Talking Therapies v Psychiatric Medication
The psychiatric model of mental healthcare is rarely challenged in Irish mainstream media. I wrote a response to one of many articles on psychiatric practice published in a popular Sunday newspaper, articles that present psychiatric thinking and practice at its most benign. The newspaper had no interest in publishing an alternative viewpoint. This is an edited version of that response.
Note: Never withdraw from psychiatric medication without consulting your physician!
Talking Therapies and Psychiatric Medication do not change brains in the same way.
Michael Fox, Clinical Psychologist.
In recent years the entire practice of Psychiatry has come under threat by the accumulating scientific evidence which discredits the biochemical/biological ‘illness’ models upon which the practice is based. While it will not be accepted for decades to come it is becoming clear to many that disorders of the mind have their origins in traumatic and painful emotional experience, particularly in childhood, rather than genetics or spontaneous changes in brain biochemistry. Importantly, it is also becoming clear that psychiatric medications often cause a lot more harm than good, which is leading more and more people to explore ‘talking therapies’. This prompted a recent article in a mainstream Irish newspaper, by a well known Irish psychiatrist, which suggested that the brain changes brought about antidepressants and anxiety medications are largely the same as those that occur during talking therapies. The implication is that psychiatric medications and psychotherapy achieve the same results by different routes, which is a wildly misleading interpretation.
It is true that every experienced moment, and everything that happens in mind, is reflected in biochemical and cellular interactions in the brain. The ‘psychological’, which is everything that happens in mind, is brain activity. Psychological disorders are neurological expressions but they are experienced in the mind. A ‘depressed’ brain is biochemically different than a brain that is not depressed, in the same way that a brain watching television is different to one that is out for a walk, or one that is thinking about financial problems. Your brain today is different than it was yesterday as it now encodes the new experience and learning of that short time, structurally and biochemically. Most of the experiences that we call ‘psychological disorder’, or “mental illness”, represent normal and natural brain functions that alert us to the presence of emotional wounds, in the same way that physical pain draws our attention to physical wounds and compels us to tend to them. Some talking therapies can lead to important natural brain change if the emotional wounds are addressed and healed successfully. The brain change that occurs due to psychiatric medication is something else entirely.
The brain is very much like a computer, and our minds are like the computer screen that only we can see. Most mind problems are ‘psychological’ and can be understood as software issues that can be seen, interpreted and adjusted on the mind-screen. Talking and thinking about difficult experiences (on the screen) allows the brain to resolve the issues, if the therapist understands how it works. The mainstream psychiatric approach, i.e. trying to treat a problem of the mind by tampering with the biochemistry and cellular structure of the brain, is the equivalent of taking the back off your computer and hacking at the hard drive with a screwdriver because your email isn’t working. You might damage the inner workings and you might not be able to undo the damage, which makes it difficult to start again and address the original software problem. Most brains that are expressing ‘disorders’ are working perfectly, exactly as they are supposed to, and they come with a lifetime guarantee unless you void the warranty.
The brain is an extremely complex and delicate organ that is at the centre of everything we are as persons. We tend to think of “my brain” as some kind of appendage that is somehow separate and distinct from “me”, but that is a conceptual error. The brain is everything that ‘I’ am. Everything I know, my basic skills and abilities, the history of my experience of life from my birth, my personality, my thoughts and feelings, and how I experience myself and my world in each moment, are all encoded in the brain in a way we don’t understand. Messing with our brains is the most serious of undertakings. Our current understanding of how the brain works at the cellular and biochemical level is truly infantile, despite the veneer of impressive and incomprehensible language that is used to talk about it. Tinkering with brain biochemistry with medications is not the same thing as taking an antibiotic or a painkiller. At times it is more like a destructive chemotherapy that impacts on “Who I Am as a Person” and “Everything that is Me” to target a small part of me that hasn’t been functioning properly, for reasons that medical psychiatry will never understand. The application of psychiatric ‘medicine’ is not as refined or as ‘scientific’ as we are led to believe. This approach to disorders of mind comes from the same tradition that brought us trepanation, lobotomy and electro-convulsive therapy and, in much the same way, it has all the sophistication of slapping a malfunctioning TV in the hope it will do something different.
The use of psychiatric medication has been based on the assumption that mind problems are medical illnesses caused by spontaneous biochemical imbalances in the brain. Scientific evidence for the existence of such imbalances has never been found, but there exists a wealth of evidence on the damage caused by medications intended to address these imaginary imbalances. Recent research suggests that antidepressant medications work mainly due to a placebo effect (eg Kirsch, 2014), but unlike a sugar pill that might achieve a similar result, antidepressants affect the brain in ways that can increase the likelihood of further and more severe depressive episodes (eg. Patel et al, 2015), and in many cases increases the likelihood of suicidal and homicidal behaviour (eg. Breggin, 2008, Lucire & Crotty 2011). Psychotic patients are far more likely to recover when they are not receiving antipsychotic medication (eg. Harrow & Jobe, 2007). Anxiety medications can create severe addictions and they prevent spontaneous recovery from emotional wounds, and their treatment through psychotherapy, because the brain simply cannot process trauma and other difficult experiential material when it is intoxicated. An interpretation of a number of studies suggests that psychiatry itself may be the biggest risk factor for suicide (Large et al 2014, Hjorthoj et al, 2014). The latter actually makes a great deal of sense to me. Prior to exposure to psychiatric services the person can hold on to the idea that he or she remains relatively ‘normal’, until psychiatric diagnosis promotes an alteration of identity to “psychiatric patient” or “mental patient” with a life-long incurable illness. This can inflict a profound emotional trauma on someone who was already in crisis. The addition of brain-altering or “me”-altering medications can create for many a truly unbearable experience of living. It becomes impossible to separate ‘illness’ from the multiple unintended side effects of medication, and further decline is usually attributed to the progression of ‘illness’.
Given the current state of our system of mental healthcare, and the refusal to explore alternative approaches, the short-term use of medication has a use in the short-term management of some mental health issues, but it clearly doesn’t fix any problems. Mental health services in Ireland, and elsewhere, have treated mental health problems as medical illnesses from their inception. This is why today we have up to 450,000 people suffering with depression, up from 300,000 in 2004. It will be 500,000 within a few years, and 600,000 a few years after that. It is our common belief in the imaginary incurable life-long ‘mental illness’, more aptly called the “Broken Unpredictable Person Model”, that sustains the stigma around mental health problems and contributes significantly to the death by suicide of hundreds of our people each year.
It is health service policy that psychiatric medication is the first line of treatment for disorders that just aren’t medical problems. This treatment approach often reshapes brains and personalities, and frequently transforms basic psychological problems into chronic medical conditions, aptly called “Psychiatric Illnesses”. Talking therapies, which can actually treat and heal emotional problems, are regarded as the wilted salad that may or may not be served along with the medical main course.
In a rational world the ham-fisted tinkering with our delicate and poorly understood brains would be undertaken only as the last possible resort, with an appreciation of the gravity and consequences of such an undertaking that is virtually absent in current psychiatric practice. In a rational world our mental health services would be fully resourced with and led by talking therapists. Psychiatrists would be external consultants, called on only in those rare cases when it is clear that biological causation is likely. In a rational world a referral from a medical physician would not be required to access treatments for psychological disorders. And waiting times would be measured in hours rather than years.
These are the author’s personal views and in no way reflect the views of mainstream Clinical Psychology.