Prescription For Scandal: Biological Psychiatry's Faustian Pact

By Athony Black
Canadian Dimension
September/October 2001
orignally published at http;//www.swans.com

The last few decades have witnessed an explosion in the use of psychiatric
medication. Indeed, the omnipresence of legal brain altering drugs in our
society is such that, nowadays, it is rare for us not to know someone else
who is on them - if we not already taking them

Moreover, and contrary to popular perception, a marked increase in the
practice of electro-shock therapy is accompanying this legal drug explosion.
Prior to 1960 this biological psychiatric arsenal was confined mostly within
the walls of the major psychiatric institutions. Since then, the biological
genie has escaped the confines of the mental institution and taken up
residence amidst the population at large.

One of the reasons for this psychiatric colonization of the normal, stems
from the increasingly intimate association between the multi-billion dollar
a year psycho-pharmaceutical industry and institutional psychiatry. Thus,
the latter's psychiatric journals, conventions and professional associations
are all substantially underwritten by the former.

Another reason is the rapid growth in Western society of an overarching
philosophy of what is known as biological reductionism. This notion posits
that, in studying any higher organizational entity, the whole can be
explained by the parts, the complex by the simple, the higher by the lower.
If you are 'depressed', it is because you have a biochemical imbalance,
rather than, perhaps, that your life has no meaning. If one goes to war it
is because of individual 'aggressive genes', rather than your being the pawn
of complex socio-political forces over which you have no control.
A third and perhaps more ominous reason for the dramatic rise in the
fortunes of biological psychiatry, is that its proponents have waged a
propaganda war on its behalf that is riven with pseudo-scientific claims and
evidential suppression.

Shock/Drug Therapy and Brain Damage

They continue to claim, for instance, against substantial research to the
contrary, that shock therapy is harmless. Needless to say, no psychiatrists
have ever volunteered to test this hypothesis themselves. In this they are
probably wise, since the original animal research (of the 1940' and 50's)
demonstrating undeniable brain damage was damning in this regard, as has
been much of the subsequent human clinical data.

Particularly disturbing are the demographic trends for this controversial
procedure. In Canada and the United States, well over 100,000 people are
subjected to the electroshock every year. Over two thirds of these patients
are women, and almost half are the elderly.

Still, while ECT is one of the heavy weapons of the modern bio-psych
arsenal, the more usual work-a-day armament is drug therapy. The first is
targeted on a population of thousands. The second on millions.

Here again, proponents make a number of bold claims. Perhaps the most
scandalous of these is that drug therapy is safe. In 1980, twenty-five years
after the introduction of neuroleptic (antipsychotic) medication, an
American Psychiatric Association task force report finally, grudgingly
confirmed what a number of previously neglected studies had attempted to
call attention to, namely, that roughly 40 percent of chronic users of these
drugs went on to develop tardive dyskinesia, a Parkinsonian-like movement
disorder indicative of permanent brain damage. Subsequent studies only
amplified these fears by pointing the finger at other permanent brain
disorders caused by the neuroleptics. These included tardive akithisia, a
highly debilitating anxiety and hyperactive movement disorder. All told, the
evidence now in supports rates of neuroleptic induced brain damage exceeding
an astounding 5 percent per year of usage.

For clearly psychotic patients there may be a cost-benefit tradeoff to
consider. except that few if any of the patients so prescribed are, or ever
have been, told of the potential cost. Moreover, these drugs are routinely
employed in institutional settings on clients that are patently not
psychotic.

Given this sobering tale, it might have been expected that biological
psychiatry would exercise the cautionary principle in its future endeavours.
This was not the case. Instead, the next round in psychiatry's legal drug
trafficking campaign was launched on an unsuspecting public with all the
same hubris, euphoria and woefully inadequate, experimental investigation as
the first.

So Began the Anti-depressant Revolution

Actually, the word 'revolution' is slightly misleading here, for some of the
anti-depressants, like the tricyclics and the monoamine oxidase inhibitors,
have been around for quite a while. Long enough, in fact, to garner a
shadowy reputation. Thus, the tricyclics, like Tofranil and Elavil, are
known to have numerous side effects, induce severe withdrawal symptoms and
be extremely lethal in overdose. The MAO inhibitors are so dangerous that
the maintenance of a special diet is necessary to avoid life-threatening
cardiovascular reactions.

The minor tranquilizers, like Valium, have also been around for decades and
are probably the most widely prescribed psychiatric medication. Technically,
they are considered apart from the anti-depressants by virtue of their
central nervous system action. Nevertheless, they too are associated with a
host of side effects in addition to being both highly addictive and lethal
in combination with other drugs.

The word 'revolution', then, should rightly be reserved for the latest
generation of anti-depressants, the so-called 'selective serotonin reuptake
inihibitors' (SSRI's) and their hybrid kin. These include such brand names
as Prozac, Paxil and Zoloft. What is revolutionary about them is less their
mode of action, than the extraordinary media fanfare and scientific claims
accompanying them. Though this is not the first time that a class of drugs
has been alleged to specifically target the presumed biological cause of a
complex psychological function (i.e. depression), they are the first to
benefit from the notion that they might enhance the normal human condition
as well.

The credibility of both these claims rests on the theory, widely embraced by
the general public, that depression involves a well-defined point source, or
sources, in the brain upon which anti-depressant drugs act like magic
bullets surgically targeting the offending region(s). Such a theory,
however, seems never to have been burdened with the facts, for the
overwhelming weight of clinical and physical evidence suggests that the
drugs act, not by targeting any hypothetical 'depression center', but by
simply blunting affect and emotion generally. They act, in other words,
non-specifically to block emotional (limbic system) and higher cognitive
(frontal lobe) connection. They don't 'target' anything other than a
generalized splitting of psychic functioning.

Indeed, there is a clear line of reasoning that the sine qua non of their
action is precisely their toxicity. In this they are related to alcohol, the
pleasantly delirious effects of which derive largely from its toxicity and
that, likewise, doesn't 'cure' or 'target' any mental dysfunction at all. In
fact, a more telling analogy is to be seen in the comparison with cocaine
and amphetamine, both of whose effects rely, in part, on their inhibition of
the reuptake of serotonin. Ironically, it was cocaine that was first hailed
as a miracle drug and panacea for psychic ills by Sigmund Freud at the turn
of the century. That was until he personally discovered its physically
destructive and addictive qualities. The analogy can be carried further.
Both cocaine and amphetamine impact additionally on the dopamine and
adrenergic neurotransmitter systems. So do the SSRI's. Moreover, the claim
that these drugs work functionally and specifically is further belied by the
fact that the serotonin system itself ramifies throughout the brain and
spinal cord.

Curiously, in light of the widespread concern about biochemical imbalances
in the brain, the only known such imbalances (apart from a few hormonal
conditions like Cushing's syndrome and Graves' disease) are those caused by
the drugs themselves. Lack of appreciation of this fact leads routinely to
travesties in assigning cause and effect. Thus, the inevitable rebound
reactions which ensue upon cessation of medication, are often interpreted in
circular fashion, by doctor and patient alike, as confirming evidence of the
previously hypothesized biological abnormality.

It must be stated at this point, that none of the foregoing is meant to
suggest that genes and biochemistry have nothing at all to do with moods and
behaviour. Nor is it meant to espouse a belief in some sort of metaphysical
mind/body dualism. I take it that the psyche is obviously based in a
physical substrate, and that constitutional factors clearly influence
everything from temperament to potential intellectual limits. But to see
biological parameters as framing human potential is a far cry from believing
that we have uncovered - or that there even exist - localized chemical
origins of complex emotional and psychological states. It is, furthermore,
naive to suppose that these drugs could ever act in a functionally specific
(i.e. fine tuned) way given what we know of the complexity of even the most
'primitive' of brain processes (like temperature and water regulation, for
instance).

Even more naive, however, is to suppose that tampering, on a daily basis for
perhaps years, even decades, on end with an organ as delicate and complex as
the human brain, is not inherently dangerous. Certainly our experience with
the neuroleptics suggests otherwise.

Equally worrying is that basic biological principles clearly argue for the
potential for permanent changes in physiology when the brain's dynamic
homeostasis is chronically altered or upset. A number of animal studies
involving amplification of the serotonin system have already demonstrated a
resulting permanent loss of serotonin receptors.

Also worrying is a recent report in the British medical journal the Lancet
describing how a group of scientists in the United States had scanned human
brains and found damage to serotonin neurons, caused, they believe, by the
street drug Ecstasy. Studies with monkeys have reinforced these results.
Ecstasy is thought to work, at least in part, by boosting the serotonin
system.

Statistical Shenanigans

Still, biological psychiatrists will argue, and most people believe, that
the SSRI's have undergone a rigorous battery of independent tests, trials
and experimental protocols under the auspices of the American FDA to insure
their efficacy and safety. Nothing could be further from the truth.

First of all, the experimental studies for these drugs are constructed,
financed, and supervised entirely by the drug companies themselves. Their
vaunted independence is a complete myth.

Second, the time line of the trials are so ludicrously short as to fly in
the face of the most elementary scientific reasoning. Prozac, for instance,
was released onto the market with only six weeks of clinical trials. In
essence, anyone now taking the drug for more than six weeks is involved in
their own study into its long-term effects.

Third, the experimental protocol and statistical design of many of these
studies are a complete scandal in their own right. In the case of Prozac,
among other statistical shenanigans: data were pooled from different
sources, then manipulated into shape; relevant clinical groups were
eliminated from participation; additional confounding medications were
administered simultaneous to the test drug; the dropout rate of roughly 50
percent - and the reasons for - were never factored into the final results;
and, finally, the total number of subjects that actually finished a
placebo-controlled study was a mere 286. It is natural to ask at this point,
why, given their potential danger, we haven't witnessed an epidemic of
adverse reactions and brain damage related to these new generation drugs.

As far as the latter effect is concerned, 'witnessed' is the operative term.
The serotonin neurotransmitter system, unlike the dopamine system upon which
the neuroleptics principally act, is not linked directly to the body's motor
system, therefore any damage that may occur is likely to be much less
visible over the short and intermediate run. Moreover, any emotional
scarring or loss that does take place is likely, again, to be interpreted as
part of the original hypothesized 'biological' disorder. That said, it must
be noted that the SSRI's do, in fact, also effect the dopamine and
adrenergic systems, and, like the neuroleptics, they can be expected to
exert a malign, if peripheral, influence on these structures as well.
Evidence to this effect has already been documented.

Prozac Horror Stories

In terms of bad reactions, the case against the SSRI's is on much firmer
clinical ground. Following its release in 1988, for instance, a flood of
Prozac horror stories hit the media. A deluge of lawsuits quickly followed,
whilst Eli Lilly, its manufacturer, embarked on a massive lobbying and
propaganda campaign to protect its $1 billion a year (1993) Prozac market.
Among the many pathological effects that Prozac appeared to induce or
exacerbate were: paranoia, compulsion, depression, suicidal ideation and
violence. Numerous bizarre and gratuitous murders and suicides were credited
to its influence, and a number of august journals including the Lancet and
the British National Formulary came out with confirming warnings about
'suicidal ideation' and 'violent behaviour'. Interestingly, this symptom
cluster is typical of amphetamine psychosis, a, by now, well known result of
protracted stimulant overdose. Like amphetamine, Prozac is functionally a
stimulant.

Apart from safety, yet another claim routinely made by proponents of the
biological psychiatric paradigm is that the long term effectiveness of
medication for neurotic disorders is superior to that of traditional
psychotherapy. Once again, a claim with little or no clinical evidence to
back it up.

Indeed, a number of comprehensive reviews over the past decade have come out
decisively in favour of psychotherapy. Commonsense would hardly dictate
otherwise, for by suggesting to people that they are merely biologically
defective mechanisms capable of handling their emotional / psychospiritual
crises only with the aid of a technological crutch, many of the fundaments
and principles of psychological healing are completely undermined.

Encouraging patients to give up on personal growth and understanding in
favour of pills, is, apart from being a philosophy of despair, a recipe for
emotional disaster. Thus, helplessness is substituted for mastery,
dependency for autonomy, and an unexamined life takes the place of
self-discovery.

Moreover, at precisely the time of greatest need, the patient-cum-psychic
adventurer is delivered up to a zombie-like state devoid of both mental
acuity, and the capacity for deep feeling, self-awareness and self-empathy.
That biological psychiatry could so blithely trample underfoot such granite
pillars of therapeutic commonsense is chilling. Even more chilling is the
fact that the biological paradigm has expanded well beyond the confines of
the adult population. For though most medicated adult patients can be said
to be nominally voluntary, medicated children can in no way be so
considered. It is curious that, in an era deluged with an avalanche of new
statistics detailing the pervasiveness of childhood poverty, neglect, and
abuse, the psychiatric profession has chosen to ignore the obvious
psychsocial causes of most childhood behavioural disorders and has opted,
instead, to crusade for the wholesale drugging of this involuntary
population on the basis of totally unsubstantiated theories of biological
causation.

Thus, there is hardly a shred of experimental evidence to buttress such
trendy childhood 'disease' entities as Minimal Brain Dysfunction, Learning
Disorder, or Attention-Deficit Hyperactivity Disorder. No underlying local
organic malformation, physiological malfunction or chemical basis has ever
been clearly demonstrated for these syndromes and no well controlled
clinical studies have ever unequivocally supported them either. This has not
stopped the escalating prescription of such stimulants as Ritalin and
Dexedrine despite a host of negative side effects including, tics, spasms.
growth suppression, and chronically elevated heart rates and blood pressure.

Increasingly, Prozac is also being given to children despite their never
having been part of the original experimental protocol. The license for such
practice derives from the fact that, once the FDA has approved a drug, there
are few restrictions on how or to whom a doctor can prescribe it. In line
with this practice, the anti-depressants in general have become a
jack-of-all-trades medication prescribed for everything from insomnia to
migraine headache.

In stark contrast to this massive, state sanctioned drug laundering
operation is the harshly punitive 'war' the state wages against illegal
drugs. Though beyond the scope of the present discussion, this fascinating
paradox points up the concluding need to briefly confront some of the
broader social implications of the biological psychiatric paradigm.

A Biased Conception Of What It Means To Be Human

As part of its general philosophical stance this paradigm is a conceptual
formation with an implicit, highly ideological portrayal of the nature of
'human nature'. In this sense it is aimed at us all, for at the heart of any
political philosophy will be found a biased conception of what it means to
be human.

Culturally, the notion that we should conceive ourselves primarily as
biochemical mechanisms is not only dangerously dehumanizing and spiritually
stunting, it leads inevitably to both a dismissive and escapist attitude
towards many genuinely psychological and social problems.

In having suborned, in other words, a substantial proportion of the
population into believing their behaviours are dictated principally by their
genes and their biochemistry, biological psychiatry has not only set back
the psychological paradigm a hundred years, it has also fanned the flames of
a simplistic, reductionist view of human nature and of human society.
Possessed by the reductionist daemon, psychiatry today, remains blind to its
own historical contingency, to its own social, cultural, economic and
political conditioning. Unable to see that it too has a case history, it
remains insensible to its own, quite advanced pathology.

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