Recently I said that sometimes I feel like buggy whip makers must have felt when automobiles began to be dominant because I am becoming more distant from the mainstream in mental health. So it is always heartening to find another voice articulately expressing some of my own concerns and reservations about this field. And I found one today: Candid Psychiatrist, whose blog seems to be more a collection of cogent essays than a traditional blog but well worth the effort to read. One excerpt, from her article, "Psychiatry's Own Inconvenient Truth"
One area of presumed scientific progress has been psychiatry, where the biological model of psychiatric disease has become dominant over the past three decades. Prescribing medications has largely supplanted any serious exploration of psychodynamic issues, and relatively few psychiatrists now practice psychotherapy at all. In large part I think this has been a favorable development—there are more and better medications nowadays, and the expertise of psychiatrists in the prescription and management of psychoactive medications is of premium value in the medical marketplace. Besides, I think other disciplines do at least as good a job of psychotherapy as psychiatrists do, and at less cost as well.
But the biological model has demonstrated particular weakness when applied to the disorder known as depression. Millions of patients have experienced significant benefit from antidepressant medications, and even dramatic improvement in a significant portion of cases. However, the prospective benefits of antidepressants have been greatly oversold by a psychiatric establishment that seems intent on promoting the biological conception of depression as a matter of faith, rather than science.
Many of us robotically prescribe serial medication trials in the face of unrelenting depression, even when we ourselves have no real expectation of seeing significant clinical improvement. We participate in this fruitless ritual rather than adequately considering and/or confronting the non-biological factors that are often contributing to these medication-resistant cases. And we justify our own circumscribed mindset with faith-based statements like “You have a chemical imbalance”, or “You will have to take this medication for the rest of your life.” We have fallen into an intellectual rut in our conception of depression, having ourselves become dependent on the idea of medications as a convenient, if somewhat unreliable, therapeutic mainstay.
But simply wishing something were true is not a justification for suspending our doubt, and for failing to reevaluate our belief system in the face of an unimpressive record of clinical success. There is a mechanism for applying skeptical thought to this sort of problem, and that is the scientific method. I think it’s a good time to rigorously reexamine the assumptions upon which most of our treatment of depression relies.
Well worth reading if you want to find another voice skeptical of the current state of affairs.