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Chapter 1: The Brain-Disabling Principles of Psychiatric Treatment
The last decade has seen escalating
reliance upon psychiatric drugs, not only within psychiatry, but throughout
medicine, mental health, and even education. Nearly every patient who is
psychiatrically hospitalized is encouraged or forced to take medications.
There is a movement within psychiatry to make it easier to force clinic
outpatients to take long-acting injections of drugs. In private practice
psychiatry, it is common to give patients a medication on the first visit and
then to instruct them that they will need drugs for their lifetime. Family
practitioners, internists, and other physicians liberally dispense
antidepressants and minor tranquilizers. Nonmedical professionals, such as
psychologists and social workers, feel obliged to refer their patients for drug
evaluations. Managed care aggressively pushes drugs to the exclusion of
psychotherapy. Adult medications are increasingly prescribed for
children.
Laypersons have
joined in the enthusiasm for drugs. Because of media support for
medication, as well as direct advertising and promotion to the public, patients
frequently arrive at the doctor’s office with the name of a psychiatric drug
already in mind. Teachers often recommend children for drug evaluation or
treatment.
As a part of this
overall resurgence in biological psychiatry, electroshock has become
increasingly popular. Even psychosurgery once again has its vociferous
advocates (reviewed in Breggin & Breggin, 1994b).
This “drug revolution” views psychiatric medications
as far more helpful than harmful, even as an unmitigated blessing. Much as
insulin or penicillin, they are frequently seen as specific treatments for
specific illnesses. Often they are said to correct biochemical imbalances
in the brain. These beliefs have created an environment in which emphasis
upon adverse drug effects is greeted without enthusiasm and criticism of
psychiatric medication in principle is uncommon heresy.
This book takes a decidedly different viewpoint –
that psychiatric drugs achieve their primary or essential effect by causing
brain dysfunction, and that they tend to do far more harm than good. I
will show that psychiatric drugs are not specific treatments for any particular
“mental disorder.” Instead of correcting biochemical imbalances,
psychiatric drugs cause them, sometimes permanently.
The critiques in this book coincide with an
alternative view that psychological, social, educational, and spiritual
approaches are the most effective in helping individuals to overcome their
personal problems and to live more fulfilling lives. I have described some
of these approaches elsewhere (e.g., Breggin, 1991a, 1992a, 1997; Breggin &
Breggin, 19941; Breggin & Stern, 1996). Many others have continued to
voice strong criticism of the biological model and physical treatments from a
variety of perspectives (Armstrong, 1993; Breeding, 1996; Caplan, 1995; Cohen,
2990; Colbert, 1995; Fisher & Greenberg, 1989; Grobe, 1995; Jacobs, 1995;
Kirk & Kutchins, 1992; Modrow, 1992; Mosher & Burti, 1989; Romme &
Escher, 1993; Sharkey, 1994). Here I want to re-evaluate the underlying
assumptions used to justify drug and shock treatment in psychiatry, and to
document their brain-disabling and brain-damaging effects.
The principles that are introduced in
this chapter will be documented and elaborated throughout the book.
Therefore, citations will be omitted in chapter 1.
Principles of Brain-Disabling Treatment
Modern psychiatric drug treatment gains
its credibility from a number of assumptions that professionals and laypersons
alike too often accept as scientifically proven. These underlying
assumptions qualify as myths: fictions that support a belief system and a set of
practices. In contrast to these myths, this book identifies principles of
psychopharmacology that are based on scientific and clinical evidence, as well
as on common sense. Together these form the brain-disabling principles of
psychiatric treatment. While the book in its entirety provides the
evidence for these principles, this chapter will summarize them:
I. All biopsychiatric treatments share a common mode of action – the disruption of normal brain function.
Pharmacologists speak of a drug’s
therapeutic index, the dosage ratio between the beneficial effect and the toxic
effect. The first brain-disabling principle of psychiatric treatment
reveals that the toxic dose is the therapeutic effect. This same principle
applies to electroshock and psychosurgery.
The brain-disabling principle states that as soon as
toxicity is reached the drug begins to have a psychoactive effect, that is, it
begins to affect the brain and mind. Without toxicity, the drug would have
no psychoactive effect.
II. All biopsychiatric interventions cause generalized brain dysfunction.
Although specific treatments do have
recognizable different effects on the brain, they share the capacity to produce
generalized dysfunction with some degree of impairment across the spectrum of
emotional and intellectual function. Because the brain is so highly
integrated, it is not possible to disable circumscribed mental functions without
impairing a variety of them. For example, even the production of a slight
emotional dullness, lethargy, or fatigue is likely to impair cognitive functions
such as attention, concentration, alertness, self-concern or self-awareness, and
social sensitivity.
Shock
treatment and psychosurgery always produce obvious generalized
dysfunction. Some medications may not obviously produce these effects in
their minimal dose range, but they may also lack any substantial “therapeutic
effect” in that range.
III. Biopsychiatric treatments have their “therapeutic” effect by impairing higher human functions, including emotional responsiveness, social sensitivity, self-awareness or self-insight, autonomy, and self-determination. More drastic effects include apathy, euphoria1, and lobotomy-like indifference.
Higher mental, psychological, and
spiritual functioning are impaired by biopsychiatric interventions as a result
of generalized brain dysfunction, as well as specific effects on the frontal
lobes, limbic system, and other structures. Sometimes there is a
lobotomy-like indifference to self and to others – a syndrome that I have called
deactivation (see chapters 2 and 4 of this volume).
Biopsychiatric treatments are deemed effective when
the physician and/or the patient prefer a state of diminished brain function
with its narrowed range of mental capacity or emotional expression. If the
drugged individual reports feeling more effective and powerful, it is most
likely based on an unrealistic appraisal, impaired judgment, or euphoria.
When patients on “maintenance doses” do not experience noticeable effects,
either the dose is too low to have a clinical effect or the patient is unable to
perceive the drug’s impact.
IV. Each biopsychiatric treatment produces its essential or primary brain-disabling effect on all people, including normal volunteers and patients with varied psychiatric diagnoses.
Despite the deeply held convictions of
drug proponents, there are no specific psychoactive drug treatments for specific
mental disorders.
There is,
of course, a certain amount of biological and psychological variation in the way
people respond to drugs, shock treatment, or even lobotomy or an accidental head
injury. However, as a general principle, biopsychiatric interventions have
a nonspecific impact that does not depend on the person’s mental state or
condition. For example, it will be shown that neuroleptics and lithium
affect animals and normal volunteers in much the same way as they affect
patients.
V. Patients respond to brain-disabling treatments with their own psychological reactions, such as apathy, euphoria, compliance or resentment.
There is some variation in the way
individuals respond to drugs. For example, the same antidepressant will
make one person sleepy and another energized. Ritalin quiets many children
but agitates others.
It can
be very difficult to separate out drug-induced form psychologically induced
responses. For example, nearly all of the antidepressants can cause
euphoria and mania2. At the same time, some of the people
who receive these drugs have their own tendency to develop these mental
states. Similarly, a variety of drugs are capable of generating agitation
and hostility in patients, yet people can develop these responses without
medication. The docility and compliance seen following the administration
of neuroleptics can be caused by the drug-induced deactivation syndrome, but can
also result from the patient’s realization that further resistance is futile or
dangerous.
Later in this
chapter, I will introduce the concept of iatrogenic helplessness and denial
which addresses the combined neurological and psychological impact of
biopsychiatric treatment. In chapter 11, I will discuss some of the
criteria for determining that a drug can itself cause abnormal mental and
emotional responses, including destructive behavior.
VI. The mental and emotional suffering routinely treated with biopsychiatric interventions have no known genetic and biological cause.
Despite more than two hundred years of
intensive research, no commonly diagnosed psychiatric disorders have been proven
to be either genetic or biological in origin, including schizophrenia, major
depression, manic-depressive disorder, the various anxiety disorders, and
childhood disorders such as attention-deficit hyperactivity.
At present, there are no know
biochemical imbalances in the brain of typical psychiatric patients – until they
are given psychiatric drugs. It is speculative an even naďve to assert
that antidepressants such as Prozac correct underactive serotonergic
neurotransmission (a serotonin biochemical imbalance), or that neuroleptics such
as Haldol correct overactive dopaminergic neurotransmission (a dopamine
imbalance). The failure to demonstrate the existence of any brain
abnormality in psychiatric patients, despite decades of intensive effort,
suggests that these defects do not exist.
It seems theoretically possible that some of the
problems treated by psychiatrists could eventually be proven to have a
biological basis. For example, mental function often improves when certain
physical disorders, such as hypothyroidism or Cushing’s Syndrome, are adequately
treated.
However, the vast
majority of problems routinely treated by psychiatrists do not remotely resemble
diseases of the brain (see chapters 5 and 9). For example, they do not
produce the cognitive deficits in memory or abstract reasoning characteristic of
brain disorders. They are not accompanied by fever or laboratory signs of
illness. To the contrary, neurological and neuropsychological testing usually
indicate normal if not superior brain function, and the body is healthy.
There seems little likelihood that any of the routinely treated psychiatric
problems are based on brain malfunction rather than on the life experiences of
individuals with normal brains.
If some patients diagnosed with major depression or
schizophrenia do turn out to have subtle biochemical imbalances, this would not
justify current biopsychiatric practice. Since these presumed imbalances
have not yet been identified, it makes no sense to give toxic drugs, including
the currently available antidepressants and neuroleptics, all of which grossly
impair brain function.
To
claim that an irrational or emotionally distressed state in itself amounts
to impaired brain function is simply false. An analogy to television may
illustrate why this is so. If a TV program is offensive or irrational, it
does not indicate that anything is wrong with the hardware or electronics of the
television set. It makes no sense to attribute the bad programming to bad
wiring. Similarly, a person can be very disturbed psychologically without
any corresponding defect in the “wiring” of the brain. However, the argument is
moot, since no contemporary biopsychiatric interventions can truthfully claim to
correct a brain malfunction the way an electronics expert can fix a television
set. Instead we blindly inflict toxic substances on a brain that is far
more subtle and vulnerable to harm than a television set. We even shock or
mutilate the brain in ways that would appall TV repair persons or their
customers, while ruining their television sets.
It is often suggested that persons suffering from
extremes of emotional disorder, such as hallucinations and delusions, or
suicidal and murderous impulses, are sufficiently abnormal to require a
biological explanation. However, the emotional life of human beings has
always included a wide spectrum of mental and behavioral activity. That a
particular mental state or action is especially irrational or destructive does
not, per se, indicate a physical origin. If extremes require biological
explanation, then it would be more compelling to ascribe extremely ethical,
rational, and loving behaviors to genetic and biological causes, since they are
especially rare in human life.
The fact that a drug “works” – that is, influences
the brain and mind in a seemingly positive fashion – does not confirm that the
individual suffers from an underlying biological disorder. Throughout recorded
history, individuals have medicated themselves for a variety of spiritual and
psychological reasons, form the quest for a higher state of consciousness to a
desire to make life more bearable. Alcoholic beverages, coffee and tea,
tobacco, and marijuana are commonly consumed by people to improve their sense of
well-being. Yet there’s no reason to believe that the results they obtain
are due to an underlying biochemical imbalance.
VII. To the extent that a disorder of the brain or mind already afflicts the individual, currently available biopsychiatric interventions will worsen or add to the disorder.
The currently available biopsychiatric
treatments are not specific for any known disorder of the brain. One and
all, they disrupt normal brain function without correcting any brain
abnormality. Therefore, if a patient is suffering from a known physical
disorder of the brain, biopsychiatric treatment can only worsen or add to
it. A classic example involves giving Haldol to control emotionally upset
Alzheimer patients. While subduing their behavior, the drug worsens their
dementia.
After psychiatric
drugs are developed and marketed by drug companies, attempts are made to justify
their use on the basis of correcting presumed biochemical imbalances. For
example, it is claimed that Prozac helps by improving serotonergic
neurotransmission. Even electroshock and lobotomy are justified on the
grounds that they correct biochemical imbalances. There is no likelihood
that these intrusions correct a biochemical imbalance. Too wide a variety
of brain-disabling agents are used to treat every disorder – everything from
Prozac to Xanax to electroshock is prescribed for depression – and each
treatment ends up disrupting innumerable brain functions. In reality, all
currently available biopsychiatric interventions cause direct harm to the brain
and hence to the mind without correcting any known malfunctions.
VIII. Individual biopsychiatric treatments are not specific for particular mental disorders.
It is often said that psychiatry has
specific treatments for specific diagnostic categories of patients: for example,
neuroleptics for schizophrenia, antidepressants for depression, minor
tranquilizers for anxiety, lithium for mania, and stimulants, such as Ritalin,
for attention-deficit hyperactivity. In actual practice, many individual
patients labeled schizophrenic to be initially treated with neuroleptics or for
depressed patients to be initially prescribed to be initially prescribed
antidepressants, this is, in part, a matter of convention within the
profession.
When a drug seems
more effective in a particular disorder, it often depends on whether it has a
suppressive or an energizing effect on the CNS. For example, if depressed
patients are already emotionally and physical slowed down, giving them a
neuroleptic that causes psychomotor retardation would tend to make them look
worse. These patients are more likely to seem improved when artificially
energized. Conversely, if schizophrenic patients are agitated and
difficult to control, it would not make sense to give them stimulants.
They are more likely to be judged “improved” when taking a neuroleptic that
reduces or flattens their overall emotional responsiveness. These gross
behavioral effects, however, are a far cry from having a “magic bullet” for a
specific disease.
IX. The brain attempts to compensate physically for the disabling effects of biopsychiatric interventions, frequently causing additional adverse reactions and withdrawal problems.
The brain does not welcome psychiatric
medications as nutrients. Instead, the brain reacts against them as toxic
agents and attempts to overcome their disruptive impact. For example, when
Prozac induces an excess of serotonin in the synaptic cleft, the brain
compensates by reducing the output of serotonin at the nerve endings and by
reducing the number of receptors in the synapse that can receive the
serotonin. Similarly, when Haldol reduces reactivity in the dopaminergic
system, the brain compensates, producing hyperactivity in the same system by
increasing the number and sensitivity of dopamine receptors.
It is difficult if not impossible to
accurately determine the underlying psychological condition of a person who is
taking psychiatric drugs. There are so many complicating factors,
including the drug’s brain-disabling effect, the brain’s compensatory reactions,
and the patient’s psychological responses to taking the drug.
Because the brain attempts to compensate
for the effects of most psychoactive drugs, patients can have difficulty
withdrawing from most psychiatric medications. Physically, the brain
cannot recover from the drug effects as quickly as the drug is withdrawn, so
that the compensatory mechanism can require weeks or months to recover after the
drug has been withdrawn. Sometimes, as in tardive dyskinesia, the brain
fails to recover. Psychologically, individuals fear that their emotional
suffering will worsen without the medication. They may have been told by
psychiatrists that they require the medication for the rest of their
lives. This can make withdrawal even more difficult.
X. Patients subjected to biopsychiatric interventions often display poor judgment about the positive and negative effects of the treatment on their functioning.
Generalized brain dysfunction tends to
reduce the individual's ability to perceive the dysfunction. Impaired
individuals not only tend to minimize their dysfunction, they often see
themselves as performing better than ever. Individuals intoxicated with
alcohol, for example, often show poor judgment in estimating their capacity to
drive an automobile or to carry on a sensible conversation. Many
individuals who chronically smoke marijuana believe that it improves their
overall psychological and social functioning, but if they withdraw from the
drug, it may become apparent to them that their memory, mental alertness,
emotional sensitivity, and social skills have been impaired while using the
drug. People intoxicated with stimulants, such as amphetamine, may feel
they have superior or even superhuman capacities, when they are often seriously
impaired. The same is true of all psychiatric drugs. Often the
patient will have little appreciation for the degree of mental or emotional
impairment until the drug has been stopped for some time and the brain has had
time to recover.
In my
experience as a clinician and forensic medical expert, I have seen patients
remain for years in severe states of intoxication from one or more psychiatric
drugs without realizing it. Attributing their condition to their own
emotional reactions or to stresses in the environment, they may ask for more
medication.
After shock
treatment and psychosurgery, patients may also fail to understand the iatrogenic
source of their mental dysfunction and instead believe that they need further
interventions.
The failure to
perceive the extent of treatment-induced impairment can have several
interrelated psychological and physiological bases:
Psychological denial.
Individuals overcome by emotional suffering are likely to deny the degree of
their psychological dysfunction. They don't want to admit to being
severely mentally impaired. If they are hoping to fell better with
the use of a drug, their denial can be further reinforced.
Placebo effect. Patients have
faith that biopsychiatric interventions will be helpful rather than harmful,
encouraging them to disregard drug-induced dysfunction or to mistakenly
attribute it to their emotional problems.
Compliance. To an extraordinary extent,
patients will tell doctors what the doctors want to hear. If a
psychiatrist clearly wants to hear that a drug is helpful, and not harmful, many
patients will comply by giving false information or by withholding contradictory
evidence.
Psychologically
induced confusion. Emotionally upset individuals can easily lose their
judgment concerning the cause of their worsening condition. They can
easily mistake a negative drug effect, such as rebound anxiety from a minor
tranquilizer or depression from a neuroleptic, for a worsening of their
emotional problems. Typically, they blame themselves rather than the
medication. This confusion is abetted when the physician exaggerates the
drug's benefits and fails to inform the patient of its potential adverse
effects.
Drug-induced
confusion. Almost all biopsychiatric interventions can at times induce
confusion, impairing the patient's awareness of the drug-induced mental
dysfunction.
Drug-induced
anosognosia. Anosognosia refers to the capacity of brain damage to
cause denial of lost function. Anosognosia is a hallmark of central
nervous system (CNS) disability (see below and chapter 5). It has physical
basis in addition to a psychological one.
XI. Physicians who prescribe biopsychiatric interventions often have an unrealistic appraisal of their risks and benefits.
In recent years, doubt has been thrown on
the objectivity of controlled clinical trials in which drugs are compared to
placebo or to alternative medications (see chapters 6 and 11). Too often
the investigators are influenced by their conscious or unconscious
biases.
If clinical and
scientific studies can be distorted by bias, it is even more likely that routine
clinical practice will be affected by the hopes and expectations of the
prescribing physician. Physicians in great numbers have prescribed drugs
with unbounded enthusiasm for years before the agents have proven to be
worthless or unacceptably dangerous. Amphetamines, for example, were
freely dispensed for many years to millions of patients for both depression and
weight control without regard for their lack of efficacy and addictive
potential. Similarly, minor tranquilizers, such as Valium, were given to
millions of patients before the profession recognized that they have little or
no long-term benefit and can become addictive. Both psychosurgery and
electroshock continue to be utilized, despite obviously devastating effects on
the mental life of the patients and the absence of proven efficacy.
IATROGENIC HELPLESSNESS
AND DENIAL (IHAD)
I have coined the term iatrogenic
helplessness and denial (IHAD) to designate the guiding principle of
biopsychiatric interventions. (Breggin, 1983b). It describes how the
biological psychiatrist uses authoritarian techniques, enforced by
brain-disabling interventions, to produce increased helplessness and dependency
on the part of the patient.
Iatrogenic helplessness and denial include the patient's and the doctor's mutual
denial of the damaging impact of the treatment, as well as their mutual denial
of the patient's underlying psychological and situational problems.
Overall, iatrogenic helplessness and denial account for the frequency with which
psychiatry has been able to utilize brain-damaging technologies, such as
electroshock and psychosurgery, as well as toxic medications.
Before the potential patient encounters
a psychiatrist, he or she has usually been feeling helpless for some time.
In my formulation, helplessness is the common denominator of all psychological
failure. Helplessness is at the core of most self-defeating approaches to
life (Breggin, 1992a, 1997). People who feel helpless tend to give up
using reason, love, and self-determination to overcome their emotional
suffering, inner conflicts, and real-life stresses. They instead seek
answers from outside themselves. In modern times, this often means from
"experts."
Iatrogenic
helplessness and denial go far beyond relatively benign suggestion (as used in
medicine and psychiatry, for example, to help overcome physical pain or
addiction). First, in iatrogenic helplessness and denial the psychiatrist
compromises the brain of the patient, enforcing the patient's submission to
suggestion through mental and physical dysfunction. Second, in iatrogenic
helplessness and denial the psychiatrist denies to himself or herself the
damaging effects of the treatment as well as the patient's continuing
psychological or situational problems.
Often denial is accompanied by confabulation -
the patient's use of rationalizations and various "cover stories" to hide the
extent of mental dysfunction. Confabulation is well understood in
psychiatry and neurology, but is generally ignored in regard to
treatment-induced effects. Many patients confabulate good results from
drug therapy when they are obviously impaired by it.
Denial is closely linked to indifference. Sometimes
it is difficult to tell if the patient doesn't care, or if the patient cares so
much that he cannot bear to face up to his mental and physical
dysfunction. Denial is also related to euphoria. After lobotomy or
shock treatment, and sometimes during drug treatment, the patient can develop an
unrealistic "high."3
Denial is one of the most primitive ways of
responding to threats. The person avoids facing problems and thereby
becomes unable to make headway with them. Denial as a basic defense tends
to result in ineffective, impotent lives.
Brain damage and dysfunction from any cause,
including accidents and illness, frequently produces helplessness and denial;
but only in psychiatry is damage and dysfunction used as "treatment" to produce
these disabling effects.
CONCLUSION
As I have discussed in earlier books (1991a, 1994a, 1994b), I believe that the concepts of "mental illness" and "mental disorder" are misleading, and that none of the problems commonly treated by psychiatrists are genetic or biological in origin. The terms "schizophrenia" and "major depression," for example, are based on concepts whose validity can easily be challenged. However, the brain-disabling principles remain valid even if some of the mental phenomena that are being treated turn out to have a genetic or biological basis. All of the currently available biopsychiatric treatments - drugs, electroshock, and psychosurgery - have their primary or therapeutic effect by impairing or disabling normal brain function.
Footnotes:
1. The term
euphoria as used in psychiatry indicates an exaggerated, irrational, or
unrealistic sense of well-being. It can be psychological in origin but is
commonly caused by brain damage or drug toxicity.
2. Euphoria is unusual in patients treated with the neuroleptics because of the suppressive effects on the CNS (see chapter 2). It is more common among patients treated with antidepressants, stimulants, and minor tranquilizers.
3. See fotnote 2, (above).