniels, the National Spokesperson for Citizens Commission on Human Rights (United Kingdom), wrote a letter to the Sunday Independent:

Violence and anti-depressants

Sir – The air accident investigation agency in France has said that Germanwings co-pilot Andreas Lubitz was using antidepressants when he crashed Flight 9525, carrying 150 people, into the Alps.

This tragedy is yet another example of the senseless violence consistently associated with the use of antidepressant drugs that have been documented to cause mania, psychosis, violence, and suicidal thoughts. It is now becoming commonplace to ask what psychiatric drugs the person was taking whenever there is a story of senseless violence around the world.

The safety of psychiatric drugs, especially antidepressants, has been questioned for years now and with so many violent deaths and suicides linked to their use, public safety is being compromised. And it’s not just adults.

The World Health Organisation recently expressed concerns about the 54pc increase in the number of children who were prescribed antidepressants between 2005 and 2012. There is an ever-increasing list of children and adolescents who have taken their own lives after being prescribed a well-known antidepressant.

Worldwide, there have been 99 drug regulatory agency warnings that antidepressants cause side effects. Of those warnings, 35 concerned suicide risk, and suicide attempts. There have also been 119 studies in 12 countries on antidepressant-induced side effects. Of those studies, 23 of them concerned antidepressants causing suicide, suicide risks and suicide attempts.

The trail of destruction is most vivid when scrutinising the schoolyard massacres. At least 31 school shootings and/or school-related acts of violence have been committed by those taking or withdrawing from psychiatric drugs, resulting in 162 wounded and 72 killed.

Psychiatrists and drug companies commonly say that the benefits of the drugs outweigh the risks.

It would be more accurate to say that the profits of the drugs outweigh the risks.

March 2016: Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool and Prof Richard Bentall, also of Liverpool University criticise the Medical Research Council: “It’s a tragedy actually. The UK Medical Research Council is one of the biggest funders of medical research in the UK but if you look at the things that they fund, by far the majority are things like brain scanners or gene sequencing machines, almost none of it is going towards understanding psychological mechanisms or social circumstances by which these problems develop.” And, “Yet the MRC spends just three per cent of its research budget funding studies into mental illness, most of which goes towards genetics or neuroscience.” 

But, guess what…”Dr Jeff Barrett, who is working on uncovering the genes behind mental illness at the Wellcome Trust’s Sanger Institute said: ‘If we understand the fundamental biology of the disease it might be relevant in developing new ideas for therapies that are applicable to a wide range of patients.

‘So if by doing studies like this we can strongly implicate one area of biology it gives a new lead for drug companies to try to develop new therapies.'” As quoted in the Daily Telegraph.

June 2016: The Lancet publishes a new study showing antidepressants for young people are ineffective and/or harmful: “When considering the risk–benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents.” Or read Sarah Knapton’s summary in the Daily Telegraph.

See also Deadly Psychiatry and Organised Denial by Peter C. Gøtzsche. The first chapter can be read here for free His article in the BMJ.com “Does long term use of psychiatric drugs cause more harm than good?” is answered in the affirmative (link).

Photo Credit: The gyri of the thinker’s brain as a maze of choices in biomedical ethics, by Bill Sanderson, Wellcome Images via Wiki Commons

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