Most people begin taking psychiatric medications because they are “distressed and distressing.” They are either experiencing overwhelming states of emotional distress, or someone else is distressed with their behavior and sends them to a doctor – or some combination of both. There are many labels for these states, like anxiety, depression, mania, psychosis, voices, and paranoia, and labels change over time. Doctors frequently tell people that their emotional distress is due to a mental disorder which has a biochemical basis, that their distress is dangerous (such as the risk of suicide) and must be stopped, and that medication with psychiatric drugs is the most appropriate therapy.
Psychiatric drugs act on the brain to change mood and consciousness like any other mind altering drug. Because many medications can blunt or control the symptoms of emotional distress – by either speeding a person up, slowing a person down, reducing sensitivity, or getting them to sleep – they can take the edge off extreme states. They help some people feel more capable of living their lives. It is important to realize, however, that psychiatric drugs do not change the underlying causes of emotional distress. They are best understood as tools or coping mechanisms that can sometimes alleviate symptoms, with significant risks for anyone who takes them.
Do Psychiatric Drugs Correct Your Chemistry?
People are told that mental disorders exist because brain chemistry levels are “abnormal” or “imbalanced,” that this results from genetic “predispositions” inherited from families, and that psychiatric drugs work by correcting these pre-existing brain chemical imbalances. However, these claims have never been proven by scientific study to be true.
Despite decades of effort and billions of dollars in research, no reliable and consistent evidence of preexisting chemical imbalances, genetic predispositions, or brain abnormalities has ever been found to go along with any psychiatric disorder diagnosis. Even the fine print of drug company ads now typically state that conditions are “believed to be caused by” or “thought to be caused by” chemical imbalances, rather than making definitive claims. Genetic theories today talk about complex interactions with the environment that differ from individual to individual based on experience, rather than genetic “blueprints” or causality.
No elevated or lowered level of any neurotransmitter has ever consistently been proven to cause a psychiatric disorder. A baseline has never even been established for what constitutes “normal” brain chemistry for all people, and no physical test, like urinalysis or blood draw, exists to detect mental disorders. Brain scans have never been able to distinguish consistently between “normal” people and people with psychiatric diagnoses (though medications can cause brain changes that show up on scans). Three people with an identical diagnosis might have completely different brain chemistry, and someone with very similar brain chemistry might have no diagnosis at all. Western medicine has not isolated any biological causes in the same way it can describe the physical mechanisms that cause illnesses such as tuberculosis, Down Syndrome, or diabetes.
Madness and mental disorder diagnoses do sometimes seem to “run in families,” but so do child abuse and artistic ability. Because of shared learning and experience, family history can mean many things other than genetic determination. Despite ambitious claims by researchers that are sensationalized in the media, no genetic cause, marker or set of markers has ever been discovered and isolated for mental disorders. In fact, the more that is understood about genetics, behavior and the brain, the more complicated the picture becomes, and the less likely of ever finding a genetic “key.” Using genetics to explain the diverse range of human behavior in a simplistic way is a throwback to the discredited concepts of social Darwinism and eugenics.
Identical twins have the same genes, but don’t always have the same psychiatric diagnosis, which proves that genes alone cannot be causal. Studies show that twins do tend have a slightly higher chance of the same diagnosis, possibly indicating some genetic role, but these studies are often flawed, and claims exaggerated. Parents certainly know that children have different temperaments and qualities even at birth, but individual traits like sensitivity and creativity only become the experiences of madness and emotional distress after the very complicated social factors of experience, including trauma and oppression, have played a role.
Every mood, thought, or experience exists somehow in the brain and body as expressions of biology, but society, mind, and learning intervene to make any causal relationship impossible to establish. Philosophers and scientists have been puzzling over the relationship between consciousness and the brain for hundreds of years. Psychiatry and neuroscience can make no credible claim to have solved the mystery of the mind-body relationship.
Ultimately, psychiatric diagnosis requires a doctor’s subjective psychological evaluation of a patient, and the doctor relies on their own interpretations, fears, and preconceptions. Doctors often disagree with each other, people sometimes have many different diagnoses over time, and discrimination based on class, race, and gender is common.
The decision to take or not take psychiatric drugs should be based on the usefulness of the drug to the person who needs help relative to the risks involved, not any false belief that they “must” be on the drug because of biology or genes.

Source: http://theicarusproject.net/downloads/ComingOffPsychDrugsHarmReductGuide1Edonline.pdf

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The article, titled: “In era of pills, fewer shrinks doing talk therapy” suggests psychotherapy is losing ground to medication in the treatment of psychological disorders. It refers to a study published this week in the Archives of General Psychiatry illuminating a trend: American psychiatrists are moving away from psychotherapy in favor of psychopharmacology. The study reports statistics showing fewer patients going to psychiatrists for psychotherapy and fewer psychiatrists providing therapy. The article cites “the expanded use of pills and insurance policies that favor short office visits” as possible reasons for this shift.
So is psychotherapy dying? Some assorted thoughts I have on the topic:
- Not necessarily; at least this article doesn’t support that idea. All it says is fewer people are going to psychiatrists for therapy. With a growing number of masters and Ph.D. level clinicians providing psychotherapy at lower fees than MD’s, I’m not at all surprised patients are going elsewhere. Also, psychiatrists earn more for medication management than therapy, so it makes financial sense for them too.
- According to Psychology Today’s own 2004 study, more than 27% of all adults (an estimated 59 million people) received mental health treatment in the two years prior. Of this group, “47% report a history of medication, but no therapy; more than a third (34%) report a history of both medication and therapy; and 19% report a history of therapy, but no medication.” That’s 30 million people in psychotherapy during that two year period. Medication clearly has an edge over therapy, but therapy appears to be alive and well.
-However, the article does raise a question for my blog colleagues (blolleagues?) over in the Psychiatry department: is psychiatry dying? If psychiatrists are losing their chops or interest in therapy, and psychologists obtain prescription privileges (as a passionate segment of psychologists are lobbying), psychiatry could face an identity crisis.
-I need to make a disclaimer here. A psychologist commenting on psychiatry is professionally analogous to the Red Sox commenting on the Yankees. There’s a tenuous relationship at times between the two fields. I have nothing but respect for my psychiatrist colleagues, and personally have no desire to prescribe. Since I’ve been around I’ve understood psychiatrists to manage medication and only occasionally provide therapy. And if they did provide therapy, it was psychoanalytic. I personally adhere to psychoanalytic principles and understand the process and outcomes are not always amenable to insurance companies’ desire for quantifiable progress. There’s no medical code for Resolution of Oedipal Conflict. This may help explain why “fewer shrinks [are] doing talk therapy.”
- Who gets to be called “shrinks” anyway? I thought all therapists were shrinks. I’m a clinical psychologist, and I’ve been called a shrink for years. This article implies only psychiatrists are shrinks. Now I’m having an identity crisis.

So is therapy going the way of the VCR? Will mapping the genome, designer pharmacology and Internet-based treatment render the couch obsolete?
In my incredibly biased opinion, no. I think therapy is here to stay. At least long enough for me to save up money to retire without the benefit of Social Security. Here are five reasons I believe therapy will be around a while:
It’s natural: In this era of organic food, hybrids, naturopathic medicines, vaccine phobia, carbon footprints and Whole Foods, we’re more wary than ever of what we put in our bodies. We have a treatment for psychological problems that doesn’t involve ECT or chemicals, and is generally understood to be as effective: therapy. It’s sitting and talking with another person, the most natural interaction you can imagine – no preservatives, no carcinogens, no mercury, no child labor, no cholesterol, no fossil fuels. I’d call it green, but you still need to drive to your appointment.
It’s relational: We’re creatures in need of contact. As much as we love technology, human connection is essential. A great number of psychological problems are created or exacerbated by our significant relationships. Would it not make sense that the treatment would be relational as well? With our significant relationships dwindling by a third over the last 20 years, it seems relationships are more essential than ever.
It’s old school: Therapy has really only been around for the last century, but it feels like we have a deep therapy tradition in our culture. For many emotional issues, people first choose therapy. Couples wanting to get married or divorced tend to go to therapy. People looking to find meaning in life go to therapy. Turn on the TV and you’ll find Tony Soprano, Bob Newhart and Betty Draper all participating in therapy. For better or worse, it’s woven its way into our culture.
It’s evolving: It would be difficult to eliminate a field that is so eager to adapt to the times. Flipping through the program for the upcoming APA conference, I’m struck by the number of new, innovative, creative theories and applications being unveiled. Generation X & Y shrinks aren’t ditching psychotherapy, they’re using research and technology to improve upon it.
It works: Insurance companies might not want to pay for it, but they can’t deny its effectiveness. If it ain’t broke….

By Ryan Howes, Ph.D. on August 07, 2008 in In Therapy
Source: http://blogs.psychologytoday.com/blog/in-therapy/200808/is-psychotherapy-dying

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