Policy implications of the biological model of mental disorder

First, do no harm: Confronting the myths of psychiatric drugs

The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with ‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drug-focused research, much of this funded by the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care.

How Do People Taking Psychiatric Drugs Explain Their “Chemical Imbalance?”

Many people believe that chemical imbalances cause mental illnesses, despite the absence of evidence to ascertain this. This study describes the reasoning that people use in their own case to justify this belief. Data come from recorded medication histories with 22 adults aged 23–68 years, taking different psychiatric drugs for various problems and varying durations, asked directly if they thought their problem was caused by a chemical imbalance and to explain their answer. About two-thirds expressed belief that they had a chemical imbalance; and the rest that they did not have one, did not or could not know, or that their medication had caused one. Reasoning backward from positive drug experiences (ex juvantibus or post hoc) and appeals to authority and convention characterized most answers expressing belief in an imbalance. Experiencing improvement while taking drugs and acquiescing in mental health practitioners’ views instills or reinforces people’s belief that they are or were chemically imbalanced, which suggests viewing the belief as a drug effect. The chemical imbalance notion is likely to persist, as its appeal to give personal meaning to symptom relief and its unfalsifiability ensure institutional support that neutralizes the absence of scientific support.

Can there be a 'cosmetic' psychopharmacology? Prozac unplugged: the search for an ontologically distinct cosmetic psychopharmacology

'Cosmetic psychopharmacology' is a term coined by Peter Kramer in his 1993 best-seller, Listening to Prozac. It has come to refer to the use of psychoactive substances to effect changes in function for conditions that are either normal or subclinical variants. In this paper, I ask: What distinguishes an existential ailment from clinical depression, or either of those from normal depressed mood, melancholic temperament, dysthymia or other depressive disorders? Can we reliably distinguish one from the other? Are the boundaries of illness and disorder really so distinct? If not, how can we know that treatment of 'depression' with Prozac in any given instance constitutes a cosmetic as opposed to, say, a medical or clinical use of psychopharmacology - a distinction that seems to turn on our ability to clearly differentiate the clinical from the cosmetic. If we cannot reliably distinguish between such conditions, can we even have a cosmetic psychopharmacology that is not a form of malpractice, broadly speaking? What if we unplugged Prozac from all the amplitude and hype that resulted in Listening to Prozac becoming an instant best-seller and simply asked whether or not we can clearly distinguish an appropriate cosmetic use of Prozac for 'depression' from an inappropriate cosmetic use of Prozac, and both of those from Prozac's appropriate clinical, that is, non-cosmetic uses? If we cannot make these distinctions, perhaps it is too early to say there can be such a thing as a cosmetic psychopharmacology.