By Loren R. Mosher M.D. and Mary Boyle Ph.D.
 

  "Depression is a flaw in chemistry, not character"
  Eight storey sign at Amsterdam Ave and 72nd St., New York City
 

  The American public is constantly being told that various forms of mental and
  emotional distress and disordered behaviour are 'illnesses like any other' -
  depression is just like diabetes. Yet, does the public know that the American
  Psychiatric Association's Diagnostic and Statistical Manual now has 374
  'mental disorders' versus 112 in 1952 and, even though we now have all these
  new 'diseases', that not one has given up its biological secrets? The US
  Surgeon General concluded in 1999 that there is no biochemical, anatomical
  or functional sign that reliably distinguishes between the brains of mental
  patients and anyone else.

  Who benefits from this proliferation of mental disease? An obvious
  beneficiary is the drug industry, for if behaviour and distress look like physical
  illnesses, then 'treatment' naturally looks like drugs. In 2000, 23 billion
  dollars were spent on psychotropic drugs, twice the 1995 cost. 

  And, although psychiatric drugs don't have specific effects on emotions and
  behaviour (they sedate, tranquillise and stimulate in non-specific ways) they
  are marketed as if they specifically treated particular mental disorders. The
  result is a strong symbiotic relationship between the DSM's ever-growing list
  of disorders and the marketing and sales of drugs. Perhaps the most striking
  aspect of this has been the dramatic growth in the children's drug market, to
  the point where an estimated 5-7 million American children now take
  stimulant drugs for 'attention deficit disorder'.

  We would be less concerned about this situation if the outcomes were
  positive. But, on the contrary, long-term outcomes for people diagnosed as
  schizophrenic are no better now, and may even be worse, than before the
  introduction of major tranquillisers (misleadingly called anti-psychotics). Not
  only that, but the World Health Organization found that outcomes for people
  with schizophrenia in developing countries, where these drugs are used much
  less, are actually better. Similarly, research indicates that antidepressants
  have not significantly reduced the suicide rate, and, as the Journal of Clinical
  Psychiatry recently reported, that these drugs may "actually increase
  biochemical vulnerability to depression and worsen long term outcomes".
  There are also serious concerns about the adverse effects of these drugs. The
  major tranquillisers can produce incurable movement disorders. The minor
  tranquillisers are addictive. The newer antidepressants induce suicidal and
  homicidal behaviour in some persons and can be addictive. Given these
  problems, it's difficult to see that the medicalization of emotion and
  behaviour, and its 'treatment' with drugs, has overall had positive effects. 

  It is not just the lack of positive outcomes that should concern us. In spite of
  claims that the medicalization of human distress is based on biomedical
  science, research paints a quite different picture. The strongest evidence
  about causes of distress and disordered behaviour comes from research on
  social and environmental factors. For example, if at least 50-60% of those
  admitted to psychiatric hospitals, regardless of diagnosis, have been physically
  or sexually abused, is it not reasonable to assume that this may have
  something to do with the distress they are experiencing? If various types of
  family dysfunction, poverty, trauma, unemployment and other environmental
  factors are consistently and strongly related to psychiatric problems, is this
  not significant? Are we seriously to assume that the best answer to these
  psychosocial issues is drugs? 

  What is especially tragic about this situation, apart from the human cost, is
  the closing down of open and honest debate. Readers who thought that the
  issue of 'mental illness' has been settled in favour of biological psychiatry may
  be surprised to learn that many people with impeccable academic and
  professional credentials continue to produce valid critiques of biological
  psychiatry's research and practice. There is also grave concern about the
  methods it uses to hide its lack of scientific respectability. But critics' views
  rarely receive media attention, while authoritative sounding medical
  assertions are given immediate credibility and publicity. Frequent
  pronouncements of genetic or biological "breakthroughs" in our
  understanding or treatment of 'mental illness' keeps the public in a constant
  state of positive anticipation. When the breakthrough comes to nothing, as it
  always has, no trumpets are heard and, in any case, another will be along
  soon. 

  As the President's New Freedom Commission report recently concluded, the
  current model of care has proven to be a failure. Given this context it is surely
  time to re-think biological psychiatry. The public deserves to be better
  informed about the scientific and ethical issues so that they can question
  critically how public money is being spent and about the standards of evidence
  on which claims about biological causation and treatment are based. More
  open and honest debate can only be good for the field and especially for users
  of mental health services. 

  Loren R. Mosher is Clinical Professor of Psychiatry at the University of
  California at San Diego and former Chief of the Centre for Studies of
  Schizophrenia at the National Institute of Mental Health and first
  Editor-in-Chief of the Schizophrenia Bulletin.

  Mary Boyle is Professor of Clinical Psychology, Head of the Doctoral Program
  in Clinical Psychology at the University of East London, UK and author of
  "Schizophrenia: A Scientific Delusion?"

  Further Resources
  The Mind Game by Phillip Day
  Available at www.credence.org