Prescription For Scandal


Anthony Black


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 who is on them —if we are not
already taking them ourselves.

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. 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
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.

The idea that
fundamentally new ontological properties and laws emerge at higher levels of
an organization, each level of which demands its own language and theory for
its description and analysis, is given short shrift in the reductionist
paradigm.

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.

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 1940s and 1950s)
demonstrating undeniable brain damage was damning in this regard, as has been
much of the subsequent human clinical data. All of this evidence, however, as
well as the vociferous condemnation by a legion of former patients, has done
nothing to squelch the practice of this jealously guarded symbol of the
psychiatric profession’s medical and legal authority.

Particularly
disturbing are the demographic trends for this controversial procedure. In
Canada and the United States, well over 100,000 people are subjected to
electroshock every year. Over two-thirds of these patients are women and
almost half are 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, 25
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 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.

That for
clearly psychotic patients there may be a cost-benefit tradeoff to consider
with respect to whether or not to take these medications (perhaps, as a
minimal, maintenance dosage) is rendered moot by the fact 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 endeavors. 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. 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 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. 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. The inevitable rebound reactions that 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 behavior. 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—specific, localized chemical substrates 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 neurophysiological 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
brain, is not inherently dangerous. Certainly our experience with the
neuroleptics suggests otherwise.

Equally
worrying is that basic neurophysiological 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
compensatory down-regulation of serotonin receptivity resulting in the
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.

 


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. 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 his/her 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.

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 behavior.” 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, this is 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 favor of psychotherapy. Common sense 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 favor of pills, is, apart from
being a philosophy of despair, a recipe for emotional disaster. 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 common sense 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
psychosocial causes of most childhood behavioral 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.


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.

Naturally, the
same dangers, the same potential for permanent damage, apply with respect to
these medications as they do to all the others, with the added complication
that, here, the potential for harm is compounded by virtue of the drugs’
interaction with the developing brain.

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.

As part of its
general philosophical stance the biological 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 conception—tendentiously tailored —of
what it means to be human and it is just this conception that the reductionist
psychiatric model seeks to address in a manner which is neither progressive
nor in any way new. Indeed, it is politically and culturally reactionary.

Politically,
the notion that the laws of human behavior and mental functioning should be
phrased predominantly in terms of biological parameters ineluctably invokes
the specter of Social Darwinism. For if our behavior is thought to be strictly
biologically determined then it is immutable, our fates inevitable, and the
status quo merely reflects the “laws of nature.” It is then but a short step
to the rationalization of the manifest inequalities of societal wealth and
privilege. A sort of updated version of the Divine Right of Kings in
pseudo-scientific jargon.

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 behaviors are dictated principally by their genes and their
biochemistry, biological psychiatry has not only set back the psychological
paradigm 100 years, it has also fanned the flames of a simplistic, reduct-
ionist view of human nature and of human society.

Psychiatry may
have festooned itself with self-congratulatory laurels vis-à-vis its
increasingly “scientific” and “objective” orientation, but ironically, it has
moved ever further away from the true meaning of those terms. Having
jettisoned the language and level of analysis necessary for an appropriate
dialogue with its clientele, it is no longer capable of seeing itself in any
remotely objective way.

Possessed by
the reductionist demon, 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.
                                    Z

Anthony
Black is a freelance writer, concentrating on international issues. He has
published in many major papers in the Toronto area, numerous web zines, and
Canadian leftist publications such as
Canadian Dimension.