Biopsychiatry controversy

The biopsychiatry controversy is an ongoing dispute over the scientific basis of biological psychiatry theory and practice. The debate is focused on criticism of mainstream psychiatric thinking, proposed by a vocal minority of psychiatrists, scientists and the Psychiatric survivors movement. These critics of mainstream psychiatry contend the field is flawed in a number of ways. They argue that the lack of biomarkers is a flaw in the evidence for a somatic, biological cause for mental illness. Instead they draw attention to trauma models of mental disorders within the psychiatric literature which have been marginalized as research efforts switched to the biological model since the 1980s.

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Overview of opposition to biopsychiatry

After a century of medical progress different specialties of medicine have developed therapeutic practices that have made illnesses more treatable and eradicable. Biological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial somatic measures.

Clinical professor of psychiatry, Alvin Pam, describes this as a "stilted, unidimensional, and mechanistic world-view" and subsequently "research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance".^[1] According to Pam the "blame the body" approach, which typically offers medication for mental distress, shifts the focus from disturbed behavior in the family to putative biochemical imbalances.

Elliot Valenstein, a psychologist and neuroscientist, claims that the broad biochemical assertions and assumptions of mainstream psychiatry are not supported by evidence. ^[2]

Uneven progress in biopsychiatric research

Biopsychiatric research has produced reproducible abnormalities of brain structure and function, and a strong genetic component for a number of psychiatric disorders. It has also elucidated some of the mechanisms of action of medications that are effective in treating some of these disorders. Still, by their own admission, this research has not progressed to the stage that they can identify clear biomarkers of these disorders.

Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer's disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.

– American Psychiatric Association, Statement on Diagnosis and Treatment of Mental Disorders^[3]

Focus on genetic factors

Researchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of dimensions of genetic risk ^[4] and reports show significant associations between specific genomic regions and psychiatric disorders.^[5][6] Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions.^[7][8] For example, one reported finding suggests that in persons diagnosed as schizophrenic as well as in their relatives with chronic psychiatric illnesses, the gene that encodes phosphodiesterase 4B (PDE4B) is disrupted by a balanced translocation.^[9]

The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways, for example by personality, temperament or life events.^[10] Therefore while twin studies and other research suggests that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is "at least as hard as the search for genes involved in other complex disorders."^[11].

Theodore Lidz,^[12] Jay Joseph ^[13][14] and others argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies. ^[15]

See also

• Anti-psychiatry - A movement critiquing psychiatry from the human rights perspective.
• Bipolar disorders research - biopsychiatric analysis into the cause of bipolar disorders.
• Elliott Valenstein - a psychologist and neuroscientist, author of Blaming the Brain.
• The Gene Illusion - a book by clinical psychologist Jay Joseph.
• Causes of schizophrenia
• Controversy about ADHD

Methodological issues

1. On the Limits of Localization of Cognitive Processes in the Brain - an essay by William R. Uttal, Professor Emeritus of Psychology at the University of Michigan, based on his book The New Phrenology (MIT Press, 2001).

References