Greetings:
Fortuitously, Jeff Shaller had posted this piece to me.
It adds a nice dimension to our current thread on
anatomical/physiological functioning and construing.
Jim Mancuso
--
James C. Mancuso Dept. of Psychology
15 Oakwood Place University at Albany
Delmar, NY 12054 1400 Washington Ave.
Tel: (518)439-4416 Albany, NY 12222
Mailto:mancusoj@capital.net
http://www.capital.net/~mancusoj
A website dedicated to a personal view of Per-
sonal Construct Psychology
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Subject: A Neuroscientists Says No to Drugs
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The Chronicle of Higher Education
http://chronicle.com
Section: Research & Publishing
Page: A10
Letters to the Editor: editor@chronicle.com
>From the issue dated December 4, 1998
TREATING MENTAL DISORDERS
A Neuroscientist Says No to Drugs
By JOSHUA ROLNICK
Elliot S. Valenstein has spent most of his career searching for
biological explanations for behavior. Now, after more than 40 years,
he is attacking the prevailing biochemical explanations for mental
illness.
"We have almost reached the point where there will be no limits to
what people will believe brain chemistry can explain," he writes in
the introduction to his new book, Blaming the Brain: The Truth About
Drugs and Mental Health (The Free Press). It's time to stop blaming
mental disorders on brain chemistry, he argues.
In simple terms, the biochemical theory holds that clinical
depression, schizophrenia, and other disorders result mainly from
chemical imbalances in the brain. Drugs like Prozac and lithium are
supposed to work because they correct such imbalances.
In his book, however, Mr. Valenstein, an emeritus professor of
psychology and neuroscience at the University of Michigan, argues that
scientifically, the biochemical explanation of mental illness rests on
shaky ground. Environmental and cognitive variables are as important
as biology, he writes, and psychotherapy is often just as effective as
drug treatments, which pharmaceutical companies, psychiatrists, and
others have successfully promoted.
Mr. Valenstein, a former chairman of Michigan's biopsychology program,
seems an unlikely crusader. In his years of research on rats and other
laboratory animals, and in more than 140 scholarly articles, he
studied how the brain and other biological factors, such as hormones,
influence behavior.
In the latter part of his career, the psychologist grew more
interested in the history of his field -- a history he has not always
praised. In Great And Desperate Cures (Basic Books, 1986), he argued
that scant scientific evidence supported the use of lobotomy to treat
certain mental disorders, even though doctors and the public embraced
the procedure in the 1940s.
When Mr. Valenstein began his new book three years ago, he planned to
write a history of brain-chemistry theory, not a critique.
"I used to lecture to students and put together a reasonably coherent
story," he says. "I knew there were gaps, but this was an emerging
science." By the time he was halfway through writing the book,
however, his skepticism had become unshakable. "I began to feel that
the evidence that didn't fit was becoming overwhelming."
A combination of factors gave rise to the acceptance of drug
treatments for schizophrenia and other mental disorders, he argues.
Researchers sometimes stumbled upon the drugs inadvertently, he
writes. For example, one drug that is rarely used now, chlorpromazine,
originally a synthetic dye, was one of the first antipsychotic
medications, after scientists concluded that it might help treat
post-surgical shock. "With no effective treatment of mental illness,"
he writes, "almost anything that held out any hope was worth trying."
As scientists learned more about the brain and its interaction with
certain drugs, theories emerged to explain several major illnesses.
Schizophrenia, for example, was believed to result from too much
activity of dopamine, a neurotransmitter. The theory evolved when
scientists discovered that, on the whole, the more an antipsychotic
drug blocked the action of dopamine in the brain, the more the
symptoms of schizophrenia were eased, Mr. Valenstein explains. But
researchers have failed to find direct evidence that dopamine is, in
fact, too active in the brains of schizophrenics, he says. And
although most antipsychotic drugs did restrict dopamine activity after
a few hours, he writes, they had no therapeutic benefit for the first
few weeks of treatment.
As a result, Mr. Valenstein writes, one study found that the drugs
helped only about 60 per cent of schizophrenics. Similarly, he says,
antidepressants appear to help only 30 to 40 per cent of patients. Mr.
Valenstein argues not that drugs never work, but that they do not
attack the real cause of a disorder. Biochemical theories, he argues,
are an "unproven hypothesis" -- and probably a false one.
The pre-eminence of drug treatments is no accident, he goes on.
Pharmaceutical companies have a financial stake in their popularity,
and promote them heavily among doctors and patients. Mr. Valenstein
cites studies that examined some of the literature distributed by the
companies and found that much of it contained misleading or unbalanced
information.
Drug companies are also the largest sponsor of medical research in the
United States and Canada, Mr. Valenstein says. In some cases, they
give complete freedom to researchers. In other cases, the contracts
they require give them the right to exclude information from published
reports, or to delay publication of the report itself.
A spokesman for one company Mr. Valenstein criticizes, Eli Lilly and
Company, declined to comment. Another, Pfizer Inc., did not respond to
requests for comment.
Psychiatrists, too, have supported the use of the drugs, he argues.
For one thing, he says, an emphasis on medication allows psychiatrists
to fend off competition from psychologists and social workers, who
usually charge less for their services, but who cannot prescribe
drugs. While that may not be the reason for their support, he writes,
"there is little doubt that since the 1960s, psychiatry has
increasingly emphasized biochemical factors as the cause of mental
disorders."
Paul H. Wender, a professor of psychiatry at the University of Utah,
denies that psychiatrists favor drug treatments as a way to limit
competition. "There have been 2,000 studies of the efficacy of
psychotropic drugs in schizophrenia," says Dr. Wender, co-author of
Understanding Depression, a book Mr. Valenstein criticizes.
"To argue that psychiatry has a medical passion is untrue," agrees
Donald F. Klein, Dr. Wender's co-author. Theories aside, he says,
psychiatrists prescribe drugs because they work.
Mr. Valenstein emphasizes that he does not intend to discourage
patients from trying medication as one option. But he hopes that
Blaming the Brain will open up a dialogue about the biochemical theory
of mental illness, even as physicians feel increasing pressure to
ignore other treatments, like psychotherapy, in favor of costly drugs
that may have serious side effects and little benefit.
Right now, he writes, "the theory is being pursued relentlessly on a
path filled with many dangers."
_________________________________________________________________
Copyright ) 1998 by The Chronicle of Higher Education
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Jeffrey A. Schaler, Ph.D.
http://rdz.acor.org/szasz/schaler
Voice: (301) 585-5664 -- Fax: (215) 402-0269
Snail: 1001 Spring St., Suite 104, Silver Spring, Maryland 20910 USA
Other e-mail: jschale@american.edu (or) jschaler@umd5.umd.edu
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