Wednesday, September 19, 2012

The Science Isn’t There

In my December 2011 post on “Nutrition and the Argument from Uncertainty” I cited and applauded the work of science writer Gary Taubes for unearthing the truth about nutrition science. The upshot was that the science just isn’t there for the conventional wisdom recommending a low fat diet and lots of exercise to protect us against obesity, diabetes, and heart disease. The science instead shows sugars and starches to be the most likely villains.

In a remarkable similarity of investigative journalism, science writer Robert Whitaker, in Anatomy of an Epidemic, demonstrates that the science isn’t there either for the chemical imbalance theory of biopsychiatry. In fact, the evidence in the psychiatric profession’s own literature shows that drug usage for depression, anxiety, and so-called schizophrenia causes more harm than help. In place of a genetic or chemical imbalance theory, Whitaker cites numerous studies supporting psychosocial issues as the causes of psychological problems and psychosocial treatment as the preferred technique to help victims of such problems improve.

To begin the presentation of Whittaker’s argument, let me repeat a point from last month’s post in which I reviewed his earlier work Mad in America: in the pre-drug era of the 1930s and ‘40s analysis of 1400 autopsied brains found no differences between the normal and the psychotic. Given this statement as a sort of prelude, what does Whittaker’s new book say about the chemical imbalance theory?

The theory for both depression and schizophrenia, as it has been tendered by the psychiatric profession, is quite simple. For depression, there is too little serotonin in the brain; for schizophrenia, there is too much dopamine. The drugs, therefore, according to the theory, should increase serotonin to combat depression and reduce dopamine to treat schizophrenia. Measurement of these neurotransmitters in cerebrospinal fluid is the benchmark for both existence and cure of alleged chemical imbalances.

What does the science show? For depression (pp. 71-75 in Whittaker*):

  • Studies in 1969 and 1971 revealed no significant difference between serotonin levels of normal and depressed subjects.
  • In 1974, serotonin levels were normal for unmedicated depressives.
  • Similar results were found repeatedly in subsequent years, leading to this statement (in PLoS Medicine, 2005) by Stanford psychiatrist David Burns: “I spent the first  several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.”
  • And this pointed conclusion by psychiatrist David Healy (in a PLoS Medicine news release, 2005): “The serotonin theory of depression is comparable to the masturbatory theory of insanity.”

A comparable pattern occurred in the studies of schizophrenia (pp. 75-79):

  • No difference between normal and schizophrenic dopamine levels (1974) and no abnormal level of dopamine in unmedicated schizophrenics (1982).
  • Similar results were found repeatedly in subsequent years, leading Steve Hyman, neuroscientist, former National Institute of Mental Health director and former provost of Harvard University, to conclude: “There is no compelling evidence that a lesion in the dopamine system is a primary cause of schizophrenia” (in Molecular Neuropharmacology, 2002).
  • And: “The evidence does not support any of the biochemical theories of mental illness.” Elliot Valenstein, U. of Michigan neuroscientist, in Blaming the Brain (1998).

How do the psychotropic drugs work? They “create perturbations in neurotransmitter functions.” The brain tries to compensate by doing the opposite of what the drug is striving to do. After a few weeks, the attempts at adaptation break down. The brain becomes “qualitatively as well as quantitatively different from the normal state.” Steve Hyman, American Journal of Psychiatry (1996). The drugs, in other words, make the brain abnormal. [Whittaker, pp. 83-84]

The drugs also worsen long-term outcomes. In schizophrenics relapse rates of psychosis increase when neuroleptics are stopped. When on the drug, the brain becomes supersensitive to dopamine, furiously trying to produce more. Upon sudden drug withdrawal, out-of-control, rapid firing of dopaminergic neurons in both the basal ganglia and limbic areas of the brain produce tics, agitation (sometimes leading to thoughts of violence or suicide), and psychotic relapse. The drug then must be brought back. Continued long-term use, however, at some point makes the wild firing of neurons irreversible. Tardive dyskinesia, frontal lobe shrinkage, and permanent psychosis result. (Guy Chouinard, physician, McGill University, in various psychiatric journals 1978-1991). [Whittaker, pp. 105-07]

Whittaker does not stop at depression and schizophrenia. He meticulously documents similarly flawed science and destructive outcomes of drugs for anxiety (the benzodiapines, such as Valium and Xanax), bipolar disorder (Lithium), and so-called ADHD (Ritalin and its relatives).

Evidence for psychosocial causes of mental illness and the effectiveness of psychosocial treatment?

  • World Health Organization cross-cultural studies in 1969, 1978, 1997 have shown that medicated schizophrenic patients in the US and five other developed countries fared much more poorly—short term and long term—than the mostly unmedicated patients in India, Nigeria, and Columbia. [Whittaker, pp. 110-11]
  • In the pre-drug era, the majority of first episode schizophrenics were dismissed from their hospitals within a year, 50 percent as cured, 30 percent as relieved. Twenty percent or fewer needed continual hospitalization. Today, the recovery rate is 36 percent and patients over a ten-year period require three times as many hospitalizations as their counterparts a century ago. The mentally ill die 15-25 years earlier than normal and their death rate has dramatically increased in the last 15 years. [Whittaker, p. 335]
  • In Tornio, Finland (western Lapland), “open-dialogue” family-centered therapy has reduced first-episode schizophrenia by 90% since the 1980s. Psychotic symptoms often retreat within a month. Drugs are seldom used; if necessary, they are used in modest dosages and short term. One ward of the hospital is empty because schizophrenia is disappearing from the region! (More here: 1, 2, 3). [Whittaker, pp. 336-44]

Bottom line: the science is not there for biopsychiatry. And the above is merely the tip of Whittaker’s iceberg of evidence.

The science is not there for biopsychiatry, just as it is not there for low fat diets. But nor is it there for zero-rate interest and “quantitative easing” in economics as cure of our current Great Recession. What bothers me in particular about psychiatry is the immediate and concrete self-evidence that the drugs cause harm, such as flattened affect, subdued behavior, and the appearance in patients of looking and acting drugged.

One can argue that economic thinking is abstract and the chains of reasoning long. Therefore, failure to understand its arguments may be excused (despite the harm caused by the boom/bust cycle of the 2000’s). But psychiatry, where the effects of the practitioners’ actions are immediately evident? Where the effects of a legal drug show little difference from the effects of an illegal one? That I do not understand.

Whittaker has performed profound service to science by writing Anatomy of an Epidemic. As with the work of Gary Taubes, I urge you to read Robert Whittaker for the science he has uncovered, for the meticulousness of his method, that is, for his epistemology, and for his courage to expose a profession that refuses to examine itself.

*Page references are to Whittaker. Full journal citations are in Whittaker’s notes. For a concise, bullet-point presentation of source documents in both of Whittaker’s books, see this web page.

No comments :