A Fundamental Flaw In Modern Psychiatry?

There is no question that as modern psychiatry has evolved it has become a powerful force in the United States.

The field underwent a major shift in paradigm the past 30 years.  Psychiatrists used to work mainly with behavioral modalities like different kinds of therapy to encourage self exploration and change, but modern psychiatry has focused on the use of powerful psychoactive drugs to alter behavior.  Psychiatrists previously spent hours in therapy with their patients but today most psychiatrists get less training in therapy in residency and in clinical practice usually only do 15 minute medication visits with patients.  In these visits they prescribe powerful medicines and inquire about side effects from drugs and leave the therapy to psychologists and social workers.  

Psychiatrists have left the therapy couch behind and transitioned mostly to drug based therapies based on the idea of biological psychiatry.  This is the basic concept that a "chemical imbalance in the brain" can be treated with a "precisely tailored" medicine.  While this concept sounds great in advertisements and commercials a closer look shows that the science is behind these "chemical imbalances" is not well defined and the drugs used are hardly precise and often have bad side effects.

The true causes of psychiatric illness goes beyond a simplified chemical imbalance and remains a nebulous combination of psychological, environmental and biological factors that probably varies tremendously among individuals.   The danger is that in actual clinical practice the treatment option most individuals get now from doctors is a drug that alters brain chemistry in a very imprecise way, but mental problems happen on many different levels.

These underlying chemical imbalances may not be well defined in mental illness, but psychiatric drugs have a place in medicine and if a doctor prescribes one a patient should NEVER stop taking it until they have an in depth conversation with the prescriber.   

As this paradigm shift has happened physicians are confronted with the danger of not considering the depth and complexity of most behavioral problems for the individual.  Advertisements and commercials make these drugs sound simple and many doctors place patients on these drugs without much thought, but be advised: Psychiatric drugs are complicated and have serious pros and cons that must be carefully considered.  The decision to start one should never be taken lightly or glanced over.

There is no doubt that part of mental illness is biology.  There are clearly functional, physiological and anatomical changes in the biology of the brain that are associated with different acute and chronic mental and emotional states.  Yet there is murky evidence that any of the biological mechanisms altered by psychoactive drugs actually cause  the "diseases" these drugs treat.  Altering these mechanisms may help change symptoms much like tylenol helps a back ache but that doesn't mean deficiency or disorder in these areas cause clinical disease.  After all, no one would argue that a lack of Tylenol causes backache. 

As Modern Psychiatry has become overly reliant and focused on drug therapy it has lost sight of the human side of behavior. It has stopped seeing the "forest for the trees" and forgotten that every illness occurs in the context of social, cultural, behavioral and psycho-spiritual factors, not simply biology.    Medicine and Psychiatry often try to drug people to meet our arbitrary cultural standards of normal and abnormal (and disease and health), when often the emotional and behavioral states of individuals are natural to that individual, appropriate based on circumstances and have potential for positive change through non-pharmacologial, human centered modalities.   

In a perfect world much thought would be given to the decision to start high functioning adults on any psychoactive medicine.  These drugs would not be routinely handed out with minimal consideration of the whole person's body, mind and spirit.   And the paradigms that doctors use to view behavioral problems would address the existential roots of human problems.


 Over the next few weeks we will present a series of topics in modern psychiatry where we look specifically at the pro and cons of drugs, investigate the science behind behavior and hopefully provide useful information to help people understand modern psychiatry better. The first topic is going to be on antidepressant use so stay tuned!