By Jean Fain
There’s been a spate of new books criticizing biological solutions to mental illness - questioning the effectiveness of psychiatric medications, the objectivity of the researchers who study them, and the motives of the psychiatrists who prescribe them. One of the most severe critics, Dr. Peter Breggin, a Bethesda-based psychiatrist and author of Your Drug May Be Your Problem: How and Why to Stop Taking Your Psychiatric Medications (Perseus Press, with David Cohen), not only denigrates every psychiatric medication, from Prozac to Ritalin, he urges readers to stop taking them with or without their doctor’s guidance.
More than confusing and provocative, I believe that advice like Breggin’s is potentially lethal to our clients. This article utilizes Breggin’s book as a springboard for discussion and inter-views I did with leading researchers, practitioners and their clients to make sense of the conflicting information and opinions on psychiatric medications. These interview have proved invaluable in helping me help my clients. (I have a private psychotherapy practice in Harvard Square). I wanted to share what I’ve learned in hopes of inspiring thoughtful discussion and decision-making in the therapeutic community.
Dr. Peter Breggin’s Perspective
When Dr. Peter Breggin talks, people listen, and some stop taking their psychiatric medications. After a TV talk show featuring Breggin, one schizophrenic man threw away his medication, became suicidal and spent two weeks on a locked hospital ward. While a 12-year-old boy, with the support of his parents and Dr. Breggin, is putting his life back together —medication free — after withdrawing from Ritalin and a handful of other prescriptions.
The current generation of psychiatric drugs, from Ritalin to Risperdal (cq), may be winning kudos from many doctors and patients, but has only inspired indignation in Dr. Breggin. In his new book, the Harvard-educated, Bethesda-based psychiatrist describes today’s biochemical solutions to mental illness as no less barbaric than lobotomies, no less ineffectual than psychoanalysis.
"Compare today’s ‘biochemical imbalance’ slogan with yesterday’s ‘unconscious conflict’ slogan," Breggin writes. "I think sometime soon we’ll look back on both and realize that neither had scientific backing, yet both were accepted and promoted uncritically by medical authorities; both were used to explain absolutely any form of psychological distress; and both ultimately left people more helpless because their message was ‘the problem is inside you but out of your control.’"
Judging from the headlines Breggin has been inspiring, including a recent op-ed piece in the Boston Globe titled "Kids Are Suffering Legal Drug Abuse," the best-selling writer-cum-psychiatrist is causing more than a little confusion and alarm. There’s no conclusive evidence that psychiatric, or psychotropic, medications have long-term benefit, Breggin asserts, and there are mountains of evidence that prove the contrary — that these medications cause serious side effects, withdrawal reactions and sometimes permanent neurological damage.
Breggin urges readers to carefully wean themselves from their medications, preferably with their doctor’s help. And, for those considering the prescription drug path, consider the alternate routes (i.e., talk therapy, family and community support.) Yes, psychiatric drugs can provide temporary relief, Breggin concedes, as can alcohol. But they don’t get to the root of the problem.
The withdrawal emphasis is new, but the message — drugs are the problem, not the solution — is one Breggin has been voicing since before his Harvard medical residency at Metropolitan State Hospital in Waltham, Massachusetts, and one he has been promoting in previous books, including Talking Back to Prozac.
The evidence, according to mental health practitioners and researchers, is not as bleak as Breggin would have you believe, nor is it as affirming as one might expect, given the abundance of anecdotes of lives resurrected with psychiatric drugs.
Contrasting Advice From Other Authors
Lauren Slater, the Boston-based psychologist who recounts her personal resurrection in Prozac Diary, knows the scientific evidence supporting the biochemical imbalance theory of mental illness is "at best, shaky." acknowedges that "very little is known about how and why these medications work", but is unwilling to dismiss the benefits of Prozac, among other prescriptions, as little more than drug company propaganda.
Slater’s view is informed by such facts as there are no tests to assess chemical imbalances in living human brains; evidence of chemical imbalances have been found in the brains of deceased mental patients, but have yet to be replicated. Drug companies acknowledge their ignorance regarding how their own medications work; according to the package insert for Zyprexa, one of Eli Lilly’s newer antipsychotic drugs, how Zyprexa or any anti-psychotic works is unknown.
"There’s probably a kernel of truth in Breggin’s stance," Slater says, "that’s what makes it potent, dangerous. You can’t simply shrug it off as idiocy." Yes, psychotropic medications can be prescribed hastily, thoughtlessly, she agrees. Yes, they have real risks.
"But chemotherapy has risks, too," says Slater, who practices at East Boston’s AfterCare Services. "And people still choose to do it. It’s important to allow people to choose what’s best for them. Breggin’s making people scared of viable medical treatment."
Breggin says he is no longer a lone wolf in his crusade against psychiatric drugs. He’s organized more than 200 professionals and 1,000 members with his Center for the Study of Psychiatry and Psychology, his web site (www.Breggin.com) and his "Ethical Human Sciences and Services" journal.
Biopsychologist Elliot S. Valenstein (cq), professor emeritus of psychology and neuroscience at University of Michigan, is one professional peer who doesn’t wholly dismiss Breggin. While Valenstein is careful not to discourage the use of psychiatric drugs, he urges readers to rethink the "chemical imbalance" explanation of mental illness, reexamine the research on drug efficacy.
Writes Valenstein, author of Blaming the Brain: The Truth about Drugs and Mental Health: "There is a tendency to confuse the giant strides that have been made in our knowledge of brain chemistry and neuropharmacology with our still primitive understanding of the causes of mental illness and knowledge of how drugs can produce psychological changes."
While impairments in the brain’s dopamine system have been correlated with the diagnosis of schizophrenia, and deficiencies in serotonin levels have been linked with depression, neither have been shown to cause the respective diagnoses.
Do psychiatric drugs work? The empirical evidence from the landmark National Institute of Mental Health study of phenothiazines (including thorazine) as well as reviews of today’s antipsychotics, is less conclusive, more ambivalent than generally believed. The 1961 NIMH study reported improvement in 95% of patients who received phenothiazines, but noted improvement in 50% with placebo. According to more recent research from Albert Einstein College of Medicine, four weeks of antipsychotic drug treatment fails to alleviate symptoms in about 50% of schizophrenic subjects, while 25-40% risk disabling tardive dyskinesia.
Antidepressants turn out to be only slightly better than placebo. Even the most optimistic studies found that two-thirds of participants did as well with placebo as with prescription antidepressants. Several studies revealed a high rate of relapse (more than 60%) after antidepressant treatment was discontinued, and, while still being administered, a waning of therapeutic efficacy.
"The views of psychiatrist Peter Breggin are similar to those of Thomas Szasz and Michel Foucault in that they also have argued that drug treatments are used to incarcerate and subdue people who are unwanted and inconvenient," Valenstein says, "rather than for treating people with illnesses. Breggin reflexively dismisses any argument that there could be biological factors that predispose people to mental illness and which might have to be addressed with biological solutions."
Breggin’s views typically provoke more disdain, less perspective. Though Listening to Prozac author Dr. Peter Kramer has sparred with Breggin on talk shows, he refused to be interviewed for this article. "Dr. Breggin’s prior work is not of a quality that would tempt me to look at his current work," Kramer says.
Dr. Jerrold (cq) Rosenbaum, Harvard Medical School psychiatry professor and Massachusetts General Hospital associate chief of psychiatry, has deemed Breggin "an anti-psychiatrist." "He makes his living offering a consistent, one-sided criticism of psychiatric medications," Rosenbaum says, "which can lead people to abandon their treatment, result in their suffering, their family’s suffering, and, in some cases, [can lead to] destroyed lives and death."
One woman with manic-depressive illness echoes Rosenbaum’s concern: "I know that many people with mental illness, myself included, struggle daily with the issue of taking our medications. Sometimes because we don’t want to believe we are sick; sometimes because of the side effects. People like Peter Breggin do a great disservice to the mentally ill by feeding the ‘you-can-cure-yourself-if-you-just-believe-you-can fantasy’ many of us have."
Breggin believes he’s serving the mentally ill better than most — that he’s one of the few psychiatrists willing to tell clients what they deserve to know.
"Patients commonly discontinue their medications abruptly," Breggin says. "By explaining the importance of careful withdrawals, I could save lives and a great deal of suffering."
Despite his denouncement of psychiatric medications, Breggin believes adult clients have the right to take them. Children, on the other hand, have no choice, and should never be given medications.
"Giving these drugs to children should be criminalized," he says. "It’s too damaging to a child’s growing brain and ethical perspective to use these drugs to control behavior."
That’s the gist of what he told the Frasers of Rockville, Maryland, when they consulted Breggin a year ago about their son Andrew. After five years of increasing doses of Ritalin for attention deficit disorder, clonidine to counteract the Ritalin, and Prozac for depression, the then 11-year-old’s original psychiatrist was recommending an anti-psychotic medication that can cause permanent neurological damage.
"We were at our wits’ end," says Bruce Fraser. "We kept going up and up on these medications and seeing more of a marginal return."
With school and parental support, Breggin guided Andrew through the withdrawal process and concomitant adjustments to family and school life. "In retrospect, we realized we’d placed our hopes more on medications, when we really should have focused more on family relationships," says Bruce Fraser. "I think a lot of parents fall into that trap because they’re desperate. I’m not going to say Andrew’s problem free, or a straight-A student," Fraser says, ‘but he’s doing much better."
How to make sense of the conflicting anecdotes, interpretations? Suggests Walter A. Brown, clinical professor of psychiatry at Brown and Tufts University medical schools: Tell clients to discuss their concerns with a doctor they trust.
"I think it’s very difficult to make sense of the tremendous flood of information one gets from books like Breggin’s. The general issues Breggin raises are worth thinking about," Brown adds, "Do these drugs have a down-side? Can they cause problems? But the conclusions he draws are irrational."
Jean Fain is a Cambridge-based social worker and journalist. She has written for the Boston Globe, the LA Times and Self magazine.
FOCUS Newsletter - July 2000
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