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Psychiatry’s Mind-Brain Problem – The New York Times

Recently, a psychiatric study on first episodes of psychosis made front-page news. People seemed quite surprised by the finding: that treatment programs that emphasized low doses of psychotropic drugs, along with individual psychotherapy, family education and a focus on social adaptation, resulted in decreased symptoms and increased wellness.

But the real surprise — and disappointment — was that this was considered so surprising. The study, by Dr. John M. Kane of Hofstra North Shore-LIJ School of Medicine and his colleagues, simply gave empirical support to the longstanding “biopsychosocial” model of illness, which acknowledges that, in ways not fully understood, biology, psychology and social forces can all affect mental health. This model has long been the basis of treatment for experienced, pragmatically minded clinicians.

Unfortunately, such clinical pragmatism has seriously declined in the United States, as psychiatry has veered toward pharmacology. After the emergence of Prozac and the newer antipsychotic drugs like Risperidone some two decades ago, there was a sustained effort by academic research leaders in American psychiatry to promote these successes, and to fight the stigmatization of the mentally ill by forgoing the complexities of the biopsychosocial model for a simpler, more authoritative claim: Mental illness is a brain disease.

via Psychiatry’s Mind-Brain Problem – The New York Times.

The idea that mental illness is a brain disease makes treatment superficially simple unless we remember that social events are also brain events and that these can strongly affect brain functions.  The ignorance of psychosocial treatment under this oversimplified model has led to millions of people being subjected to the side effects of potent psychotropic drugs for long periods of time without the concomitant social treatment which is essential to their cure.  They exist in a netherworld of psychotropic fog, condemned to years of drug treatment without a cure.

This ignorance of psychosocial treatment has hollowed out psychiatry.  It has become a superficial, drug oriented program that can be administered by a physician’s assistant who refills the medication and monitors the side effects while perpetuating the social situation that has exacerbated the disease, if not actually caused it in the first place.

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