Fox in the Henhouse of Mental Health Care

Peter Gøtzsche is a sort of anti-vaxxer in the field of mental health care.

The Danish physician is head of an organization called the Nordic Cochrane Center at Rigshospitalet, a Copenhagen, Denmark, hospital (which does not, by the way, list mental health care on its website as among the services it offers). The center has made recent assertions that challenge solid presumptions of traditional medical care.

• They claim mammograms subject women to significant, long-lasting emotional trauma, but produce barely any statistically significant medical benefit, such as reducing breast cancer mortality.
• They (and Gøtzsche himself) also claim the medications used to treat mental illness actually produce symptoms of mental illness.

Following an article that presents that second issue, The Guardian – a highly regarded newspaper and website published in the United Kingdom – ran a summary written by Gøtzsche, headlined “Psychiatry Gone Astray.” In it, Gøtzsche claims it is entirely a myth that mental illness is caused by a chemical imbalance in the brain, and that medications realign the balance. “The truth is just the opposite,” he writes. “There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract.”

If you have experience with typical modern psychiatric treatment – as a patient, as a family member of a patient, as a prescriber, or even as an attentive member of the public – your response to this assertion by Gøtzsche may hinge on your personal experience – but may be highly influenced by the information in the next paragraph:

In the summary, Gøtzsche cites as primary support for his argument: the rates of suicides and suicide attempts in adolescents who are prescribed antidepressants. He blames the rates of suicides on the medications and what he calls misprescription of medications, laying responsibility at the feet of the medical professionals he largely dismisses as inept.

Not surprisingly, the comments section following the summary in The Guardian has drawn many writers who emotionally address these topics – especially suicides and suicide attempts.

Equally unsurprising is that Gøtzsche’s claims at large are enormously controversial and have met with responses that, given the often staid temperament of the scientific and academic worlds, one might characterize as roiling outrage. The Guardian has published a series of opinion pieces on the topic (which you can begin to locate by following the highlighted links located in this post).

But in the temptation to find someone to blame in tragedy, a new trend has developed. Around the globe, courts are beginning to assess guilt on the professionals treating those who act out violently – precisely because there is a debate about what the true influence might be of the medications being prescribed. Gøtzsche himself is blaming the medications and the prescribers alike. And the public seems to be climbing on board, as seen in some of the reader comments that appear whenever Gøtzsche publishes his ideas in public places.

Seen generously, Gøtzsche’s claims simply extend (and seen less generously perhaps complicate) a longstanding and far more tepid discussion about how much of the cause of mental illness might be biochemical and how much might be blamed on life events such as trauma, neglect, or the like. This is a discussion that has been drawing increased attention recently, partly because of increased findings that “talk therapy,” at least mixed with biochemical therapy, can retain a productive place in a traditional treatment plan.

Therapy once was all talk; the development of medications, and then increasingly sophisticated and targeted medications, may have suggested to some that biochemical therapy could make talk therapy largely unnecessary. The pendulum has been swinging back toward a more balanced approach, posing questions of what might be the most effective mix of biochemical therapy and talk therapy – whether it is traditional psychotherapy (couch-based or not) or more modern and innovative therapies such as Cognitive Behavioral Therapy. This type of mixed hybrid experience – medications and meetings – could become more central as insurance protocol increasingly limits the duration of talk therapy in a typical treatment plan, sometimes barely supporting it beyond the rudiments of medication maintenance – making sure the medications are doing what they are prescribed to do.

Gøtzsche, however, takes a more radical path. He claims that typical modern deployment of psychotropic medication may not only be less effective than talk therapy, but is actually hazardous. He claims the entire premise of psychotropic medication is contrived and counterproductive. He insists that psychotropic medication should be avoided altogether. And herein lies another – and possibly far more perilous – complication.

There are plenty of psychiatric patients – people with clear mental illness (measured by traditional methods), out in the world to varying degrees, whose daily stability and success in this world seem to rely on regular and sometimes substantial medical intervention. Their responses vary along a broad spectrum.

• Some of them are medicated and happy about it.
• Some are medicated and not happy about the loss of independence.
• Some are medicated and emotionally resistant, for a wide variety of reasons.
• Some remember their pre-medication days and are nostalgic for whatever capabilities or “edge” they feel they have lost by being on medications that sometimes have significant side effects.
• Some are fundamentally suspicious – sometimes clinically paranoid – of medications or of those prescribing it or of those who manufacture it or of the insurance industry.
• Some grow tired of the physical drain on their bodies of what amount to serious medication regimens that limit their capacity for thought, for work, for activity – and can possibly shorten their lives.

The shared experience for many people, in many circumstances, for many reasons, is that they wish they could navigate their days without medication – and probably many of them would welcome an opportunity to abandon their medication regimens or strategies – some of them with or without a replacement strategy. Backup or no backup.

It is easy, over a leisurely evening on the Internet, to find hundreds of people in these various circumstances on chat sites billed as support groups. In enthusiastic throngs, night after night, and throughout the night, from all around the globe, they …

• talk about having found, or hoping to find, herbal substitutes that will lift them out of their reliance on prescribed psychotropic medication
• talk about having found, or hoping to find, miraculous dietary substitutes that will lift them out of their reliance on prescribed psychotropic medications
• talk about having found, or hoping to find, over-the-counter substitutes that will lift them out of their reliance on prescribed psychotropic medications
• talk about having found, or hoping to find, exercise programs that will lift them out of their reliance on prescribed psychotropic medications
• talk about having found, or hoping to find, religious or spiritual programs that will lift them our of their reliance on prescribed psychotropic medications
• talk about simply growing tired of needing to rely on prescribed psychotropic medications, and considering abandoning their medications altogether, with or without a backup plan

… and then along comes someone like Peter Gøtzsche – a physician whose articles are receiving wide distribution, who is telling them …

• they should stop stop taking their prescribed medications (which many of them already believe)
• their doctors are inept (which many of them already believe)
• their doctors actually don’t know what they’re talking about (which many of them already believe)
• their doctors are doing them harm (which many of them already believe)

And now it is not a fellow chat room poster or a friend or a neighbor telling them this – it is a doctor telling them all this – and paradoxically, they can believe him.

As sincerely as I believe there is room for improvement in the dispensing of vaccines to our youngest children (but not for abandoning the practice), I also believe there is room for dramatic improvement in the testing and dispensing of psychotropic medications (but not for abandoning the practice).

I also sincerely believe it is wildly irresponsible to conduct – in broad public – this open conversation about abandoning those medications, wholesale.

Perhaps this is a vital discussion that needs to take place; science often enough learns from disagreement and challenge and experiment – growth can come from conflict. But this is a conversation that absolutely does not belong – without clear moderation – in places as public as The Guardian – where everyone looking for a quick way out of their own pain and suffering will find a promise – that cannot be fulfilled.