Oct 12, 2024 05:07 PM
The drug-based approach to mental illness has Failed. What are alternatives?
https://johnhorgan.org/cross-check/the-d...ternatives
EXCERPTS: I haven’t read a more consequential work of science journalism than Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Robert Whitaker presents evidence that bio-psychiatry, which views mental illness as biochemical disorders best treated with medications, has failed. Whitaker is an award-winning journalist, author of two other books on mental illness and publisher of the website madinamerica.com, which provides informed critiques of mental-health care. Below is an updated Q&A I carried out with him in 2020. I’ve highlighted especially pertinent quotes. —John Horgan
Horgan: Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a fair summary?
Whitaker: Yes, although my thinking has evolved somewhat since I wrote that book.
I am more convinced than ever that psychiatric medications, over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes.
However, my thinking has evolved in this way: I am not so sure anymore that the medications provide a short-term benefit for patient populations as a whole. When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal and fails to rise to the level of a “clinically meaningful” benefit.
Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their psychiatric medications and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects. A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?
In short, research on the short-term effects of psychiatric drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first-episode patients. Which is rather startling, when you think of it.=
[...] You have many alternative programs springing up, even at the governmental level. Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.”
You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress.
All of those initiatives tell of an effort to find a new way. But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold... (MORE - missing details)
https://johnhorgan.org/cross-check/the-d...ternatives
EXCERPTS: I haven’t read a more consequential work of science journalism than Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Robert Whitaker presents evidence that bio-psychiatry, which views mental illness as biochemical disorders best treated with medications, has failed. Whitaker is an award-winning journalist, author of two other books on mental illness and publisher of the website madinamerica.com, which provides informed critiques of mental-health care. Below is an updated Q&A I carried out with him in 2020. I’ve highlighted especially pertinent quotes. —John Horgan
Horgan: Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a fair summary?
Whitaker: Yes, although my thinking has evolved somewhat since I wrote that book.
I am more convinced than ever that psychiatric medications, over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes.
However, my thinking has evolved in this way: I am not so sure anymore that the medications provide a short-term benefit for patient populations as a whole. When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal and fails to rise to the level of a “clinically meaningful” benefit.
Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their psychiatric medications and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects. A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?
In short, research on the short-term effects of psychiatric drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first-episode patients. Which is rather startling, when you think of it.=
[...] You have many alternative programs springing up, even at the governmental level. Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.”
You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress.
All of those initiatives tell of an effort to find a new way. But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold... (MORE - missing details)