Chapter 7 of PBM is entitled “Marching to ‘Pharmageddon’: Psychopharmacy Unmasked” and argues that psychiatric drugs, the “kingpin itself,” are inherently dangerous, and can only damage, not help.
We’ll pass over the sections describing the flaws in the drug creation and approval process (selectively referenced of course) and proceed to the primary argument intended to demonize psychiatric medications en masse.
The Argument
Here we’re going to be relying on the idea that mental illness has to do with imbalances (too much, too little) of several different neurotransmitters. To summarize, again from PBM:
… these substances alter brain chemistry, and given that the people being treated for “mental illnesses” in point of fact have “normal” brain chemistry, it stands to reason that these substances themselves create imbalances. [italics in original]
Sounds logical enough, leading us to the next question of whether or not people being treated for mental illnesses do have “normal” brain chemistry.
To address that, PBM leads us through an exceedingly lengthy description of neurotransmitters, how larger or smaller amounts of each can affect us behaviourally (e.g. stimulating, relaxing). The main point that she makes with respect to the argument in question is that the brain has mechanisms which automatically adjust the level of neurotransmitters to bring things back into equilibrium, to correct levels when things are too off-balance.
Because the brain does that as a normal part of its functioning, this is normal brain chemistry.
Anything that alters it is therefore abnormal brain chemistry. The drugs alter this normal functioning of the brain and its chemistry, ergo they are creating abnormal brain chemistry.
Normal
Stated that way, a lot seems to rest on this “normal” vs. “abnormal” distinction. If you’re getting a sense of deja vu, you should be, because as with the argument “mental illness has no known physical cause so it’s not real”, you have to buy the validity of this particular definition of “normal” for the argument to work.
Can we look at this another way, that is perhaps, more person-centered?
Assume that without medications, our neurotransmitters do their thing as “normal”, and our brain’s corrective mechanisms do their “normal” thing to keep everything in equilibrium. Yet oddly, for no apparent reason we’re still curled up in the fetal position on the floor in a dark room, crying and screaming 18 hours a day, like we’ve been doing for the last week.
Our spouse drags us to the doctor, who suggests a medication trial. Some psychotropic medications are added, which disrupt our brain’s “normal” way of balancing out all the neurotransmitters. We are making an “abnormal” change. Yet, we’re now able to rise, speak, eat, think, communicate with our friends and family, feel positive and negative emotions, and participate in life.
If that’s what “normal” and “abnormal” were to look like for me, sign me up.
Again, relying on a dubious definition, even when surrounding it with as many examples as you’d like of bad things that psychiatric medications have done, does not make for a convincing argument.
Treating symptoms
A slight variation of the argument is also used, namely that psychotropics are inherently flawed because there is no underlying cause for mental illness, and as such there is nothing for them to work on. We’ve addressed the physical cause issue in the “Mental Illness Isn’t Real” section already.
I will just add at this point that there are hundreds if not thousands of diseases in other areas of medicine that are treated partially, primarily or solely via treating the symptoms, and not an underlying physical pathology. Those diseases with no known etiology are just a tiny fraction of that.
Are they effective?
Once we dismiss this notion that the drugs are inherently damaging, we can discuss whether or not they are effective, cause problems, how often this occurs, etc.
PBM provides all kinds of studies and examples, many from patients directly, where harms were caused (or allegedly caused, depending on the example).
The psychiatry community can bring studies and examples, many from patients directly, where the medications were helpful to them.
This is a great situation! Let’s all actually look at all the evidence, and judge it on its strengths and weaknesses. Where we’re missing evidence, or the evidence we have isn’t compelling, let’s get more. Let’s actually address this issue through evidence.
The alternative is throwing up our hands, dismissing everything as hopelessly biased as a result of the government-pharmaceutical-industrial complex, and tossing around conspiracy theories and “logical” arguments based on ridiculous premises.
Chemical Imbalance
A quick note on the whole idea of chemical imbalances as a theory for how psychotropic medications work. While the idea of “too much serotonin” or what not may have been at one time suggested by some overzealous academic looking for tenure, it’s a gross oversimplification of our current understanding of neurobiology.
It is, however, useful as a fairly easy to comprehend model for explaining the basic idea to people. It’s the same way that we’ll still refer to Newtonian mechanics and think about things through that lens, even though we know that quantum mechanics is a more accurate depiction of physics. So don’t get too caught up in arguments resting on the existence of chemical imbalances.
Summary
Having dispatched with the ridiculous notion that all psychiatric medications are inherently flawed as a concept, we are left being able to think of them as we would other medications. What are the benefits and risks, and how do they compare with the benefits and risks of either other treatments, or doing nothing?
For most people who choose to use them, psychiatric medications represent the “least bad alternative.” Just like medications for other illnesses. They may be overused in certain circumstances for all kinds of reasons (e.g., cost, “quick fix”), but are either highly recommended, or an option that should be seriously considered, in many situations for many people.
