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Pharmaceutical companies and organized psychiatry have conducted a worldwide campaign to convince ever greater numbers of people to take psychiatric drugs. At the 1998 annual meeting of the American Psychiatric Association, an alliance of "mental illness advocates" announced the results of its international survey: Two-thirds of people "with psychiatric disorders" often wait two to five years or more before seeking treatment. This survey was funded by a grant from Bristol-Myers Squibb Company which manufactures both an antidepressant and an antianxiety drug13. The results were presented and discussed at the world's most prestigious psychiatric meeting by professors from Harvard Medical School, the New York University Medical School, and the University of Toronto.
The survey unintentionally confirmed a major reason that so many people don't seek treatment: The treatment frequently does more harm than good. More than 50 percent of patients drop out of psychiatric drug treatment "due to side effects", including drug-induced "sleep problems, anxiety and agitation, and sexual dysfunction". These results confirm the obvious limits of drug treatment; yet the survey director announced the need for a "worldwide" campaign to encourage more people to seek psychiatric treatment. A more recent survey found that 42 percent of American adults prescribed an antidepressant between 1996 and 2001 stopped taking it within one month; only 28 percent remained on the drug past three months (Olfson et al., 2006 [295]).
The National Institute of Mental Health (NIMH) and pharmaceutical companies have been placing increasing emphasis on marketing psychiatric drugs to children14. Consistent with this strategy the survey urged "aggressive treatment in childhood and adolescence". Children, of course, have less power than adults to reject the drugs, no matter how bad the adverse effects become.
Claims that "mental illness" is caused by "biochemical imbalances" is the major public relations thrust of current drug promotion. In magazine advertisements and during consultations with doctors in their offices, potential patients are repeatedly told that psychiatric drugs "work" by correcting known "biochemical imbalances" in the brains (Lacasse and Leo, 2005 [237]). Media reports treat these claims as the gospel truth, and the American Psychiatric Association reports that 75 percent of Americans believe in them (APA, 2005 [7]). What is the basis for them?
During the FDA approval process, new drugs are first tested on healthy animals to see if they have effects similar to those already in use, such as other antidepressants or stimulants. They are sorted out for future testing on humans on the basis of how they affect animals. Thus, if they cause loss of appetite, weight loss, and hyperactivity in animals, they will be tested on people as "stimulants" or perhaps as "antidepressants", and if they produce a calming effect, slowed reflexes, and sleep in animals, they will be tested on people as sleeping pills or tranquilizers.
After being screened for their effects on animals, the drugs are tested on healthy volunteers to make a gross estimate of safety and to determine the doses needed to achieve a therapeutic impact. Only then are they tried on specific diagnostic groups of patients. The drug effects, which are the same in healthy animals, healthy volunteers, and diagnosed psychiatric patients, result from the drugs, impact on these animals, volunteers, and patients.
The process of testing drugs for FDA approval thus confirms, step by step, that psychiatric drugs have the same effects on healthy animals, healthy people, and patients with psychiatric diagnoses.
Not all drugs were first discovered through the process of screening their effects on animals. Sometimes the effects were accidentally discovered in people. Nonetheless, it turns out that the drugs have the same effects on healthy animals and volunteers as on patients.
For example, so-called antianxiety drugs such as Xanax, Ativan, and Klonopin have the same calming effects on healthy animals and volunteers as on anxious people. As the dose increases, these drugs will put all creatures to sleep and eventually into a potentially fatal coma. The drugs also bring about the same adverse effects, such as memory loss, in healthy animals, healthy volunteers, and diagnosed patients.
Stimulants also affect animals and people in the same characteristic ways. They produce "good caged rats" much as they produce "good school children"15. The drugged animals, like compliant school children, lose their motivation to explore, to innovate, to socialize, and to escape. Instead, they sit around in their cages performing meaningless tasks, such as repetitive grooming or chewing on the bars.
Even antipsychotic agents have the same effects on animals and people alike, producing apathy, indifference, docility, and movement disorders in all creatures16.
Because of ethical and legal restraints, researchers cannot conduct studies that are certain to cause brain damage in human subjects. For example, they are not allowed to implant electrodes or to inject minute amounts of drugs into the brain tissue of living patients to test the effects of experimental drugs. Because there is no other way to do it, the basic biochemical research on drug effects is carried out on animals rather than on humans. Most of the information about a psychiatric drugs biochemical effect is deduced from conducting tests on living animal brains or, more often, from killing the animals in order to study their brain tissue following exposure to drugs. Furthermore, the animals almost never have anything wrong with them, the drug effects are being studied in healthy mammalian brains.
In short, when explaining how a psychiatric drug like Prozac or lithium affects the biochemistry of the human brain, researchers are drawing almost entirely on animal research conducted on normal mammalian brains rather than from studies involving people with supposed biochemical imbalances in their brains!
The concept of biochemical imbalances in people diagnosed with depression, anxiety, or other "disorders" remains highly speculative and even suspect. Although we have ample reason to doubt the validity of this concept, there is at present no way to prove its validity. Specifically, we lack the technical capacity to measure biochemical concentrations in the synapses between nerve cells. Although medication advocates often speak with seeming confidence about how psychiatric drugs can correct biochemical imbalances in the brain, they are merely indulging in pure speculation or using figures of speech that they know will resonate with their audiences. Theres little evidence for the existence of any such imbalances and absolutely no way to demonstrate how the drugs would affect them if they did exist.
As confirmed in animal research, all psychiatric drugs directly affect the brain's normal chemistry by disrupting it. Ritalin, for example, is known to produce overactivity in three of the brain's neurotransmitter systems: dopamine, norepinephrine, and serotonin. However, the fact that a drug increases brain cell activity by no means indicates that it will increase behavioral activity.
In the case of stimulants such as Ritalin or amphetamine, the effects on people are very complex, variable even in the same user at different times, and sometimes inconsistent. Often these drugs subdue or numb those who take them, making them more docile and manageable. This is precisely why they are used to treat behavior problems in children. At other times, however, stimulants produce opposite effects, making some children and adults hyperactive and impulsive.
Prozac, Zoloft, Paxil, and Luvox produce hyperactivity in the serotonin system; but since serotonin nerves spread throughout the entire brain, the effects are widespread and ultimately involve other neurotransmitter systems such as dopamine. The minor tranquilizers, such as Xanax, Valium, Klonopin, and Ativan, produce hyperactivity in yet another neurotransmitter system, GABA; but GABA activation produces a suppressive effect on the overall functioning of the brain.
It is important to keep this in mind: The brain is always impaired by psychiatric drugs17. If a drug is strong enough to have a supposedly positive effect, then it is disrupting normal brain function. Although this conclusion may seem controversial, it is supported by common sense and an enormous amount of scientific research detailing the biochemical imbalances in the brain created by psychiatric medication18. These drug-induced biochemical imbalances commonly cause psychiatric disorders in routine psychiatric practice. An egregious example of how far researchers can go to deny damage caused by psychotropic drugs is illustrated by a report in which researchers found gliosis - scarring tissue around neurons that is a hallmark sign of cell death and degeneration - in healthy rhesus monkeys after they received antipsychotic drugs. The researchers nonetheless proposed that gliosis "may be beneficial to cortical function despite the negative connotation of the term `gliosis' due to long-established association with neurodegenerative processes" (Selemon et al., 1999 [338])!
Even if some emotional problems turned out to be caused by subtle, as-yet-undetected biochemical imbalances, this finding would not be a rational justification for using any of the psychiatric drugs that are currently available. Because they impair normal brain function, such drugs only add to any existing brain malfunction. When psychiatric drugs are given to patients who do have known brain dysfunctions such as head injury or hormonal disorder, psychiatric drugs add to their brain dysfunction, frequently causing further mental deterioration. Experienced clinicians who work with brain-injured patients, for example, avoid prescribing brain-altering chemicals to them. And endocrinologists try to correct actual hormonal problems instead of suppressing their symptoms with psychiatric drugs. Unfortunately the psychiatric literature is also replete with examples of the opposite practice, prescribing multiple psychiatric drugs to persons with traumatic brain injuries, despite a dearth of evidence that these treatments reduce behavioral problems in such patients.
If psychiatric drugs could correct specific biochemical imbalances, specific types of drugs for specific disorders would be available. But this is not the case. For example, even though Prozac mainly affects just one neurotransmitter system, it is used with supposed success for a broad range of difficulties, from anxiety to depression to behavior problems in children. The same has been true of other psychiatric drugs. Even the first "antipsychotics", such as Thorazine, were originally marketed for nearly every possible human problem, from behavioral difficulties in children to insomnia and anxiety in adults, as well as for a variety of supposed psychosomatic disorders, including skin and digestive problems. Similarly, the stimulants, such as Ritalin and amphetamine, were originally advertised not only for behavioral control of children but also for stress and depression - and even for energizing old people.
Furthermore, many psychiatric disorders are treated with a variety of drugs with widely varying biochemical effects. The treatment for depression, for example, involves drugs that affect the serotonin, norepinephrine, acetylcholine, dopamine, and GABA systems.
No psychiatric drug has ever been tailored to a known biochemical derangement. Instead, the drugs are marketed on the basis of whether they "work" in short clinical trials on one particular diagnostic group - although subjects in that group typically carry other diagnoses as well and may have little in common with each other (Cohen and Jacobs, 2007 [106]). The drug companies, followed by drug advocates, then construct an argument that the medications must be correcting a biochemical imbalance in this group of patients.
At the same time, no biochemical imbalances have ever been documented with certainty in association with any psychiatric diagnosis. The hunt goes on for these elusive imbalances; but their existence is pure speculation, inspired by those who advocate drugs19.
Arguing that psychiatric drugs "work" by correcting a biochemical imbalance in patients is similar to arguing that surgical anesthesia renders patients unconscious by correcting a biochemical imbalance in them. The comparison is not farfetched. Some psychiatric drugs, such as the benzodiazepines, can be and are given in higher doses to produce surgical anesthesia. And the original "antipsychotic" drug, Thorazine, was first used by a French surgeon who noticed that it was useful in making surgical patients indifferent or apathetic toward the pain that they were undergoing20. There is also evidence that the SSRIs may produce a particular sort of emotional blunting, apathy, and unconcern (Barnhart et al., 2004 [29]; Garland and Baerg, 2005; Hoehn-Saric et al., 1990 [203]; Obproek et al., 2002). Scientific evidence can be marshaled to support the hypothesis that most psychiatric drugs "work" by producing a kind of anesthesia of the mind, spirit, or feelings (Breggin, 1991 [49], 1997a [55]).
If a person falls asleep more quickly due to the chemical effects of a sleeping pill such as Ambien or becomes more calm after taking a tranquilizer such as Valium, the effect is due to a suppression of brain function. The impact of the drugs, in fact, is very similar to that of alcohol. All three agents - Ambien, Valium, and alcohol - activate an inhibitory system in the brain called GABA. This inhibitory system, when made hyperactive by a drug, causes varying degrees of brain suppression that, following high enough doses, will produce sleep and then coma. The abnormalities caused in the GABA system can be studied in animal brains. Various abnormalities in brain waves in humans demonstrate how the drugs disrupt normal awake/asleep patterns in people, regardless of whether they have a sleep problem or anxiety.
Similarly, in cases where an individuals mood swings seem to be "smoothed out" on lithium, the drug has suppressed the normal electrical transmission of brain cells, limiting the individuals capacity to feel or to react. Lithium literally replaces basic elements in the brains electrical transmission system, including sodium and potassium ions, thereby slowing down nerve conduction. This intrusion produces a grossly abnormal condition in any animal or person quite apart from any supposed biochemical imbalance.
When a person's emotions are altered by drugs, the effect is not limited to the emotion-regulating centers of the brain. Indeed, since the brain is a highly integrated organ, and since the drugs cause widespread disruptions within it, emotional suffering cannot be dulled without harming other functions such as concentration, alertness, sensitivity, and self-awareness21.
Despite a hugely successful promotional campaign by drug companies and biological psychiatry, the effectiveness of most or all psychiatric drugs remains difficult to demonstrate. The drugs often prove no more effective than sugar pills, or placebos22 - and to accomplish even these limited positive results, the clinical trials and data that they generate typically have to be statistically manipulated. Furthermore, no psychiatric drugs have consistently demonstrated effectiveness in studies lasting more than a few weeks or months23.
Concerning antidepressants, for example, meta-analyses (overviews) of hundreds of published clinical trials are challenging the idea that such drugs, including Prozac, have any genuine antidepressant effect (Horgan, 1999 [204]). Studies show that at least 80 percent of the antidepressant effect is a placebo effect - the positive response that people have to any treatment that they hope or think will work. But the remaining 20 percent of the positive result may be caused by the "active placebo" effect - which is related to the fact that the antidepressants, unlike placebos, have noticeable side effects that convince the subjects that they are getting "strong" or "real" medicine.
Ideally, clinical trials involving drugs are "double-blind", so that both the researchers and the patients are unaware of who is getting the real drug and who is getting the placebo. This research design is supposed to maintain the objectivity of both the investigators and the patients. Otherwise, both are likely to give higher ratings of improvement to the new "miracle drug" than to the sugar pill.
Unfortunately the ideal of the double-blind is rarely attained. The side effects of psychiatric drugs - including antidepressants, stimulants, and tranquilizers - are usually very noticeable. In short, they let the investigators and the patients know who is taking a real drug rather than a sugar pill. This knowledge destroys the double-blind and allows bias in favor of the drug to affect the outcome of drug studies24. Still, despite these advantages in favor of drugs, recent clinical trials of SSRI antidepressants consistently show these drugs to be equaled or outperformed by placebos (Cohen and Jacobs, 2007 [106]).
Regarding antianxiety drugs such as Xanax, researchers have even greater difficulty establishing any effectiveness because the rebound and withdrawal effects often leave the patients worse off than before they started taking the drugs. Marginal positive results are erased by the eighth week, at which time many or most patients experience more anxiety than before they began taking the drugs25.
Psychostimulants, such as Ritalin and Adderall, can also leave children worse off than before they began receiving the drugs. In addition, they have never been shown to have any long-term positive effects at all. Their impact is limited to subduing the behavior of children for a period ranging from seven to twelve weeks. Even in the short term, stimulants have not been shown to improve a child's mental state, academic performance, or learning. Prescription of these drugs is strictly a method for short-term behavioral inhibition26.
Despite their almost universal use as a first resort, often the use of psychiatric drugs is justified as a "last resort" or as a means of "saving a life" from suicide or violence. Yet there is no scientific evidence that drugs are useful to people during acute emotional crises. The testing employed for the approval of psychiatric drugs by the FDA usually excludes people who are suicidal or violent27. And, in any case, the FDA has never approved a drug specifically for the prevention or control of suicide or violence.
More generally there is no convincing evidence that any psychiatric medication can reduce the suicide rate or curtail violence. But there is substantial evidence that many classes of psychiatric drugs - including neuroleptics (antipsychotics), antidepressants, stimulants, and minor tranquilizer - can cause or exacerbate depression, suicide, paranoia, and violence.
Most people are aware that psychiatrists commonly tell their patients, "It can take eight weeks or more for the drug to take full effect". Yet there is little evidence in support of this assertion, given that clinical trials seldom last beyond four to six weeks. Because the brain compensates for drug effects, drugs often stop hating their anticipated effects after four to six weeks. Moreover, many patients drop out after a few weeks because of diminishing positive effects and increasing adverse effects, so there aren't enough left to draw any statistical conclusions beyond the short term. Thus it's very difficult to conduct a clinical trial that will last for more than a few weeks28.
It's also difficult to show any good effect from psychiatric drugs during the first one or two weeks. This is another reason that drugs should not be relied upon to provide immediate relief to people who are in crisis or acute distress. For example, the FDA requires antidepressants to carry a warning about the danger of suicide during the first few weeks before the drug effect kicks in. The warning is misleading, however, since there's no evidence that the antidepressants reduce the suicide rate even after they achieve their maximum effect.
Movies about mental hospitals or psychiatric treatment sometimes accurately depict how psychiatric drugs can turn people into zombies. In "The Dream Team", a comedy starring Michael Keaton, mental patients successfully masquerade as doctors. The patients manage to escape by prescribing enforced medication for the psychiatrists themselves, who are last seen staring in a drugged stupor at the TV on a hospital ward.
To some extent, at least, this zombie effect can render people temporarily unable to harm themselves or others. For instance, "antipsychotic" drugs, which can be injected into the muscles to quickly subdue resistant patients, are used in this way in emergency rooms, hospitals, and prisons. The resistant patients are chemically controlled by the numbing effect on the brain. This procedure has accurately been called a "chemical lobotomy". "Antipsychotic" drugs also suppress the brain centers that control voluntary movement, rendering the person unable to respond with any speed, agility or determination-thus warranting the descriptive phrase "pharmacological straitjacket"29.
The use of such drugs should be viewed not as "therapy" but as chemical restraint - as a seemingly easy, inexpensive, and efficient way to temporarily subdue a person. Unfortunately doctors often fail to implement the best way to calm disturbed and disturbing individuals - by spending time with them in a confident, caring, and skillful manner (Breggin, 1997b [56]).
Chemical force is sometimes used as a police method for controlling people, much as straitjackets, shackles, and "quiet rooms" are used for the same purpose. In fact, a good case can be made for the greater safety of physical restraint compared to chemical restraint, the former restrains the limbs, the latter can harm the brain. Furthermore, the use of drugs for short-term control does not empower patients to handle their own emotions and their lives more effectively. To the contrary holding people down in order to inject them with paralyzing drugs adds to their sense of personal shame, resentment, and helplessness. In any case, skilled individuals using sound therapeutic approaches are almost always able to calm down upset and menacing patients without the use of drugs.
There is a great deal of discussion in the media and in professional journals about the relative merits of medication and psychotherapy. Claims are usually made for the superiority of medication; it is supposedly faster, more economical, and more effective. In reality, however, the comparable or superior efficacy of psychotherapeutic interventions, even for severely disturbed persons, is much better documented than most therapists or the public realize30.
It is also misleading and futile to compare drugs to talk therapy. Drugs and psychotherapy don't have the same effects. Both their immediate effects and their outcomes are different. Their "efficacy" cannot be measured by the same standards. Drugs can suppress "symptoms", such as intense emotions, but they may also impair overall brain function. Psychotherapy can strengthen and liberate individuals to respond to their emotions in a rational way and to live better, more fulfilling lives.
Even emotionally disabled, institutionalized individuals respond better to personal attention than to drugs. Peter Breggin's "clinical" experience began in the 1950s when, as a college student volunteer, he worked with very disturbed and disturbing inmates in a dilapidated state mental hospital31. While still an undergraduate college student, he became director of the Harvard-Radcliffe Mental Hospital Volunteer Program32. He and his fellow students developed a special project that allowed more than a dozen of them to work with their own individual patients under the group supervision of a therapist. Each of the students was assigned a "chronic inmate" who had little hope of release from the hospital. They were able to help almost every patient to leave the hospital.
There was no need for a special control group of untreated patients to show what would have happened without the intervention of the Harvard-Radcliffe student volunteers in their lives. The whole hospital was the control group! In the mid-1950s, the patients from the "back wards" were almost never discharged. Even after the "miracle drugs" were introduced, no large-scale increase in discharges occurred until a decade later, when hospital admission and discharge polices were changed for political and economic reasons33. Without the help of the volunteers as caring therapists and case aides, few if any of the patients would have left the state hospital for many years, if ever.
Therapy has also been shown to be more effective than drugs in helping patients diagnosed with their first "schizophrenic" break. Nowadays it is argued that these people must have drugs and that psychotherapy is futile; yet nothing could be further from the truth. In controlled studies, untrained therapists in a home-like setting have proven more successful than drugs and mental hospitals in treating patients diagnosed with their first episode of schizophrenia34. A key factor was the caring, noncoercive approach of these therapists.
According to an international study by the World Health Organization (WHO), less industrialized cultures characterized by extended families have a very positive effect on the recovery of individuals who are diagnosed as schizophrenic - in contrast to their counterparts in Western cultures, where isolated families are more common, in cultures with extended families, a large proportion of very disturbed individuals labeled schizophrenic had complete recoveries. Tragically, this study also showed that the availability of modern psychiatric treatment with drugs has a negative effect on the outcome for people diagnosed as schizophrenic (See de Girolamo, 1996 [130]). This finding corroborates our own assertion that biological psychiatry does more harm than good.
If nondrug, caring approaches work better for severely disturbed people, they are clearly even more effective with less impaired people who can benefit from relationships and "talk therapy".
Virtually everyone today recognizes that the public has been subjected to a high-power selling campaign for psychiatric drugs. This campaign, conducted by drug companies and organized psychiatry has convinced most people that psychiatric drugs are much safer and more valuable than they really are35.
Psychiatric drugs do not work by correcting anything wrong in the brain. We can be sure of this because such drugs affect animals and humans, as well as healthy people and diagnosed patients, in exactly the same way. There are no known biochemical imbalances and no tests for them. Thats why psychiatrists do not draw blood or perform spinal taps to determine the presence of a biochemical imbalance in patients. They merely observe the patients and announce the existence of the imbalances. The purpose is to encourage patients to take drugs.
Ironically psychiatric drugs cause rather than cure biochemical imbalances in the brain. In fact, the only known biochemical imbalances in the brains of patients routinely seen by mental health professionals are brought about through the prescription of mind-altering drugs.
Psychiatric drugs "work" precisely by causing imbalances in the brain - by producing enough brain malfunction to dull the emotions and judgment or to produce an artificial high. Some people may choose this alternative because they do not know that other options exist or because they have lost faith in themselves and in the ability of other people to help them, or because they have been taught to believe that their brain is defective and that a drug will temporarily fix the problem.
In the experience of the authors, when people are caught in emotional crises and are suffering from extreme emotional pain, the most important therapeutic intervention is a caring individual or group willing to create a safe space and a safe relationship. We further discuss this point in the final chapter, after examining in more detail the hazards of taking psychiatric drugs and the process of stopping them.