Just a few decades ago, psychiatry’s reputation was surging. Biological theories of and treatments for the brain, notably drugs like Thorazine, lithium, Valium, and Prozac, were displacing Freudian psychobabble and transforming psychiatry into a truly scientific discipline. Or so boosters of bio-psychiatry claimed.
But bio-psychiatry has failed to live up to its hype. That is the sobering theme of Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, by Harvard historian Anne Harrington, who will be speaking at Stevens on September 25. “Today one is hard-pressed to find anyone knowledgeable who believes that the so-called biological revolution of the 1980s made good on most or even any of its therapeutic and scientific promises,” Harrington writes.
Harrington’s book chronicles the largely futile efforts of scientists to find biological (as opposed to psychological) causes and cures for mental illness. She goes through the sordid history of insulin-coma therapy, electroconvulsive therapy, the lobotomy, and the fever cure. The latter, which assumed that high fever could purge madness from patients, called for infecting them with malaria. Some patients served as “malaria reservoirs,” whose blood supplied pathogens for infecting others.
The practical and ethical flaws of these biological methods allowed psychological approaches to mental illness to flourish. By the mid-20th century, psychoanalysis, the theory/therapy invented by Freud, was dominating American psychiatry. Psychoanalysts insisted that mental illnesses had psychological causes and were best treated by psychological remedies, namely talk therapy. The influence of psychoanalysis waned in the 1950s with the advent of drugs for treating schizophrenia, bipolar disorder, depression, and anxiety.
In the past few decades, as prescriptions for psychiatric medications have soared, their limitations have become increasingly apparent. Many are scarcely more effective than placebos, and they have severe adverse effects, including weight gain, tremors, addiction, and suicide. Meanwhile, researchers have failed to trace mental illnesses to genetic mutations, neural anomalies, viruses, or other physiological factors that would justify physiological treatments. No clear-cut biological markers for any mental illnesses have been found.
Psychiatry’s biological “revolution,” which Harrington calls a “False Dawn,” now appears to have been motivated as much by greed as compassion. By the late 1980s, she notes, “a critical mass of clinicians and researchers had aligned their professional interests with the commercial interests of the pharmaceutical industry.” Speakers at the 2008 meeting of the American Psychiatric Association disclosed more than 1,300 consulting or speaking contracts with drug firms. Companies viewed psychiatrists as “salespeople,” who were compensated based on their ability to boost prescriptions.
Psychiatrists did their job well. Sales of medications for mental illness increased by a factor of six between 1987 and 2001. Psychiatrists and drug companies aggressively promoted drugs for shyness and other traits that had not previously been considered illnesses. Manufacturers of selective serotonin reuptake inhibitors (SSRIs) promoted the “chemical imbalance” theory of depression in advertising, even as research was discrediting the theory.
Meanwhile, Harrington notes, many pharmaceutical companies, frustrated by the slow pace of research on the biology of mental illness, have “abandoned the field of psychiatry altogether.” Thomas Insel, who directed the National Institute of Mental Health from 2002-2015, said after stepping down, “I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
Harrington believes that psychiatry’s current “crisis” is also an opportunity for reform. Psychiatry should admit its mistakes and ethical lapses, especially “the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering.” It should focus on severe mental illness, as it did in the past, and allow psychologists, social workers, and other non-physicians to treat the “worried well.” The mind-fixers, in other words, must fix themselves.
John Horgan directs the Center for Science Writings, which is hosting a talk by Harrington on Wednesday, September 25, 4 p.m., in Babbio Auditorium. This column is adapted from one originally published in Scientific American.
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