Letters

More data on mental health meds

The article "Inappropriate prescribing" in the June Monitor had balance and breadth, but left out some facts that call into question the wisdom of using drugs at all in the treatment of persons diagnosed with mental disorders.

The recovery rate from schizophrenia is twice as high in countries like Nigeria, India and Colombia, where drugs are not used, as it is in the United States.¹ The Finnish users of the open-dialogue approach—which does not use drugs as a primary modality of treatment—report an 80 percent recovery rate from early psychosis.² Since the advent of drugs as the primary modality of treatment, the number of Americans on Social Security Disability due to mental illness has increased from 1 in 468 to 1 in 76.³ In the United States, people diagnosed with schizophrenia who don't use drugs recover at a rate of 40 percent. Those who use drugs recover at a rate of 5 percent.⁴

The worst thing about the use of drugs is that it gives patients a cynical view of themselves and other human beings. It tells them that they are subject to the whim of random biological forces. Human beings are not random organisms. They are meaning-making, desiring organisms who experience distress when they are not able to live the way they want to live. The symptoms of such distress are meaningful, somewhat functional and potentially useful in helping them recover. The use of drugs says otherwise. That is a great disservice to people.

Al Galves, PhD
Las Cruces, N.M.

According to the June Monitor article "Our Moral Motivations" on the new book by Jonathan Haidt, PhD ("The Righteous Mind"), Haidt dismisses self-interest as hostile to morality and, I infer, overlooks the essentialness embedded in self-interest as a shot of brio livening up frequently supine human behavior.

Haidt's derogation of self-interest is at odds with self-interest's dominant and socially useful role in illuminating why we behave as we do. Further, his implied demonization of self-interest obscures heroic efforts to fathom the whys and wherefores of this crapshoot we call life. These views and this appreciation of self-interest are presented exhaustively in my 1986 presidential address [American Psychologist (AP), 42, pp. 3-ll, 1987], "Self-Interest and Personal Responsibility Redux," selected by a panel as AP's best article in 1987.

Trumpeting self-interest as an efficacious tool we use in our daily affairs, Adam Smith famously declared that "it is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their interest," where it is fair to equate "interest" with self-interest.

Self-interest triggers and motivates performance, beneficially enabling us to cope with illness and traumatic life events. Congruently, Friedman and Friedman (1980) in their book, "Free to Choose, A Personal Statement" advise that "self-interest is not myopic selfishness. It is whatever they value, whatever goals they pursue. The scientist … the missionary … the philanthropist … are all pursuing their interests as they see them, as they judge them by their own values." Again, a boost for self-interest, a utilitarian tool that we should be thankful is in humankind's quiver of accessories for assisting us to live better lives. Haidt's implicit discrediting of self-interest is wide off the mark and should be balanced with the tsunami of benefits self-interest enables society to savor. Indeed, self-interest should be celebrated, not taken to the woodshed. To put down self-interest is an undeserved putdown.

Robert Perloff, PhD
University of Pittsburgh

The roots of mental illness

The June article "The roots of mental illness" was an impressive exploration of the ways in which our understanding of the brain and the biological underpinnings of disorders has grown. However, this article failed to present a full picture of the limitations of these biological explanations of mental illness. Postmortem studies of the brains of people diagnosed with schizophrenia and other severe disorders are confounded by the fact that these patients are generally on lifelong medications that permanently damage the brain. Also, studies of children diagnosed with schizophrenia have shown that their healthy siblings have similar brain abnormalities that are no longer present by the time they reach adulthood (Gogtay, 2008), indicating that such abnormalities can potentially return to normal. In fact, studies have shown that remission of psychosis, as well as other psychiatric disorders, is associated with this plasticity of the brain (e.g., Gogtay & Rapoport; Lindauer et al., 2008).

The acceptance of the strong biological roots of schizophrenia is undermined by the fact that the best outcomes in the world for treating this disorder are psychotherapeutic approaches that rarely use neuroleptics (e.g., Aaltonen, Seikkula, & Lehtinen, 2011), as well as robust evidence of the relationship between childhood trauma and psychosis (see Read, van Os, Morrison, & Ross, 2005, for a review). The existence of brain abnormalities does not equate with etiology or prognosis. As psychologists, we must move beyond the biomedical research and give a strong voice to the powerful effects of psychosocial factors on biology.

Noel Hunter
Long Island University–Post

References

Asltonen, J., Seikkula, J., & Lehtinen, K. (2011). The comprehensive Open-Dialogue approach in Western Lapland: II. The incidence of non-affective psychosis and prodromal states. Psychosis, 3(3), 192-204.

Gogtay, N. (2008). Cortical brain development in schizophrenia: Insights from neuroimaging studies in childhood-onset schizophrenia. Schizophrenia Bulletin, 34(1), 30-36.

Gogtay, N., & Rapoport, J. L. (2008). Childhood-onset schizophrenia: Insights from neuroimaging studies. Journal of the American Academy Of Child & Adolescent Psychiatry, 47(10), 1120-1124.

Lindauer, R. L., Booij, J. J., Habraken, J. A., van Meijel, E. M., Uylings, H. M., Olff, M. M., & ... Gersons, B. R. (2008). Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: A randomized clinical trial. Psychological Medicine: A Journal Of Research In Psychiatry And The Allied Sciences, 38(4), 543-554.

Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350.

In the June Monitor, "The roots of mental illness" questioned the very underpinnings of our current mental illness model and another story, "Inappropriate prescribing," pointed out serious problems with the appropriate use and effectiveness of psychotropic medication. Given the depth of the criticisms and abuses cited, it would be reasonable to ask what psychology is going to do to address the issues raised in the articles.

Unfortunately, the take-away message was largely to ignore the findings and embrace the mental health industrial complex (i.e., medicine, insurance and pharmaceuticals) that pays homage to the very theoretical formulations and treatment modalities the articles bring into question. In the wake of the Supreme Court's momentous decision on the Affordable Care Act, the health industry is now being forced to re-examine and redefine its relationship with the American people. Is it time for APA to do the same by initiating a meaningful dialogue about the need for a more nuanced and realistic paradigm of mental illness that is less dependent on the tenuous but lucrative links to medicine and pharmaceuticals? To paraphrase an old fable, if APA is not willing to question whether the king really has any clothes, will they at least stop trying to sell him coat hangers? Or will even this limited challenge to the status quo be too high a price to pay for being allowed to remain in the king's court?

Thomas W. White, PhD
Overland Park, Kan.

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Please send letters to Sara Martin, Monitor  Editor. Letters should be no more than 250 words and may be edited for space and clarity.

¹ Leff, J, et al. (1992) “The international pilot study of schizophrenia: five-year follow-up findings.” Psychological Medicine 22: 131-145

² Seikkula J (2006). “Five-year experience of first episode nonaffective psychosis in open-dialogue approach.” Psychotherapy Research, Vol. 16(2): 214-228

³ Whitaker R (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs and the astonishing rise of mental illness in America. New York: Crown Publishers

⁴ Harrow M, et al. (2007). “Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications.” Journal of Nervous and Mental Disease 195: 406-414